835 resultados para critically important antimicrobials
Resumo:
O currículo é, indubitavelmente, o mentor da aprendizagem. Produzido pelos educadores de infância, é importante que, ao contextualizá-lo, reflitam, de forma crítica e construtiva, sobre que conhecimentos, importantes ou válidos, merecem fazer parte do currículo, e se é importante dar tempo às crianças para interiorizarem as aprendizagens. Assim, o trabalho começa por apresentar uma revisão literária sobre a essência dos conceitos aludidos, passando, de seguida, para uma reflexão sobre a (re)construção do currículo ancorado na proposta de um currículo-sem-tempo, por forma a dar tempo às crianças para construírem a sua identidade, subjetividade, interesses e aprendizagens.
Resumo:
As ilhas da Macaronésia (Açores, Madeira, Selvagens, Canárias e Cabo Verde) estão englobadas no Hotspot de Biodiversidade da Bacia do Mediterrâneo, devido ao elevado grau de endemismos que apresentam. Das ca. 900 espécies de plantas endémicas que ocorrem na Macaronésia, a maioria exibe uma distribuição geográfica muito limitada, o que pode implicar um elevado risco de extinção. No caso de Cabo Verde, são conhecidos atualmente 94 taxa de plantas endémicas, que necessitam de conservação e proteção urgente. O principal objetivo deste trabalho é atualizar a Primeira Lista Vermelha de Cabo Verde, publicada por Leyens e Lobin (1996), através da avaliação do estatuto de conservação da flora endémica. Este estudo segue os critérios e categorias da IUCN e utiliza o software RAMAS Red List. Os resultados indicam que a maioria das plantas endémicas de Cabo Verde tem uma distribuição geográfica muito limitada, sendo que metade dos taxa têm áreas de ocupação e extensões de ocorrência inferiores a 20km2 e 200km2, respetivamente. Além disso, são comparadas duas atitudes em relação ao parâmetro tolerância ao risco, nomeadamente, RT = 0,5 para uma atitude neutra e RT = 0,6 para uma atitude evidenciaria. Com RT = 0,5, cerca de 77% dos taxa foram classificados como Criticamente em Perigo e 10% como em Perigo. Por outro lado, com RT =0, 6 obteve-se uma melhor discriminação nas diferentes categorias de ameaça: 29% dos taxa foi classificado como Criticamente em Perigo, 40% como em Perigo e 8% como Vulnerável. Neste estudo propõem-se que o ajuste de uma atitude em relação ao parâmetro tolerância ao risco (RT) pode ser um método importante a considerar na aplicação dos critérios IUCN em pequenas regiões, como é o caso das lhas de Cabo Verde, sem alterar as regras de avaliação da IUCN.
Resumo:
Na elaboração do presente trabalho, que tem como tema “Os manuais de língua portuguesa e o desenvolvimento da expressão oral no ensino secundário de Cabo Verde”, procurou-se investigar, a partir da perspectiva dos manuais de Língua Portuguesa, até que ponto os mesmos podem servir ou não para o desenvolvimento da competência comunicativa dos alunos do ensino secundário, na modalidade de expressão oral. Para isso foi adoptada uma metodologia situada no campo da investigação educacional, sem pôr de lado os métodos da pesquisa qualitativa e quantitativa, o que permitiu abordar as questões relacionadas com as constantes situações de insucesso na aprendizagem da Língua Portuguesa, cujas causas têm sido atribuídas, quase sempre, aos factores como as metodológicas, aos problemas linguísticos, decorrentes da forte presença da língua materna no quotidiano dos aprendentes e ao uso de materiais desajustados da realidade nacional. Assim, para o cumprimento dos objectivos propostos, foi possível trabalhar sobre dois corpora; por um lado analisaram-se os manuais do ensino secundário, por outro, foi examinado o inquérito aplicado tanto aos professores como aos alunos, e cujo tratamento dos dados permitiu confirmar a aceitação entusiástica dos manuais escolares no contexto pedagógico, apesar da descrença na potencialidade dos exercícios propostos em desenvolver a capacidade de expressão oral dos alunos. Outro aspecto digno de registo foi o desejo manifestado pelos informantes em ter outros materiais capazes de melhorar o ensino do Português como língua segunda. Em termos do ensino da citada disciplina, foram apresentadas algumas sugestões para que a sua melhoria reverta a favor do sucesso de aprendizagem de todos os alunos
