Chagas disease: What is known and what should be improved: a systemic review

This study consists of a broad review on what is known and what should be improved regarding knowledge of Chagas disease, not only through analysis on the main studies published on the topics discussed, but to a large extent based on experience of this subject, acquired over the past 50 years (1961-2011). Among the subjects covered, we highlight the pathogenesis and evolution of infection by Trypanosoma cruzi, drugs in use and new strategies for treating Chagas disease; the serological tests for the diagnosis and the controls of cure the infection; the regional variations in prevalence, morbidity and response to treatment of the disease; the importance of metacyclogenesis of T. cruzi in different species of triatomines and its capacity to transmit Chagas infection; the risks of adaptation of wild triatomines to human dwellings; the morbidity and need for a surveillance and control program for Chagas disease in the Amazon region and the need to prioritize initiatives for controlling Chagas disease in Latin America and Mexico and in non-endemic countries, which is today a major international dilemma. Finally, we raise the need for to create a new initiative for controlling Chagas disease in the Gran Chaco, which involves parts of Argentina, Bolivia and Paraguay.

Self-transcendence is related to higher female sexual desire

One facet of self-transcendence is creative self-forgetfulness (CSF; tendency to be attentionally absorbed in mindaltering experiences). Proneness to mind-altering attentional absorption and other aspects of self-transcendence were previously related to vaginal intercourse frequency, sexual arousability, and female coital orgasm. Given that sexual responsiveness is enhanced by focused attention, itwas testedwhether CSF correlates with sexual responsiveness, and if maladaptive defenses, openness to experience, and testosterone explain the hypothesized relationships. One hundred thirty-nine Portuguese (98 women) provided saliva samples for testosterone determination by luminescence immunoassays before and after a romantic movie scene and reported how intensely they felt sexual desire and arousal during the movie. CSF was measured by the Temperament and Character Inventory– Revised, maladaptive defenses by the immature defenses subscale of the Defense Style Questionnaire (DSQ-40), male and female past month desire by the desire dimensions of the International Index of Erectile Function (IIEF), and Female Sexual Function Index (FSFI). Female desire and arousal during themoviewere independently predicted by CSF, openness to experience and testosterone, but not by immature defenses. Female past month desire was independently predicted by CSF, testosterone, and less immature defenses. Possible psychobiological processes linking self-transcendence and sexual responsiveness are discussed.

Management consulting labs-Galp loyalty learning experience

The purpose of this project was to analyze Galp’s loyalty approach in the Portuguese fuel market given the industry context, namely the entry of hypermarket and the resulting increase in competitiveness. The team performed analyses based on analytical models, qualitative research and internal interviews in order to assess Galp’s potential in the field of loyalty and consumers’ behavior. The final recommendations were based on incremental improvements to the Galp’s existing loyalty tool and an innovative paradigm change of the approach to loyalty.

From "Humanities and Computing" to "Digital Humanities": Digital Humanities in Portugal with a focus on Historical Research

In the following text I will develop three major aspects. The first is to draw attention to those who seem to have been the disciplinary fields where, despite everything, the Digital Humanities (in the broad perspective as will be regarded here) have asserted themselves in a more comprehensive manner. I think it is here that I run into greater risks, not only for what I have mentioned above, but certainly because a significant part, perhaps, of the achievements and of the researchers might have escaped the look that I sought to cast upon the past few decades, always influenced by my own experience and the work carried out in the field of History. But this can be considered as a work in progress and it is open to criticism and suggestions. A second point to note is that emphasis will be given to the main lines of development in the relationship between historical research and digital methodologies, resources and tools. Finally, I will try to make a brief analysis of what has been the Digital Humanities discourse appropriation in recent years, with very debatable data and methods for sure, because studies are still scarce and little systematic information is available that would allow to go beyond an introductory reflection.

