862 resultados para Failure to Thrive


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Background : Phenobarbital is the first-line choice for neonatal seizures treatment, despite a response rate of approximately 45%. Failure to respond to acute anticonvulsants is associated with poor neurodevelopmental outcome, but knowledge on predictors of refractoriness is limited. Objective : To quantify response rate to phenobarbital and to establish variables predictive of its lack of efficacy. Methods : We retrospectively evaluated newborns with electrographically confirmed neonatal seizures admitted between January 1999 and December 2012 to the neonatal intensive care unit of Parma University Hospital (Italy), excluding neonates with status epilepticus. Response was categorized as complete (cessation of clinical and electrographic seizures after phenobarbital administration), partial (reduction but not cessation of electrographic seizures with the first bolus, response to the second bolus), or absent (no response after the second bolus). Multivariate analysis was used to identify independent predictors of refractoriness. Results : Out of 91 newborns receiving phenobarbital, 57 (62.6%) responded completely, 15 (16.5%) partially, and 19 (20.9%) did not respond. Seizure type (p = 0.02), background electroencephalogram (EEG; p ≤ 0.005), and neurologic examination (p ≤ 0.005) correlated with response to phenobarbital. However, EEG (p ≤ 0.02) and seizure type (p ≤ 0.001) were the only independent predictors. Conclusion : Our results suggest a prominent role of neurophysiological variables (background EEG and electrographic-only seizure type) in predicting the absence of response to phenobarbital in high-risk newborns.

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The problem investigated was negative effects on the ability of a university student to successfully complete a course in religious studies resulting from conflict between the methodologies and objectives of religious studies and the student's system of beliefs. Using Festinger's theory of cognitive dissonance as a theoretical framework, it was hypothesized that completing a course with a high level of success would be negatively affected by (1) failure to accept the methodologies and objectives of religious studies (methodology), (2) holding beliefs about religion that had potential conflicts with the methodologies and objectives (beliefs), (3) extrinsic religiousness, and (4) dogmatism. The causal comparative method was used. The independent variables were measured with four scales employing Likert-type items. An 8-item scale to measure acceptance of the methodologies and objectives of religious studies and a 16-item scale to measure holding of beliefs about religion having potential conflict with the methodologies were developed for this study. These scales together with a 20-item form of Rokeach's Dogmatism Scale and Feagin's 12-item Religious Orientation Scale to measure extrinsic religiousness were administered to 144 undergraduate students enrolled in randomly selected religious studies courses at Florida International University. Level of success was determined by course grade with the 27% of students receiving the highest grades classified as highly successful and the 27% receiving the lowest grades classified as not highly successful. A stepwise discriminant analysis produced a single significant function with methodology and dogmatism as the discriminants. Methodology was the principal discriminating variable. Beliefs and extrinsic religiousness failed to discriminate significantly. It was concluded that failing to accept the methodologies and objectives of religious studies and being highly dogmatic have significant negative effects on a student's success in a religious studies course. Recommendations were made for teaching to diminish these negative effects.

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The brothel, as a ‘symbolic location’ was the object of analysis in this dissertation, ascribable to its unusual and recurrent presence in Latin American narrative. The brothel was presented as a scenario, with polyvalent implications of both the space itself, as well as the different archetypes of the characters who occupy it. ^ Our analysis showed how the brothel functions as a cultural entity, social archetype, power center, mythical place and symbolic space, where man plays out his utmost dominant self. To achieve this, the analysis focused on sifting through the concepts of machismo, economic and political power, and the configuration of the ‘house’ as emblematic elements of Latin American culture. ^ The four novels chosen to underwrite this analysis were representative of the historical time frame, from Colonial times to the present, highlighting all the most distinctive features. These, in turn, led the reader to the inescapable fact that owing to certain characteristics of Latin American culture, the brothel maintains its raison d'être as a space that represents existential situations, and that far from converting itself into an anachronism, it will continue to thrive in the most significant achievements of Latin American prose. ^

