Efficacy and safety of autologous platelet rich plasma for the treatment of vascular ulcers in primary care: Phase III study

Background: Vascular ulcers are commonly seen in daily practice at all levels of care and have great impact at personal, professional and social levels with a high cost in terms of human and material resources. Given that the application of autologous platelet rich plasma has been shown to decrease healing times in various different studies in the hospital setting, we considered that it would be interesting to assess the efficacy and feasibility of this treatment in primary care. The objectives of this study are to assess the potential efficacy and safety of autologous platelet rich plasma for the treatment of venous ulcers compared to the conventional treatment (moist wound care) in primary care patients with chronic venous insufficiency (C, clinical class, E, aetiology, A, anatomy and P, pathophysiology classification C6). Design: We will conduct a phase III, open-label, parallel-group, multicentre, randomized study. The subjects will be 150 patients aged between 40 and 100 years of age with an at least 2-month history of a vascular venous ulcer assigned to ten primary care centres. For the treatment with autologous platelet rich plasma, all the following tasks will be performed in the primary care setting: blood collection, centrifugation, separation of platelet rich plasma, activation of coagulation adding calcium chloride and application of the PRP topically after gelification. The control group will receive standard moist wound care. The outcome variables to be measured at baseline, and at weeks 5 and 9 later include: reduction in the ulcer area, Chronic Venous Insufficiency Quality of Life Questionnaire score, and percentage of patients who require wound care only once a week. Discussion: The results of this study will be useful to improve the protocol for using platelet rich plasma in chronic vascular ulcers and to favour wider use of this treatment in primary care.

Necessidades de autocuidado à qualidade de vida de clientes com câncer de cabeça e pescoço: contribuição da enfermagem

Aborda-se a consulta de enfermagem como estratégia de pesquisa, visando identificar necessidades de autocuidado (AC) em clientes com câncer de cabeça e pescoço em tratamento paliativo ambulatorial. Tem-se como objetivos: identificar o perfil sociodemográfico e nosológico dos clientes com câncer de cabeça e pescoço atendidos no ambulatório para cuidados paliativos; identificar a qualidade de vida (QV) dessas pessoas através da consulta de enfermagem; avaliar as mudanças no sistema de autocuidado, considerando a intervenção de enfermagem. O estudo fundamenta-se nos conceitos, protocolos e instrumentos específicos da temática escolhida, e na Teoria do Déficit de Autocuidado de Orem. Escolheu-se o método quantitativo, descritivo, com delineamento pré-experimental tempo-série anterior e posterior em grupo único, que recebeu orientações para o autocuidado na consulta de enfermagem (CE). Foram sujeitos do estudo 77 clientes cadastrados no ambulatório especializado em tratamento paliativo, do INCA do Rio de Janeiro, no período de março a agosto de 2011. Variáveis sociodemográficas e nosológicas compõem o instrumento de produção de dados; enquanto as etapas da sistematização da assistência de enfermagem compõem o formulário para a implementação da CE. Para avaliar a QV aplicou-se o formulário QLQ30-H&N45, sendo os dados produzidos tratados mediante a estatística descritiva. Constatou-se, que a maioria dos 77 (100%) sujeitos do estudo é do sexo masculino e situam-se na faixa etária de 50 a 60 anos. Predominam os residentes na Baixada Fluminense, com ensino fundamental e aposentados. Têm união estável, cuidador informal e referem pouca realização de lazer. A maioria possuía hábito de tabagismo e alcoolismo. Quanto ao perfil nosológico, a maioria possui lesão tumoral inodora, sendo a cavidade oral o sítio mais acometido por câncer, e a metástase local a mais frequente. Quanto à capacidade para AC, a maioria se alimenta, se veste e se locomove sem auxilio. Ressalte-se que, na avaliação da QV, os escores predominantes apontam indicativos de controle de sintomas e funcionalidade. Foram formulados 33 diagnósticos de enfermagem, destacando-se nos domínios: físico, a deglutição prejudicada; no psicológico, a baixa autoestima crônica; no social, a interação social prejudicada; no cognitivo, conhecimento deficiente da doença. Concluiu-se que os objetivos da pesquisa foram alcançados, identificando-se que os clientes com câncer de cabeça e pescoço, em tratamento paliativo, possuem diferentes necessidades de autocuidado, sendo o enfermeiro o profissional responsável pela sua educação em saúde e consequente identificação de demandas para outros profissionais da equipe multiprofissional.

