O efeito imediato da estimulação elétrica neuromuscular na função de deglutição em indivíduos com câncer de cabeça e pescoço após terapia antineoplásica

A estimulação elétrica neuromuscular (EENM) é uma recente técnica terapêutica no tratamento das disfagias orofaríngeas. Poucos estudos utilizaram a EENM em casos oncológicos, havendo muitas dúvidas sobre o método de aplicação e os resultados de diferentes condições de estimulação nessa população. Este trabalho teve por objetivo verificar o efeito imediato da EENM sensorial e motora, nas fases oral e faríngea da deglutição, em pacientes após tratamento do câncer de cabeça e pescoço. Para isso foi realizado um estudo transversal intervencional que incluiu 11 pacientes adultos e idosos (mediana de 59 anos) acometidos por câncer de cabeça e pescoço. Todos os indivíduos foram submetidos ao exame de videofluoroscopia da deglutição, no qual, de modo randomizado, foram solicitadas deglutições de 5 ml de alimentos nas consistências líquida, mel e pudim em três condições distintas: sem estimulação, com EENM sensorial, com EENM motora. Foi classificado o grau da disfunção da deglutição por meio da escala DOSS (Dysphagia Outcome and Severity Scale), a presença de estase de alimentos (escala de Eisenhuber), de penetração laríngea, aspiração laringotraqueal (Penetration and Aspiration Scale - PAS), além da medida do tempo de trânsito oral e faríngeo (em segundos). Para a comparação dos resultados, considerando os três estímulos aplicados, na escala de resíduos, na escala de penetração aspiração, na escala DOSS e no tempo de trânsito oral e faríngeo foi aplicado o teste de Friedman ou a análise de variância para medidas repetidas (de acordo com a distribuição dos dados). Para todos os testes foi adotado nível de significância de 5%. Os resultados demonstraram que houve melhora com a estimulação sensorial e motora na escala DOSS e na escala PAS para um paciente tratado de câncer de boca e outro de laringe e piora, em ambas as escalas, para dois pacientes (câncer de boca), sendo um para a estimulação motora e outro na sensorial. A aplicação da escala de Eisenhuber permitiu verificar que a EENM, tanto em nível sensorial como motor, modificou de forma variável a presença de resíduos para os casos de câncer de boca, enquanto para o paciente com câncer de laringe houve redução de resíduos em valécula/raiz da língua para a estimulação sensorial e motora, além de aumento de resíduos em parede posterior da faringe com o estímulo motor. Além disso, não foi encontrada diferença estatisticamente significante para o tempo de trânsito oral e faríngeo nas diferentes estimulações para todas as consistências testadas (p>0,05). Diante desses achados, concluiu-se que a EENM, em nível sensorial e motor, apresentou variável impacto imediato nas fases oral e faríngea da deglutição, podendo melhorar a função de deglutição de pacientes com significante disfagia após o tratamento para o câncer de cabeça e pescoço, no que se diz respeito ao grau da disfagia e à presença de penetração e aspiração.

Resistência à fadiga de tubo API 5L X65 cladeado e soldado circunferencialmente com eletrodos de Inconel® 625