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Past HIV interventions have been critiqued for their failure to incorporate relational factors linked to condom use. Furthermore, few studies have focused on the relational context of sexual risk behavior among adolescents at elevated risk for HIV/STI exposure in the context of substance use. Therefore, this study evaluated the influence of three key relational factors (rejection sensitivity, intimacy dating goals, intercourse-related anxiety) salient for understanding condom use among adolescents in outpatient substance abuse treatment in South Florida. Structural equation modeling was used to test relational factors as direct and indirect predictors of condom use. Specifically, the current study investigated the influence of rejection sensitivity and intimacy dating goals on percentage of protected intercourse, with intercourse-related anxiety modeled as a mediator of this association. ^ Results obtained from the hypothesized structural model suggest rejection sensitivity and intimacy dating goals are significant predictors of percentage of protected intercourse. As expected, rejection sensitivity was related to lower levels of percentage of protected intercourse via heightened levels of intercourse-related anxiety and was not related directly to percentage of protected intercourse. Intercourse-related anxiety was indicated as a partial mediator between rejection sensitivity and percentage of protected intercourse. In contrast, intimacy dating goals was related to lower levels of percentage of protected intercourse directly. The findings demonstrate the importance of relational factors in condom use among adolescents in outpatient substance abuse treatment. Levels of protected intercourse are likely to increase when relational factors are targeted among adolescents in this high-risk population. Implications for prevention strategies targeting this high-risk subgroup of adolescents are discussed. ^

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Equisetum giganteum L., a giant horsetail, is one of the largest living members of an ancient group of non-flowering plants with a history extending back 377 million years. Its hollow upright stems grow to over 5 m in height. Equisetum giganteum occupies a wide range of habitats in southern South America. Colonies of this horsetail occupy large areas of the Atacama river valleys, including those with sufficiently high groundwater salinity to significantly reduce floristic diversity. The purpose of this research was to study the ecophysiological and biomechanical properties that allow E. giganteum to successfully colonize a range of habitats, varying in salinity and exposure. Stem ecophysiological behavior was measured via steady state porometry (stomatal conductance), thermocouple psychrometry (water potential), chlorophyll fluorescence, and ion specific electrodes (xylem fluid solutes). Stem biomechanical properties were measured via a 3-point bending apparatus and cross sectional imaging. Equisetum giganteum stems exhibit mechanical characteristics of semi-self-supporting plants, requiring mutual support or support of other vegetation when they grow tall. The mean elastic moduli (4.3 Chile, 4.0 Argentina) of E. giganteum in South America is by far the largest measured in any living horsetail. Stomatal behavior of E. giganteum is consistent with that of typical C3 vascular plants, although absolute values of maximum late morning stomatal conductance are very low in comparison to typical plants from mesic habitats. The internode stomata exhibit strong light response. However, the environmental sensitivity of stomatal conductance appeared less in young developing stems, possibly due to higher cuticular conductance. Exclusion of sodium (Na) and preferential accumulation of potassium (K) at the root level appears to be the key mechanism of salinity tolerance in E. giganteum. Overall stomatal conductance and chlorophyll fluorescence were little affected by salinity, ranging from very low levels up to half strength seawater. This suggests a high degree of salinity stress tolerance. The capacity of E. giganteum to adapt to a wide variety of environments in southern South America has allowed it to thrive despite tremendous environmental changes during their long tenure on Earth.

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This study describes the case of private higher education in Ohio between 1980 and 2006 using Zumeta's (1996) model of state policy and private higher education. More specifically, this study used case study methodology and multiple sources to demonstrate the usefulness of Zumeta's model and illustrate its limitations. Ohio served as the subject state and data for 67 private, 4-year, degree-granting, Higher Learning Commission-accredited institutions were collected. Data sources for this study included the National Center for Education Statistics Integrated Postsecondary Data System as well as database information and documents from various state agencies in Ohio, including the Ohio Board of Regents. ^ The findings of this study indicated that the general state context for higher education in Ohio during the study time period was shaped by deteriorating economic factors, stagnating population growth coupled with a rapidly aging society, fluctuating state income and increasing expenditures in areas such as corrections, transportation and social services. However, private higher education experienced consistent enrollment growth, an increase in the number of institutions, widening involvement in state-wide planning for higher education, and greater fiscal support from the state in a variety of forms such as the Ohio Choice Grant. This study also demonstrated that private higher education in Ohio benefited because of its inclusion in state-wide planning and the state's decision to grant state aid directly to students. ^ Taken together, this study supported Zumeta's (1996) classification of Ohio as having a hybrid market-competitive/central-planning policy posture toward private higher education. Furthermore, this study demonstrated that Zumeta's model is a useful tool for both policy makers and researchers for understanding a state's relationship to its private higher education sector. However, this study also demonstrated that Zumeta's model is less useful when applied over an extended time period. Additionally, this study identifies a further limitation of Zumeta's model resulting from his failure to define "state mandate" and the "level of state mandates" that allows for inconsistent analysis of this component. ^