Integrated treatment of first episode psychosis with online training (e-learning): study protocol for a randomised controlled trial

Background: The integrated treatment of first episode psychosis has been shown to improve functionality and negative symptoms in previous studies. In this paper, we describe a study of integrated treatment (individual psychoeducation complementary to pharmacotherapy) versus treatment as usual, comparing results at baseline with those at 6-month re-assessment (at the end of the study) for these patients, and online training of professionals to provide this complementary treatment, with the following objectives: 1) to compare the efficacy of individual psychoeducation as add-on treatment versus treatment as usual in improving psychotic and mood symptoms; 2) to compare adherence to medication, functioning, insight, social response, quality of life, and brain-derived neurotrophic factor, between both groups; and 3) to analyse the efficacy of online training of psychotherapists. Methods/design: This is a single-blind randomised clinical trial including patients with first episode psychosis from hospitals across Spain, randomly assigned to either a control group with pharmacotherapy and regular sessions with their psychiatrist (treatment as usual) or an intervention group with integrated care including treatment as usual plus a psychoeducational intervention (14 sessions). Training for professionals involved at each participating centre was provided by the coordinating centre (University Hospital of Alava) through video conferences. Patients are evaluated with an extensive battery of tests assessing clinical and sociodemographic characteristics (Positive and Negative Syndrome Scale, State-Trait Anxiety Inventory, Liebowitz Social Anxiety Scale, Hamilton Rating Scale for Depression, Scale to Assess Unawareness of Mental Disorders, Strauss and Carpenter Prognostic Scale, Global Assessment of Functioning Scale, Morisky Green Adherence Scale, Functioning Assessment Short Test, World Health Organization Quality of Life instrument WHOQOL-BREF (an abbreviated version of the WHOQOL-100), and EuroQoL questionnaire), and brain-derived neurotrophic factor levels are measured in peripheral blood at baseline and at 6 months. The statistical analysis, including bivariate analysis, linear and logistic regression models, will be performed using SPSS. Discussion: This is an innovative study that includes the assessment of an integrated intervention for patients with first episode psychosis provided by professionals who are trained online, potentially making it possible to offer the intervention to more patients.

Teoria dos crimes omissivos

O trabalho está voltado à elaboração de uma teoria dos crimes omissivos, com o sentido de obter uma limitação de sua expansão. Para alcançar esse objetivo, são postas em discussão todas as concepções do crime omissivo, tanto no aspecto dogmático quanto de política criminal. Na primeira parte, estão apresentados os problemas práticos da omissão, sua evolução legislativa e sua importância. A partir daí, são discutidas as elaborações doutrinárias quanto à sua natureza, à sua estrutura e à sua punibilidade. Quanto à sua natureza, a omissão é analisada como forma de ação, como forma equiparada de ação e como forma correspondente de ação. Quanto à sua estrutura, a omissão é vista sob o enfoque de seu tratamento legal, que requer um aprofundamento da composição da norma e de seus elementos comunicativos. Quanto à sua punibilidade, são destacados seus aspectos contraditórios referentes à falta de simetria entre sua estrutura empírica e normativa, de um lado, e as consequências pelo descumprimento do dever, de outro lado. Na segunda parte, formata-se uma conclusão dogmática crítica de toda a discussão em torno da natureza, da estrutura e da punibilidade da omissão. Inicia-se sob uma crítica dos objetivos da dogmática e se projeta sobre todas as questões fundamentais que envolvem os crimes omissivos. São feitas assertivas sobre a tipicidade, a antijuridicidade e a culpabilidade da omissão, assim como sobre o concurso de pessoas e suas fases de execução. Para não sobrecarregar o texto, são tratados em anexo os temas relacionados ao concurso de crimes e aos delitos omissivos culposos. Tendo em vista que a segunda parte constitui uma conclusão de todo o desenvolvimento crítico da omissão, realizado na primeira parte, não foram enumerados tópicos conclusivos. O método empregado está baseado no princípio dialético construtivista de Holzcamp.

Mechanisms involved in Escherichia coli and Serratia marcescens removal during activated sludge wastewater treatment

Wastewater treatment reduces environmental contamination by removing gross solids and mitigating the effects of pollution. Treatment also reduces the number of indicator organisms and pathogens. In this work, the fates of two coliform bacteria, Escherichia coli and Serratia marcescens, were analyzed in an activated sludge process to determine the main mechanisms involved in the reduction of pathogenic microorganisms during wastewater treatment. These bacteria, modified to express green fluorescent protein, were inoculated in an activated sludge unit and in batch systems containing wastewater. The results suggested that, among the different biological factors implied in bacterial removal, bacterivorous protozoa play a key role. Moreover, a representative number of bacteria persisted in the system as free-living or embedded cells, but their distribution into liquid or solid fractions varied depending on the bacterium tested, questioning the real value of bacterial indicators for the control of wastewater treatment process. Additionally, viable but nonculturable cells constituted an important part of the bacterial population adhered to solid fractions, what can be derived from the competition relationships with native bacteria, present in high densities in this environment. These facts, taken together, emphasize the need for reliable quantitative and qualitative analysis tools for the evaluation of pathogenic microbial composition in sludge, which could represent an undefined risk to public health and ecosystem functions when considering its recycling.

