Cuidados paliativos para pacientes em estado terminal em Unidades de Terapia Intensiva: revisão sistemática e metanálise

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Working Experience and Librarians' Knowledge of Information and Communication Technologies (ICTs) in Nigerian University Libraries

This paper discuses the influence of librarians' years of working experience and sources of acquisition of ICTs' knowledge and skills. The study is based on 169 librarians working in thirteen university libraries in the universities of six states located in the South-South zone of Nigeria. The purpose of the paper is to find out if years of working experience has an effect on librarians' sources/means of acquisition of ICT knowledge and skills. The questionnaires used were answered by two categories of librarians. Those with longer years of experience – 16 years and above and those with fewer years of working experience. It was concluded that librarians with fewer years of working experience explore means of acquiring ICTs knowledge and skills more than librarians with more years of working experience. It was recommended that librarians with longer years of working experience develop more interest in sources through which they can acquire ICT knowledge and skills.

Longitudinal reference ranges for fetal ultrasound biometry in twin pregnancies

OBJECTIVE: The purpose of this study was to establish longitudinal reference ranges for fetal ultrasound biometry measurements and growth parameters in twin pregnancies. METHOD: A total of 200 uncomplicated twin pregnancies before 21 weeks of gestation were recruited for this prospective, longitudinal study. Women who abandoned follow-up, pregnancies with unknown outcomes or pregnancies with complications were excluded. Ultrasound scans were performed every three weeks, and biparietal and occipitofrontal diameters, head and abdominal circumferences, and femur diaphysis length measurements were obtained for each fetus at each visit. Estimated fetal weight, biparietal/occipitofrontal diameter, head circumference/abdominal circumference, and femur diaphysis length/abdominal circumference ratios were also calculated. Multilevel regression analysis was performed on normalized data. RESULTS: A total of 807 ultrasound examinations were performed in 125 twin pregnancies between 14 and 38 weeks of gestation (6.5 +/- 1.4 scans/pregnancy). Regression analysis demonstrated significant correlations for all variables with gestational age, namely log of the biparietal diameter (r = 0.98), log of the occipitofrontal diameter (r = 0.98), log of the head circumference (r = 0.99), log of the abdominal circumference (r = 0.98), square root of the femur length (r = 0.99), log of the estimated fetal weight (r = 0.99), biparietal/occipitofrontal ratio (r = -0.11), head/abdomen circumference ratio (r = -0.56), and log of the femur length/abdominal circumference ratio (r = 0.61). Values corresponding to the 10th, 50th, and 90th percentiles for estimated fetal weight at 28, 32, and 36 weeks, respectively, were as follows: 937, 1,096, 1,284 g; 1,462, 1,720, 2,025 g; and 2,020, 2,399, 2,849 g. CONCLUSION: In twin pregnancies, fetal ultrasound biometry measurements and growth parameters show a significant correlation with gestational age.

Acellular dermal matrix graft with or without enamel matrix derivative for root coverage in smokers: a randomized clinical study

Aim: The aim of this randomized controlled clinical study was to compare the use of an acellular dermal matrix graft (ADMG) with or without the enamel matrix derivative (EMD) in smokers to evaluate which procedure would provide better root coverage. Material and Methods: Nineteen smokers with bilateral Miller Class I or II gingival recessions >= 3 mm were selected. The test group was treated with an association of ADMG and EMD, and the control group with ADMG alone. Probing depth, relative clinical attachment level, gingival recession height, gingival recession width, keratinized tissue width and keratinized tissue thickness were evaluated before the surgeries and after 6 months. Wilcoxon test was used for the statistical analysis at significance level of 5%. Results: No significant differences were found between groups in all parameters at baseline. The mean gain recession height between baseline and 6 months and the complete root coverage favored the test group (p = 0.042, p = 0.019 respectively). Conclusion: Smoking may negatively affect the results achieved through periodontal plastic procedures; however, the association of ADMG and EMD is beneficial in the root coverage of gingival recessions in smokers, 6 months after the surgery.

