Health professionals ethical and legal liability on patient’s inadequate clarification in order to obtain free and informed consent

It is required that patients are provided information about therapeutic possibilities, showing the risks, benefits, prognosis and costs of each possible and indicated alternative. This is an ethical and legal resolution. However, health professionals possess the clinical/technical/scientific knowledge and determine what information will be (or not) provided. The patient in question decides to undergo a treatment, providing his/her free and informed consent on the basis of the data presented. Unfortunately, some professionals may not provide all the information necessary for making an informed decision or, after obtaining the consent of the patient, may provide him information that causes the patient to give up on the treatment initially accepted. Such information, if relevant, and not a supervening fact, should have been provided initially. However, the information may not be entirely true, and bring the patient, for instance, to decide based on inadequately presented risks. The craniofacial rehabilitation of the temporomandibular joint (TMJ) by means of TMJ prosthesis, is indicated in many situations. Often, patients in need of such prostheses have aesthetic and functional problems and the rehabilitation expectations run high. This work presents a case and discusses ethical and legal issues, including the liability of partial and inadequate information to a patient.

Dental development of children and adolescents with cleft lip and palate

Aim: To evaluate the dental development of Brazilian children and adolescents with cleft lip and palate. Methods: The sample consisted of 107 panoramic radiographs of children and adolescents with cleft lip and/or palate (cleft group) and 107 panoramic radiographs of children and adolescents without cleft lip and/or palate (control group), with chronological ages ranging from 6 to 15 years, matched in gender and chronological age within 60 days. Radiographs were digitized and masked and dental age was assessed using the method described by Demirjian et al. (1973). Three trained examiners conducted the assessments. Each examiner evaluated the radiographs three times. Data were statistically analyzed using non-parametric tests and univariate linear regression (p<0.05). Results: The dental age was overestimated in relation to the chronological age in both groups (p<0.0001). Compared to the control group, there was a delay in the dental age in the cleft group of 0.17 years (2.1 months). However, no statistically significant difference in the dental age between the cleft and the control group was found even when considering the different cleft types (p=0.152). Conclusions: There was no statistically significant difference in the dental age between the cleft and the control groups. The evaluation of dental development in individuals with cleft lip and palate should be approached in the same way as in individuals without clefts, with a focus on the individualization of diagnosis and treatment planning.

Structure, organization, and expression of the alpha prolamin multigenic family bring new insights into the evolutionary relationships among grasses

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Organization and behavior of the synaptonemal complex during achiasmatic meiosis of four buthid scorpions

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Estratégias de sustentabilidade na prática odontológica

Dentists have widely discussed environmental issues with a view to the implementation of sustainability strategies in dental practice. It is unacceptable the practice of dentistry today as merely the solution of dental problems. The Dentist has a social responsibility to incorporate into your daily work concrete actions to reduce the impact of its production process. The purpose of this study is to characterize the development and application of performanceoriented model of social responsibility in dental practice, built to preserve the environmental cause in dentistry in order to trace change scenario that allows the environmental management without compromising the quality of services offered.

Essays on Industrial Organization and Environmental Economics

This dissertation studies environmental regulation issues in the hog production industry as well as forces behind the reorganization of the industry during the past two decades. Federal and State-level environmental regulations imposed on U.S. hog production during the year 2003 are examined in Chapter 1. Based on the number of regulations passed by the Federal government and states, the 2003 regulatory index is constructed. The regulatory stringency index suggests that state-level regulations vary across states and have increased over the years. In addition, state-level regulations are more stringent than federal regulations. Chapter 2 develops an empirically implementable theoretical model which allows us to investigate the long-run effects of environmental regulations on the U.S. hog industry. Hog feeding operations (HFOs) are divided into large feeding operations (LHFOs) and small feeding operations (SHFOs). The impact of the presence of a large number of LHFOs on the entry and exit of CHFOs is also examined. Results of this study suggest that: Increased state-level regulation stringency significantly lowers the output of SHFOs; increased state-level regulation stringency significantly lowers the output of LHFOs; increased state-level regulation stringency significantly lowers the number of SHFOs; SHFO output rises significantly in states that have a greater number of LHFOs; LHFO output rises significantly in states that have a greater number of LHFOs; the number of SHFOs significantly increases in states that have a greater numbers of LHFOs; regulation increases the average SHFO size; and regulation decreases the average LHFO size. Chapter 3 examines the importance of input availability, market attractiveness, agglomeration economies and environmental regulations on the reorganization of U.S. hog production for a panel of 22 U.S. hog producing states which include, Northern states, Southern states and Midwest states for the period 1994-2006. Results from this study suggest that: Hog production in a state is positively affected by hog production in a nearby state, confirming the presence of agglomeration economies; Environmental regulations and high corn price have negative effects on state-level U.S. hog production; High hog prices, and favorable labor cost, and land values attract hog production; and transportation cost has no effect on hog production. Advisors: Azzeddine Azzam and Karina Schoengold

United Way and University partnerships in community-wide human services planning and plan implementation: The case of Lincoln/Lancaster County, Nebraska.

