612 resultados para Paramount


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A presente dissertação consiste na análise do romance Longe de Manaus, de Francisco José Viegas, publicado em 2005, em Portugal. O trabalho tem como objetivo responder ao questionamento de quais são as funções dos testemunhos na refiguração do tempo e na narração do passado? No âmbito teórico, analisa os atos de testemunhar e narrar associados ao conceito de memória e à ideia de distância a partir das abordagens de Paul Ricoeur e das contribuições de Carlo Guinzburg, de modo a relacionar a tradição do olhar interior com o exterior. Nos dois casos, a leitura de Agostinho se faz presente, pois o filósofo inaugura a memória como um produto da linguagem e preconiza a busca dos vestígios nos fenômenos mnemônicos. O contexto de produção é introduzido com as proposições de Eduardo Lourenço sobre a identidade nacional portuguesa, com a definição de sul proposta por Boaventura de Souza Santos e pelas colocações de Edgar Morin acerca do marxismo na atualidade, além de retomar a conjuntura da década de 1970 tendo em vista as pesquisas dos historiadores Eric Hobsbawn e Majhemout Diop, que estudaram o neocolonialismo. No âmbito analítico, é interpretada a organização cíclica do romance que entrecruza personagens e vozes narrativas de espaços e temporalidades diferentes, com a finalidade de abordar como a pobreza e a violência podem ser fatores constantes na África da década de 1970, sob o domínio imperial lusitano, ou nas cidades do Porto, São Paulo e Manaus contemporâneas. O narrador apresenta problemas sociais em Portugal, nos anos 2000, atrelados às politicas econômicas e à entrada de imigrantes do sul; concomitantemente, o protagonista Jaime Ramos debate a sua sociedade a partir de dois critérios: o de identidade nacional portuguesa, segundo o critério levantado por ele de solidão, e o de defesa da luta de classes como fator primordial para compreender os assassinatos investigados pela personagem. O estudo articula as noções de memória e literatura com a finalidade de analisar as estratégias narrativas presentes em Longe de Manaus.

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Nos últimos anos com a evolução dos sistemas de saúde tem-se verificado uma melhoria na qualidade dos serviços médicos prestados, conduzindo a uma esperança média de vida mais longa. Muitas patologias, apesar de patentes, são tratadas e/ou controladas de modo a permitir que a população possa adquirir um estilo de vida normal. As doenças cardiovasculares com o seu carácter multidimensional, têm consequências graves para o cidadão comum, para a sociedade e para o sistema de saúde, o que determina que sejam encaradas como um dos mais importantes problemas de saúde pública, problema este que urge minorar. Dentro das doenças cardiovasculares, a cardiopatia isquémica tem um significado relevante, uma vez que, engloba condições que necessitam de cuidados médicos especiais, em situações de emergência, como o enfarte agudo do miocárdio e a angina de peito (estável e instável). O médico dentista deve estar atento ao doente com cardiopatia isquémica, tendo em conta os cuidados especiais em consultório dentário que o mesmo necessita. A recolha de uma anamnese detalhada e história clínica atualizada, são fundamentais para o sucesso do tratamento dentário. O médico dentista deverá estar habilitado para atuar em situações de emergência e ter o consultório devidamente equipado, de forma a agir em conformidade com estes possíveis eventos.

