Failure of normal glycaemic regulation in a patient with severe hypothermia

This report describes the case of an 88-year-old non-diabetic female who presented to the emergency department following a presumed hypoijtycaemic collapse due to self-neglect. Subsequent rewarming and resuscitation demonstrated a number of the significant consequences of severe hypothermia, including apparent secondary impairment of glycaemic autoregulation. The phenomenon of reversible inhibition of insulin secretion due to severe hypothermia has been documented previously in the field of cardiac surgery. The hyperglycaemia was not treated with any antihyperglycaernic agent, and her recovery was uneventful. Subsequent blood sugar level monitoring was normal. If insulin is administered to the hypothermic patient, intensive monitoring of blood glucose is essential due to the increase in endogenous insulin secretion on rewarming. (c) 2005 Elsevier Ireland Ltd. All rights reserved.

Transport diffusion of gases is rapid in flexible carbon nanotu

Molecular dynamics simulations of rigid, defect-free single-walled carbon nanotubes have previously suggested that the transport diffusivity of gases adsorbed in these materials can be orders of magnitude higher than any other nanoporous material (A. I. Skoulidas et al., Phys. Rev. Lett. 2002, 89, 185901). These simulations must overestimate the molecular diffusion coefficients because they neglect energy exhange between the diffusing molecules and the nanotube. Recently, Jakobtorweihen et al. have reported careful simulations of molecular self-diffusion that allow nanotube flexibility (Phys. Rev. Lett. 2005, 95, 044501). We have used the efficient thermostat developed by Jakobtorweihen et al. to examine the influence of nanotube flexibility on the transport diffusion of CH4 in (20,0) and (15,0) nanotubes. The inclusion of nanotube flexibility reduces the transport diffusion relative to the rigid nanotube by roughly an order of magnitude close to zero pressure, but at pressures above about I bar the transport diffusivities for flexible and rigid nanotubes are very similar, differing by less than a factor or two on average. Hence, the transport diffusivities are still extremely large compared to other known materials when flexibility is taken into account.

Predictors of failure by medical practitioners to report suspected child abuse in Queensland, Australia

Objective: The goal of this investigation was to examine the level of notification of child abuse and neglect and the perceived deterrents to reporting by medical practitioners, who a're mandated to report their suspicions but might choose not to do so. Design: A random sample of medical practitioners was surveyed. About three hundred medical practitioners were approached through the local Division of General Practice. 91 registered medical practitioners in Queensland, Australia, took part in the study. Results: A quarter of medical practitioners admitted failing to report suspicions, though they were mostly cognisant of their responsibility to report suspected cases of abuse and neglect. Only the belief that the suspected abuse was a single incident and unlikely to happen again predicted non-reporting (X2 [1, N =89] =7.60, p

Workplace diversity: The moderating role of work context on the relationship between surface and deep level diversity and group functioning

This research examines the relationship between perceived group diversity and group conflict, and the moderating role of team context. Currentiy, diversity research predominantly focuses on surface and job-related dimensions, largely to the neglect of deep-level diversity (in terms of values, attitude and beliefs). First, this research hjfpothesised that all three dimensions of diversity would be positively related to group conflict, with deep-level diversity the strongest predictor of task. conflict. Second, it was hypothesised that team context would moderate the relationship between deep-level diversity and group conflict. Team context refers to the extent to which the work performed (1) has high consequences (in terms of health and well being for team members and others); (2) is relatively isolating, (3) requires a high reliance upon team members; (4) is volatile; and (5) interpersonal attraction and mutual helpfulness is essential. Two studies were conducted. The first study employed 44 part-time employees across a range of occupations, and the second study employed 66 full-time employees from a mining company in Australia. A series of hierarchical multiple regressions and moderated multiple regressions confirmed both hypotheses. Practical implications and future research directions are discussed.

Are Sri Lankan entrepreneurs motivated by the need for achievement?