As recentes descobertas de petróleo e gás na camada do Pré-sal representam um enorme potencial exploratório no Brasil, entretanto, os desafios tecnológicos para a exploração desses recursos minerais são imensos e, consequentemente, têm motivado o desenvolvimento de estudos voltados a métodos e materiais eficientes para suas produções. Os tubos condutores de petróleo e gás são denominados de elevadores catenários ou do inglês \"risers\", e são elementos que necessariamente são soldados e possuem fundamental importância nessa cadeia produtiva, pois transportam petróleo e gás natural do fundo do mar à plataforma, estando sujeitos a carregamentos dinâmicos (fadiga) durante sua operação. Adicionalmente, um dos problemas centrais à produção de óleo e gás das reservas do Pré-Sal está diretamente associado a meios altamente corrosivos, tais como H2S e CO2. Uma forma mais barata de proteção dos tubos é a aplicação de uma camada de um material metálico resistente à corrosão na parte interna desses tubos (clad). Assim, a união entre esses tubos para formação dos \"risers\" deve ser realizada pelo emprego de soldas circunferenciais de ligas igualmente resistentes à corrosão. Nesse contexto, como os elementos soldados são considerados possuir defeitos do tipo trinca, para a garantia de sua integridade estrutural quando submetidos a carregamentos cíclicos, é necessário o conhecimento das taxas de propagação de trinca por fadiga da solda circunferencial. Assim, neste trabalho, foram realizados ensaios de propagação de trinca por fadiga na região da solda circunferencial de Inconel® 625 realizada em tubo de aço API 5L X65 cladeado, utilizando corpos de prova do tipo SEN(B) (Single Edge Notch Bending) com relações entre espessura e largura (B/W) iguais a 0,5, 1 e 2. O propósito central deste trabalho foi de obter a curva da taxa de propagação de trinca por fadiga (da/dN) versus a variação do fator de intensidade de tensão (ΔK) para o metal de solda por meio de ensaios normatizados, utilizando diferentes técnicas de acompanhamento e medição da trinca. A monitoração de crescimento da trinca foi feita por três técnicas: variação da flexibilidade elástica (VFE), queda de potencial elétrico (QPE) e análise de imagem (Ai). Os resultados mostraram que as diferentes relações B/W utilizadas no estudo não alteraram significantemente as taxas de propagação de trinca por fadiga, respeitado que a propagação aconteceu em condições de escoamento em pequena escala na frente da trinca. Os resultados de propagação de trinca por fadiga permitiram a obtenção das regiões I e II da curva da/dN versus ΔK para o metal de solda. O valor de ΔKlim obtido para o mesmo foi em torno de 11,8 MPa.m1/2 e os valores encontrados das constantes experimentais C e m da equação de Paris-Erdogan foram respectivamente iguais a 1,55 x10-10 [(mm/ciclo)/(MPa.m1/2)m] e 4,15. A propagação de trinca no metal de solda deu-se por deformação plástica, com a formação de estrias de fadiga.

Nosocomios higienistas: el caso Florence Nightingale

Los impresionantes cambios surgidos tras el inicio de la Revolución Industrial ayudaron a que de manera reiterada se buscaran soluciones a los diferentes problemas que se sucedían, uno tras de otro, como resultado del hacinamiento y las modificaciones sociopolíticas y económicas. Los avances en el campo de la ciencia, y en particular en las ciencias de la salud, fueron innumerables, estableciéndose en la sociedad una preocupación marcada por solucionar los problemas de las clases más desfavorecidas. En el campo de la sanidad, progresivamente se fueron dejando atrás posturas ancladas en los modelos basados en los «miasmas», para pasar a fundamentarse en el modelo microbiano de la mano de Pasteur y Lister. Estos descubrimientos fueron trasladados a la arquitectura progresivamente, dando paso a edificios que buscaban mantener unas condiciones higiénicas adecuadas que exiliaran las enfermedades del interior de los «paramentos de los hospitales». Ejemplo de esta lucha fue la llevada a cabo por la enfermera Florence Nightingale, que gracias a la observación y a sus conocimientos adquiridos tanto en el Instituto de Diaconisas de Kaiserswerth en Alemania como en la Maison de la Providence de las Hermanas de la Caridad de París, logró establecer una serie de pautas que aplicó al establecimiento que gestionó, el Hospital Scutari, durante la Guerra de Crimea.

La materialidad del Pacto de Teodomiro a la luz de la arqueología

El tratado de Teodomiro ha sido un tema crucial en la historiografía española, pero la investigación arqueológica sobre el temprano al-Andalus desarrollada en el sudeste de la península Ibérica ha aportado una nueva perspectiva. Su objetivo es analizar no sólo la geopolítica del tratado y la realidad urbana, sino también las implicaciones fiscales y agrícolas del asentamiento ğundí y la construcción de un nuevo paisaje social.

Tratado rápido de filosofía y otros poemas

Se presentan en “Tratado rápido de filosofía y otros poemas”, cuatro poemas seleccionados de tres poemarios escritos por Bartolomé Nieto Munuera, surcador incansable de mares de letras y sentimientos sujetos a mareas, algas y musgos: Ribera de la entropía, La estirpe del aire, y Noches de Quart Hadasht. A pesar de su prematura muerte, a este gran poeta le ha sobrado tiempo para regalarnos una obra intensa y coherente donde abundan interpretaciones saturadas de inteligencia y una estética cuya serenidad se mece dialécticamente en el pensamiento crítico regalándonos versos de una profundidad casi insondable. Nieto interpreta la realidad como la vive y la piensa dejando translucir un perfume delicado que se desprende lentamente al son de la pulcritud irredenta de este hermeneuta culto e intuitivo.

Análisis de las dos líneas de transmisión del tratado de Tudmīr (94 H./713 e.C.)