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Introduction: It is complex to define learning disabilities, there is no single universal definition used; there are different interpretations and definitions used for learning disabilities in different countries and communities. Primarily, the term “learning disability” sometimes used as “learning difficulties” is a term widely used in UK. There are various types and degree of severity of learning disabilities depending upon the extent of disorder. Though different definitions used all over the world, its types and classification coupled with their health and oral health needs are discussed in this review. Objectives:  To review the background literature on definitions of learning disabilities and health needs of this population.  To review literature on individual clinical preventive intervention to determine the effectiveness in promoting oral health amongst adults in learning disabilities.  To review literature in relation to community based preventive dental measures.  To determine the interventions in this areas are appropriate to support policy and practice and if these interventions establish good evidence to suggest that the oral health needs of adults with learning disabilities are met or not.  To make recommendations in implementing future preventive oral health interventions for adults with learning disabilities. Methodology: It was develop a comprehensive narrative synthesis of previously published literature from different sources and summarizes the whole research in a particular area identifying gap of knowledge. It provides a broad perspective of a subject and supports continuing education. It also is directed to inform policy and further research. It is a qualitative type of research with a broad question and critical analysis of literature published in books, article and journals. The research question evaluated on PICOS criteria is: Effectiveness of preventive dental interventions in adults with learning disabilities. The research question clearly defines the PICOS i.e. participants, interventions, comparison, outcome and study design. The Cochrane database of systematic reviews (CDSR), Database of Abstracts of Reviews of effects (DARE) through York University and National institute of Health and Clinical Excellence (NICE) was searched to identify need of this review. There was no literature review found on the preventive dental interventions found hence, justifying this review. The guidance used in this review is from York University and methods opted for search of literature is based on the following: Type of participants, interventions, outcome measure, studies and search. The review of literature; author search; systematic and narrative reviews, through the following electronic databases via UFP library services: Pub-Med, Medline, EMBASE, CINHAL, Google scholar; Science Direct; Social and Medicine. A comprehensive search of all available literature from 1990-2015, including systematic reviews, policy documents and some guideline documents was done. Internet resource used to access; Department of Health, World Health Organization, Disability World, Disability Rights Commission, the Stationery office, MENCAP, Australian Learning Disability Association. The literature search was carried out with single word, combined words and phrases, authors' names and the title of literature search. Results: It is primarily looking at the oral health interventions available for adults with learning disabilities in clinical settings and the community measures observed over a period of 25 years 1990-2015. There were 7of the clinical intervention studies and one community based intervention study was added in this review. Conclusion: There is a gap of knowledge identified in not having ample research in the area of preventive dental interventions in adults with learning or intellectual disabilities and there is a need of more research, studies need to be of a better quality and a special consideration is required in the community settings where maintenance of oral hygiene for this vulnerable group of society is hugely dependent on their caregivers. Though, the policy and guideline directs on the preventive dental interventions of adults with LD there still a gap evident in understanding and implication of the guidance in practice by the dental and care support team. Understanding learning disabilities and to identify their behavior, compliance and oral health needs is paramount for all professionals working with or for them at each level.

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The purpose of this study was to analyze emotions related to a child’s critical illness from the perspective of the family and discuss the link those emotions might form with value creation. High quality service is of paramount importance in hospital care, especially when a child is diagnosed with critical illness. Through the analysis of patient family emotions and their triggers, the study was aiming to deepen the understanding of value creation for customer. Therefore, the research sought to find answers to the following three sub-questions: 1. What are the emotions experienced? 2. What triggers them? 3. How are the emotions linked to amelioration or aggravation of value for patient and family? The theoretical background of this research is built on two core concepts: emotions and value creation. As both concepts are wide and multifaceted, the research concentrates on viewing emotions from the applicable cognitive angle, identifying and categorizing emotions in a general level. Value creation is studied from the service perspective, discussing the possible relations between emotions and value creation. Moreover, the suitability of views regarding customer value co-creation to health care encounters is analyzed. Qualitative approach was selected as the most appropriate methodology for conducting the empirical research. The empirical data was collected from public blogs, for which a total of 18 blogs were reviewed. Five blogs were selected for the analysis, which had the intent of identifying the emotions experienced by patient families and deepening the knowledge of their role in value creation during health care service encounters. The empirical study of this research discovered a wide range of positive and negative emotions, which denotes that a severe life situation does not prevent the feeling of positive emotions. Furthermore, by combining the empirical findings to the theoretical background, this study concludes that recognizing and treating the patient family as a partner and value creator is essential. The high quality technical aspect of care is vital, but it is not the sole attribute for service quality, as the interpersonal communication plays a large role in the customer’s overall assessment of the health care performance. The patients and their families largely evaluate the service encounter based on their perceptions, thus emotions play a significant role. Depending on the service experience, value maybe created or destructed. Hence, this study posits emotion at the core of the service encounter, indicating towards the importance of active assessment of customer perceptions and the recognition of the emotional states

