769 resultados para Barriers to access
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Piezosurgery is a new and modern technique of bone surgery in implantology. Selective cutting is possible for different ultrasonic frequencies acting only in hard tissues (mineralized), saving vital anatomical structures. With the piezoelectric osteotomy technique, receptor site preparation for implants, autogenous bone graft acquistition (particles and blocks), osteotomy for alveolar bone crest expansion, maxillary sinus lifting, and dental implant removal can be performed accurately and safely, providing excellent clinical and biological results, especially for osteocyte viability. The aim of this review was, through literature review, to present clinical applications of piezosurgery in implant dentistry and outline their advantages and disadvantages over conventional surgical systems. Moreover, this study addressed the biological aspects related to piezosurgery that differentiate it from those of bone tissue approaches. Overall, piezosurgery enables critical operations in simple and fully executable procedures; and effectively, areas that are difficult to access have less risk of soft tissue and neurovascular tissue damage via piezosurgery.
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The various changes occurring in society in the late twentieth century created a context of true technological revolution based on information. These changes resulted in three points: a new way to communicate with the emergence of new media and communication platforms; a new role assigned to organizations increasingly blamed for social problems, and a greater access to information by society, which forms more critical and demanding. The convergence of these three consequences observed strengthening of the concept of Corporate Social Responsibility and the importance of internal communication in their construction. This literature review and empirical research, based on a case study with the Junior Enterprise of Public Relations at Unesp Bauru, studied the role of Public Relations in the process of communication management as a facilitator of internal processes towards mobilization for Social Responsibility. It intent to see which are the main barriers to the inclusion of the concept too. The study shows the relevant current context itself, in which the concern with the changing social scenario should be seen as opportunities for growth. The concept of Corporate Social Responsibility should be inserted into the organizational DNA to its consolidation, characterizing itself as a cultural and dependent matter of internal restructuring. The role of public relations in this context covers the management of communication and harmony of the interests of all public organization
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Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)
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Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)
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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
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In the context of medical school instruction, the segmented approach of a focus on specialties and excessive use of technology seem to hamper the development of the professional-patient relationship and an understanding of the ethics of this relationship. The real world presents complexities that require multiple approaches. Engagement in the community where health competence is developed allows extending the usefulness of what is learned. Health services are spaces where the relationship between theory and practice in health care are real and where the social role of the university can be revealed. Yet some competencies are still lacking and may require an explicit agenda to enact. Ten topics are presented for focus here: environmental awareness, involvement of students in medical school, social networks, interprofessional learning, new technologies for the management of care, virtual reality, working with errors, training in management for results, concept of leadership, and internationalization of schools. Potential barriers to this agenda are an underinvestment in ambulatory care infrastructure and community-based health care facilities, as well as in information technology offered at these facilities; an inflexible departmental culture; and an environment centered on a discipline-based medical curriculum.
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Educational institutions of all levels invest large amounts of time and resources into instructional technology, with the goal of enhancing the educational effectiveness of the learning environment. The decisions made by instructors and institutions regarding the implementation of technology are guided by perceptions of usefulness held by those who are in control. The primary objective of this mixed methods study was to examine the student and faculty perceptions of technology being used in general education courses at a community college. This study builds upon and challenges the assertions of writers such as Prensky (2001a, 2001b) and Tapscott (1998) who claim that a vast difference in technology perception exists between generational groups, resulting in a diminished usefulness of technology in instruction. In this study, data were gathered through student surveys and interviews, and through faculty surveys and interviews. Analysis of the data used Kendall’s Tau test for correlation between various student and faculty variables in various groupings, and also typological analysis of the transcribed interview data. The analysis of the quantitative data revealed no relationship between age and perception of technology’s usefulness. A positive relationship was found to exist between the perception of the frequency of technology use and the perception of technology’s effectiveness, suggesting that both faculty members and students believed that the more technology is used, the more useful it is in instruction. The analysis of the qualitative data revealed that both faculty and students perceive technology to be useful, and that the most significant barriers to technology’s usefulness include faulty hardware and software systems,lack of user support, and lack of training for faculty. The results of the study suggest that the differences in perception of technology between generations that are proposed by Prensky may not exist when comparing adults from the younger generation with adults from the older generation. Further, the study suggests that institutions continue to invest in instructional technology, with a focus on high levels of support and training for faculty, and more universal availability of specific technologies, including web access, in class video, and presentation software. Adviser: Ronald Joekel
