Manifestações orais em crianças em tratamento oncológico

Projeto de Pós-Graduação/Dissertação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Medicina Dentária

Anglo-Irish relations in the framework of the EEC and Northern Ireland, 1969-1975

This thesis will analyse Anglo-Irish relations between 1969 and 1975, when two topics dominated the relationship: Northern Ireland and the entry of Britain and Ireland into the European Economic Community (hereafter EEC). In 1969 entry to the EEC was still only a possibility and awaited political developments, while the Northern Ireland problem had yet to escalate. 1975 on the other hand confirmed that Ireland would remain in the EEC even if Britain left while Direct Rule for Northern Ireland was confirmed as the British policy for the foreseeable future. These dates are significant because they encompass firstly pre and post entry to the EEC and how this transformed Anglo-Irish relations. Secondly they contain the commencement and then deterioration of the Northern Ireland problem and the attempts to resolve it that finally led to direct rule by Westminster. The study will examine the fluctuating nature of the relationship between Britain and Ireland. Special regard will be devoted to the demands of internal British politics and how such demands affected the relationship. Overall, the study will demonstrate how the bilateral relationship evolved under the pressure of events in Northern Ireland and adapted to the multilateral context of the EEC. It will compare the dynamics of the states’ interactions in two extremely different areas. The thesis will demonstrate how entry to the EEC transformed the unequal Anglo-Irish economic relationship and created one of partners within the EEC. It will also analyse how the developing Northern Ireland problem caused changes to British policy. In particular, it will examine how the British Government came to recognise the beneficial role that the Republic of Ireland might play in resolving the Troubles in Northern Ireland.

Renal failure and the neural control of the kidney

Renal failure (RF) is associated with an over activation of the sympathetic nervous system. The aim of this thesis was to investigate the hypothesis that as the kidney progresses into RF there is an inappropriate and sustained activation of renal afferent nerves which results in a dysregulation of basal RSNA and reflexly controlled RSNA by the high and low pressure baroreceptors. Baroreflex gain curves for both RSNA and HR were generated in control and RF rats. This study clearly showed a blunted high-pressure baroreflex in RF rats, an impairment which was almost completely corrected by bilateral renal denervation. The integrity of the low-pressure cardiopulmonary receptors to inhibit RSNA was investigated using acute saline volume. Again, a blunted reflex sympatho-inhibition of RSNA was observed, which was corrected by renal denervation. Finally a functional study to examine how the renal excretory response to volume expansion differed in RF was carried out. This study revealed an impairment of the low-pressure baroreflex control of the sympathetic outflow. The result of these studies suggest that cisplatin induced RF initiates a neural signal from within the kidney, which over rides the normal reflex regulation of RSNA by the high and low – pressure baroreceptors and that this impairment in function can be normalised by renal denervation. This raises further questions as to the mechanisms involved in the afferent over activation arising from the diseased kidneys.

Algorithms for indoor localization based on IEEE 802.15.4-2011 UWB and inertial sensors

In this thesis, extensive experiments are firstly conducted to characterize the performance of using the emerging IEEE 802.15.4-2011 ultra wideband (UWB) for indoor localization, and the results demonstrate the accuracy and precision of using time of arrival measurements for ranging applications. A multipath propagation controlling technique is synthesized which considers the relationship between transmit power, transmission range and signal-to-noise ratio. The methodology includes a novel bilateral transmitter output power control algorithm which is demonstrated to be able to stabilize the multipath channel, and enable sub 5cm instant ranging accuracy in line of sight conditions. A fully-coupled architecture is proposed for the localization system using a combination of IEEE 802.15.4-2011 UWB and inertial sensors. This architecture not only implements the position estimation of the object by fusing the UWB and inertial measurements, but enables the nodes in the localization network to mutually share positional and other useful information via the UWB channel. The hybrid system has been demonstrated to be capable of simultaneous local-positioning and remote-tracking of the mobile object. Three fusion algorithms for relative position estimation are proposed, including internal navigation system (INS), INS with UWB ranging correction, and orientation plus ranging. Experimental results show that the INS with UWB correction algorithm achieves an average position accuracy of 0.1883m, and gets 83% and 62% improvements on the accuracy of the INS (1.0994m) and the existing extended Kalman filter tracking algorithm (0.5m), respectively.