Given the similar interests of United Way organizations and universities in planning, implementation, and evaluation of human services, the two social institutions could be extensively and effectively partnering with one another. However, there is little documentation that such cooperative efforts are taking place. This article describes one such collaboration in Lincoln, Nebraska. The purpose of the article is to show the potential of such collaboration to improve community-wide coordination and outcomes by following the principles of a community-engagement model, to generate more effective use of evaluative tools that can assist in developing evidence-based practices in community planning, and to connect areas of study within the university to United Way efforts.

Implementing Human Papillomavirus Testing in a Public Health Hospital: Challenges and Opportunities

Objectives: Robust evidence now supports human papillomavirus (HPV) testing as a more effective option to screening and as more sensitive than cytology in detecting high-grade cervical intraepithelial neoplasia. Our goal was to analyze the performance of the Hybrid Capture II (HC2) assay for high-risk HPV (hrHPV) in women undergoing gynecological examination at a public health hospital as part of the evaluation of HPV screening as an alternative or complement to cytology. Study Design: This analysis is a subset of a cross-sectional study carried out at a large public hospital serving a predominantly low-resource population. A total of 705 women were enrolled; the sensitivity and specificity of each test were estimated and compared. Results: The analysis identified 272 hrHPV-positive women (mean age 36.3 years) and 433 hrHPV-negative women (mean age 41.2 years). HPV testing showed a significantly increased sensitivity of the HC2 assay versus cytology (84.5 vs. 69.7%; p < 0.0001) but a lower specificity (49.90 vs. 88.78%; p < 0.0001). Conclusion: The combination of both methods seems to be useful in improving detection of cervical lesions. Copyright (C) 2012 S. Karger AG, Basel

The red-billed curassow (Crax blumenbachii): social organization, and daily activity patterns

We studied the Red-billed Currasow (Cray blumenbachii) in Vale Natural Reserve, Linhares, Espirito Santo State, Brazil, using camera traps. We found the Red-billed Curassow present in the entire area of the reserve (similar to 22,000 ha) during 40 months of camera trapping (2005-2008). Most records were of single individuals, especially males, but pairs and even groups of individuals were also recorded. Males were paired with one and two females, suggesting polygyny in the species. The species was recorded throughout the day with one peak from 0500 to 0600 hrs and another after 1600 hrs. The daily activity pattern was similar for males and females. The number and widespread nature of the records suggests the local population of this species may be higher than previously thought. Received 10 March 2011. Accepted 5 December 2011.

Mapping the biosphere: exploring species to understand the origin, organization and sustainability of biodiversity

The time is ripe for a comprehensive mission to explore and document Earth's species. This calls for a campaign to educate and inspire the next generation of professional and citizen species explorers, investments in cyber-infrastructure and collections to meet the unique needs of the producers and consumers of taxonomic information, and the formation and coordination of a multi-institutional, international, transdisciplinary community of researchers, scholars and engineers with the shared objective of creating a comprehensive inventory of species and detailed map of the biosphere. We conclude that an ambitious goal to describe 10 million species in less than 50 years is attainable based on the strength of 250 years of progress, worldwide collections, existing experts, technological innovation and collaborative teamwork. Existing digitization projects are overcoming obstacles of the past, facilitating collaboration and mobilizing literature, data, images and specimens through cyber technologies. Charting the biosphere is enormously complex, yet necessary expertise can be found through partnerships with engineers, information scientists, sociologists, ecologists, climate scientists, conservation biologists, industrial project managers and taxon specialists, from agrostologists to zoophytologists. Benefits to society of the proposed mission would be profound, immediate and enduring, from detection of early responses of flora and fauna to climate change to opening access to evolutionary designs for solutions to countless practical problems. The impacts on the biodiversity, environmental and evolutionary sciences would be transformative, from ecosystem models calibrated in detail to comprehensive understanding of the origin and evolution of life over its 3.8 billion year history. The resultant cyber-enabled taxonomy, or cybertaxonomy, would open access to biodiversity data to developing nations, assure access to reliable data about species, and change how scientists and citizens alike access, use and think about biological diversity information.

Framing the difficulties resulting from implementing a Participatory Management Model in a public hospital

Objective: This study aims to address difficulties reported by the nursing team during the process of changing the management model in a public hospital in Brazil. Methods: This qualitative study used thematic content analysis as proposed by Bardin, and data were analyzed using the theoretical framework of Bolman and Deal. Results: The vertical implementation of Participatory Management contradicted its underlying philosophy and thereby negatively influenced employee acceptance of the change. The decentralized structure of the Participatory Management Model was implemented but shared decision-making was only partially utilized. Despite facilitation of the communication process within the unit, more significant difficulties arose from lack of communication inter-unit. Values and principals need to be shared by teams, however, that will happens only if managers restructure accountabilities changing job descriptions of all team members. Conclusion: Innovative management models that depart from the premise of decentralized decision-making and increased communication encourage accountability, increased motivation and satisfaction, and contribute to improving the quality of care. The contribution of the study is that it describes the complexity of implementing an innovative management model, examines dissent and intentionally acknowledges the difficulties faced by employees in the organization.