Resumo:
Some biochemical functions of vitamin C make it an essential component of parenteral nutrition (PN) and an important therapeutic supplement in other acute conditions. Ascorbic acid is a strong aqueous antioxidant and is a cofactor for several enzymes. The average body pool of vitamin C is 1.5 g, of which 3%-4% (40-60 mg) is used daily. Steady state is maintained with 60 mg/d in nonsmokers and 140 mg/d in smokers. Shocked surgical, trauma, and septic patients have a drastic reduction of circulating plasma ascorbate concentrations. These low concentrations require 3-g doses/d to restore normal plasma ascorbate concentrations, questioning the recommended PN dose of 100 mg/d. Determination of intravenous requirements is usually based on plasma concentrations, which are altered during the inflammatory response. There is no clear indicator of deficiency: serum or plasma ascorbate concentrations <0.3 mg/dL (20 micromol/L) indicates inadequate vitamin C status. On the basis of available pharmacokinetic data the 100 mg/d dose for patients receiving home PN and 200 mg/d for stable adult patients receiving PN are adequate, but requirements have been shown to be higher in perioperative, trauma, burn, and critically ill patients, paralleling oxidative stress. One recommendation cannot fit all categories of patients. Large vitamin C supplements may be considered in severe critical illness, major trauma, and burns because of increased requirements resulting from oxidative stress and wound healing. Future research should distinguish therapeutic use of high-dose ascorbic acid antioxidant therapy from nutritional PN requirements.
Resumo:
All major antihypertensive drug classes i.e. diuretics, beta-blockers, calcium antagonists and blockers of the renin-angiotensin system have been shown to effectively lower blood pressure and hence to reduce cardiovascular outcomes in hypertensive patients. These drugs decrease cardiovascular complications in hypertension essentially because they reduce systemic blood pressure. Nevertheless, there is growing evidence that the extent of the benefits differed between drug classes suggesting that the various classes of antihypertensive agents are not equivalent in their ability to protect against target organ damages and cardiovascular and renal endpoints. More recently, evidence has also accumulated to demonstrate that even combination therapies are not equally effective in reducing the occurrence of cardiovascular complications in hypertension. These recent observations suggest that the means to lower blood pressure are as important as the achieved target blood pressure in the management of hypertensive patients.
Resumo:
Dipteran larvae were collected from rabbit (Oryctolagus cunniculus L.) carcasses during the four seasons in 2005 in the southernmost state of Rio Grande do Sul, Brazil. The larvae were fed ground beef at ambient temperatures following collection from carcasses. The development of each species under these conditions was estimated. The most abundant species in the carcasses were Lucilia eximia (Wiedemann) and Chrysomya albiceps (Wiedemann) (Calliphoridae), and they were found in all seasons. The data were fitted to a linear model that describes the relationship between temperature and linear developmental rating. These two species are primary forensic indicators in southern Brazil. Other species such as Hemilucilia semidiaphana (Rondani) (Calliphoridae), Synthesiomyia nudiseta (Wulp), Muscina stabulans (Fallen) (Muscidae), and Fannia pusio (Wiedemann) (Fanniidae) were forensically less important because they only occurred in high frequency in certain seasons and during the first days of carcass decomposition.