Los dos textos principales de las líneas de transmisión del tratado de Tudmīr (94 H/713 e.C.), incluidos por al-‘Uḏrī y al-Ḍabbī en sus respectivas obras, son editados y traducidos en base a la relectura de los manuscritos que los contienen y de ello se extraen una serie de conclusiones sobre su proceso de copia. Luego son comparados los dos textos entre sí y se enumeran una serie de diferencias textuales. Finalmente, como hipótesis interpretativa se propone que el texto de al-‘Uḏrī es el más antiguo, y habría sido copiado de un traslado del original por su autor, mientras que la transmisión de al-Ḍabbī habría sido más reciente y se habría fundado en otra fuente más antigua que habría puesto por escrito un relato oral del texto.

Letters from Timothy Pickering to his brother and father, 1797-1798

These two handwritten letters by Timothy Pickering were written on February 14, 1797 and June 14, 1798 to his brother John Pickering and his father Timothy Pickering, respectively. The letter to his brother, John, discusses mutual friends, classmate Thomas Lee, and John’s recent attendance at a sermon by Dr. Joseph Priestley. The letter from Timothy to his father includes a discussion of Timothy’s expenses and the amount of money needed to pay his debts, a request for new shoes for commencement, the news of Timothy’s invitation to join honor society Phi Beta Kappa, and a few comments on his forensics course at Harvard.

South India, 1800 (Raster Image)

This layer is a georeferenced raster image of the historic paper map entitled: The peninsula of India : from the Kistnah River to Cape Comorin : exhibiting the partition of the territories of the late Tippoo Sultaun, according to the treaty of 1792, made by the Marquis Cornwallis, and that of 1799, made by the Marquis Wellesley by J. Rennell ; writing b W. Harrison. It was published by J. Rennell : sold by G. Nicol in 1800. Scale [ca. 1:2,300,000]. The image inside the map neatline is georeferenced to the surface of the earth and fit to the Kalianpur 1975 India Zone III projected coordinate system. All map collar and inset information is also available as part of the raster image, including any inset maps, profiles, statistical tables, directories, text, illustrations, index maps, legends, or other information associated with the principal map. This map shows features such as drainage, cities and other human settlements, territorial, administrative and colonial boundaries, shoreline features, and more. Relief shown by hachures.This layer is part of a selection of digitally scanned and georeferenced historic maps from the Harvard Map Collection. These maps typically portray both natural and manmade features. The selection represents a range of originators, ground condition dates, scales, and map purposes.

Reflections on the institutional balance, the Community Method and the interplay between jurisdictions after Lisbon. Research Papers in Law, 04/2012

[Introduction.] Over the last two years, not only inside but also outside the framework of the EU treaties, far reaching measures have been taken at the highest political level in order to address the financial and economic crisis in Europe and in particular the sovereign debt crisis in the Euro area. This has triggered debates forecasting the “renationalisation of European politics.” Herman Van Rompuy, the President of the European Council, countered the prediction that Europe is doomed because of such a renationalisation: “If national politics have a prominent place in our Union, why would this not strengthen it?” He took the view that not a renationalisation of European politics was at stake, but an Europeanization of national politics emphasising that post war Europe was never developed in contradiction with nation states.1 Indeed, the European project is based on a mobilisation of bundled, national forces which are of vital importance to a democratically structured and robust Union that is capable of acting in a globalised world. To that end, the Treaty of Lisbon created a legal basis. The new legal framework redefines the balance between the Union institutions and confirms the central role of the Community method in the EU legislative and judiciary process. This contribution critically discusses the development of the EU's institutional balance after the entry into force of the Treaty of Lisbon, with a particular emphasis on the use of the Community Method and the current interplay between national constitutional courts and the Court of Justice. This interplay has to date been characterised by suspicion and mistrust, rather than by a genuine dialogue between the pertinent judicial actors.

Current challenges in EU politics. A perspective from North Rhine-Westphalia. ZEI Discussion Paper C216, 2013

I would like to briefly recapitulate where Europe stands today, and what has been achieved. Because I maintain that in the EU’s 27 Member States we have, despite the failings and shortcomings we all bemoan, reached a level of unity, prosperity and rule of law unheard of in the history of this continent, and possibly of the world. As far as territory is concerned: the European Economic Community started out with six members. The late Bronislaw Geremek, former Foreign Minister of Poland and an eminent historian, used to point out that this, at the time, corresponded in size and shape roughly to the empire of Charlemagne, one of the greatest unified territories the continent has ever known. And yet, a mere 55 years after the Treaty of Rome we have gone far beyond that. Today’s European Union encompasses 27 countries, more than 4 million square kilometers in territory and 500 million people. When it comes to Europe’s policies, at present, all eyes are on the Euro and the future of our common monetary and financial policy. But within our common space, we have achieved so much more than a common currency for a majority of Member States.