Workplace drug testing, different matrices different objectives

Drug testing is used by employers to detect drug use by employees or job candidates. It can identify recent use of alcohol, prescription drugs, and illicit drugs as a screening tool for potential health and safety and performance issues. Urine is the most commonly used sample for illicit drugs. It detects the use of a drug within the last few days and as such is evidence of recent use; but a positive test does not necessarily mean that the individual was impaired at the time of the test. Abstention from use for three days will often produce a negative test result. Analysis of hair provides a much longer window of detection, typically 1 to 3 months. Hence the likelihood of a falsely negative test using hair is very much less than with a urine test. Conversely, a negative hair test is a substantially stronger indicator of a non-drug user than a negative urine test. Oral fluid (saliva) is also easy to collect. Drugs remain in oral fluid for a similar time as in blood. The method is a good way of detecting current use and is more likely to reflect current impairment. It offers promise as a test in post-accident, for cause, and on-duty situations. Studies have shown that within the same industrial settings, hair testing can detect twice as many drug users as urine testing. Copyright (C) 2012 John Wiley & Sons, Ltd.

Fostering Children and Adolescents in Situations of Abandonment, Violence and Separation

Childhood protection is undergoing several changes. Our study aimed to outline the complex network of meanings which includes adoption as well as institutional and family foster care, by combining theory, research and practice. We investigated various contexts and protagonists: judicial system, foster institutions, birth parents, foster and adoptive parents, and families and their children. Diverse data collection procedures were used: socio-demographic investigations, case-studies, follow-ups, interviews, analysis of foster institutions and legal court documents. Results pointed to "invisibility" of birth family, frequent child (re)abuse, failures in the network of protection, meanings of "healthy family" and role of attachment concepts. Implications for social policies and social practices are discussed.

Efficient plasmonic coupling between Er3+:(Ag/Au) in tellurite glasses

We report a systematic study of the localized surface plasmon resonance effects on the photoluminescence of Er3+-doped tellurite glasses containing Silver or Gold nanoparticles. The Silver and Gold nanoparticles are obtained by means of reduction of Ag ions (Ag+ -> Ag-0) or Au ions (Au3+ -> Au-0) during the melting process followed by the formation of nanoparticles by heat treatment of the glasses. Absorption and photoluminescence spectra reveal particular features of the interaction between the metallic nanoparticles and Er3+ ions. The photoluminescence enhancement observed is due to dipole coupling of Silver nanoparticles with the I-4(13/2) -> I-4(15/2) Er3+ transition and Gold nanoparticles with the H-2(11/2)-> I-4(13/2) (805 nm) and S-4(3/2) -> I-4(13/2) (840 nm) Er3+ transitions. Such process is achieved via an efficient coupling yielding an energy transfer from the nanoparticles to the Er3+ ions, which is confirmed from the theoretical spectra calculated through the decay rate. Crown Copyright (C) 2011 Published by Elsevier B.V. All rights reserved.

Implant-Supported Prosthesis Misalignment Related to the Dental Arch: A 14-Year Clinical Follow-up

The purpose of this study was to warn the dental community about a possible problem in function with partial implant-supported prostheses used for long periods. The misalignment between natural teeth and the implant-supported prosthesis on teeth 11 and 12, observed in a 14-year clinical follow-up, illustrates the fact. The metal-ceramic crowns were placed in 1995 after a rigorous occlusal adjustment. Evaluations were made at 4, 6, 9, and 14 years, when it was noticed that the restorations were positioned palatally and extruded in comparison with the natural teeth. After 9 years, a greater discrepancy was noticed, with anterior occlusion and esthetic changes. The possible causes have been discussed: occlusal problems, parafunctional habits, and natural movement. The first 2 options were discarded after clinical analysis and diagnosis. Therefore, the natural movement probably deriving from an interaction of mechanical and genetic factors might have been the cause. The implants do not have periodontal ligaments but rather ankylosis, so they do not suffer those movements. This case emphasizes the need to inform patients that implants can last more than 10 years in function, but this is not the case with restorations, which lose function and esthetics and must be replaced.

