Analgesia e sedação durante a instalação do cateter central de inserção periférica em neonatos

Objetivou-se caracterizar as estratégias de analgesia e sedação em neonatos submetidos à instalação do cateter central de inserção periférica (CCIP) e relacioná-las ao número de punções venosas, duração do procedimento e posicionamento da ponta do cateter. Estudo transversal com coleta prospectiva de dados, realizado em uma unidade de cuidados intensivos neonatais de um hospital privado na cidade de São Paulo, no período de 31 de agosto de 2010 a 01 de julho de 2011, em que foram avaliadas 254 inserções do CCIP. A adoção de estratégias analgésicas ou sedativas ocorreu em 88 (34,6%) instalações do cateter e não esteve relacionada ao número de punções venosas, duração do procedimento ou posicionamento da ponta do cateter. As estratégias mais frequentes foram a administração endovenosa de midazolam em 47 (18,5%) e fentanil em 19 (7,3%) inserções do cateter. Recomenda-se maior adoção de estratégias analgésicas antes, durante e após o procedimento.

Special Investigation of the Central Iowa Fair, For the Period July 1, 2004 through September 30, 2006

Other Audit Reports - Special Investigation

Central Iowa Juvenile Detention Center, Independent Auditor's Reports, Financial Statement and Required Supplementary Information, Schedule of Findings, June 30, 2006

Other Audit Reports - 28E Organization

Câmaras coloniais e poder central: uma relação directa privilegiada

Toda a história colonial de Cabo Verde está marcada pela acção e protagonismo do poder local. Este protagonismo é acentuado ou atenuado dependendo do poder económico, social e militar da elite que representa esse poder. O poder local em Cabo Verde foi ocupado durante os séculos XVI, XVII e XVIII por três elites diferentes na sua composição social, económica e rácica. A primeira elite (século XVI) — reinol, nobre, urbana, cosmopolita, armadora, proprietária rural — era uma ramificação da elite portuguesa, que se aventurara e se instalara no arquipélago, recém-descoberto, para comerciar em segurança, com o continente fronteiro. Foi ela que construiu a Ribeira Grande, primeira cidade lusa dos trópicos, e que a tornou em uma das escalas mais procuradas no Atlântico nesse período.

c-Cbl expression levels regulate the functional responses of human central and effector memory CD4 T cells.

The biochemical mechanisms controlling the diverse functional outcomes of human central memory (CM) and effector memory (EM) T-cell responses triggered through the T-cell receptor (TCR) remain poorly understood. We implemented reverse phase protein arrays to profile TCR signaling components in human CD8 and CD4 memory T-cell subsets isolated ex vivo. As compared with CD4 CM cells, EM cells express statistically significant increased amounts of SLP-76 and reduced levels of c-Cbl, Syk, Fyn, and LAT. Moreover, in EM cells reduced expression of negative regulator c-Cbl correlates with expression of c-Cbl kinases (Syk and Fyn), PI3K, and LAT. Importantly, consistent with reduced expression of c-Cbl, EM cells display a lower functional threshold than CM cells. Increasing c-Cbl content of EM cells to the same level as that of CM cells using cytosolic transduction, we impaired their proliferation and cytokine production. This regulatory mechanism depends primarily on c-Cbl E3 ubiquitin ligase activity as evidenced by the weaker impact of enzymatically deficient c-Cbl C381A mutant on EM cell functions. Our study reports c-Cbl as a critical regulator of the functional responses of memory T cell subsets and identifies for the first time in humans a mechanism controlling the functional heterogeneity of memory CD4 cells.

Report on a special investigation of programs administered by the Central Iowa Employment and Training Consortium (CIETC) and Iowa Workforce Development (IWD) for the period July 1, 2003 through December 15, 2005

Report on a special investigation of programs administered by the Central Iowa Employment and Training Consortium (CIETC) and Iowa Workforce Development (IWD) for the period July 1, 2003 through December 15, 2005

Spirometry reference equations for central European populations from school age to old age.