Development of hemispheric specialization for lexical pitch-accent in Japanese infants.

Infants' speech perception abilities change through the first year of life, from broad sensitivity to a wide range of speech contrasts to becoming more finely attuned to their native language. What remains unclear, however, is how this perceptual change relates to brain responses to native language contrasts in terms of the functional specialization of the left and right hemispheres. Here, to elucidate the developmental changes in functional lateralization accompanying this perceptual change, we conducted two experiments on Japanese infants using Japanese lexical pitch-accent, which changes word meanings with the pitch pattern within words. In the first behavioral experiment, using visual habituation, we confirmed that infants at both 4 and 10 months have sensitivities to the lexical pitch-accent pattern change embedded in disyllabic words. In the second experiment, near-infrared spectroscopy was used to measure cortical hemodynamic responses in the left and right hemispheres to the same lexical pitch-accent pattern changes and their pure tone counterparts. We found that brain responses to the pitch change within words differed between 4- and 10-month-old infants in terms of functional lateralization: Left hemisphere dominance for the perception of the pitch change embedded in words was seen only in the 10-month-olds. These results suggest that the perceptual change in Japanese lexical pitch-accent may be related to a shift in functional lateralization from bilateral to left hemisphere dominance.

The incidence of unacceptable movement with motor evoked potentials during craniotomy for aneurysm clipping.

OBJECTIVE: To review the experience at a single institution with motor evoked potential (MEP) monitoring during intracranial aneurysm surgery to determine the incidence of unacceptable movement. METHODS: Neurophysiology event logs and anesthetic records from 220 craniotomies for aneurysm clipping were reviewed for unacceptable patient movement or reason for cessation of MEPs. Muscle relaxants were not given after intubation. Transcranial MEPs were recorded from bilateral abductor hallucis and abductor pollicis muscles. MEP stimulus intensity was increased up to 500 V until evoked potential responses were detectable. RESULTS: Out of 220 patients, 7 (3.2%) exhibited unacceptable movement with MEP stimulation-2 had nociception-induced movement and 5 had excessive field movement. In all but one case, MEP monitoring could be resumed, yielding a 99.5% monitoring rate. CONCLUSIONS: With the anesthetic and monitoring regimen, the authors were able to record MEPs of the upper and lower extremities in all patients and found only 3.2% demonstrated unacceptable movement. With a suitable anesthetic technique, MEP monitoring in the upper and lower extremities appears to be feasible in most patients and should not be withheld because of concern for movement during neurovascular surgery.

Interleukin-15 receptor blockade in non-human primate kidney transplantation.

BACKGROUND: Interleukin (IL)-15 is a chemotactic factor to T cells. It induces proliferation and promotes survival of activated T cells. IL-15 receptor blockade in mouse cardiac and islet allotransplant models has led to long-term engraftment and a regulatory T-cell environment. This study investigated the efficacy of IL-15 receptor blockade using Mut-IL-15/Fc in an outbred non-human primate model of renal allotransplantation. METHODS: Male cynomolgus macaque donor-recipient pairs were selected based on ABO typing, major histocompatibility complex class I typing, and carboxy-fluorescein diacetate succinimidyl ester-based mixed lymphocyte responses. Once animals were assigned to one of six treatment groups, they underwent renal transplantation and bilateral native nephrectomy. Serum creatinine level was monitored twice weekly and as indicated, and protocol biopsies were performed. Rejection was defined as a increase in serum creatinine to 1.5 mg/dL or higher and was confirmed histologically. Complete blood counts and flow cytometric analyses were performed periodically posttransplant; pharmacokinetic parameters of Mut-IL-15/Fc were assessed. RESULTS: Compared with control animals, Mut-IL-15/Fc-treated animals did not demonstrate increased graft survival despite adequate serum levels of Mut-IL-15/Fc. Flow cytometric analysis of white blood cell subgroups demonstrated a decrease in CD8 T-cell and natural killer cell numbers, although this did not reach statistical significance. Interestingly, two animals receiving Mut-IL-15/Fc developed infectious complications, but no infection was seen in control animals. Renal pathology varied widely. CONCLUSIONS: Peritransplant IL-15 receptor blockade does not prolong allograft survival in non-human primate renal transplantation; however, it reduces the number of CD8 T cells and natural killer cells in the peripheral blood.

