Distúrbio de hiperatividade e déficit de atenção na síndrome de apnéia obstrutuiva do sono: Há melhora com tratamento cirúrgico?

Neuropsychological disorders are frequently associated with obstructive ventilatory disorders (OVD). Aim: To analyze the incidence of neuropsychological disorders in Brazilian children with OVD, using a screening questionnaire and to compare the answers given before and after surgery. Patients and Methods: We studied 30 children with clinical diagnosis of OVD. The children were divided into 3 groups: group I, children aged 4 to 7; group II, from 8 to 10; and group III, children over 11. The applied questionnaires were answered by the parents or tutors, and comprised 30 questions, 10 for each disorder: attention deficit, hyperactivity and impulsivity. The children were diagnosed with one of the disorders when presented 3 or more positive answers. The follow up interview occurred 6 months after adenotonsillectomy. Results: There was a predominance of male gender (60.6%) over female gender (39.4%). Group II presented the highest number of significant changes, with reductions raging from 87.5% to 33.3% of patients with attention deficit, 75% to 50% of the hyperactive patients, and 50% to 33% of the impulsive patients. Conclusion: There was neuropsychological improvement after the surgery, which occurred mainly in the children from group II. More interaction among health professionals is necessary when diagnosing and following up similar cases.

Ossificação da sutura palatina mediana após o procedimento de expansão rápida da maxila: Estudo radiográfico

Objective: the current study aims at following up radiographically the evolution of the midpalatal suture during the expansion procedure since the opening of the suture until bone formation. Methods: the sample comprised 38 patients in the mixed dentition stage submitted to the rapid palatal expansion protocol of the Hospital for Rehabilitation of Craniofacial Anomalies. Results: it was observed an individual variation on the period of bone ossification of the midpalatal suture, which justifies the radiographic follow-up as determinant for the appliance removal. Due to long-term post-treatment stability, the expander should be removed after the new suture is completely formed. Conclusions: the findings show that it is necessary more than three months for the complete reorganization of the midpalatal suture during the passive phase of the rapid palatal expansion.

Input for the preparation of a regional agenda for the programme of action of the International Conference on Population and Development: towards 2014 and beyond

Spanish version available at the Library

The millennium development goals: strategic implications for the Latin American and Caribbean statistical systems

Includes bibliography

A educação não-formal como campo de estágio: contribuições na formação inicial do arte/educador

Pós-graduação em Artes - IA

Population, social equity and changing production patterns

Includes bibliography

Interferências do lançamento de efluente da ETE Salgado Filho na qualidade de água do córrego Anhanduí na cidade de Campo Grande (MS)

Pós-graduação em Engenharia Civil - FEIS

Identificação, caracterização e avaliação da patogenicidade de diferentes isolados de fusarium spp. para o controle de thaumastocoris peregrinus (hemiptera: thaumastocoridae)