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Hybrid halide perovskites have emerged as promising active constituents of next generation solution processable optoelectronic devices. During their assembling process, perovskite components undergo very complex dynamic equilibria starting in solution and progressing throughout film formation. Finding a methodology to control and affect these equilibria, responsible for the unique morphological diversity observed in perovskite films, constitutes a fundamental step towards a reproducible material processability. Here we propose the exploitation of polymer matrices as cooperative assembling components of novel perovskite CH3NH3PbI3 : polymer composites, in which the control of the chemical interactions in solution allows a predictable tuning of the final film morphology. We reveal that the nature of the interactions between perovskite precursors and polymer functional groups, probed by Nuclear Magnetic Resonance (NMR) spectroscopy and Dynamic Light Scattering (DLS) techniques, allows the control of aggregates in solution whose characteristics are strictly maintained in the solid film, and permits the formation of nanostructures that are inaccessible to conventional perovskite depositions. These results demonstrate how the fundamental chemistry of perovskite precursors in solution has a paramount influence on controlling and monitoring the final morphology of CH3NH3PbI3 (MAPbI3) thin films, foreseeing the possibility of designing perovskite : polymer composites targeting diverse optoelectronic applications.

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Lake Nakivali is one of the four small lakes that form what is known as the Koki lakes system. It is 14 km long, 6 km wide, 26 km2 in area and has maximum depth of 3.5 m at high water level. The lake is located in a lake-swamp complex with River Rwizi as the principle inflow, and a number of peripheral lakes among which are four major ones, i.e. Lakes Nakivali, Mburo, Kachira, and Kijanebalola. The survey therefore established that Lake Nakivali is a healthy ecosystem capable of sustaining fisheries production. While stock enhancement through restocking with fry could boost fish stocks, especially of the Nile tilapia, effective management measures that allow natural regeneration of stocks of indigenous fish species is paramount. This may require closed fishing seasons and control of fishing effort. Tank aquaculture is a viable option for increasing fish production and Ngege (O. niloticus) and Male (C. gariepinus) are candidate fish species for fish farming.

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As fluoroquinolonas são antibióticos que têm um largo espectro de ação contra bactérias, especialmente Gram-negativas. O seu mecanismo de ação assenta na inibição de enzimas responsáveis pela replicação do DNA. Porém, devido ao seu uso indevido, o surgimento de resistência bacteriana a estes antibióticos tem-se tornado um grave problema de saúde pública. Uma vez que os seus alvos de ação se situam no meio intracelular, a redução da permeabilidade da membrana externa de bactérias Gram-negativas constitui um dos mecanismos de resistência mais conhecidos. Esta redução é associada à baixa expressão ou mutações em porinas necessárias para permitir o seu transporte, mais concretamente, da OmpF. Estudos prévios demonstraram que a coordenação de fluoroquinolonas com iões metálicos divalentes e 1,10-fenantrolina (genericamente designados metaloantibióticos) são potenciais candidatos como alternativa às fluoroquinolonas convencionais. Estes metaloantibióticos exibem um efeito antimicrobiano comparável ou superior à fluoroquinolona na forma livre, mas parecem ter uma via de translocação diferente, independente de porinas. Estas diferenças no mecanismo de captura podem ser fundamentais para contornar a resistência bacteriana. De forma a compreender o papel dos lípidos no mecanismo de entrada dos metaloantibióticos, estudou-se a interação e localização dos metaloantibióticos da Ciprofloxacina (2ª geração), da Levofloxacina (3ª geração) e Moxifloxacina (4ª geração) com um modelo de membranas de Escherichia coli desprovido de porinas. Estes estudos foram realizados através de técnicas de espectroscopia de fluorescência, por medições em modo estacionário e resolvida no tempo. Os coeficientes de partição determinados demonstraram uma interação mais elevada dos metaloantibióticos relativamente às respetivas fluoroquinolonas na forma livre, um facto que está diretamente relacionado com as espécies existentes em solução a pH fisiológico. Os estudos de localização mostraram que estes metaloantibióticos devem estar inseridos na membrana bacteriana, confirmando a sua entrada independente de porinas. Este mecanismo de entrada, pela via hidrofóbica, é potenciado por interações eletrostáticas entre as espécies catiónicas de metaloantibiótico que existem a pH 7,4 e os grupos carregados negativamente dos fosfolípidos da membrana. Desta forma, os resultados obtidos neste estudo sugerem que a via de entrada dos metaloantibióticos e das respetivas fluoroquinolonas deve ser diferente. Os metaloantibióticos são candidatos adequados para a realização de mais testes laboratoriais e uma alternativa promissora para substituir as fluoroquinolonas convencionais, uma vez que parecem ultrapassar um dos principais mecanismos de resistência bacteriana a esta classe de antibióticos.