Activation in mesolimbic and visuospatial neural circuits elicited by smoking cues: evidence from functional magnetic resonance imaging.

OBJECTIVE: The authors sought to increase understanding of the brain mechanisms involved in cigarette addiction by identifying neural substrates modulated by visual smoking cues in nicotine-deprived smokers. METHOD: Event-related functional magnetic resonance imaging (fMRI) was used to detect brain activation after exposure to smoking-related images in a group of nicotine-deprived smokers and a nonsmoking comparison group. Subjects viewed a pseudo-random sequence of smoking images, neutral nonsmoking images, and rare targets (photographs of animals). Subjects pressed a button whenever a rare target appeared. RESULTS: In smokers, the fMRI signal was greater after exposure to smoking-related images than after exposure to neutral images in mesolimbic dopamine reward circuits known to be activated by addictive drugs (right posterior amygdala, posterior hippocampus, ventral tegmental area, and medial thalamus) as well as in areas related to visuospatial attention (bilateral prefrontal and parietal cortex and right fusiform gyrus). In nonsmokers, no significant differences in fMRI signal following exposure to smoking-related and neutral images were detected. In most regions studied, both subject groups showed greater activation following presentation of rare target images than after exposure to neutral images. CONCLUSIONS: In nicotine-deprived smokers, both reward and attention circuits were activated by exposure to smoking-related images. Smoking cues are processed like rare targets in that they activate attentional regions. These cues are also processed like addictive drugs in that they activate mesolimbic reward regions.

Cross-hemispheric collaboration and segregation associated with task difficulty as revealed by structural and functional connectivity.

Although it is known that brain regions in one hemisphere may interact very closely with their corresponding contralateral regions (collaboration) or operate relatively independent of them (segregation), the specific brain regions (where) and conditions (how) associated with collaboration or segregation are largely unknown. We investigated these issues using a split field-matching task in which participants matched the meaning of words or the visual features of faces presented to the same (unilateral) or to different (bilateral) visual fields. Matching difficulty was manipulated by varying the semantic similarity of words or the visual similarity of faces. We assessed the white matter using the fractional anisotropy (FA) measure provided by diffusion tensor imaging (DTI) and cross-hemispheric communication in terms of fMRI-based connectivity between homotopic pairs of cortical regions. For both perceptual and semantic matching, bilateral trials became faster than unilateral trials as difficulty increased (bilateral processing advantage, BPA). The study yielded three novel findings. First, whereas FA in anterior corpus callosum (genu) correlated with word-matching BPA, FA in posterior corpus callosum (splenium-occipital) correlated with face-matching BPA. Second, as matching difficulty intensified, cross-hemispheric functional connectivity (CFC) increased in domain-general frontopolar cortex (for both word and face matching) but decreased in domain-specific ventral temporal lobe regions (temporal pole for word matching and fusiform gyrus for face matching). Last, a mediation analysis linking DTI and fMRI data showed that CFC mediated the effect of callosal FA on BPA. These findings clarify the mechanisms by which the hemispheres interact to perform complex cognitive tasks.

Preoperative predictors of extended hospital length of stay following total knee arthroplasty.

The purpose of this study was to identify the preoperative predictors of hospital length of stay after primary total knee arthroplasty in a patient population reflecting current trends toward shorter hospitalization and using readily obtainable factors that do not require scoring systems. A single-center, multi-surgeon retrospective chart review of two hundred and sixty consecutive patients who underwent primary total knee arthroplasty was performed. The mean length of stay was 3.0 days. Among the different variables studied, increasing comorbidities, lack of adequate assistance at home, and bilateral surgery were the only multivariable significant predictors of longer length of stay. The study was adequately powered for statistical analyses and the concordance index of the multivariable logistic regression model was 0.815.