The entrepreneurship models in existence in Sri Lanka are often based on the assumptions of n-Ach and personality trait theory. In this paper we describe empirical research into entrepreneurial motivations in Sri Lanka that addresses the neglect of socio-cultural factors. Our findings suggest that entrepreneurial motivation in Sri Lanka is rooted not in a need for individual achievement, but in the conscious or unconscious need to satisfy a sense of social intimacy. The emphasis on social power, social relations and collectivism create a setting for entrepreneurial motivation in Sri Lanka that drives almost directly counter to western ideologies of entrepreneurial motivation (from paper).

Asma, abitudini e stile di vita "Analisi retrospettiva di un campione di pazienti asmatici seguito in ambulatorio di terzo livello"

Growing evidence suggest the importance of different environments in promoting the pathogenesis and/or exacerbation of asthma. Indoor air pollution is a major contributor to human exposure, since people spend up to 90% of their day indoors. Apart from active smoking, indoor pollution is considered one of the major preventable risk factors of chronic respiratory diseases. The professional activity can also be dangerous because it exposes the subject to environments that can promote the onset of asthma or worsening of the latter in those already affected. Even bad habits such as incorrect diet, lead to more difficulty in controlling their disease. However asthma is a multifactorial disease in nature so it is not easy to distinguish the role of occupational exposure, pollution and normal habits such as smoking, nutrition, sports, etc. This retrospective study was conducted on a sample of asthma patients residing in the metropolitan area of Parma. 116 patients were selected among those who are followed up at least two years at the Asthma outpatient Clinic of Parma University Hospital. The sample in question is therefore closely controlled and monitored; it comes to patients who are well educated on the control of their disease, are able to take appropriate measures to minimize the symptomatology. With this tight approach is proposed to minimize the effect of confounding and then traced with greater certainty the possible cause of the failure to control the disease. For this purpose, each patient was subjected to regular checkups; we took as a reference the period of time between April and October 2015. During each visit, in addition to general data for each patient, we were collected personal information about their habits and way of life through a validated questionnaire delivered and completed by the patient during the visit in the presence of the permanent staff. The questionnaire covers mainly the qualification of the patient, its possible occupational exposure, his home, with information about nearby traffic, time spent outside, physical activity (place and time), exposure to chemicals, exposure to various fumes (fireplace or stove) and cigarette smoke, comorbidities and any drugs taken during the visits considered. Regarding the respiratory conditions of patients during every examination we were considered: Asthma Control Test (a test performed by patients to assess the state of the disease during the month preceding the test), the measurement of exhaled nitric oxide (FeNO) as an index of airways inflammation, measuring the resistance level of small airways (R5-R20) and some spirometric values observed in experiment; in particular the forced vital capacity (FVC), forced expiratory volume in the first second (FEV 1), FEV1/FVC ratio, forced expiratory flow rate over the middle 50% of the FVC (FEF25–75) and FEF25-75/FVC were recorded. The sample has been studied considering both the changes of the respiratory parameters for every patient in their examinations, and the respiratory parameters of all the examinations took as a whole in relation with the variables considered. From the results obtained, the patients are clinically stable; their adopted lifestyle and the exposure to possible sources of outdoor pollution, seems not affect the overall control of their disease. Some findings of our study are of interest. First, the subjects who carry a steroid therapy show a clinical worst, as revealed by the decrease of most spirometric indices, particularly FEF25, FEF75, FEF25-75 and R5-R20; also, the presence of comorbidities and the subsequent intake of other drugs, in addition to normal therapy for asthma, seem to be conditions associated with poorer performance in the functional respiratory parameters in particular FEV1/FVC, FEF75 and FEF25-75. Spirometric indexes that are down are mainly those related to obstruction imposed on small airways; this suggests a neglect to the latter on the contrary should be further explored and treated accordingly. It is also observed that both patients are overweight than those living on the lower floors and/or who have the most windows exposed to traffic, showed a decrease of pulmonary function, especially those relate to an obstruction at the small airways level. In conclusion, our results provided the evidence that a most appropriate therapy, specific to reach the small airways, associated with a healthy lifestyle, can help improve the management of asthma.