Family health team knowledge concerning the health needs of people with tuberculosis

The purposes of the study were to get to know conceptions on tuberculosis and health needs and to describe the care provided to people with tuberculosis, according to health professionals' perspective. Qualitative study developed at family health units in Capao Redondo, Sao Paulo. The data were collected through open interviews in January 2010 and submitted to discourse analysis, resulting in three categories: meanings attributed to tuberculosis and health needs and care characteristics. The conceptions regarding the disease are supported by the multi-causal theory of the health-disease process. The care is characterized by interventions that go beyond the biological dimension. The precarious living conditions define the needs of most people with tuberculosis, and can be more important to the ill than the very diagnosis of the disease, influencing treatment adherence, and should gain relevance in care.

Preditores da realização de consultas odontológicas de rotina e por problema em pré-escolares

OBJETIVO: Estimar a prevalência do uso de serviços odontológicos por pré- escolares e fatores associados. MÉTODOS: Estudo transversal com 1.129 crianças de cinco anos de idade da Coorte de Nascimentos de Pelotas 2004, RS, de setembro de 2009 a janeiro de 2010. Registrou-se o uso de serviço odontológico pelo menos uma vez na vida e o motivo para a primeira consulta odontológica da criança. As categorias do desfecho foram: ter feito a primeira consulta por rotina, para resolver um problema ou nunca ter ido ao dentista. Os exames bucais e as entrevistas foram realizados nos domicílios. Aspectos socioeconômicos e variáveis independentes ligadas à mãe e à criança foram analisados por meio de regressão logística multinomial. RESULTADOS: A prevalência de uso por qualquer motivo foi 37,0%. Os principais preditores para consulta de rotina foram nível econômico mais elevado, mãe com maior escolaridade e ter recebido orientação sobre prevenção. Principais preditores para consulta por problema foram ter sentido dor nos últimos seis meses, mãe com maior escolaridade e ter recebido orientação sobre prevenção. Cerca de 45,0% das mães receberam orientação de como prevenir cárie, principalmente fornecida por dentistas. Filhos de mães com história de maior aderência a programas de saúde tiveram maior probabilidade de ter feito uma consulta odontológica de rotina. CONCLUSÕES: A taxa de utilização dos serviços odontológicos por pré- escolares foi inferior às de consultas médicas (puericultura). Além da renda e da escolaridade, comportamentos maternos têm papel importante no uso por rotina. Relato de dor nos últimos seis meses e número elevado de dentes afetados por cárie, independentemente dos demais fatores, estiveram associados ao uso para resolver problema. É necessária a integração de ações de saúde bucal nos programas materno-infantis.

Kinetic parameters and monomeric conversion of different dental composites using standard and soft-start photoactivation modes

This paper evaluates the photopolymerization kinetics and degree of conversion of different commercial dental composites when photoactivated by a LED curing unit using two different modes (standard and soft-start mode). The investigation was performed on with RelyX ARC (dual-cured), Filtek Z-350 (Nanocomposite), Filtek Z-250 (Hybrid), and Filtek Z-350flow (Flowable) resin composites. The analysis used was attenuated total reflection with a Fourier transform infrared (ATR-FTIR). The RelyX ARC resin demonstrated the highest degree of conversion with both LED photoactivation modes. For this resin a 28% decrease in maximum rate was observed and the time to reach its highest rate was almost 2.3 times higher than when the soft-start photoactivation light curing was used. Z-350flow resin recorder a higher maximum rate using the soft-start mode rather than the standard mode. In contrast, the Z-250 showed a higher value using the standard mode. Although Z-250 and Z-350 showed a higher total degree of conversion effectiveness using the soft-start mode, RelyX and Z-350flow achieved a higher value using the standard mode.

Molecular organization and doping in poly(2-methoxyaniline)/Ni(dmit)(2) films obtained with the Langmuir-Blodgett technique

The control of the properties of materials at the molecular level is pursued for many applications, especially those associated with nanostructures. In this paper, we show that the coordination compound [Ni(dmit)(2)], where (dmit) is the 1,3-dithiole-2-thione-4,5-dithiolate ligand, can induce doping of poly(2-methoxyaniline) (POMA) in molecularly ordered Langmuir and Langmuir-Blodgett (LB) films. Doping was associated with interactions between the components and the compression of the Langmuir film at the air-water interface, according to polarization-modulated infrared reflection-absorption spectroscopy (PM-IRRAS) data. Taking these results together with in situ UV-Vis absorption measurements, we could identify the molecular groups involved in the interaction, including the way they were reoriented upon film compression. The Langmuir films were sufficiently stable to be transferred as Y-type LB films, while the hybrid POMA/[Ni(dmit)(2)] films remain doped in the solid state. As expected, the molecular charges affected the film morphology, as observed from combined atomic and electric force microscopy measurements. In summary, with adequate spectroscopy and microscopy tools we characterized molecular-level interactions, which may allow one to design molecular electronic devices with controlled electrical properties.