Pós-graduação em Agronomia (Proteção de Plantas) - FCA

Struktur-Dynamik-Beziehungen in amorphen festen Lösungen

Feste Lösungen homogen dispergierter Wirkstoffmoleküle in amorphen Polymermatrizen sind wichtige Materialien in vielen pharmazeutischen Anwendungen, bei denen eine kontrollierte Abgabe wasserunlöslicher Wirkstoffe in wässrige Systeme eine Rolle spielt. Die intermolekulare Bindungs-stärke zwischen Polymer- und Wirkstoffmolekülgruppen bestimmt die Stabilität der festen Lösung und steuert somit die biologische Aktivität der Wirkstoffmoleküle. In festen Lösungen, die aus acryl-säurehaltigen Copolymeren (Protonendonoren) und basischen Wirkstoffmolekülen (Protonenakzepto-ren) hergestellt werden, sind intermolekulare Wasserstoffbrücken zwischen den Systemkomponenten Triebkraft für die Bildung einer stabilen homogenen Dispersion und für die Entstehung struktureller Merkmale zwischen den Molekülgruppen der Systemkomponenten. Zudem ist die Bindungsstärke der Wasserstoffbrücken im Hinblick auf die kontrollierte Abgabe der Wirkstoffe von Bedeutung. Da dynamische chemische Gleichgewichte bei der Bildung der Wasserstoffbrücken eine wichtige Rolle spielen müssen neben strukturellen Parametern auch dynamische Faktoren beleuchtet werden. Ziel dieser Arbeit ist neben der Ermittlung von intermolekularen Bindungsstärken vor allem die Identifika-tion struktureller Verhältnisse zwischen den Systemkomponenten auf molekularer Ebene. Die Be-stimmung der Abhängigkeit dieser Parameter von der Struktur der verwendeten Polymere und einer Vielzahl weiterer Einflüsse wie z.B. Feuchtigkeit, Lagerdauer oder Wirkstoffkonzentration soll ein kontrolliertes Design fester Lösungen mit definierten anwendungsspezifischen Eigenschaften ermögli-chen. Temperaturabhängige 1H-Festkörper-MAS-NMR (Magic Angle Spinning Nuclear Magnetic Resonance) Experimente an festen Lösungen mit unterschiedlichen Copolymer-Zusammensetzungen weisen die Existenz dynamischer chemischer Gleichgewichte in den komplexen Wasserstoffbrücken-netzwerken nach. Veränderungen in der chemischen Verschiebung und in der Linienform der Reso-nanzlinien acider Protonen erlauben einen tiefen Einblick in die Architektur dieser Netzwerke und legen die Bindungsverhältnisse unter Berücksichtigung der Polymerchemie und der Mobilität der Systemkomponenten dar, wobei die Befunde mithilfe quantenchemischer Rechnungen untermauert werden können. Die Gegenwart acider Protonen ermöglicht einen einfachen 1H-2H-Austausch, wor-aufhin mithilfe rotorsynchronisierter temperaturabhängiger 2H-MAS-NMR Experimente die Wasser-stoffbrückenbindungsstärke bestimmt werden kann. Mit 1H-1H-Korrelationsexperimenten (Doppelquantenspektroskopie) stehen Methoden für die Bestimmung homonuklearer dipolarer 1H-1H-Kopplungen zur Verfügung, die strukturelle Aussagen aufgrund von bevorzugten räumlichen Kontak-ten bestimmter Molekülgruppen ermöglichen. Weiterhin können diese Experimente verwendet werden, um Wasserstoffbrücken zwischen Polymergruppen von Polymer-Wirkstoff-Wasserstoffbrücken zu unterscheiden, wodurch eine quantitative Beschreibung des Bindungsnetzwerks und der Konkurrenz-prozesse zwischen den einzelnen wasserstoffverbrückten Spezies ermöglicht wird. Eine Kristallisation der Wirkstoffmoleküle ist in vielen Anwendungen unerwünscht, da sie die biologische Verfügbarkeit des Wirkstoffs reduzieren. Mit 1H-Festkörper-MAS-NMR Experimenten können kristalline von amorph dispergierten Wirkstoffmolekülen unterschieden werden, wodurch eine Quantifizierung der Destabilisierungsprozesse ermöglicht wird, die durch Exposition der festen Lösungen mit Wasserdampf ausgelöst werden können. Die Zeit- und Konzentrationsabhängigkeit der Wasseraufnahme kann mit NMR-Experimenten verfolgt werden, wobei unterschiedlich mobile Was-serspezies an unterschiedlichen Bindungsorten identifiziert werden können, was zum molekularen Verständnis der Destabilisierungsprozesse beiträgt. Zusätzlich wird die Mobilität der Wirkstoffmole-küle bestimmt, die sich – wie auch die Wirkstoffkonzentration - als wichtige Größe in der Beschrei-bung der Destabilisierung erweist. Aufbauend auf den Beobachtungen wird ein Zusammenhang zwischen der Copolymerzusammensetzung und einer kritischen Wirkstoffkonzentration hergestellt, der für die Anwendungen amorpher fester Lösungen in biologischen Systemen von großer Bedeutung ist.