O REINO DE CRISTO E O REINO DO ANTICRISTO NO POEMA O GRANDE INQUISIDOR , DE DOSTOIÉVSKI

Em O Grande Inquisidor , Dostoiévski apresenta uma crítica ao materialismo, ao poder e à autoridade como constrangimento. Nesta obra, não se pode ignorar o alerta deixado por ele a qualquer tipo de regime que em nome da justiça e da felicidade humana suprime a liberdade e oculta o sofrimento de modo a transformar os seres humanos em objetos manipuláveis. Para Dostoiévski, influenciado pela mística ortodoxa oriental, a liberdade é a marca de Deus no ser humano. A negação da liberdade, como é proposta no reino do anticristo inquisidor, implica num distanciamento com o divino que levará ao niilismo. Neste sentido, o caminho proposto por Dostoiévski é o enfrentamento e a aceitação desta liberdade trágica, que só é vivida plenamente em Cristo e na prática do amor.

O COORDENADOR PEDAGÓGICO E A FORMAÇÃO CONTINUADA DOS PROFISSIONAIS DE CRECHE: POSSIBILIDADES E DESAFIOS

O Plano Nacional de Educação (PNE) determina que 50% das crianças de 0 a 3 anos tenham vagas garantidas em Creches Públicas e a Lei do Piso n. 11.738/08 apresenta, em seu parágrafo quarto, que na composição da jornada de trabalho do professor observar-se-á um terço destinado à formação. A determinação destas mudanças aumenta a preocupação e responsabilidade em qualificar a formação continuada nestas instituições, as quais ainda sentem o peso dos vários anos de negligência. Pela atualidade e importância temática, a presente abordagem investiga a trajetória formativa e profissional de educadores de Creche, com o objetivo de possibilitar a reflexão e a análise sobre as estratégias utilizadas na formação continuada, bem como um debate dialético entre as práticas e as teorias trazidas nos estudos e pesquisas. Através da metodologia da Pesquisa de Campo de Natureza Qualitativa, buscou-se, ao contatar profissionais de cinco creches do município de São Bernardo do Campo, investigar a seguinte questão: De que forma o Coordenador Pedagógico que atua em creche tem contribuído, ou não, com a formação de profissionais reflexivos, pesquisadores e autores da própria prática? No intuito de responder a questão, foram realizadas entrevistas com cinco Coordenadoras Pedagógicas (CPs), três Professoras e dois Auxiliares em Educação e, em vista de maiores subsídios necessários ao debate, também foram entrevistadas uma Coordenadora de um curso de Pedagogia, com a finalidade de ampliar os conhecimentos sobre o curso de Pedagogia na atualidade, e uma Gestora (Chefe de Região) de São Bernardo do Campo, a fim de entender o olhar que o município tem hoje para a Creche. É importante ressaltar que o foco das entrevistas foi o trabalho desenvolvido pelo CP e que o trabalho investigativo junto aos demais profissionais envolvidos auxiliam na busca e obtenção de respostas para os questionamentos que levaram à construção deste trabalho. Os referenciais teóricos, desenvolvidos através da metodologia da Pesquisa de Natureza Bibliográfica e Documental para a revisão da literatura disponível sobre o tema, estão ancorados em Almeida e Placco (2002; 2010; 2011) que observam o papel do CP sob diversos aspectos; Day (1999) que discute os desafios fundamentais a serem considerados na formação; Fullan e Hargreaves (2002) que apresentam questionamentos sobre as estratégias formativas; Nóvoa (2009) ao investigar sobre a formação permanente dos professores; Perrenoud e Thurler (2002) que destacam novos paradigmas na formação dos professores; Vasconcellos (2009) que observa as articulações necessárias ao trabalho do CP; Campos et al (2011) que mostram a qualidade da Educação Infantil no país, entre outros. A análise dos conteúdos das entrevistas realizadas indica que a formação continuada avança gradativamente e, este mérito é dado, em grande parte, à formação que os gestores vêm recebendo e às parcerias produtivas que se estabelecem no processo, porém, os estudos e pesquisas teóricas apontam que muito ainda precisa ser feito e sinalizam mudanças imprescindíveis e que sejam capazes de impulsionar a formação a sair do tradicionalismo, tornando-se mais voltada à reflexão e humanização.