What the brain stem tells the frontal cortex. II. Role of the SC-MD-FEF pathway in corollary discharge.

One way we keep track of our movements is by monitoring corollary discharges or internal copies of movement commands. This study tested a hypothesis that the pathway from superior colliculus (SC) to mediodorsal thalamus (MD) to frontal eye field (FEF) carries a corollary discharge about saccades made into the contralateral visual field. We inactivated the MD relay node with muscimol in monkeys and measured corollary discharge deficits using a double-step task: two sequential saccades were made to the locations of briefly flashed targets. To make second saccades correctly, monkeys had to internally monitor their first saccades; therefore deficits in the corollary discharge representation of first saccades should disrupt second saccades. We found, first, that monkeys seemed to misjudge the amplitudes of their first saccades; this was revealed by systematic shifts in second saccade end points. Thus corollary discharge accuracy was impaired. Second, monkeys were less able to detect trial-by-trial variations in their first saccades; this was revealed by reduced compensatory changes in second saccade angles. Thus corollary discharge precision also was impaired. Both deficits occurred only when first saccades went into the contralateral visual field. Single-saccade generation was unaffected. Additional deficits occurred in reaction time and overall performance, but these were bilateral. We conclude that the SC-MD-FEF pathway conveys a corollary discharge used for coordinating sequential saccades and possibly for stabilizing vision across saccades. This pathway is the first elucidated in what may be a multilevel chain of corollary discharge circuits extending from the extraocular motoneurons up into cerebral cortex.

Fuerzas impulsoras de una organización colectiva exitosa : el caso de los pequeños productores de banano orgánico para exportación en Perú

En Perú muchos de los pequeños productores de banano se han organizado en asociaciones y su producción tradicional de banano convencional está siendo reemplazada por la producción de banano orgánico. Una de estas asociaciones es la de pequeños productores de banano orgánico de Samán y Anexos (APPBOSA) que a partir del año 2008 viene exportando su producción sin intermediarios e incrementando las cantidades exportadas cada año. Esta ocupa el primer puesto en el ranking de exportación de banano orgánico de Perú. Teniendo en cuenta que todas las asociaciones operan bajo el mismo ambiente institucional formal, surge como pregunta de investigación cuáles han sido las fuerzas impulsoras de APPBOSA sobre las que se ha apalancado el éxito de esta asociación. El objetivo de este trabajo fue estudiar la relación entre el crecimiento de las exportaciones de banano orgánico de APPBOSA y los factores de los ambientes organizacional, tecnológico y comercial para identificar aquellos de mayor relevancia sobre crecimiento exportador de la asociación. La metodología de trabajo utilizada fue el estudio de caso simple incrustado, utilizando como tipo de investigación la epistemología fenomenológica y combinando la investigación cualitativa con la cuantitativa (mediante encuestas). Se encuestaron 100 socios (24 por ciento) de la organización en base a un muestreo aleatorio simple. Los resultados se procesaron a partir del software PC-ORD con herramientas de análisis multivariado: Análisis de Componentes Principales (ACP) y el Análisis de Cluster. Del análisis de las variables del ambiente organizacional surge que la transacción entre el productor asociado y APPBOSA está alineada, existe dependencia bilateral y bajos costos de transacción. Los productores presentaron un reconocimiento positivo en torno a la variable del liderazgo y conformidad en el precio y plazo de pago. En el ambiente tecnológico los asociados manifestaron un alto impacto de la tecnología implementada por APPBOSA, que les permitió posicionarse por encima de la media tecnológica del subsistema de banano orgánico de Perú. En el ambiente comercial, se caracterizó por dos estrategias: la diferenciación y la segmentación (mercado de orgánico y comercio justo). Se encontró alta conformidad de los asociados en torno a las decisiones comerciales tomadas por la asociación. A partir del ACP se retuvieron los dos primeros autovalores (F1: liderazgo y F2: estrategias comerciales) por acumular el 62,38 por ciento del total de la varianza. Los indicadores de conformidad de precio y plazo de pago guardaron una alta correlación positiva con las estrategias comerciales y con la innovación tecnológica. Se concluye que las fuerzas impulsoras sobre las que se apalancó el éxito exportador de APPBOSA tienen su base en la dependencia bilateral entre productores y Asociación, donde con un objetivo común, innovaron y definieron estrategias comerciales acordes a un negocio de especialidad y bajo un liderazgo marcado. De este modo, fue posible que pequeños productores alcancen mediante la acción colectiva, a ubicar su producto en el mercado externo.