Resumo:
This paper analyses the effect of tobacco prices on the propensity tostart and quit smoking using a pool of the 1993, 1995 and 1997 editionsof the Spanish National Health Surveys. The estimates for severalparametric models of the hazard rate for starting and quitting suggestthat i) The public health measures applied as of 1992 have had asignificative effect on both reducing the hazard of starting andincreasing the hazard of quitting, ii) Prices have a very weak effect onthe hazard of starting in the male population and no significant effectin the female population, iii) The price floor of cigarrettes, proxiedby the average price of a pack of black cigarrettes, has a significanteffect on the quitting hazard which is robust across specifications andapplies to both men and women. The implied price elasticity of the timeup to quitting is situated around -1.4.
Resumo:
Euglossine bee communities in small forest fragments of the Atlantic Forest, Rio de Janeiro state, southeastern Brazil (Hymenoptera, Apidae). Euglossine bees are important pollinators in forests and agricultural areas. Although the structure of their communities is critically affected by anthropogenic disturbances, little is known about these bees in small forest fragments. The objectives of this study were to analyze the composition, abundance, and diversity of euglossine bee species in nine small fragments of different phytophysiognomies of the Atlantic Forest in southeastern Brazil, and to identify the environmental variables that may be related to the species composition of these communities. Males were sampled quarterly from May 2007 to May 2009 with aromatic traps containing methyl cinnamate, vanillin, eucalyptol, benzyl acetate, and methyl salicylate. A total of 1558 males, belonging to 10 species and three genera of Euglossina were collected. The richness ranged from five to seven species per fragment. Euglossa cordata, E. securigera, Eulaema nigrita e E. cingulata were common to all fragments studied. The diversity differed significantly among areas, ranging from H' = 1.04 to H' = 1.65. The precipitation, phytophysiognomy, and altitude had the highest relative importance over the species composition variation. The results presented in this study demonstrate that small forest fragments are able to support populations of euglossine bee species, most of which are widely distributed and reportedly tolerant to open and/or disturbed areas and suggest that the conservation of such areas is important, particularly in areas that are regenerating and in regions with agricultural matrices where these bees can act as important pollinators
Resumo:
Developmental biology, polymorphism and ecological aspects of Stiretrus decemguttatus (Hemiptera, Pentatomidae), an important predator of cassidine beetles. Stiretrus decemguttatus is an important predator of two species of cassidine beetles, Botanochara sedecimpustulata (Fabricius, 1781) and Zatrephina lineata (Fabricius, 1787) (Coleoptera, Cassidinae), on the Marajó Island, Brazil. It attacks individuals in all development stages, but preys preferentially on late-instar larvae. Its life cycle in the laboratory was 43.70 ± 1.09 days, with an egg incubation period of six days and duration from nymph and adult stages of 16.31 ± 0.11 and 22.10 ± 1.67 days, respectively. The duration of one generation (T) was 12.65 days and the intrinsic population growth rate (r) 0.25. These data reveal the adjustment of the life cycle of S. decemgutattus with those of the two preys, but suggest greater impact on Z. lineata. However, no preference over cassidine species was shown in the laboratory. Up to 17 different color patterns can be found in adults of S. decemguttatus, based on combinations of three basic sets of color markings. Some of them resemble the markings of chrysomelids associated with Ipomoea asarifolia (Convolvulaceae) and are possibly a mimetic ring. Three color patterns were identified in nymphs, none of which was associated with any specific adult color pattern.