UK Mental health professionals volunteering in LMIC-benefits to UK and host countries

RESUMO: O Royal College of Psychiatrists tem um programa de voluntariado internacional desde 2005. O interesse no Reino Unido tem crescido nos últimos 15 anos com muitos projetos novos. Os benefícios para vários países têm sido reconhecidos. O que está menos claro são os benefícios da experiência para o Reino Unido e do programa de voluntariado do Royal College of Psychiatrists. O objectivo desta dissertação é explorar os benefícios do voluntariado para o Sistema Nacional de Saúde focando principalmente, mas não exclusivamente, o programa de voluntariado do Royal College of Psychiatrists. Nesta dissertação abordamos primeiro o contexto antes de discutirmos dois grandes estudos de psiquiatras e hospitais do Sistema Nacional de Saúde no Reino Unido. Incluimos no estudo todos os psiquiatras registados como Voluntários no Royal College of Psychiatrists e o Grupo de Interesse Especial associado. Foi ainda possível incluir os Diretores Médicos de todos os hospitais do Reino Unido. Os estudos foram desenhados para analisar as opiniões dos Voluntários do Reino Unido sobre os benefícios para os países recetores de baixo e médio rendimento e para o Reino Unido. Todos os 60 hospitais do Sistema Nacional de Saúde foram incluí dos para analisar a opinião sobre Voluntariado. As limitações dos estudos foram a baixa taxa de resposta, mas esta foi comparável a outros estudos do College. É provável haver um enviezamento de resposta e favorecimento dos que estão envolvidos no Voluntariado. Os resultados mostraram um interesse forte no voluntariado e benefícios no Sistema Nacional de Saúde, nas. áreas de liderança, transculturalismo, gestão e recursos e capacidades pessoais. Os hospitais do Sistema Nacional de Saúde valorizaram o voluntariado e, em contrapartida, o valor acrescido para competências profissionais. Os obstáculos contra o Voluntariado a nível individual e dos hospitais foram maioritariamente de natureza prática, tais como obter dispensa do trabalho, substituição no trabalho e custos. As implicações destes estudos são que o programa de voluntariado do College precisa de ser fortalecido. Para assegurar que este trabalho continua é necessário existir uma sensibilização nacional e maior responsabilização sobre os benefícios para o Reino Unido e a nível global. -------------------------- ABSTRACT: The Royal College of Psychiatrists has had an international volunteering programme since 2005. The interest in UK has grown over the past 15 years with many new projects. The benefits in various countries has been acknowledged. What has been less clear are the benefits of the experience back in the UK and of the Royal College of Psychiatrists Volunteer Scheme. The aim of this dissertation is to explore the benefit of volunteering to the NHS focusing mainly, but not exclusively on the Royal College of Psychiatrists Volunteering scheme. In this dissertation we first look at background information before discussing two large surveys of Psychiatrists and NHS Trusts in UK. We surveyed all those registered as Volunteers at the Royal College of Psychiatrists and the associated Special Interest Group. We also were able to survey the Medical Directors of all UK Trusts. The Surveys were designed to assess views of UK Volunteers of benefits to hosts in LMIC and back in UK. All 60 NHS Trusts were surveyed to assess the view of Volunteering. Limitation of the surveys were the low response rate but this was comparable to other College surveys. There is likely to be a bias in response and favour those who are engaged in the Volunteering agenda. Results showed a strong interest in volunteering and perceived benefits in NHS. These areas included leadership, transcultural, resource management and personal skills. NHS trusts valued volunteering and added value to professional competencies on return. Obstacles to Volunteering at individual and Trust level were mainly practical issues such as getting time off, cover and costs. Implications of these surveys are that the College volunteering scheme needs strengthening. There needs to be a National advocacy to ensure that this work continues and greater accountability as to benefits in UK and globally.

Orifice diseases project - experience of the "Hospital das Clínicas" University of São Paulo Medical Center in day-hospital of anorectal disease

The treatment of malignant or benign colorectal pathologies that require more complex management are priorities in tertiary hospitals such as "Hospital das Clínicas" University of São Paulo Medical Center (HCFMUSP). Therefore, benign, uncomplicated orifice conditions are relegated to second place. The number of patients with hemorrhoids, perianal fistulas, fissures, condylomas and pilonidal cysts who seek treatment at the HFMUSP is very great, resulting in over-crowding in the outpatient clinics and a long waiting list for recommended surgical treatment (at times over 18 months). The authors describe the experience of the HCFMUSP over an eight-day period with day-hospital surgery in which 140 patients underwent surgery. Data was prospectively taken on the patients undergoing surgery for benign orifice pathologies including age, sex, diagnosis, surgery performed, immediate and late postoperative complications, and follow-up. 140 patients operated on over eight days were studied. 68 were males (48.75%) with ages ranging from 25 to 62 (mean 35.2 yrs.). Hemorrhoids was the most frequent condition encountered (82 hemorrhoidectomies, 58.6%), followed by perineal fistula (28 fistula repairs, 20.0%). The most common complication was headache secondary to rachianesthesia occurring in 9 patients (6.4%). One patient (0.7%) developed bleeding immediately PO that required reoperation. Mean follow-up was 104 days. Day-surgery characterized by quality care and low morbidity is feasible in tertiary public hospitals, permitting surgery for benign orifice pathologies on many patients within a short period of time.

