Exit ventriculoperitoneal shunt; enter endoscopic third ventriculostomy (ETV): contemporary views on hydrocephalus and their implications on management

Hydrocephalus has been known to affect humans since the birth of human medicine as it is described by Hippocrates. The management of this condition is however still dodged by challenges due to a poor understanding of its pathophysiology. The ventriculoperitoneal shunt presents considerable problems especially with respect to infection and shunt malfunction. Low income countries, that currently face the greater burden of paediatric hydrocephalus. experience an increased challenge with ventriculoperitoneal shunts due to a shortage of qualified personnel to handle shunt complications. Recent advances in neuro-endoscopic surgery have presented opportunities for alternative treatment options for hydrocephalus such as endoscopic third ventriculostomy (ETV). This paper explores the alternative views in the pathophysiology of hydrocephalus and how they explain the effectiveness of ETV in treating hydrocephalus arising from a variety of causes.

Avaliação de projetos sociais: análise da metodologia utilizada pela Petrobrás

On the aggravation of social problems and the shortage of resources, the improvement of evaluation methods and control of its application, requiring more efficiency, efficacy, effectiveness and participation in its management, has been growing. As a result, emerges the importance of studying and developing such methodologies. The overall goal of this dissertation is to know what are the difficults to incorporate the point of view of executers and beneficiaries in evaluation process. To do so, has been done a research characterized as qualitative, with a field strategy using the case study of two social projects called Petrobras Child Program, situated in the metropolitan region of Natal, and Content Analysis technique for analyze the data. The conclusions of this work can assist in improving the process of projects evaluation financed by Petrobras, contributing with its social role, besides the possibility of encouraging a greater participation of other society actors, such as beneficiaries, in the evaluation process

Apoio geoespacial a uma operação NEO

No âmbito das obrigações que o Estado Português tem em garantir a segurança dos seus cidadãos, é efetuada, em países ou regiões onde há comunidades nacionais, uma avaliação quanto ao risco de vida para os cidadãos nacionais que aí residam ou aí se encontrem, entendendo-se, à luz do direito internacional consuetudinário, que é legítima a eventual execução de intervenção militar de extração de nacionais não combatentes dessas zonas de risco. Este trabalho pretende contribuir para uma reflexão sobre o apoio geoespacial a uma operação de extração de cidadãos nacionais não combatentes, que se denomina NEO (non-combatant evacuation operation). Dada a importância do conhecimento holístico do ambiente operacional para os comandantes militares, os Sistemas de Informação Geográfica desempenham um papel fundamental em termos da análise, contextualização e visualização da informação geoespacial, sendo um precioso sistema de apoio à decisão. A tomada de decisão é efetuada com os contributos de várias áreas de conhecimento, sendo fundamental que o planeamento seja efetuado com base na mesma informação geoespacial, evitando a existência de uma multitude de dados geoespaciais nem sempre coerentes, atualizados e acessíveis a todos os que deles necessitam, pretendendo-se com este trabalho fornecer um contributo para resolver este problema. Aborda-se também a escassez dos dados geográficos nas zonas em que este tipo de operações se poderá desenrolar, a pertinência e a adequabilidade de utilização de dados espaciais abertos, os modelos de dados, bem como a forma como a informação pode ser disponibilizada.

Estudo da incorporação da cal em composições binárias de solo-cimento para produção de tijolos maciços

The use of binders in the soil for the production of solid bricks is an old construction technique that has been used by several civilizations over time. At the same time, the need for environmental preservation and the tendency of scarcity of natural resources make the construction invest in researching new concepts, methods and materials for building systems for the sustainability of their economic activities. Thus arises the need to obtain building materials with low power consumption, capable of reducing the growing housing shortage of rural and urban population. Currently, research has been conducted on this topic to better understand the cementitious and pozzolanic reactions that occur in the formation of the microstructure of the soil-cement when added to other materials such as, for example, lime, and the relationship between microstructure and formed interfaces with the physical, mechanical and chemical analysis in compounds made from these ternary compositions. In this context, this study aimed to analyze the results of the influence of the incorporation of lime to the soil-cement to form a ternary mixture to produce soil-cement bricks and mortar without structural purposes. From the inclusion of contents of 6 %, 8 %, 10% and 12% lime to the soil, and soil-cement mixes in amounts of 2 %, 3 %, 4 % and 5 % were shaped-bodies of -cylindrical specimens to determine the optimum moisture content and maximum dry apparent specific weight. Then they were cured, and subjected to the tests of compressive strength, absorption and durability modified. Compositions obtained the best results in the tests performed on the bodies-of-proof cylindrical served as a parameter for molding of solid bricks, which underwent the same experimental methodology previously cited. The raw materials used, as well as compositions in which the bricks were molded solid, were characterized by physical and chemical tests, X-ray diffraction and scanning electron microscopy. The results obtained in the study indicate that the compositions studied, that showed the best results in terms of compressive strength, water absorption and durability ternary composition was soil, 10 % cement and 2 % lime