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Relatório de Estágio apresentado à Escola Superior de Educação de Paula Frassinetti para obtenção de grau de Mestre em Educação Pré-Escolar

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Wydział Neofilologii: Katedra Orientalistyki

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O estudo do crescimento econômico é de suma importância para que possamos averiguar a trajetória de uma economia ao longo do tempo, a proposta desse trabalho é analisar o crescimento econômico no estado do Rio Grande do Sul, através do instrumental das cadeias de Markov, a ideia principal do estudo está na hipótese de convergência de renda. Primeiramente será testado a hipótese de convergência de renda do estado por meio das microrregiões, para isso serão utilizados dados de produto per capita dos anos de 1990, 2000 e 2010. Também será testado a hipótese de convergência para os municípios do Conselho Regional de Desenvolvimento Sul, situado no Rio Grande do Sul, utilizando dados de renda per capita dos anos de 1991, 2000 e 2010. Os resultados obtidos para as microrregiões do Rio Grande do Sul mostram que as economias não estão convergindo em sua totalidade para uma classe de renda especifica, porém é percebido que no longo prazo haverá uma maior concentração das microrregiões nos extratos de renda próximos a média, o tempo esperado para que as economias cheguem ao seu estado estacionário é de seis períodos. Por meio dos resultados obtidos para a região do Corede Sul, temos que as economias convergirão em sua maioria para a classe de renda médio pobre, seguido pela classe dos médios ricos. Ambas as classes estão situadas próximas a média regional, sendo que as classes de renda pobre e rico situadas aos extremos serão extintas no longo prazo. O tempo esperado para que as economias cheguem ao estado estacionário é de onze períodos.

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Cabomba caroliniana is a submersed macrophyte that has become a serious invader. Cabomba predominantly spreads by stem fragments, in particular through unintentional transport on boat trailers ('hitch hiking'). Desiccation resistance affects the potential dispersal radius. Therefore, knowledge of maximum survival times allows predicting future dispersal. Experiments were conducted to assess desiccation resistance and survival ability of cabomba fragments under various environmental scenarios. Cabomba fragments were highly tolerant of desiccation. However, even relatively low wind speeds resulted in rapid mass loss, indicating a low survival rate of fragments exposed to air currents, such as fragments transported on a boat trailer. The experiments indicated that cabomba could survive at least 3 h of overland transport if exposed to wind. However, even small clumps of cabomba could potentially survive up to 42 h. Thus, targeting the transport of clumps of macrophytes should receive high priority in management. The high resilience of cabomba to desiccation demonstrates the risk of continuing spread. Because of the high probability of fragment viability on arrival, preventing fragment uptake on boat trailers is paramount to reduce the risk of further spread. These findings will assist improving models that predict the spread of aquatic invasive macrophytes.

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Recent developments in the physical parameterizations available in spectral wave models have already been validated, but there is little information on their relative performance especially with focus on the higher order spectral moments and wave partitions. This study concentrates on documenting their strengths and limitations using satellite measurements, buoy spectra, and a comparison between the different models. It is confirmed that all models perform well in terms of significant wave heights; however higher-order moments have larger errors. The partition wave quantities perform well in terms of direction and frequency but the magnitude and directional spread typically have larger discrepancies. The high-frequency tail is examined through the mean square slope using satellites and buoys. From this analysis it is clear that some models behave better than the others, suggesting their parameterizations match the physical processes reasonably well. However none of the models are entirely satisfactory, pointing to poorly constrained parameterizations or missing physical processes. The major space-time differences between the models are related to the swell field stressing the importance of describing its evolution. An example swell field confirms the wave heights can be notably different between model configurations while the directional distributions remain similar. It is clear that all models have difficulty in describing the directional spread. Therefore, knowledge of the source term directional distributions is paramount in improving the wave model physics in the future.