Fuerzas impulsoras de una organización colectiva exitosa : el caso de los pequeños productores de banano orgánico para exportación en Perú

En Perú muchos de los pequeños productores de banano se han organizado en asociaciones y su producción tradicional de banano convencional está siendo reemplazada por la producción de banano orgánico. Una de estas asociaciones es la de pequeños productores de banano orgánico de Samán y Anexos (APPBOSA) que a partir del año 2008 viene exportando su producción sin intermediarios e incrementando las cantidades exportadas cada año. Esta ocupa el primer puesto en el ranking de exportación de banano orgánico de Perú. Teniendo en cuenta que todas las asociaciones operan bajo el mismo ambiente institucional formal, surge como pregunta de investigación cuáles han sido las fuerzas impulsoras de APPBOSA sobre las que se ha apalancado el éxito de esta asociación. El objetivo de este trabajo fue estudiar la relación entre el crecimiento de las exportaciones de banano orgánico de APPBOSA y los factores de los ambientes organizacional, tecnológico y comercial para identificar aquellos de mayor relevancia sobre crecimiento exportador de la asociación. La metodología de trabajo utilizada fue el estudio de caso simple incrustado, utilizando como tipo de investigación la epistemología fenomenológica y combinando la investigación cualitativa con la cuantitativa (mediante encuestas). Se encuestaron 100 socios (24 por ciento) de la organización en base a un muestreo aleatorio simple. Los resultados se procesaron a partir del software PC-ORD con herramientas de análisis multivariado: Análisis de Componentes Principales (ACP) y el Análisis de Cluster. Del análisis de las variables del ambiente organizacional surge que la transacción entre el productor asociado y APPBOSA está alineada, existe dependencia bilateral y bajos costos de transacción. Los productores presentaron un reconocimiento positivo en torno a la variable del liderazgo y conformidad en el precio y plazo de pago. En el ambiente tecnológico los asociados manifestaron un alto impacto de la tecnología implementada por APPBOSA, que les permitió posicionarse por encima de la media tecnológica del subsistema de banano orgánico de Perú. En el ambiente comercial, se caracterizó por dos estrategias: la diferenciación y la segmentación (mercado de orgánico y comercio justo). Se encontró alta conformidad de los asociados en torno a las decisiones comerciales tomadas por la asociación. A partir del ACP se retuvieron los dos primeros autovalores (F1: liderazgo y F2: estrategias comerciales) por acumular el 62,38 por ciento del total de la varianza. Los indicadores de conformidad de precio y plazo de pago guardaron una alta correlación positiva con las estrategias comerciales y con la innovación tecnológica. Se concluye que las fuerzas impulsoras sobre las que se apalancó el éxito exportador de APPBOSA tienen su base en la dependencia bilateral entre productores y Asociación, donde con un objetivo común, innovaron y definieron estrategias comerciales acordes a un negocio de especialidad y bajo un liderazgo marcado. De este modo, fue posible que pequeños productores alcancen mediante la acción colectiva, a ubicar su producto en el mercado externo.

Birth-death processes with disaster and instantaneous resurrection

A new structure with the special property that instantaneous resurrection and mass disaster are imposed on an ordinary birth-death process is considered. Under the condition that the underlying birth-death process is exit or bilateral, we are able to give easily checked existence criteria for such Markov processes. A very simple uniqueness criterion is also established. All honest processes are explicitly constructed. Ergodicity properties for these processes are investigated. Surprisingly, it can be proved that all the honest processes are not only recurrent but also ergodic without imposing any extra conditions. Equilibrium distributions are then established. Symmetry and reversibility of such processes are also investigated. Several examples are provided to illustrate our results.