Essays on Financial Constraints, R&D Investments, and Competition

This dissertation consists of two chapters of theoretical studies that investigate the effect of financial constraints and market competition on research and development (R&D) investments. In the first chapter, I explore the impact of financial constraints on two different types of R&D investments. In the second chapter, I examine the impact of market competition on the relationship between financial constraints and R&D investments. In the first chapter, I develop a dynamic monopoly model to study a firm’s R&D strategy. Contrary to intuition, I show that a financially constrained firm may invest more aggressively in R&D projects than an unconstrained firm. Financial constraints introduce a risk that a firm may run out of money before its project bears fruit, which leads to involuntary termination on an otherwise positive-NPV project. For a company that relies on cash flow from assets in place to keep its R&D project alive, early success can be relatively important. I find that when the discovery process can be expedited by heavier investment (“accelerable” projects), a financially constrained company may find it optimal to “over”-invest in order to raise the probability of project survival. The over-investment will not happen if the project is only “scalable” (investment scales up payoffs). The model generates several testable implications regarding over-investment and project values. In the second chapter, I study the effects of competition on R&D investments in a duopoly framework. Using a homogeneous duopoly model where two unconstrained firms compete head to head in an R&D race, I find that competition has no effect on R&D investment if the project is not accelerable, and the competing firms are not constrained. In a heterogeneous duopoly model where a financially constrained firm competes against an unconstrained firm, I discover interesting strategic interactions that lead to preemption by the constrained firm in equilibrium. The unconstrained competitor responds to its constrained rival’s investment in an inverted-U shape fashion. When the constrained competitor has high cash flow risk, it accelerates the innovation in equilibrium, while the unconstrained firm invests less aggressively and waits for its rival to quit the race due to shortage of funds.

Caracterização de casos de lesão medular e a sua relação com a independência funcional e qualidade de vida

Introdução: As lesões medulares acarretam consigo a problemática da deficiência, as suas respectivas sequelas interferem na qualidade de vida bem como na independência funcional destas pessoas, sendo habitual a existência de limitações que se prolongam ao longo a vida. O presente estudo visa a caracterização de sujeitos com lesão medular há mais de um ano, no que diz respeito à sua qualidade de vida e independência funcional, assim como, a relação entre as variáveis sóciodemográficas (género, idade, estado civil, escolaridade e profissão) e clínicas em estudo (nível, tipo, etiologia e data da lesão). Materiais e Métodos: O presente trabalho apresenta-se como um estudo observacional exploratório descritivo com abordagem quantitativa. A amostra foi formada por indivíduos adultos com lesão medular recrutados através da Associação Salvador e Associação Vida Independente. As medidas instrumentais utilizadas pelo estudo são o questionário sóciodemográfico e clínico, bem com a escala MIF (Granger, Hamilton, Keith, Zielezny, & Sherwins, 1986) e a escala SF-36 (Ware % Sherbourne, 1992). Resultados e Discussão: As análises demonstraram valores satisfatórios. A independência funcional e sua respectiva dimensão física e sóciocognitiva revelam resultados estatisticamente significativos com a variável nível neurológico. No que diz respeito à qualidade de vida esta demonstrou resultados estatisticamente significativos entre a dimensão desempenho emocional e a escolaridade entre o desempenho físico e a profissão e vitalidade e idade. Revelou igualmente valores satisfatórios entre todas as dimensões e o nível neurológico, entre a função social e data da lesão e por último entre a etiologia e função social, vitalidade, dor, saúde geral e mental. Conclusão: Os resultados obtidos com este estudo vêm reforçar a visão de que apesar dos indivíduos experienciarem um evento traumático e aspetos negativos após a lesão medular, há diferentes níveis de percepção de QoL e IF e que estas variam em função de algumas variáveis sóciodemográficas e clínicas. Neste ponto são ainda apresentadas as limitações do estudo e discutidas propostas de trabalhos futuros.