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O estudo do crescimento econômico é de suma importância para que possamos averiguar a trajetória de uma economia ao longo do tempo, a proposta desse trabalho é analisar o crescimento econômico no estado do Rio Grande do Sul, através do instrumental das cadeias de Markov, a ideia principal do estudo está na hipótese de convergência de renda. Primeiramente será testado a hipótese de convergência de renda do estado por meio das microrregiões, para isso serão utilizados dados de produto per capita dos anos de 1990, 2000 e 2010. Também será testado a hipótese de convergência para os municípios do Conselho Regional de Desenvolvimento Sul, situado no Rio Grande do Sul, utilizando dados de renda per capita dos anos de 1991, 2000 e 2010. Os resultados obtidos para as microrregiões do Rio Grande do Sul mostram que as economias não estão convergindo em sua totalidade para uma classe de renda especifica, porém é percebido que no longo prazo haverá uma maior concentração das microrregiões nos extratos de renda próximos a média, o tempo esperado para que as economias cheguem ao seu estado estacionário é de seis períodos. Por meio dos resultados obtidos para a região do Corede Sul, temos que as economias convergirão em sua maioria para a classe de renda médio pobre, seguido pela classe dos médio ricos. Ambas as classes estão situadas próximas a média regional, sendo que as classes de renda pobre e rico situadas aos extremos serão extintas no longo prazo. O tempo esperado para que as economias cheguem ao estado estacionário é de onze períodos.

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Pancreaticoduodenectomy with or without adjuvant chemotherapy remains the only modality of possible cure in patients with cancer involving the head of the pancreas and the periampullary region. While mortality rates after pancreaticoduodenectomy have improved considerably over the course of the last century, morbidity remains high. Patient selection is of paramount importance in ensuring that major surgery is offered to individuals who will most benefit from a pancreaticoduodenectomy. Moreover, identifying preoperative risk factors provides potential targets for prehabilitation and optimisation of the patient's physiology before undertaking surgery. In addition to this, early identification of patients who are likely to develop postoperative complications allows for better allocation of critical care resources and more aggressive management high risk patients. Cardiopulmonary exercise testing is becoming an increasingly popular tool in the preoperative risk assessment of the surgical patient. However, very little work has been done to investigate the role of cardiopulmonary exercise testing in predicting complications after pancreaticoduodenectomy. The impact of jaundice, systemic inflammation and other preoperative clinicopathological characteristics on cardiopulmonary exercise physiology has not been studied in detail before in this cohort of patients. The overall aim of the thesis was to examine the relationships between preoperative clinico-pathological characteristics including cardiopulmonary exercise physiology, obstructive jaundice, body composition and systemic inflammation and complications and the post-surgical systemic inflammatory response in patients undergoing pancreaticoduodenectomy. Chapter 1 reviews the existing literature on preoperative cardiopulmonary exercise testing, the impact of obstructive jaundice, perioperative systemic inflammation and the importance of body composition in determining outcomes in patients undergoing major surgery with particular reference to pancreatic surgery. Chapter 2 reports on the role of cardiopulmonary exercise testing in predicting postoperative complications after pancreaticoduodenectomy. The results demonstrate that patients with V˙O2AT less than 10 ml/kg/min are more likely to develop a postoperative pancreatic fistula, stay longer in hospital and less likely to receive adjuvant therapy. These results emphasise the importance of aerobic fitness to recover from the operative stress of major surgery without significant morbidity. Cardiopulmonary exercise testing may prove useful in selecting patients for intensive prehabilitation programmes as well as for other optimisation measures to prepare them for major surgery. Chapter 3 evaluates the relationship between cardiopulmonary exercise physiology and other clinicopathological characteristics of the patient. A detailed analysis of cardiopulmonary exercise test parameters in jaundiced versus non-jaundiced patients demonstrates that obstructive jaundice does not impair cardiopulmonary exercise physiology. This further supports emerging evidence in contemporary literature that jaundiced patients can proceed directly to surgery without preoperative biliary drainage. The results of this study also show an interesting inverse relationship between body mass index and anaerobic threshold which is analysed in more detail in Chapter 4. Chapter 4 examines the relationship between preoperative cardiopulmonary exercise physiology and body composition in depth. All parameters measured at cardiopulmonary exercise test are compared against body composition and body mass index. The results of this chapter report that the current method of reporting V˙O2, both at peak exercise and anaerobic threshold, is biased against obese subjects and advises caution in the interpretation of cardiopulmonary exercise test results in patients with a high BMI. This is particularly important as current evidence in literature suggests that postoperative outcomes in obese subjects are comparable to non-obese subjects while cardiopulmonary exercise test results are also abnormally low in this very same cohort of patients. Chapter 5 analyses the relationship between preoperative clinico-pathological characteristics including systemic inflammation and the magnitude of the postoperative systemic inflammatory response. Obstructive jaundice appears to have an immunosuppressive effect while elevated preoperative CRP and hypoalbuminemia appear to have opposite effects with hypoalbuminemia resulting in a lower response while elevated CRP in the absence of hypoalbuminemia resulted in a greater postoperative systemic inflammatory response. Chapter 6 evaluates the role of the early postoperative systemic inflammatory response in predicting complications after pancreaticoduodenectomy and aims to establish clinically relevant thresholds for C-Reactive Protein for the prediction of complications. The results of this chapter demonstrate that CRP levels as early as the second postoperative day are associated with complications. While post-operative CRP was useful in the prediction of infective complications, this was the case only in patients who did not develop a post-operative pancreatic fistula. The predictive ability of inflammatory markers for infectious complications was blunted in patients with a pancreatic fistula. Chapter 7 summarises the findings of this thesis, their place in current literature and future directions. The results of this thesis add to the current knowledge regarding the complex pathophysiological abnormalities in patients undergoing pancreaticoduodenectomy, with specific emphasis on the interaction between cardiopulmonary exercise physiology, obstructive jaundice, systemic inflammation and postoperative outcomes. The work presented in this thesis lays the foundations for further studies aimed at improving outcomes after pancreaticoduodenectomy through the development of individualised, goal-directed therapies that are initiated well before this morbid yet necessary operation is performed.