Resumo:
OBJECTIVE: To provide an update to the original Surviving Sepsis Campaign clinical management guidelines, "Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock," published in 2004. DESIGN: Modified Delphi method with a consensus conference of 55 international experts, several subsequent meetings of subgroups and key individuals, teleconferences, and electronic-based discussion among subgroups and among the entire committee. This process was conducted independently of any industry funding. METHODS: We used the GRADE system to guide assessment of quality of evidence from high (A) to very low (D) and to determine the strength of recommendations. A strong recommendation indicates that an intervention's desirable effects clearly outweigh its undesirable effects (risk, burden, cost), or clearly do not. Weak recommendations indicate that the tradeoff between desirable and undesirable effects is less clear. The grade of strong or weak is considered of greater clinical importance than a difference in letter level of quality of evidence. In areas without complete agreement, a formal process of resolution was developed and applied. Recommendations are grouped into those directly targeting severe sepsis, recommendations targeting general care of the critically ill patient that are considered high priority in severe sepsis, and pediatric considerations. RESULTS: Key recommendations, listed by category, include: early goal-directed resuscitation of the septic patient during the first 6 hrs after recognition (1C); blood cultures prior to antibiotic therapy (1C); imaging studies performed promptly to confirm potential source of infection (1C); administration of broad-spectrum antibiotic therapy within 1 hr of diagnosis of septic shock (1B) and severe sepsis without septic shock (1D); reassessment of antibiotic therapy with microbiology and clinical data to narrow coverage, when appropriate (1C); a usual 7-10 days of antibiotic therapy guided by clinical response (1D); source control with attention to the balance of risks and benefits of the chosen method (1C); administration of either crystalloid or colloid fluid resuscitation (1B); fluid challenge to restore mean circulating filling pressure (1C); reduction in rate of fluid administration with rising filing pressures and no improvement in tissue perfusion (1D); vasopressor preference for norepinephrine or dopamine to maintain an initial target of mean arterial pressure > or = 65 mm Hg (1C); dobutamine inotropic therapy when cardiac output remains low despite fluid resuscitation and combined inotropic/vasopressor therapy (1C); stress-dose steroid therapy given only in septic shock after blood pressure is identified to be poorly responsive to fluid and vasopressor therapy (2C); recombinant activated protein C in patients with severe sepsis and clinical assessment of high risk for death (2B except 2C for post-operative patients). In the absence of tissue hypoperfusion, coronary artery disease, or acute hemorrhage, target a hemoglobin of 7-9 g/dL (1B); a low tidal volume (1B) and limitation of inspiratory plateau pressure strategy (1C) for acute lung injury (ALI)/acute respiratory distress syndrome (ARDS); application of at least a minimal amount of positive end-expiratory pressure in acute lung injury (1C); head of bed elevation in mechanically ventilated patients unless contraindicated (1B); avoiding routine use of pulmonary artery catheters in ALI/ARDS (1A); to decrease days of mechanical ventilation and ICU length of stay, a conservative fluid strategy for patients with established ALI/ARDS who are not in shock (1C); protocols for weaning and sedation/analgesia (1B); using either intermittent bolus sedation or continuous infusion sedation with daily interruptions or lightening (1B); avoidance of neuromuscular blockers, if at all possible (1B); institution of glycemic control (1B) targeting a blood glucose < 150 mg/dL after initial stabilization ( 2C ); equivalency of continuous veno-veno hemofiltration or intermittent hemodialysis (2B); prophylaxis for deep vein thrombosis (1A); use of stress ulcer prophylaxis to prevent upper GI bleeding using H2 blockers (1A) or proton pump inhibitors (1B); and consideration of limitation of support where appropriate (1D). Recommendations specific to pediatric severe sepsis include: greater use of physical examination therapeutic end points (2C); dopamine as the first drug of choice for hypotension (2C); steroids only in children with suspected or proven adrenal insufficiency (2C); a recommendation against the use of recombinant activated protein C in children (1B). CONCLUSION: There was strong agreement among a large cohort of international experts regarding many level 1 recommendations for the best current care of patients with severe sepsis. Evidenced-based recommendations regarding the acute management of sepsis and septic shock are the first step toward improved outcomes for this important group of critically ill patients.