Curso online para a parte pral do Celpe-Bras : contribuições da avaliação de proficiência para o ensino-aprendizagem de PLE

Dissertação (mestrado)—Universidade de Brasília, Departamento de Línguas Estrangeiras e Tradução, Programa de Pós-Graduação em Linguística Aplicada, 2016.

Calidad del sueño y rendimiento académico en estudiantes de medicina de la Universidad de Cuenca marzo- agosto 2015

Antecedentes: La mala calidad del sueño en los estudiantes de medicina debido a sus horarios de estudio, turnos, carga académica, estrés emocional y académico, repercute en su salud física y mental. Estudios previos han demostrado la existencia de una relación entre la mala calidad del sueño y un menor rendimiento académico. Objetivo General: Caracterizar la calidad del sueño y su relación con el rendimiento académico en los estudiantes de medicina de la Universidad de Cuenca durante el periodo lectivo Marzo- Agosto 2015. Metodología: Se realizó un estudio transversal a partir de una muestra de 246 estudiantes de medicina seleccionada mediante conglomerados al azar simple. Participaron 244 estudiantes, tras aplicar criterios de exclusión Se utilizó el ICSP para valorar la calidad del sueño y se obtuvo el promedio global de notas del último bimensual. Se buscó relación entre calidad de sueño y rendimiento escolar a través del cálculo de p, OR e IC. Conclusiones: La prevalencia de mala calidad del sueño fue de 66,2%; siendo más frecuente en el sexo femenino (71%). De los estudiantes con un rendimiento académico “Bueno”, el 67% tienen una mala calidad del sueño. Por lo tanto no se encontró una asociación estadísticamente significativa entre la calidad del sueño y el rendimiento académico. Resultados: Se logró obtener una visión general de la prevalencia de la calidad del sueño de los estudiantes de nuestra universidad, y su relación con el rendimiento académico de los mismos. La importancia de este estudio radica en que existen pocos estudios y datos del tema en nuestro país

Análise do provimento de médicos em municípios participantes do programa mais médicos entre 2013 e 2014

Dissertação (mestrado)—Universidade de Brasília, Faculdade de Ciências da Saúde, Programa de Pós-Graduação em Saúde Coletiva, 2016.

Eutrofização e capacidade de carga de fósforo de seis reservatórios a bacia do Rio Seridó, região semi-árida do Estado do RN

The eutrofization is a natural process of accumulation of nutrients in aquatic´s body that it has been accelerated for the human´s actives, mainly the related with the activities of camp, industrial and the inadequate disposition of the domestic sewage. The enrichment of the aquatic´s body with nutrients, mainly the nitrogen and the phosphorus, and the consequent proliferation of algae and Cyanobacteria can commit the quality of the water for the public provisioning, for the fish farming and for other ends. The problem becomes more critical when there is a shortage of water naturally as in the semi-arid area of the Brazilian northeast. Before that problem this work had as objective evaluates the trophic state of six reservoirs of the basin of River Seridó of Rio Grande of Norte and also estimate the capacity of load of match of the reservoir and risk probabilities based on the established limits by the resolution Conama 357/05. The results demonstrate that the six reservoirs are eutrofization, with concentration of total phosphorus and cloro a in the water upster to 50 e 12 μg l-1. The results show that space homogeneity exists in the state trophic of the reservoirs, but a significant variation interanual in function of the increase of the concentrations of nutrients and decrease of the transparency of the water with the reduction of the body of water accumulated in the reservoirs.The results of the simulation risk estocastic show that the reservoirs could receive annually from 72 to 216 Kg of P, assuming a risk of 10% of increasing in more than 30 μg l-1 the annual medium concentrations of total match in the water of these reservoirs. This load could be high in until 360 kg of P a year in case the managers assume a risk of 10% of increasing in more than 50 μg l-1 the annual medium concentrations of total phosphorus in the waters of these reservoirs

Agroindustria rural, acción colectiva y SIALES: ¿Desarrollo o lucha contra la pobreza?