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Urban paving is of paramount importance for a city, both socioeconomic and in quality of life. The urban flooring not different so-called road surface are constituted by a set of horizontal layers, overlaid on the ground, which have the main function of supporting the actions induced by the vehicle redistributing the stresses transmitted to the ground. Soils are important materials for the execution of paving, mainly because they are part of the basic structure of the floor and mostly be available in abundance, with a very low cost, however, their properties usually do not meet the requirements necessary to perform the floor. The soil stabilization for the implementation of urban pavement bases and sub-bases is an increasingly important aspect in the current situation, because always there is the concern with the environment, and there is now the clear awareness that every effort should be made to minimize the effects caused by the exploitation of deposits and deposition of material. In this sense this work presents the effects of adding different proportions of lime to stabilize a sedimentary soil sample from the urban area of the city of Curitiba. It selected a sample quantity of soil in the region to study the stabilization insertion of hydrated lime type (CHIII) powder. The two variables in the study are related to the content of lime mixed with the soil at 0% percentages of 3%, 6%, 8% and 16%, and cure times at which these mixtures were subjected to (0, 7, 14, 28 and 56 days). The tested mixtures were prepared from dosages defined by two methods: one checking the chemical behavior of the samples by means of changes in pH values, and the second analyzing the mechanical behavior through the RCS values. It has been found that the chemical stability analyzed by addition of lime, provided an average increase of RCS in most soil samples studied, because of some physical and chemical characteristics thereof. For mixtures with 6%, 8% and 16% of lime after 28 days of curing, the average RCS was 0,57 MPa, 1,06 MPa and 2,37 MPa, respectively, for the normal proctor, and as for intermediate proctor, in the same curing time and on the same percentages RCS results were 0,54 MPa, 1,04 MPa and 2,71 MPa, respectively. In global terms, the soil-lime mixtures studied showed acceptable behavior by law to use as layers of sub-base. However, only the mixture with 16% of lime, at 28 days, is recommended for use on floors bases. Even so, the mixtures studied constitute a good alternative economic and socio-environmental.