Resumo:
This thesis contains three parts. The first one offers the theoretical basement, where the history of the police from their beginning in the early 19th century to this day is shown. The emphasis however is laid on the last 40 years, which gave birth to a multitude of innovations, such as community, problem-oriented, hot-spots or zero-tolerance policing. Those innovations are described in detail and are critically commented. At the end of this section, I present a scheme, where all the approaches are classified as strategic or methodic innovations, but united under a model called "modern policing". The fact that the innovations are not competitive but rather complementary is the most important finding of this examination. The second part of this work deals with a unique survey about the implementation of four innovations and eight problem- and community-oriented activities in 85 Swiss police forces. This explorative study shows that in the last 15 years the Swiss police forces have increasingly adopted innovative approaches. The most frequent innovation is community policing, which has been implemented all over the country. Due to the results, we can also assume that the implementation of the innovations is mostly substantial and profound. However, particularly in the area of problem-solving there is still a need for improvements. The third section consists of a scientific evaluation of a temporary special unit of the municipal police Zurich, which, during nine months, fought against public drug dealing and illegal prostitution in a particular neighborhood called Langstrasse. The effects of this hot-spot project were measured with police data, observations and several population surveys. In general, the special unit achieved a positive outcome and helped to defuse the hot-spot. Additionally, a survey conducted within the police department showed that the personal attitude towards the special unit differed widely between the policemen. We found significant differences between both police regions East and West, rank-and-file and higher ranking officers, different ages and the personal connection to the special unit. In fact, the higher the rank, the lower the age, and the closer the relationship, the more positive the officers were towards the unit.
Resumo:
This editorial examines the actions undertaken in number 5 and announces two important changes for the numbers 6 and 7, namely frequency and languages. Furthermore, the use of some bibliometric indicators, such as impact factor and refusal rate, is critically analyzed.
Resumo:
In the 2005-01 trial, we have demonstrated that bortezomib-dexamethasone as induction therapy before autologous stem cell transplantation was superior to vincristine-adriamycin-dexamethasone. We conducted a post-hoc analysis to assess the prognostic impact of initial characteristics as well as response to therapy in patients enrolled in this study. Multivariate analysis showed that ISS stages 2 and 3 and achievement of response less than very good partial response (VGPR) both after induction therapy and after autologous stem cell transplantation were adverse prognostic factors for progression-free survival, the most important one being achievement of response less than VGPR after induction. Progression-free survival was significantly improved with bortezomib-dexamethasone induction therapy in patients with poor-risk cytogenetics and ISS stages 2 and 3 compared with vincristine-adriamycin-dexamethasone. In these 2 groups of patients, achievement of at least VGPR after induction was of major importance. This study is registered with EudraCT (https://eudract.ema.europa.eu; EUDRACT 2005-000537-38) and http://clinicaltrials.gov (NCT00200681).
Resumo:
Hypertensive patients often experience poor adherence to treatment, a frequent cause of uncontrolled blood pressure. In this study, we have evaluated whether or not the use of electronic monitoring for drug adherence is a useful approach to identify and correct compliance problems in hypertensive patients, which may ultimately enhance the effect of antihypertensive therapy. Sixty-nine treated patients with an office blood pressure greater than 140/90 mm Hg were enrolled in this study. With patient consent, current antihypertensive therapy was dispensed in electronic pillboxes that record the time and date of each opening without changing the drug regimen. The intention was to provide physicians with objective measurements of drug compliance. The monitoring of compliance per se without any other intervention induced a marked decrease of blood pressure in the whole group (from 159/104Â+/-23/12 mm Hg to 143/92Â+/-20/15, meansÂ+/-standard deviation, p less than 0.001). A complete normalization of blood pressure (less than 140/90 mm Hg) was obtained in one third of the patients (group 1, n=23) during the monitoring period. A significant improvement of blood pressure control was found in another third (group 2, n=23), whereas in the remaining patients (group 3, n=23) no change in blood pressure was observed. The distribution of individual compliance values, as well as the mean compliances was comparable in the three subgroups. Conversely, the compliance reports have identified several potentially overtreated patients in group 1, a large number of patients with a poor adherence to the prescribed therapy in all groups, and patients who clearly needed a change in pharmacotherapy mainly in group 3. Thus, our results suggest that electronic monitoring of compliance can considerably enhance the efficacy of antihypertensive therapy in patients with uncontrolled hypertension. This procedure should be used more extensively in clinical practice whenever the blood pressure response to therapy appears insufficient. (c)2000 by Le Jacq Communications, Inc.