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For the first time in more than fifty years, the domestic and external conflicts in Latin America and the Caribbean (LAC) are not primarily ideological in nature. Democracy continues to thrive and its promise still inspires hope. In contrast, the illegal production, consumption, and trading of drugs – and its links to criminal gangs and organizations – represent major challenges to the region, undermining several States’ already weak capacity to govern. While LAC macroeconomic stability has remained resilient, illegal economies fill the region, often offering what some States have not historically been able to provide – elements of human security, opportunities for social mobility, and basic survival. Areas controlled by drug trafficking organizations (DTOs) are now found in Central America, Mexico, and the favelas of Rio de Janeiro and São Paulo, reflecting their competition for land routes and production areas. Cartels such as La Familia, Los Zetas, and Primeiro Comando da Capital (PCC-Brazil), among others, operate like trade and financial enterprises that manage millions of dollars and resources, demonstrating significant business skills in adapting to changing circumstances. They are also merciless in their application of violence to preserve their lucrative enterprises. The El Salvador-Guatemala-Honduras triangle in Central America is now the most violent region in the world, surpassing regions in Africa that have been torn by civil strife for years. In Brazil’s favelas and Guatemala’s Petén region, the military is leaving the barracks again; not to rule, however, but to supplement and even replace the law enforcement capacity of weak and discredited police forces. This will challenge the military to apply lessons learned during the course of their experience in government, or from the civil wars that plagued the region for nearly 50 years during the Cold War. Will they be able to conduct themselves according to the professional ethics that have been inculcated over the past 20 years without incurring violations of human rights? Belief in their potential to do good is high according to many polls as the Armed Forces still enjoy a favorable perception in most societies, despite frequent involvement in corruption. Calling them to fight DTOs, however, may bring them too close to the illegal activities they are being asked to resist, or even rekindle the view that only a “strong hand” can resolve national troubles. The challenge of governance is occurring as contrasts within the region are becoming sharper. There is an increasing gap between nations positioned to surpass their “developing nation” status and those that are practically imploding as the judicial, political and enforcement institutions fall further into the quagmire of illicit activities. Several South American nations are advancing their political and economic development. Brazil in particular has realized macro-economic stability, made impressive gains in poverty reduction, and is on track to potentially become a significant oil producer. It is also an increasingly influential power, much closer to the heralded “emerging power” category that it aspired to for most of the 20th century. In contrast, several Central American States have become so structurally deficient, and have garnered such limited legitimacy, that their countries have devolved into patches of State controlled and non-State-controlled territory, becoming increasingly vulnerable to DTO entrenchment. In the Caribbean, the drug and human trafficking business also thrives. Small and larger countries are experiencing the growing impact of illicit economies and accompanying crime and violence. Among these, Guyana and Suriname face greater uncertainty, as they juggle both their internal affairs and their relations with Brazil and Venezuela. Cuba also faces new challenges as it continues focusing on internal rather than external affairs and attempts to ensure a stable leadership succession while simultaneously trying to reform its economy. Loosening the regime’s tight grip on the economy while continuing to curtail citizen’s civil rights will test the leadership’s ability to manage change and prevent a potential socio-economic crisis from turning into an existential threat. Cuba’s past ideological zest is now in the hands of Venezuela’s President Hugo Chavez, who continues his attempts to bring the region together under Venezuelan leadership ideologically based on a “Bolivarian” anti-U.S. banner, without much success. The environment and natural disasters will merit more attention in the coming years. Natural events will produce increasing scales of destruction as the States in the region fail to maintain and expand existing infrastructure to withstand such calamities and respond to their effects. Prospects for earthquakes, tsunamis, and hurricanes are high, particularly in the Caribbean. In addition, there are growing rates of deforestation in nearly every country, along with a potential increase in cross-sector competition for resources. The losers might be small farmers, due to their inability to produce quantities commensurate to larger conglomerates. Regulations that could mitigate these types of situations are lacking or openly violated with near impunity. Indigenous and other vulnerable populations, including African descendants, in several Andean countries, are particularly affected by the increasing extraction of natural resources taking place amongst their terrain. This has led to protests against extraction activities that negatively affect their livelihoods, and in the process, these historically underprivileged groups have transitioned from agenda-based organization to one that is bringing its claims and grievances to the national political agenda, becoming more politically engaged. Symptomatic of these social issues is the region’s chronically poor quality of education that has consistently failed to reduce inequality and prepare new generations for jobs in the competitive global economy, particularly the more vulnerable populations. Simultaneously, the educational deficit is also exacerbated by the erosion of access to information and freedom of the press. The international panorama is also in flux. New security entities are challenging the old establishment. The Union of South American Nations, The South American Defense Council, the socialist Bolivarian Alliance, and other entities seem to be defying the Organization of American States and its own defense mechanisms, and excluding the U.S. And the U.S.’s attention to areas in conflict, namely Iraq, Afghanistan, and Pakistan – rather than to the more stable Latin America and Caribbean – has left ample room for other actors to elbow in. China is now the top trading partner for Brazil. Russian and Iran are also finding new partnerships in the region, yet their links appear more politically inclined than those of China. Finally, the aforementioned increasing commercial ties by LAC States with China have accelerated a return to the preponderance of commodities as sources of income for their economies. The increased extraction of raw material for export will produce greater concern over the environmental impact that is created by the exploitation of natural resources. These expanded trade opportunities may prove counterproductive economically for countries in the region, particularly for Brazil and Chile, two countries whose economic policies have long sought diversification from dependence on commodities to the development of service and technology based industries.