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With the popularity of the Internet, it is easy to access sexually explicit material. Past research has demonstrated that exposure to sexually explicit material in traditional formats (i.e. magazines and videos) may have an influence on male attitudes and behaviors towards females, but these effects appear to be minimal and dissipate over the long term. Though the body of literature examining Internet sexually explicit material is smaller, researchers have found little to no effects on attitudes or aggressive behaviors immediately after exposure. However, research regarding exposure to online sexually explicit material has not included forensically relevant variables. Previous research has suggested that undergraduate males who report engaging in sexually coercive or aggressive behaviors differ in terms of personality, attitudinal, and behavioral variables from individuals who do not report this type of behavior. Therefore, the purpose of this study was to examine the same personality and attitudinal variables that have been studied in previous research, but to extend this research by including behavioral variables related to the viewing of online sexually explicit material. Male undergraduate students were provided with a link to take an online survey examining personality (empathy, sensation-seeking, and psychopathy), attitudinal (rape myth belief, acceptance of interpersonal violence, and hostility towards women) and behavioral (online sexual compulsivity and online behaviors with regard to sexual material) variables. The relationship between these variables and sexually coercive behavior was examined. Results indicate there is a significant relationship between some scales related to empathy and viewing sexually explicit or degrading material. Further results indicated that individuals who identified as having engaged in sexually aggressive behavior endorsed more items related to online sexually compulsive behaviors. Exploratory analyses revealed that the amount, as opposed to the type, of sexually explicit material viewed appears to be more related to adverse outcomes.
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The scope of this paper is to analyze delays in locating health services for the diagnosis of tuberculosis in Ribeirao Preto in 2009. An epidemiological and cross-sectional study was conducted with 94 TB patients undergoing treatment. A structured questionnaire, based on the Primary Care Assessment Tool adapted for TB care was used. A median (15 days or more) was established to characterize delay in health attendance. Using the Prevalence Ratio, the variables associated with longer delay were identified. The first healthcare services sought were the Emergency Services (ES) (57.5%). The longest period between seeking assistance occurred among males, aged between 50 and 59, who earned less than five minimum wages, had pulmonary TB, were new cases, were not co-infected with TB/HIV, did not consume alcohol, had satisfactory knowledge about TB before diagnosis (with a statistically significant association with delay) and who did not seek healthcare close to home before developing TB. There is a perceived need for training healthcare professionals about the signs and symptoms of the disease, reducing barriers of access to timely diagnosis of TB and widely disseminating it to the community in general.
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Landfarm soils are employed in industrial and petrochemical residue bioremediation. This process induces selective pressure directed towards microorganisms capable of degrading toxic compounds. Detailed description of taxa in these environments is difficult due to a lack of knowledge of culture conditions required for unknown microorganisms. A metagenomic approach permits identification of organisms without the need for culture. However, a DNA extraction step is first required, which can bias taxonomic representativeness and interfere with cloning steps by extracting interference substances. We developed a simplified DNA extraction procedure coupled with metagenomic DNA amplification in an effort to overcome these limitations. The amplified sequences were used to generate a metagenomic data set and the taxonomic and functional representativeness were evaluated in comparison with a data set built with DNA extracted by conventional methods. The simplified and optimized method of RAPD to access metagenomic information provides better representativeness of the taxonomical and metabolic aspects of the environmental samples.
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Interoperability is a crucial issue for electronic government due to the need of agencies' information systems to be totally integrated and able to exchange data in a seamless way. A way to achieve it is by establishing a government interoperability framework (GIF). However, this is a difficult task to be carried out due not only to technological issues but also to other aspects. This research is expected to contribute to the identification of the barriers to the adoption of interoperability standards for electronic government. The article presents the preliminary findings from a case study of the Brazilian Government framework (e-PING), based on the analyses of documents and face-to-face interviews. It points out some aspects that may influence the establishment of these standards, becoming barriers to their adoption.