Immune pathomechanism of drug hypersensitivity reactions

Drug hypersensitivity research has progressed enormously in recent years, and a greater understanding of mechanisms has contributed to improved drug safety. Progress has been made in genetics, enabling personalized medicine for certain drugs, and in understanding drug interactions with the immune system. In a recent meeting in Rome, the clinical, chemical, pharmacologic, immunologic, and genetic aspects of drug hypersensitivity were discussed, and certain aspects are briefly summarized here. Small chemicals, including drugs, can induce immune reactions by binding as a hapten to a carrier protein. Park (Liverpool, England) demonstrated (1) that drug haptens bind to protein in patients in a highly restricted manner and (2) that irreversibly modified carrier proteins are able to stimulate CD4(+) and CD8(+) T cells from hypersensitive patients. Drug haptens might also stimulate cells of the innate immune system, in particular dendritic cells, and thus give rise to a complex and complete immune reaction. Many drugs do not have hapten-like characteristics but might gain them on metabolism (so-called prohaptens). The group of Naisbitt found that the stimulation of dendritic cells and T cells can occur as a consequence of the transformation of a prohapten to a hapten in antigen-presenting cells and as such explain the immune-stimulatory capacity of prohaptens. The striking association between HLA-B alleles and the development of certain drug reactions was discussed in detail. Mallal (Perth, Australia) elegantly described a highly restricted HLA-B∗5701-specific T-cell response in abacavir-hypersensitive patients and healthy volunteers expressing HLA-B∗5701 but not closely related alleles. Expression of HLA-B∗1502 is a marker known to be necessary but not sufficient to predict carbamazepine-induced Stevens-Johnson syndrome/toxic epidermal necrolysis in Han Chinese. The group of Chen and Hong (Taiwan) described the possible "missing link" because they showed that the presence of certain T-cell receptor (TCR) clonotypes was necessary to elicit T-cell responses to carbamazepine. The role of TCRs in drug binding was also emphasized by Pichler (Bern, Switzerland). Following up on their "pharmacological interactions of drugs with immune receptors" concept (p-i concept), namely that drugs can bind directly to TCRs, MHC molecules, or both and thereby stimulate T cells, they looked for drug-binding sites for the drug sulfamethoxazole in drug-specific TCRs: modeling revealed up to 7 binding sites on the CDR3 and CDR2 regions of TCR Vα and Vβ. Among many other presentations, the important role of regulatory T cells in drug hypersensitivity was addressed.

Measurement of strain and strain rate by echocardiography - Ready for prime time?

Strain and strain rate (SR) are measures of deformation that are basic descriptors of both the nature and the function of cardiac tissue. These properties may now be measured using either Doppler or two-dimensional ultrasound techniques. Although these measurements are feasible in routine clinical echocardiography, their acquisition and analysis nonetheless presents a number of technical challenges and complexities. Echocardiographic strain and SR imaging has been applied to the assessment of resting ventricular function, the assessment of myocardial viability using low-dose dobutamine infusion, and stress testing for ischemia. Resting function assessment has been applied in both the left and the fight ventricles, and may prove particularly valuable for identifying myocardial diseases and following up the treatment response. Although the evidence base is limited, SR imaging seems to be feasible and effective for the assessment of myocardial viability. The use of the technique for the detection of ischemia during stress echocardiography is technically challenging and likely to evolve further. The clinical availability of strain and SR measurement may offer a solution to the ongoing need for quantification of regional and global cardiac function. Nonetheless, these techniques are susceptible to artifact, and further technical development is necessary.

UMA JUVENTUDE ORGANIZADA E NÃO-PARTICIPATIVA: UM ESTUDO DE CASO SOBRE UMA GESTÃO JOVEM EM SÃO BERNARDO DO CAMPO

Esta pesquisa estuda a existência e atuação de uma organização da sociedade civil em São Bernardo do Campo (SBC). A partir da utilização de ferramentas da participação cidadã, em especial a que constitui o Orçamento Participativo, ela analisa se e como esta organização se relaciona com os munícipes e com as esferas do poder executivo na busca por uma proposta de governo que atenda aos anseios daqueles a que representa, além das próprias aspirações. O estudo busca, através de um relato histórico, contextualizar o município pelos aspectos econômicos, políticos e sociais. A partir de levantamentos bibliográficos e acompanhamento, por meio de entrevistas, realizou-se um estudo de caso em uma entidade social não governamental que tem especial olhar sobre o jovem cidadão são-bernardense, a fim de verificar como esta entidade é planejada e gerida para atender às aspirações sociais destes. Espera-se, ao final, entender como uma organização da sociedade civil, em consonância com o que pretende para si mesma, reflete seus objetivos nas propostas e plenárias de Orçamento Participativo de SBC, realizadas em 2010 para o ano 2011.(AU)

The pharmacist's contribution towards monitoring and reporting adverse drug reactions