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Over the last decade, the Colombian military has successfully rolled back insurgent groups, cleared and secured conflict zones, and enabled the extraction of oil and other key commodity exports. As a result, official policies of both the Uribe and Santos governments have promoted the armed forces to participate to an unprecedented extent in economic activities intended to consolidate the gains of the 2000s. These include formal involvement in the economy, streamlined in a consortium of military enterprises and social foundations that are intended to put the Colombian defense sector “on the map” nationally and internationally, and informal involvement expanded mainly through new civic action development projects intended to consolidate the security gains of the 2000s. However, failure to roll back paramilitary groups other than through the voluntary amnesty program of 2005 has facilitated the persistence of illicit collusion by military forces with reconstituted “neoparamilitary” drug trafficking groups. It is therefore crucially important to enhance oversight mechanisms and create substantial penalties for collusion with illegal armed groups. This is particularly important if Colombia intends to continue its new practice of exporting its security model to other countries in the region. The Santos government has initiated several promising reforms to enhance state capacity, institutional transparence, and accountability of public officials to the rule of law, which are crucial to locking in security gains and revitalizing democratic politics. Efforts to diminish opportunities for illicit association between the armed forces and criminal groups should complement that agenda, including the following: Champion breaking existing ties between the military and paramilitary successor groups through creative policies involving a mixture of punishments and rewards directed at the military; Investigation and extradition proceedings of drug traffickers, probe all possible ties, including as a matter of course the possibility of Colombian military collaboration. Doing so rigorously may have an important effect deterring military collusion with criminal groups. Establish and enforce zero-tolerance policies at all military ranks regarding collusion with criminal groups; Reward military units that are effective and also avoid corruption and criminal ties by providing them with enhanced resources and recognition; Rely on the military for civic action and development assistance as minimally as possible in order to build long-term civilian public sector capacity and to reduce opportunities for routine exposure of military forces to criminal groups circulating in local populations.