Fundamental rights in the EU: three years after Lisbon, the Luxembourg perspective. Research Paper in Law (Cooperative Research Paper) 02/2013

For more than 10 years after the signature of the Treaty of Rome in 1957, the question of the protection of human rights had never been in issue. The emphasis was on the creation and consolidation of the common market establishing the free movement of persons, of services, of goods and of capital. Neither the initial Treaties nor the jurisprudence of the Court made any reference to the protection of human rights in the process of the creation of the common market. It all started in 1969 in the Stauder case with this very short sentence: “Interpreted in this way the provision at issue contains nothing capable of prejudicing the fundamental human rights enshrined in the general principles of Community law and protected by the Court”. Forty years later, with the adoption of the Treaty of Lisbon, which came into force on 1 December 2009, fundamental rights are part of primary law. The achievement has been remarkable if we consider the very beginning of the process. It is not an exaggeration to say that the Court with its jurisprudence has been the driving force and the source of inspiration for this achievement.

EU immigration trends and policies: Spain and France as case studies. Jean Monnet/Robert Schuman Paper Series Vol. 13 No. 10, August 2013

From the Introduction. The Treaty on European Union, also known as the Treaty of Maastricht or the Maastricht Treaty, created the European Union (EU) from the existing European Economic Community (EEC.) It was signed by the member states on February 7, 1992, and entered into force on November 1, 1993.1 Among its many innovations was the creation of European citizenship, which would be granted to any person who was a citizen of an EU member state. Citizenship, however, is intertwined with immigration, which the Treaty also attempted to address. Policy on visas, immigration and asylum was originally placed under Pillar 3 of the EU, which dealt with Justice and Home Affairs. In 1997, however, the Amsterdam Treaty moved these policies from Pillar 3 to Pillar 1, signaling “a shift toward more supranational decision-making in this area,” as opposed to the intergovernmental method of Pillars 2 and 3.2

Taking stock after the Warsaw COP. CEPS Commentary, 4 December 2013

Drawing on his direct participation in the latest round of climate talks in Warsaw, Andrei Marcu looks at the results of the 19th COP through the lens of three basic questions, with a view to understanding how much progress was made and where we stand two years ahead of Paris. Are the targets adequate and how do we reach environmentally adequate targets? Can one understand and compare what other Parties are promising to do to ensure that the level of effort is comparable and equitable, and that companies are not asked to do more than their competitors in other jurisdictions? Is there comparability and equity in the eyes of the beholder? Do we understand what tools each country uses (what is available, what one gets as support) to ensure that no one country (and its companies) gets an easier ride or competitive advantage in meeting the commitment/promises that countries make. The author asserts that these questions need to be answered if an agreement is to be reached in 2015. And if they are not, he warns of mistrust, fear of carbon leakage and the temptation to resort to protectionist measures to compensate for competitive disadvantage.

Lisbon Fado: The European Union under Reform

From the Introduction. To address the uncertainties surrounding the Treaty of Lisbon, this book examines several issues from various angles. Regardless of the results of the second referendum in Ireland and the pending ratifications in Poland, the Czech Republic and Germany, the European Union (EU) will not be the same after the Lisbon Treaty. If it comes into effect, Europeans will enter into a new stage in the deepening of the integration process; if it is rejected, the first decade of the 21st Century will represent a period of institutional stagnation in Europe’s integration. Nonetheless, the chapters in this book share the consensus that, despite its limitations, the Lisbon Treaty will make the EU decision making process more efficient, enhance regional democracy and strengthen its international voice.

The European Parliament’s New Role in Trade Policy: Turning power into impact. CEPS Special Report No. 89, 21 May 2014

The power of the European Parliament in EU trade policy has increased significantly with the Lisbon Treaty. Even though it had already acquired a greater informal role, the codification of its involvement enables the EP to have a stronger say in trade policy. Against the background of increased legal competences granted by the Treaty of Lisbon to the European Parliament in EU trade policy, this Policy Brief addresses two important questions. The first concerns the extent to which the EP’s power in trade policy has increased: Has the EP effectively played a bigger role since the end of 2009? The second relates to the substance of the EP’s trade policy preferences: Does the EP attempt to push EU trade relations into a more or less normative and/or protectionist direction? Its main argument is that the Lisbon Treaty not only heralds a major leap forward in legal terms, but that the current EP legislature has also managed to increase its political clout in trade policy-making. Nevertheless, a major challenge for the new EP legislature 2014-2019 will be to turn this into effective influence.