The activities and function of the West Midlands Adverse Drug Reaction Study Group are described. The impact of the Group on the reporting of adverse drug reactions to the CSM by the yellow card system has been evaluated in several ways including a comparison with the Trent Region. The role of the pharmacist in the Group is highlighted. A nationwide survey of the hospital pharmacist's involvement in adverse drug reaction reporting and monitoring is described, the results are reported and discussed. The available sources of information on adverse drug reactions, both primary and secondary, are critically reviewed. A checklist of necessary details for case reports is developed and examples of problems in the literature are given. The contribution of the drug information pharmacist in answering enquiries and encouraging reporting is examined. A role for the ward pharmacist in identifying, reporting, documenting and following up adverse drug reactions is proposed. Studies conducted to support this role are described and the results discussed. The ward pharmacist's role in preventing adverse drug reactions is also outlined. The reporting of adverse drug reactions in Australia is contrasted with the U.K. and particular attention is drawn to the pharmacist's contribution in the former. The problems in evaluating drug safety are discussed and examples are given where serious reactions have only been recognised after many patients have been exposed. To remedy this situation a case is made for enhancing the CSM yellow card scheme by further devolution of reporting, increasing the involvement of pharmacists and improving arrangements at the CSM. It is proposed that pharmacists should undertake the responsibility for reporting reactions to the CSM in some instances.

Developing A Catering Sales Program

A successful catering sales program consists of developing and properly following up on three types of accounts: present, past, and new. Ray Hooks reveals a systematic approach to increasing business in catering sales.

Professional Practice in Learning and Development: How to Design and Deliver Plans for the Workplace

Introduction The world is changing! It is volatile, uncertain, complex and ambiguous. As cliché as it may sound the evidence of such dynamism in the external environment is growing. Business-as-usual is more of the exception than the norm. Organizational change is the rule; be it to accommodate and adapt to change, or instigate and lead change. A constantly changing environment is a situation that all organizations have to live with. What makes some organizations however, able to thrive better than others? Many scholars and practitioners believe that this is due to the ability to learn. Therefore, this book on developing Learning and Development (L&D) professionals is timely as it explores and discusses trends and practices that impact organizations, the workforce and L&D professionals. Being able to learn and develop effectively is the cornerstone of motivation as it helps to address people’s need to be competent and to be autonomous (Deci & Ryan, 2002; Loon & Casimir, 2008; Ryan & Deci, 2000). L&D stimulates and empowers people to perform. Organizations that are better at learning at all levels; the individual, group and organizational level, will always have a better chance of surviving and performing. Given the new reality of a dynamic external environment and constant change, L&D professionals now play an even more important role in their organizations than ever before. However, L&D professionals themselves are not immune to the turbulent changes as their practices are also impacted. Therefore, the challenges that L&D professionals face are two-pronged. Firstly, in relation to helping and supporting their organization and its workforce in adapting to the change, whilst, secondly developing themselves effectively and efficiently so that they are able to be one-step ahead of the workforce that they are meant to help develop. These challenges are recognised by the CIPD, as they recently launched their new L&D qualification that has served as an inspiration for this book. L&D plays a crucial role at both strategic (e.g. organizational capability) and operational (e.g. delivery of training) levels. L&D professionals have moved from being reactive (e.g. following up action after performance appraisals) to being more proactive (e.g. shaping capability). L&D is increasingly viewed as a driver for organizational performance. The CIPD (2014) suggest that L&D is increasingly expected to not only take more responsibility but also accountability for building both individual and organizational knowledge and capability, and to nurture an organizational culture that prizes learning and development. This book is for L&D professionals. Nonetheless, it is also suited for those studying Human Resource Development HRD at intermediate level. The term ‘Human Resource Development’ (HRD) is more common in academia, and is largely synonymous with L&D (Stewart & Sambrook, 2012) Stewart (1998) defined HRD as ‘the practice of HRD is constituted by the deliberate, purposive and active interventions in the natural learning process. Such interventions can take many forms, most capable of categorising as education or training or development’ (p. 9). In fact, many parts of this book (e.g. Chapters 5 and 7) are appropriate for anyone who is involved in training and development. This may include a variety of individuals within the L&D community, such as line managers, professional trainers, training solutions vendors, instructional designers, external consultants and mentors (Mayo, 2004). The CIPD (2014) goes further as they argue that the role of L&D is broad and plays a significant role in Organizational Development (OD) and Talent Management (TM), as well as in Human Resource Management (HRM) in general. OD, TM, HRM and L&D are symbiotic in enabling the ‘people management function’ to provide organizations with the capabilities that they need.