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Current high school completion rates in Dade County and across the nation are considered to be unacceptable. This has led to the development of student assistance profiles to aid in the early identification of students considered to be at risk to allow for some form of intervention. The purpose of this research was to examine the current Dade County Public Schools profile as applied to one specific high school in which most of the students are Hispanic (mostly of Mexican descent) and Black (African-Americans, as well as recent Haitian immigrants). Additionally, the effectiveness of the alternative intervention program provided at this high school--a school within a school--were evaluated. School records of the 1992 in-coming ninth grade class became the initial data base. The individual student records of this cohort were then examined over a four-year period until their expected date or graduation. The DCPS profile used to identify potential dropouts from this group was evaluated, using chi-square and multivariate analysis, to determine its overall effectiveness, as well as the effectiveness of the individual indicators which comprise the profile. The Student Assistance Profile was found to an effective predictor, but it over-identified students from this cohort, particularly minorities, to the extent that it became largely ineffective, especially considering the limited resources available for intervention. The intervention program was found to be ineffective in reducing the dropout rate. Further analysis of the individual indicators used in the DCPS profile as they applied to this school population resulted in the development of an improved profile. By reducing the number of indicators to those found to be most highly associated with failure to graduate--academic performance and absences--a simpler student assistance profile was developed which appears to be better suited to high schools with similar demographics and budget restraints. ^

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Objective Patients can experience urinary retention (UR) after Holmium laser enucleation of the prostate (HoLEP) that requires bladder distension during the procedure. The aim of this retrospective study is to identify factors affecting the UR after HoLEP. Materials and Methods 336 patients, which underwent HoLEP for a symptomatic benign prostatic hyperplasia between July 2008 and March 2012, were included in this study. Urethral catheters were routinely removed one or two days after surgery. UR was defined as the need for an indwelling catheter placement following a failure to void after catheter removal. Demographic and clinical parameters were compared between the UR (n = 37) and the non-urinary retention (non-UR; n = 299) groups. Results The mean age of patients was 68.3 (±6.5) years and the mean operative time was 75.3 (±37.4) min. Thirty seven patients (11.0%) experienced a postoperative UR. UR patients voided catheter free an average of 1.9 (±1.7) days after UR. With regard to the causes of UR, 24 (7.1%) and 13 (3.9%) patients experienced a blood clot-related UR and a non-clot related UR respectively. Using multivariate analysis (p<0.05), we found significant differences between the UR and the non-UR groups with regard to a morcellation efficiency (OR 0.701, 95% CI 0.498–0.988) and a bleeding-related complication, such as, a reoperation for bleeding (OR 0.039, 95% CI 0.004–0.383) or a transfusion (OR 0.144, 95% CI 0.027–0.877). Age, history of diabetes, prostate volume, pre-operative post-void residual, bladder contractility index, learning curve, and operative time were not significantly associated with the UR (p>0.05). Conclusions De novo UR after HoLEP was found to be self-limited and it was not related to learning curve, patient age, diabetes, or operative time. Efficient morcellation and careful control of bleeding, which reduces clot formation, decrease the risk of UR after HoLEP.

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A popular refrain in the politics of American education, often buttressed by a steady stream of studies, contends that ‘we are falling behind’ students from other countries. Sometimes this decline is specified in terms of discipline, but the general premise is that American students lag behind their foreign counterparts, with special dread attached to the notion of falling behind adversaries such as China. The failure to rectify our educational inadequacies apparently portends a genuine crisis, the loss of global dominance. The articulation of such fears is particularly instructive in discerning the political role of education in late capitalism, its conceptualization and uses within the context of politics. How do the fears of falling behind speak to the political role of education in late capitalism? I draw upon the ideas of the Herbert Marcuse and his Marxist intervention into Freudian psychoanalysis. Using Marcuse’s framework, I argue that in late capitalism the political role of education, formerly understood to serve life affirming value, has been reoriented to further the aims of the death drive. The fears of falling behind, and the policies that have followed, are symptomatic of a disposition toward education that has reconfigured the school as a means of conquest, subjugation, and war.