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Background: There are no available statistical data about sudden cardiac death in Brazil. Therefore, this study has been conducted to evaluate the incidence of sudden cardiac death in our population and its implications. Methods: The research methodology was based on Thurstone's Law of Comparative Judgment, whose premise is that the more an A stimulus differs from a B stimulus, the greater will be the number of people who will perceive this difference. This technique allows an estimation of actual occurrences from subjective perceptions, when compared to official statistics. Data were collected through telephone interviews conducted with Primary and Secondary Care physicians of the Public Health Service in the Metropolitan Area of Sao Paulo (MASP). Results: In the period from October 19, 2009, to October 28, 2009, 196 interviews were conducted. The incidence of 21,270 cases of sudden cardiac death per year was estimated by linear regression analysis of the physicians responses and data from the Mortality Information System of the Brazilian Ministry of Health, with the following correlation and determination coefficients: r = 0.98 and r2= 0.95 (95% confidence interval 0.81.0, P < 0.05). The lack of waiting list for specialized care and socioadministrative problems were considered the main barriers to tertiary care access. Conclusions: The incidence of sudden cardiac death in the MASP is high, and it was estimated as being higher than all other causes of deaths; the extrapolation technique based on the physicians perceptions was validated; and the most important bureaucratic barriers to patient referral to tertiary care have been identified. (PACE 2012; 35:13261331)
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Objective: To assess the risk factors for delayed diagnosis of uterine cervical lesions. Materials and Methods: This is a case-control study that recruited 178 women at 2 Brazilian hospitals. The cases (n = 74) were composed of women with a late diagnosis of a lesion in the uterine cervix (invasive carcinoma in any stage). The controls (n = 104) were composed of women with cervical lesions diagnosed early on (low-or high-grade intraepithelial lesions). The analysis was performed by means of logistic regression model using a hierarchical model. The socioeconomic and demographic variables were included at level I (distal). Level II (intermediate) included the personal and family antecedents and knowledge about the Papanicolaou test and human papillomavirus. Level III (proximal) encompassed the variables relating to individuals' care for their own health, gynecologic symptoms, and variables relating to access to the health care system. Results: The risk factors for late diagnosis of uterine cervical lesions were age older than 40 years (odds ratio [OR] = 10.4; 95% confidence interval [CI], 2.3-48.4), not knowing the difference between the Papanicolaou test and gynecological pelvic examinations (OR, = 2.5; 95% CI, 1.3-4.9), not thinking that the Papanicolaou test was important (odds ratio [OR], 4.2; 95% CI, 1.3-13.4), and abnormal vaginal bleeding (OR, 15.0; 95% CI, 6.5-35.0). Previous treatment for sexually transmissible disease was a protective factor (OR, 0.3; 95% CI, 0.1-0.8) for delayed diagnosis. Conclusions: Deficiencies in cervical cancer prevention programs in developing countries are not simply a matter of better provision and coverage of Papanicolaou tests. The misconception about the Papanicolaou test is a serious educational problem, as demonstrated by the present study.
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Abstract Background Leptospirosis is considered a re-emerging infectious disease caused by pathogenic spirochaetes of the genus Leptospira. Pathogenic leptospires have the ability to survive and disseminate to multiple organs after penetrating the host. Leptospires were shown to express surface proteins that interact with the extracellular matrix (ECM) and to plasminogen (PLG). This study examined the interaction of two putative leptospiral proteins with laminin, collagen Type I, collagen Type IV, cellular fibronectin, plasma fibronectin, PLG, factor H and C4bp. Results We show that two leptospiral proteins encoded by LIC11834 and LIC12253 genes interact with laminin in a dose - dependent and saturable mode, with dissociation equilibrium constants (KD) of 367.5 and 415.4 nM, respectively. These proteins were named Lsa33 and Lsa25 (Leptospiral surface adhesin) for LIC11834 and LIC12253, respectively. Metaperiodate - treated laminin reduced Lsa25 - laminin interaction, suggesting that sugar moieties of this ligand participate in this interaction. The Lsa33 is also PLG - binding receptor, with a KD of 23.53 nM, capable of generating plasmin in the presence of an activator. Although in a weak manner, both proteins interact with C4bp, a regulator of complement classical route. In silico analysis together with proteinase K and immunoflorescence data suggest that these proteins might be surface exposed. Moreover, the recombinant proteins partially inhibited leptospiral adherence to immobilized laminin and PLG. Conclusions We believe that these multifunctional proteins have the potential to participate in the interaction of leptospires to hosts by mediating adhesion and by helping the bacteria to escape the immune system and to overcome tissue barriers. To our knowledge, Lsa33 is the first leptospiral protein described to date with the capability of binding laminin, PLG and C4bp in vitro.