El desarrollo y reforzamiento de los sistemas agroalimentarios localizados, conjuntos de pequeñas unidades de agroindustria rural, pueden considerarse como un medio importante de reducción de la pobreza en las regiones rurales de América Latina.   Sin embargo, la validez de tal propuesta tiene que ser valorada, teniendo en cuenta los siguientes elementos: La dinámica de los SIALES radica en procesos de activación de recursos específicos, que son productos de la acción colectiva. Forman parte de cadenas con una gobernabilidad caracterizada por el dominio de actores de debajo de la cadena, tal como las grandes distribuidoras. La pobreza no se define únicamente por la falta de recursos monetarios, sino también por la falta de capacidades.   La eficacia de la acción colectiva de activación de los recursos específicos yace en la capacidad de control de estos recursos por parte de los actores involucrados, hasta con el diseño de dispositivos de exclusión acerca de ellos, lo que puede con llevar la marginalización de otros actores. Es una necesidad tanto más apremiante cuanto más ubica el SIAL en un contexto de mercado globalizado. El caso de las señales de calidad basadas en el origen territorial de los productos lo ilustra. Por otra parte, la dinámica de los SIALES puede conllevar a profundizar las capacidades, especialmente a través de procesos de aprendizaje. Las políticas públicas pueden reforzar el proceso, proporcionando bienes públicos y fomentando procesos participativos a nivel local.   Al final el desarrollo de los SIALES no constituye de por sí una garantía de reducción de las desigualdades, pero refuerza las capacidades y además es un tipo de cambio estructural, de los que se suelen asociar con la noción de desarrollo.   ABSTRACT The development of Local agri-food systems (LAS), as clusters of small rural food-processing units, can be seen as a powerful means of poverty alleviation in rural areas of Latin America.   The relevance of such a statement must, nevertheless, be assessed in the light of the following elements: LAS dynamics rest on activation processes of specific resources, as a result of collective action. LAS are part of commodity chains whose governance is characterized by the domination of downstream actors such as large retailers. Poverty does not only refer to the shortage of monetary income, but also to the absence of capacities.   The efficiency of collective action involved in the activation process of specific resources depends on the capacity of relevant actors to control the access. As a result, other actors can be cast aside in the process. It is true that these resources must be valorized in a globalized market. The case of quality signals based on geographical origin can be an example of that. On the other side, LAS dynamics can boost the development of capacities, particularly by promoting learning by doing. Public policies can channel tis process by delivering public goods and promoting participation at a local level.   All in all, the development of LAS is not per se a guarantee against the deepening of inequality. But it is a capacity-building factor and entails structural changes which are yhe essence of development processes.

Ecologia alimentar de aves insetívoras de um fragmento de mata decídua do extremo norte da Mata Atlântica

The diet study of birds has contributed historically as a model for use to understanding ecological patterns and strategies used by several other groups of vertebrates, which are observed in season patterns and temporal availability of resources, and other. This study has as objective generate information concerning the diet of insectivorous birds during rainy season and dry season, as well as analyze Index food importance, niche overlap, niche breadth, electivity, and seasonal availability of prey. The study was conducted in a fragment of about 270 ha (center coordinates and 5 º 53'S 35 ° 23'W). The sampling of birds occurred between March 2008 and December 2009 in three pre-established trails. Catches of birds were performed using 10 mist nets placed in line, where each trails was sampled once a month. Samples of pellets were obtained by means of tartar emetic. Sampling of availability of prey occurred between February 2009 to December 2009. We used two methods of sampling (pitfall traps and Shake cloths). We captured 269 individuals of 21 species of insectivorous birds. We collected 4116 invertebrates of which 3259 in the rainy season and 857 in the dry season. We obtained 174 samples stomach, where 10 species were exclusively insectivorous diet, nine fed on insect/plant material, an insect/plant material/vertebrate and one for insect/vertebrate. During the rainy season was observing difference between the consumption of items with higher food importance. The Coleoptera was item with higher food importance (73%), followed by Formicidae (7%) and Araneae (6%). During the dry season, no difference was found difference between the consumption of items with higher food importance. The Coleoptera was item with higher food importance (34%), followed by seeds (29%) and Formicidae (18%). The highest levels of niche overlap occurred during the rainy season, while the dry season was characterized by high levels of niche 11 segregation. This indicates that the local insectivorous birds community was structured differently between periods. No was found correlation between the values of niche breadth to the mean weight of the body size. We observed seasonal patterns in prey availability, with the peak availability of invertebrates observed seasonal patterns in rainy season. The insectivorous birds selected the same species richness during both periods, showing a specialized diet. Thamnophilus pelzelni was the only species that had their diet influenced by seasonality. Regarding the overall diet of insectivorous birds, observed a high consumption of prey, whose food availability caused the birds could invest and increase their food resources