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In this paper, I analyze the processes that transformed aquaculture into a major export industry in India, in order to understand the role aquaculture has as a social and economic development strategy of the Indian state. The discussion employs a political ecology approach as I explore the complex relations between access and control of India’s coastal resources, society, and economy. I argue that many of the forces that initiated the development of aquaculture in India, namely the involvement of the Indian state, continue to shape the industry today. I also discuss how despite widespread social conflict, the shrimp farming industry, in particular, continues to thrive and grow in rural India. My analysis utilizes ethnographic and archival data collected over the course of 9 months of fieldwork in Tamil Nadu, India. Keywords: rural development, aquaculture, India, State, ethnography

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1. Area of Investigation The relative need of higher standards in healthcare foodservice facilities. Individual opinions of foodservice directors. 2. Materials and Methods Used Existing text, trade publications, interviews with industry leaders, conferences with estemmed professors and the author's own experience were used for research and evaluation. An important method used to evaluate the need for higher standards was a descriptive survey and the analysis thereof. 3. Major Findings A. The survey showed, with a 42 percent response, that the overwhelming majority of the respondents have problems within their department. B. It is presumed that these problems are caused by a lack of standards and/or a failure to meet existing standards. 4. Results and Conclusions A. The objectives of the majority of health-care facilities is to provide the best possible care at lowest possible price. The objectives of the foodservice department is to provide the best possible food at the most reasonable cost. B. Continuous education of foodservice directors in all facets of the industry are necessary so that each foodservice director has the capacity to establish and maintain, and in some cases surpass his or her own standards. C. Where no standards exist minimum requirements should be set to satisfy the objectives and goals of both the facility and foodservice department.

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Unequaled improvements in processor and I/O speeds make many applications such as databases and operating systems to be increasingly I/O bound. Many schemes such as disk caching and disk mirroring have been proposed to address the problem. In this thesis we focus only on disk mirroring. In disk mirroring, a logical disk image is maintained on two physical disks allowing a single disk failure to be transparent to application programs. Although disk mirroring improves data availability and reliability, it has two major drawbacks. First, writes are expensive because both disks must be updated. Second, load balancing during failure mode operation is poor because all requests are serviced by the surviving disk. Distorted mirrors was proposed to address the write problem and interleaved declustering to address the load balancing problem. In this thesis we perform a comparative study of these two schemes under various operating modes. In addition we also study traditional mirroring to provide a common basis for comparison.

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Three megascopic and disseminated tephra layers (which we refer to as layers A, B, and C) occur in late Quaternary glaciomarine sediments deposited on the West Antarctic continental margin. The stratigraphical positions of the distal tephra layers in 28 of the 32 studied sediment cores suggest their deposition during latest Marine Isotopic Stage (MIS) 6 and MIS 5. One prominent tephra layer (layer B), which was deposited subsequent to the penultimate deglaciation (Termination II), is present in almost all of the cores. Geochemical analyses carried out on the glass shards of the layers reveal a uniform trachytic composition and indicate Marie Byrd Land (MBL), West Antarctica, as the common volcanic source. The geochemical composition of the marine tephra is compared to that of ash layers of similar age described from Mount Moulton and Mount Takahe in MBL and from ice cores drilled at Dome Fuji, Vostok and EPICA Dome C in East Antarctica. The three tephra layers in the marine sediments are chemically indistinguishable. Also five englacial ash layers from Mt. Moulton, which originated from highly explosive Plinian eruptions of the Mt. Berlin volcano in MBL between 142 ka and 92 ka ago, are chemically very similar, as are two tephra layers erupted from Mt. Takahe at ca. 102 ka and ca. 93 ka. Statistical analysis of the chemical composition of the glass shards indicates that the youngest tephra (layer A) in the marine cores matches the ash layer erupted from Mt. Berlin at 92 ka, which was previously correlated with tephra layers in the EPICA Dome C and the Dome Fuji ice cores. A tephra erupted from Mt. Berlin at 136 ka seems to correspond to a tephra layer deposited at 1733 m in the EPICA Dome C ice core. Additionally, the oldest tephra (layer C) in the marine sediments resembles an ash layer deposited at Vostok around 142 ka, but statistical evidence for the validity of this correlation is inconclusive. Although our results underscore the potential of tephrostratigraphy for correlating terrestrial and marine palaeoclimate archives, our study also reveals limitations of this technique, which may result in the miscorrelation of tephra. Such pitfalls comprise failure to recognise the occurrence of various tephra layers in marine sediment cores, 'swamping' of records with chemically indistinguishable tephra from a single volcanic source, and exclusive use of 'geochemical fingerprinting' for correlating ash layers.