Experience with the first Internet-based course at the Faculty of Medicine, University of São Paulo

PURPOSE: The Internet expands the range and flexibility of teaching options and enhances the ability to process the ever-increasing volume of medical knowledge. The aim of this study is to describe and discuss our experience with transforming a traditional medical training course into an Internet-based course. METHOD: Sixty-nine students were enrolled for a one-month course. They answered pre- and post-course questionnaires and took a multiple-choice test to evaluate the acquired knowledge. RESULTS: Students reported that the primary value for them of this Internet-based course was that they could choose the time of their class attendance (67%). The vast majority (94%) had a private computer and were used to visiting the Internet (75%) before the course. During the course, visits were mainly during the weekends (35%) and on the last week before the test (29%). Thirty-one percent reported that they could learn by reading only from the computer screen, without the necessity of printed material. Students were satisfied with this teaching method as evidenced by the 89% who reported enjoying the experience and the 88% who said they would enroll for another course via the Internet. The most positive aspect was freedom of scheduling, and the most negative was the lack of personal contact with the teacher. From the 80 multiple-choice questions, the mean of correct answers was 45.5, and of incorrect, 34.5. CONCLUSIONS: This study demonstrates that students can successfully learn with distance learning. It provides useful information for developing other Internet-based courses. The importance of this new tool for education in a large country like Brazil seems clear.

Tissue expander complications in plastic surgery: a 10-year experience

INTRODUCTION: Tissue expanders have been of great value in plastic surgery. Tissue expansion was developed for a specific indication; however, within a very short time, the concept of tissue expansion found wide applicability. From 1990 to 1999, 315 expanders in 164 patients were utilized. A retrospective analysis of complications and prognostic factors for complications were done. METHODS: The indications for tissue expansion were burns (50%), trauma (32%), and sequelae of previous surgery (8.8%). The expanders were inserted most frequently in the scalp, trunk and neck. RESULTS: There were 22.2% of complications and the most common were expander exposure (50%), infection (24%) and bad function of the expander (12.8%). The present study revealed an increased rate of minor complications in the group of 0 to 10 years of age and an increased rate of major complications for face and neck expansions compared to trunk expansion. There were no increased complication rates for the other age and anatomic site groups, previous expansion, concomitant expansion and type of expander used. CONCLUSIONS: The outcomes from tissue expansion procedures done in our hospital are similar to those reported in the literature. Tissue expansion is a good and safe technique.

Hypertonic/hyperoncotic solution in hypovolemic patients: experience in the emergency room

Hypertonic solutions have been studied extensively in the treatment of hypovolemic shock, both in experimental and clinical models. Safety, efficacy, and long-term effects on animals and patients have been evaluated. The present article reviews indications, safety, mortality rates, and outcome in patients with hemorrhagic hypovolemic shock who were treated after admission with a hypertonic/hyperoncotic solution under strict observation in the emergency room.

Surgical treatment of endocrine exophthalmos by removal of orbital fat: clinical experience

PURPOSE: To report a series of 73 patients with endocrine exophthalmos treated by removal of orbital fat using the transpalpebral approach during the period 1989 to 1999. METHODS: The operation was performed according to the technique described by Olivari. Aesthetic analysis was done preoperatively and postoperatively (more than 6 months after surgery). The number of complications was also observed. RESULTS: The average volume of resected fat was approximately 7.6 mL per orbit. No major complication was observed. In 9 patients with epiphora, all improved. One patient developed postoperative diplopia and 5 complained of temporary diplopia. Appearance improved in 62 patients (85%). CONCLUSION: Surgical removal of orbital fat associated with endocrine exophthalmos provides consistent improvement in appearance with a low rate of complications. Additional procedures may be indicated to improve the cosmetic outcome.