Neurogenic neuroprotection: Future perspectives

Neurogenic neuroprotection elicited by deep brain stimulation is emerging as a promising approach for treating patients with ischemic brain lesions. In rats, stimulation of the fastigial nucleus, but not dentate nucleus, has been shown to reduce the volume of focal infarction. Protection of neural tissue is a rapid intervention that has a relatively long-lasting effect, rendering fastigial nucleus stimulation (FNS) a potentially valuable method for clinical application. We review some of the main findings of animal experimental research from a clinical perspective. Results: Although the complete mechanisms of neuroprotection induced by FNS remain unclear, important data has been presented in the last two decades. The acute effect of electrical stimulation of the fastigial nucleus is likely mediated by a prolonged opening of potassium channels, and the sustained effect appears to be linked to inhibition of the apoptotic cascade. A better understanding of the cellular and molecular mechanisms underlying neurogenic neuroprotection by stimulation of deep brain nuclei, with special attention to the fastigial nucleus, can contribute toward improving neurological outcomes in ischemic brain insults.

VEGETATIVE PROPAGATION OF ANGICO-VERMELHO Anadenanthera macrocarpa (Benth) Brenan) HALF-SIBS BY MINI-CUTTINGS

The objective of this work is to evaluate the efficiency of the mini-cuttings technique in the vegetative propagation of half-sibs of angico-vermelho (Anadenanthera macrocarpa(Benth) Brenan) regarding to the productive capacity and survival of mini-stumps, rooting of the apical and intermediate mini-cuttings treated with different doses of IBA (0, 2000, 4000 and 6000 mg L-1) as well as to determine the speed of rooting in the greenhouse. The mini-stumps were obtained from seedlings of the six progenies of Anadenanthera macrocarpa half-sibs. The mini-stumps presented productivity from 1,2 to 3,7 mini-cuttings/mini-stump/collection and survival of 84% to 98% after six harvests. The apical mini-cuttings were higher than the intermediate, more prone to root, but the IBA had no significant effect on the rooting of the progenies. The results of the rooting speed showed variation among the progenies.

Endogenous nitric oxide formation correlates negatively with circulating matrix metalloproteinase (MMP)-2 and MMP-9 levels in black subjects

Deficient formation of endogenous nitric oxide (NO) contributes to cardiovascular diseases, and this may be associated with increased circulating levels of matrix metalloproteinase-9 (MMP-9), as previously shown in white subjects. Because interethnic differences exist with respect to risk factors, prevalence, and severity of cardiovascular diseases, we designed this study to examine whether the circulating levels of nitrites (a marker of endogenous NO formation) are associated with the plasma levels of MMP-9 and MMP-2 in healthy black subjects. We studied 198 healthy subjects self-reported as blacks not taking any medications. Venous blood samples were collected and plasma and whole blood nitrite levels were measured using an ozone-based chemiluminescence assay. Plasma MMP-2 and MMP-9 levels were determined by gelatin zymography. We found a positive correlation between plasma MMP-9 and MMP-2 levels (P < 0.0001, rs = 0.556). Interestingly, we found a negative relationship between the plasma MMP-9 levels and the plasma or whole blood nitrites levels (P = 0.04, rs = -0.149; and P < 0.0001, rs = -0.349, respectively). In parallel, we found similar negative relationships between plasma MMP-2 levels and plasma or whole blood nitrites levels (P = 0.02, rs = -0.172; and P < 0.0001, rs = -0.454, respectively). This is the first study to show that endogenous nitric oxide formation correlates negatively with the circulating levels of both MMP-2 and MMP-9 in black subjects. Our findings suggest a mechanistic link between deficient NO formation and increased MMPs levels, which may promote cardiovascular diseases.

Relating network rigidity, time scale hierarchies, and expression noise in gene networks

Fluctuation-dissipation theorems can be used to predict characteristics of noise from characteristics of the macroscopic response of a system. In the case of gene networks, feedback control determines the "network rigidity," defined as resistance to slow external changes. We propose an effective Fokker-Planck equation that relates gene expression noise to topology and to time scales of the gene network. We distinguish between two situations referred to as normal and inverted time hierarchies. The noise can be buffered by network feedback in the first situation, whereas it can be topology independent in the latter.