Justiça e Prudência: Virtudes Civis, Virtudes Políticas

A presente tese de doutorado se dedicou a apontar o conjunto de pressupostos, bem como os elementos jurídicos, políticos e filosóficos que formaram o entendimento político-governamental de Tomás de Aquino, partindo da hipótese de que as virtudes cardeais da prudência e da justiça são, na visão do Aquinate, as mais necessárias para aquilo que ele entendia como consentâneo aos fins próprios da cidade ou comunidade política. Para tanto, o trabalho apresentou o tratamento tomasiano sobre a prudência, entendida como reta razão do agir, sobre a justiça, vontade constante e perpétua de dar a cada um o seu direito e, finalmente, sobre a sociedade: sua natureza, seus fins e suas condições de existência e aperfeiçoamento. Outros temas correlatos e de interesse foram igualmente vistos, como a própria noção de virtude, o direito, a lei etc. Deu-se especial ênfase às modalidades denominadas prudência legislativa e justiça legal, por dizerem respeito ao bem comum, elemento essencial para visão tomasiana de sociedade. Concluiu-se pela necessidade da presença das virtudes da prudência e da justiça no governante da sociedade política.

Influence of heat treatment on spectroscopic properties of Er3+ in multicomponent ZrF4-ZnF2-AlF3-YF3-MF2 (M = Ca, Sr, Ba) based glass

Er3+ doped multicomponent fluoride based glass was prepared. These precursor fluoride glass samples were then heated using different schedules. Crystalline phase particles were successfully precipitated in the multicomponent fluoride glass samples after heat treatment. The influence of heat treatment on the spectroscopic properties of Er3+ in multicomponent fluoride based glass samples were discussed. Small changes of the Judd-Ofelt parameters Omega(i) (i = 2,4,6) were found in multicomponent fluoride glass samples before and after heat treatment compared to oxyfluoride telluride glass. Preparation conditions used to produce transparent multicomponent fluoride glass ceramics doped with rare-earth ions are discussed. (c) 2007 Elsevier B.V. All rights reserved.

Workshop on turtle bycatch mitigation for longline fisheries: experimental design and data analysis, 7-8 November 2007, San Ramón de Alajuela, Costa Rica

Large numbers of fishing vessels operating from ports in Latin America participate in surface longline fisheries in the eastern Pacific Ocean (EPO), and several species of sea turtles inhabit the grounds where these fleets operate. The endangered status of several sea turtle species, and the success of circle hooks (‘treatment’ hooks) in reducing turtle hookings in other ocean areas, as compared to J-hooks and Japanese-style tuna hooks (‘control’ hooks), prompted the initiation of a hook exchange program on the west coast of Latin America, the Eastern Pacific Regional Sea Turtle Program (EPRSTP)1. One of the goals of the EPRSTP is to determine if circle hooks would be effective at reducing turtle bycatch in artisanal fisheries of the EPO without significantly reducing the catch of marketable fish species. Participating fishers were provided with circle hooks at no cost and asked to replace the J/Japanese-style tuna hooks on their longlines with circle hooks in an alternating manner. Data collected by the EPRSTP show differences in longline gear and operational characteristics within and among countries. These aspects of the data, in addition to difficulties encountered with implementation of the alternating-hook design, pose challenges for analysis of these data.

Effects of thermal treatment on broadband near-infrared emission from Bi-doped chalcohalide glasses

GeGaSKBr glass with Bi ions as emission centers were fabricated. An intense emission centered at around 1230 nm with the width of more than 175 nm was observed by 808 nm photo-excitation of the glass. Lower quenching rate and thermal treatment promote micro-crystallization process, thus strengthening the emission. Crown Copyright (c) 2008 Published by Elsevier Ltd. All rights reserved.

Effects of surface treatment on sapphire substrates

The influence of mechanical polishing, chemo-mechanical polishing (CMP), as well as CMP and subsequent chemical etching on the properties of sapphire substrate surfaces has been studied. The sapphire substrates have been investigated by means of polarizing microscopy, atomic force microscopy (AFM). X-ray diffraction rocking curves (XRCs) and micro-Raman spectroscopy. The results show that CMP with subsequent chemically etching yields the best-quality sapphire substrate surfaces. (C) 2004 Elsevier B.V. All rights reserved.

Analysis and evaluation of public health policy in Cuba : progress on millennium development goals

[EN] The main objective of this project is to analyze Cuban public health policy and the Millennium Development Goals, especially those linked to the issue of health, presenting their potential and strengths with a well-defined time horizon (2000-2015). The Millennium Development Goals are the international consensus on development and was signed as an international minimum agreement, with which began the century. The MDGs promote various goals and targets, with the corresponding monitoring indicators, which should be achieved by all countries for the present year. Health is an area that is at the center of the Millennium Development Goals, which reinforce each other to get a true human development itself. The research was done through theoretical frameworks of social production of health and disease, social justice and the power structure. A retrospective analysis of Cuban economic and social context is performed in order to study whether health-related MDGs are likely to be completed by the deadline on the island and likewise, the main parameters related to health compared with those of the neighboring countries in the Americas.