ESTRUTURA E DINÂMICA DO FUNCIONAMENTO PSÍQUICO DE HOMENS ENVOLVIDOS EM VIOLÊNCIA DOMÉSTICA

A violência, de qualquer tipo e natureza, é um fenômeno que acontece desde os primórdios. A Organização Mundial de Saúde define violência como o uso intencional da força física ou do poder, real ou por ameaça, contra a própria pessoa, contra outra pessoa, contra um grupo ou uma comunidade, que pode resultar em morte, lesão, dano psicológico, problemas de desenvolvimento ou privação. A violência doméstica é definida pela APA como qualquer ação que causa dano físico a um ou mais membros de sua unidade familiar e pode ocorrer a partir de um conflito de gerações e de gênero, configurando-se por agressão física, abuso sexual, abuso psicológico, negligência, dentro da família, perpetradas por um agressor em condições de superioridade (física, etária, social, psíquica e/ou hierárquica). Esta pesquisa tem como objetivo investigar a Estrutura e dinâmica do Funcionamento Psíquico de Homens Envolvidos em Violência Doméstica. Utilizou-se o método clínico-qualitativo, com quatro homens em situação de violência doméstica. Como forma de coleta de dados foi empregada uma entrevista e o Teste das Relações Objetais (TRO) de Phillipson. Ao analisar os resultados, pode-se observar que o ego fragilizado teme a solidão, as situações de perda, e os ataques destrutivos do id e o superego permissivo não os contêm, e para suportar os ataques persecutórios dos objetos, e em função da persecutoriedade e da culpa persecutória o ego recorre a identificação projetiva maciça e a idealização para proteger-se da destrutividade, permanecendo na posição esquizoparanóide. Conclui-se que a análise da estrutura e da dinâmica psíquica e o tratamento psicológico (individual ou em grupo) de homens envolvidos em violência doméstica, em conjunto com outras medidas judiciais e sociais são ações necessárias, pois, pode ser uma forma de ajudá-los a enfrentar suas limitações, lidar com suas angústias, entender e controlar os impulsos, rever e compreender suas crenças e trabalhar sua autoestima. Partindo-se do pressuposto que a violência doméstica ocorre na relação entre homem-mulher, o tratamento e o entendimento dos aspectos psicológicos de homens envolvidos em violência doméstica são de extrema importância para minimizar este fenômeno, e deve ser aliado às ações, já existentes dirigidas às mulheres.

Phakometric measurement of ocular surface radii of curvature, axial separations and alignment in relaxed and accommodated human eyes

Measurements (autokeratometry, A-scan ultrasonography and video ophthalmophakometry) of ocular surface radii, axial separations and alignment were made in the horizontal meridian of nine emmetropes (aged 20-38 years) with relaxed (cycloplegia) and active accommodation (mean ± 95% confidence interval: 3.7 ± 1.1 D). The anterior chamber depth (-1.5 ± 0.3 D) and both crystalline lens surfaces (front 3.1 ± 0.8 D; rear 2.1 ± 0.6 D) contributed to dioptric vergence changes that accompany accommodation. Accommodation did not alter ocular surface alignment. Ocular misalignment in relaxed eyes is mainly because of eye rotation (5.7 ± 1.6° temporally) with small amounts of lens tilt (0.2 ± 0.8° temporally) and decentration (0.1 ± 0.1 mm nasally) but these results must be viewed with caution as we did not account for corneal asymmetry. Comparison of calculated and empirically derived coefficients (upon which ocular surface alignment calculations depend) revealed that negligible inherent errors arose from neglect of ocular surface asphericity, lens gradient refractive index properties, surface astigmatism, effects of pupil size and centration, assumed eye rotation axis position and use of linear equations for analysing Purkinje image shifts. © 2004 The College of Optometrists.