Surgical treatment of rectal prolapse: experience and late results with 51 patients

The "best" surgical technique for the management of complete rectal prolapse remains unknown. Due to its low incidence, it is very difficult to achieve a representative number of cases, and there are no large prospective randomized trials to attest to the superiority of one operation over another. PURPOSE: Analyze the results of surgical treatment of complete rectal prolapse during 1980 and 2002. METHOD: Retrospective study. RESULTS: Fifty-one patients underwent surgical treatment during this period. The mean age was 56.7 years, with 39 females. Besides the prolapse itself, 33 patients complained of mucous discharge, 31 of fecal incontinence, 14 of constipation, 17 of rectal bleeding, and 3 of urinary incontinence. Abdominal operations were performed in 36 (71%) cases. Presacral rectopexy was the most common abdominal procedure (29 cases) followed by presacral rectopexy associated with sigmoidectomy (5 cases). The most common perineal procedure was perineal rectosigmoidectomy associated with levatorplasty (12 cases). Intraoperative bleeding from the presacral space developed in 2 cases, and a rectovaginal fistula occurred in another patient after a perineal rectosigmoidectomy. There were 2 recurrences after a mean follow-up of 49 months, which were treated by reoperation. CONCLUSION: Abdominal and perineal procedures can be used to manage complete rectal prolapse with safety and good long-term results. Age, associated medical conditions, and symptoms of fecal incontinence or constipation are the main features that one should bear in mind in order to choose the best surgical approach.

Rating corporate groups a modelling experience

This paper aims to provide a model that allows BPI to measure the credit risk, through its rating scale, of the subsidiaries included in the corporate groups who are their clients. This model should be simple enough to be applied in practice, accurate, and must give consistent results in comparison to what have been the ratings given by the bank. The model proposed includes operational, strategic, and financial factors and ends up giving one of three results: no support, partial support, or full support from the holding to the subsidiary, and each of them translates in adjustments in each subsidiary’s credit rating. As it would be expectable, most of the subsidiaries should have the same credit rating of its parent company.

Enhancing fan experience during live sports broadcasts through second screen applications

When sports fans attend live sports events, they usually engage in social experiences with friends, family members and other fans at the venue sharing the same affiliation. However, fans watching the same event through a live television broadcast end up not feeling so emotionally connected with the athletes and other fans as they would if they were watching it live, together with thousands of other fans. With this in mind, we seek to create mobile applications that deliver engaging social experiences involving remote fans watching live broadcasted sports events. Taking into account the growing use of mobile devices when watching TV broadcasts, these mobile applications explore the second screen concept, which allows users to interact with content that complements the TV broadcast. Within this context, we present a set of second screen application prototypes developed to test our concepts, the corresponding user studies and results, as well as suggestions on how to apply the prototypes’ concepts not only in different sports, but also during TV shows and electronic sports. Finally, we also present the challenges we faced and the guidelines we followed during the development and evaluation phases, which may give a considerable contribution to the development of future second screen applications for live broadcasted events.

How aspiring filmmakers cope with unexpected events on set

Making the transition between plans and unexpected occurrences is something organizations are used to doing every day. However, not much is known about how actors cope with unanticipated events and how they accommodate them within predefined schedules. In this study, we draw on an inductive analysis of aspiring filmmakers’ film sets to elaborate on how they plan their shooting activities every day, only to adjust them when unforeseen complications arise. We discover that film crews anchor their expectations for the day based on a planned shooting schedule, yet they incorporate a built-in assumption that it will inevitably be disrupted. We argue that they resort to triage processes and “troubleshooting protocols” that help decipher incoming problems. Familiar problems are solved by making use of experience obtained from past situations, whereas unprecedented problems are solved through a tacit protocol used as a tool to quickly devise an appropriate game plan. This study contributes to the literature on sense-making and provides valuable information about the unexplored world of filmmaking.

Regret associated with past and future messes under a maximizing mind-set

Promotions can make you happy if you get the “best” deal or miserable if you miss it. Previous research on this topic has shown that people favor products associated with a past miss to products associated with a future miss, and people in a maximizing mind-set, i.e. people who search for the best in different domains, feel more regret in a consumption domain. This research confirms that consumers prefer purchasing a product associated with a past miss (Experiments 1 and 2) and that regret levels are higher when participants come across the future miss, under the maximizing mind-set (Experiment 2). These studies add to the notion that information on regret might prompt people to make decisions towards a more optimistic outcome.