A hybrid localization approach in 3D wireless sensor network

Location information acquisition is crucial for many wireless sensor network (WSN) applications. While existing localization approaches mainly focus on 2D plane, the emerging 3D localization brings WSNs closer to reality with much enhanced accuracy. Two types of 3D localization algorithms are mainly used in localization application: the range-based localization and the range-free localization. The range-based localization algorithm has strict requirements on hardware and therefore is costly to implement in practice. The range-free localization algorithm reduces the hardware cost but at the expense of low localization accuracy. On addressing the shortage of both algorithms, in this paper, we develop a novel hybrid localization scheme, which utilizes the range-based attribute RSSI and the range-free attribute hopsize, to achieve accurate yet low-cost 3D localization. As anchor node deployment strategy plays an important role in improving the localization accuracy, an anchor node configuration scheme is also developed in this work by utilizing the MIS (maximal independent set) of a network. With proper anchor node configuration and propagation model selection, using simulations, we show that our proposed algorithm improves the localization accuracy by 38.9% compared with 3D DV-HOP and 52.7% compared with 3D centroid.

Living and deceased organ donation should be financially neutral acts

The supply of organs—particularly kidneys—donated by living and deceased donors falls short of the number of patients added annually to transplant waiting lists in the United States. To remedy this problem, a number of prominent physicians, ethicists, economists and others have mounted a campaign to suspend the prohibitions in the National Organ Transplant Act of 1984 (NOTA) on the buying and selling of organs. The argument that providing financial benefits would incentivize enough people to part with a kidney (or a portion of a liver) to clear the waiting lists is flawed. This commentary marshals arguments against the claim that the shortage of donor organs would best be overcome by providing financial incentives for donation. We can increase the number of organs available for transplantation by removing all financial disincentives that deter unpaid living or deceased kidney donation. These disincentives include a range of burdens, such as the costs of travel and lodging for medical evaluation and surgery, lost wages, and the expense of dependent care during the period of organ removal and recuperation. Organ donation should remain an act that is financially neutral for donors, neither imposing financial burdens nor enriching them monetarily.

Sisyphus and self-management : the chronic condition self-management paradox

Chronic condition self-management is promoted internationally as not only a possible solution to the health problems of our increasingly chronically ill and ageing population, but as part of a new wave of consumer-led and volunteer-managed health care initiatives. Consumers are now indicating that they want to be more involved in the management of their lives and their health care options, while, especially in rural and smaller communities in Australia, a shortage of clinicians means that health care is rapidly changing. This emphasis on self-management raises crucial questions about where consumer action and control in health care should end and where clinical and medical intervention might begin. Hence, as in the case of Sisyphus and his rock, the self-management process is a difficult and demanding one that poses major challenges and loads for health system reformers and represents a struggle in which new difficulties are constantly emerging. This paper examines some implications of new self-management approaches to chronic illness from an ideological perspective and highlights key elements that underpin the effort to promote health-related lifestyle change. While peer-led self-management programs may assist certain individuals to live engaged and meaningful lives, the essential social and economic determinants of health and wellbeing mean that these programs are not the answer to our urgent need for major reform in the health care arena. Rather, self-management, from an ideological perspective, represents a minor adjustment to the fabric of our health system.