The Once and future pioneers? : the role of voluntary organizations in innovation in the personal social services

This thesis explores the innovative capacity of voluntary organizations in the field of the personal social services. It commences with a full literature review, which concludes that the wealth of research upon innovation in the organization studies field has not addressed this topic, whilst the specialist literatures upon voluntary organizations and upon the personal social services have neglected the study of innovation. The research contained in this thesis is intended to right this neglect and to integrate lessons from both fields. It combines a survey of the innovative activity of voluntary organizations in three localities with cross-sectional case studies of innovative, developmental and traditional organizations. The research concludes that innovation is an important, but not integral, characteristic of voluntary organizations. It develops a contingent model of this innovative capacity of voluntary organizations, which stresses the role of external environmental and institutional forces in shaping and releasing this capacity. It concludes by considering the contribution of this model both to organization studies and to the study of voluntary organizations.

Analysing organisational culture : a critical ethnography of public relations and personnel specialists in a state bureaucracy

Following an introductory chapter, I examine (i) typologies which have differentiated the literature on organisational culture and symbolism (Chapter 2), (ii) the contribution of organisation theory to organisation culture (Chapter 3), and (iii) recent literature on organisational culture and symbolism (Chapter 4). Within these chapters, I adopt Habermas' (1972) notion of knowledge-constitutive interests, assessing the contrubutions to understanding organisational culture made by literature guided by technical, practical and emancipatory cognitive interests. In doing so, I suggest that more critical studies on organisational culture and symbolism have been comparatively neglected. Lamenting this neglect, I suggest that Giddens' theory of structuration can be employed to advance the development of a critical, emancipatory conceptualisation of organisational culture. In particular, I argue that this Giddensian analysis, by penetrating the existential, poltical and material processes of cultural reproduction (Chapter 5), is able to disclose some of the more contradictory features of organisation culture. The remainder of the thesis comprises of a critical ethnography of the work cultures of public relations and personnel specialists located in a state bureaucracy. I begin the ethnography with a dicussion of my research methods (Chapter 6) and an overview of the departments studied (Chapter 7): I then examine (i) the work cultures of the specialists (Chapter 8), (ii) the specialists' management of the relationships with the hosts bureaucracy (Chapter 9); and, (iii) opportunities the specialists had for developing an emancipatory praxis (Chapter 10). Finally, in a concluding section, I offer some critical reflections on the contributions of the thesis and suggest areas for future research.

Design and synthesis of potential antimicrobial agents

Tuberculosis is one of the most devastating diseases in the world primarily due to several decades of neglect and an emergence of multidrug-resitance strains (MDR) of M. tuberculosis together with the increased incidence of disseminated infections produced by other mycobacterium in AIDS patients. This has prompted the search for new antimycobacterial drugs. A series of pyridine-2-, pyridine-3-, pyridine-4-, pyrazine and quinoline-2-carboxamidrazone derivatives and new classes of carboxamidrazone were prepared in an automated fashion and by traditional synthesis. Over nine hundred synthesized compounds were screened for their anti mycobacterial activity against M. fortutium (NGTG 10394) as a surrogate for M. tuberculosis. The new classes of amidrazones were also screened against tuberculosis H37 Rv and antimicrobial activities against various bacteria. Fifteen tested compounds were found to provide 90-100% inhibition of mycobacterium growth of M. tuberculosis H37 Rv in the primary screen at 6.25 μg mL-1. The most active compound in the carboxamidrazone amide series had an MIG value of 0.1-2 μg mL-1 against M. fortutium. The enzyme dihydrofolate reductase (DHFR) has been a drug-design target for decades. Blocking of the enzymatic activity of DHFR is a key element in the treatment of many diseases, including cancer, bacterial and protozoal infection. The x-ray structure of DHFR from M. tuberculosis and human DHFR were found to have differences in substrate binding site. The presence of glycerol molecule in the Xray structure from M. tuberculosis DHFR provided opportunity to design new antifolates. The new antifolates described herein were designed to retain the pharmcophore of pyrimethamine (2,4- diamino-5(4-chlorophenyl)-6-ethylpyrimidine), but encompassing a range of polar groups that might interact with the M. tuberculosis DHFR glycerol binding pockets. Finally, the research described in this thesis contributes to the preparation of molecularly imprinted polymers for the recognition of 2,4-diaminopyrimidine for the binding the target. The formation of hydrogen bonding between the model functional monomer 5-(4-tert-butyl-benzylidene)-pyrimidine-2,4,6-trione and 2,4-diaminopyrimidine in the pre-polymerisation stage was verified by 1H-NMR studies. Having proven that 2,4-diaminopyrimidine interacts strongly with the model 5-(4-tert-butylbenzylidene)- pyrimidine-2,4,6-trione, 2,4-diaminopyrimidine-imprinted polymers were prepared using a novel cyclobarbital derived functional monomer, acrylic acid 4-(2,4,6-trioxo-tetrahydro-pyrimidin-5- ylidenemethyl)phenyl ester, capable of multiple hydrogen bond formation with the 2,4- diaminopyrimidine. The recognition property of the respective polymers toward the template and other test compounds was evaluated by fluorescence. The results demonstrate that the polymers showed dose dependent enhancement of fluorescence emissions. In addition, the results also indicate that synthesized MIPs have higher 2,4-diaminopyrimidine binding ability as compared with corresponding non-imprinting polymers.