Root niche separation can explain avoidance of seasonal drought stress and vulnerability of overstory trees to extended drought in a mature Amazonian forest

Large areas of Amazonian evergreen forest experience seasonal droughts extending for three or more months, yet show maximum rates of photosynthesis and evapotranspiration during dry intervals. This apparent resilience is belied by disproportionate mortality of the large trees in manipulations that reduce wet season rainfall, occurring after 2-3 years of treatment. The goal of this study is to characterize the mechanisms that produce these contrasting ecosystem responses. A mechanistic model is developed based on the ecohydrological framework of TIN (Triangulated Irregular Network)-based Real Time Integrated Basin Simulator + Vegetation Generator for Interactive Evolution (tRIBS+VEGGIE). The model is used to test the roles of deep roots and soil capillary flux to provide water to the forest during the dry season. Also examined is the importance of "root niche separation," in which roots of overstory trees extend to depth, where during the dry season they use water stored from wet season precipitation, while roots of understory trees are concentrated in shallow layers that access dry season precipitation directly. Observational data from the Tapajo's National Forest, Brazil, were used as meteorological forcing and provided comprehensive observational constraints on the model. Results strongly suggest that deep roots with root niche separation adaptations explain both the observed resilience during seasonal drought and the vulnerability of canopy-dominant trees to extended deficits of wet season rainfall. These mechanisms appear to provide an adaptive strategy that enhances productivity of the largest trees in the face of their disproportionate heat loads and water demand in the dry season. A sensitivity analysis exploring how wet season rainfall affects the stability of the rainforest system is presented. Citation: Ivanov, V. Y., L. R. Hutyra, S. C. Wofsy, J. W. Munger, S. R. Saleska, R. C. de Oliveira Jr., and P. B. de Camargo (2012), Root niche separation can explain avoidance of seasonal drought stress and vulnerability of overstory trees to extended drought in a mature Amazonian forest, Water Resour. Res., 48, W12507, doi:10.1029/2012WR011972.

Theoretical study of the XP3 (X = Al, B, Ga) clusters

The lowest singlet and triplet states of AlP3, GaP3 and BP3 molecules with C-s, C-2v and C-3v symmetries were characterized using the B3LYP functional and the aug-cc-pVTZ and aug-cc-pVQZ correlated consistent basis sets. Geometrical parameters and vibrational frequencies were calculated and compared to existent experimental and theoretical data. Relative energies were obtained with single point CCSD(T) calculations using the aug-cc-pVTZ, aug-cc-pVQZ and aug-cc-pV5Z basis sets, and then extrapolating to the complete basis set (CBS) limit. (C) 2011 Elsevier B.V. All rights reserved.

Aspergillus fumigatus mitochondrial electron transport chain mediates oxidative stress homeostasis, hypoxia responses and fungal pathogenesis

We previously observed that hypoxia is an important component of host microenvironments during pulmonary fungal infections. However, mechanisms of fungal growth in these in vivo hypoxic conditions are poorly understood. Here, we report that mitochondrial respiration is active in hypoxia (1% oxygen) and critical for fungal pathogenesis. We generated Aspergillus fumigatus alternative oxidase (aoxA) and cytochrome C (cycA) null mutants and assessed their ability to tolerate hypoxia, macrophage killing and virulence. In contrast to ?aoxA, ?cycA was found to be significantly impaired in conidia germination, growth in normoxia and hypoxia, and displayed attenuated virulence. Intriguingly, loss of cycA results in increased levels of AoxA activity, which results in increased resistance to oxidative stress, macrophage killing and long-term persistence in murine lungs. Thus, our results demonstrate a previously unidentified role for fungal mitochondrial respiration in the pathogenesis of aspergillosis, and lay the foundation for future research into its role in hypoxia signalling and adaptation.