Measurement of productivity and cost of the direct labour organisation within highways maintenance departments

The objective of this thesis is to investigate, through an empirical study, the different functions of the highways maintenance departments and to suggest methods by means of which road maintenance work could be carried out in a more efficient way by utilising its resources of men, material and plant to the utmost advantage. This is particularly important under the present circumstances of national financial difficulties which have resulted in continuous cuts in public expenditure. In order to achieve this objective, the researcher carried out a survey among several Highways Authorities by means of questionnaire and interview. The information so collected was analysed in order to understand the actual, practical situation within highways manintenance departments, and highlight any existing problems, and try to answer the question of how they could become more efficient. According to the results obtained by the questionnaire and the interview, and the analysis of these results, the researcher concludes that it is the management system where least has been done, and where problems exist and are most complex. The management of highways maintenance departments argue that the reasons for their problems include both financial and organisational difficulties, apart from the political aspect and nature of the activities undertaken. The researcher believes that this ought to necessitate improving the management's analytical tools and techniques in order to achieve the most effective way of performing each activity. To this end the researcher recommends several related procedures to be adopted by the management of the highways maintenance departments. These recommendations, arising from the study, involve the technical, practical and human aspects. These are essential factors of which management should be aware - and certainly should not neglect - in order to achieve its objectives of improved productivity in the highways maintenance departments.

Product design in the context of the social needs in less industrialised economies

This thesis is related to the subject of technical innovation, specifically to the activity of design in microenterprises operating in less industrialised economies. Design here is understood as a process, which is not the sole domain of formally trained categories such as engineers, architects or industrial designers. The 'professional boundary' discussion in this investigation is perceived as secondary as, in this context, products are designed, copied or adapted by workers, entrepreneurs themselves, or directly by the poor community. Design capacity at this level is considered to be important both in relation to the conception of capital and consumer goods and to the building up of technical knowledge. Although professional design emerged in Latin America little over three decades ago, this activity has remained marginalised throughout industry. Design activity tends to be concentrated in some product categories in the formalised industrial sector. For microenterprises operating informally, industrial design appears to be unknown. The existing literature pays little attention to 'informal design' capacity. Other areas of knowledge, such as development economies, recognise the importance of microenterprises and technological capability but neglect the potential role of industrial design in small manufacturing units. The management literature, though it focuses on technical innovation and design, has also paid little attention to 'informal design'. In less industrialised economies this neglect is felt by the lack of programmes specifically tailored to create or stimulate 'informal design'. There is a need for recognition of 'informal design' capacity and for the implementation of programmes which specifically target design as a central activity in the manufacturing firm, independent of their size and technological capability. Addressing 'design by the poor for the poor', requires a down-to-earth approach.