BACKGROUND: Spirometry reference values are important for the interpretation of spirometry results. Reference values should be updated regularly, derived from a population as similar to the population for which they are to be used and span across all ages. Such spirometry reference equations are currently lacking for central European populations. OBJECTIVE: To develop spirometry reference equations for central European populations between 8 and 90 years of age. MATERIALS: We used data collected between January 1993 and December 2010 from a central European population. The data was modelled using "Generalized Additive Models for Location, Scale and Shape" (GAMLSS). RESULTS: The spirometry reference equations were derived from 118'891 individuals consisting of 60'624 (51%) females and 58'267 (49%) males. Altogether, there were 18'211 (15.3%) children under the age of 18 years. CONCLUSION: We developed spirometry reference equations for a central European population between 8 and 90 years of age that can be implemented in a wide range of clinical settings.

Blood pressure response to central and/or peripheral inhibition of phenylethanolamine N-methyltransferase in normotensive and hypertensive rats

We studied the effects on blood pressure and heart rate of two different phenylethanolamine N-methyltransferase (PNMT) inhibitors in normotensive, in two-kidney renal hypertensive, and in deoxycorticosterone-salt (DOC-salt) hypertensive rats. One compound (SK&F 64139) blocks the conversion of norepinephrine to epinephrine in both the central and the peripheral nervous system, whereas the other (SK&F 29661) does not cross the blood-brain barrier and therefore is active mostly in the adrenal glands. In the rats given SK&F 29661, practically no acute blood pressure changes were in the adrenal glands. In the rats given SK&F 64139 induced only a minor blood pressure and heart rate response in normotensive and two-kidney renal hypertensive rats. However, in DOC-salt hypertensive rats, it reduced arterial pressure to approximately normal levels and concomitantly slowed pulse rate. There was a close correlation between the magnitude of the blood pressure response observed in all SK&F 64139-treated animals and the control plasma norepinephrine (4 = -0.795, P less than 0.001) and epinephrine (r = -0.789, P less than 0.001) levels. These results suggest an important role for central epinephrine in regulating the peripheral sympathoadrenomedullary and the baroreceptor reflex activity, particularly when the maintenance of the high blood pressure is not renin-dependent.

Effectiveness of heparin versus 0.9% saline solution in maintaining the permeability of central venous catheters: a systematic review

Abstract OBJECTIVE Determining which is the most effective solution (heparin flush compared to 0.9% saline flush) for reducing the risk of occlusions in central venous catheters (CVC) in adults. METHOD The systematic review followed the principles proposed by the Cochrane Handbook; critical analysis, extraction and synthesis of data were performed by two independent researchers; statistical analysis was performed using the RevMan program 5.2.8. RESULTS Eight randomized controlled trials and one cohort study were included and the results of the meta-analysis showed no difference (RR=0.68, 95% CI=0.41-1.10; p=0.12). Analysis by subgroups showed that there was no difference in fully deployed CVC (RR=1.09, CI 95%=0.53-2.22;p=0.82); Multi-Lumen CVC showed beneficial effects in the heparin group (RR=0.53, CI 95%=0.29-0.95; p=0.03); in Double-Lumen CVC for hemodialysis (RR=1.18, CI 95%=0.08-17.82;p=0.90) and Peripherally inserted CVC (RR=0.14, CI 95%=0.01-2.60; p=0.19) also showed no difference. CONCLUSION Saline solution is sufficient for maintaining patency of the central venous catheter, preventing the risks associated with heparin administration.

Audit report on the South Central Iowa Regional E-911 Service Board for the year ended June 30, 2006

Audit report on the South Central Iowa Regional E-911 Service Board for the year ended June 30, 2006

Audit report on the Iowa Department of Human Services – Central Distribution Center for the year ended June 30, 2006

Audit report on the Iowa Department of Human Services – Central Distribution Center for the year ended June 30, 2006

Comunidade de formigas que nidificam em pequenos galhos da serrapilheira em floresta da Amazônia Central, Brasil

Community of ants that nest in dead twigs on the ground of Central Amazonian forest, Brazil. A total area of 2,880 m² in four forest sites, near Manaus, Brazil, was searched for ant colonies nesting in dead twigs on the ground. An amount of 3,706 twigs (0.5-5 cm in diameter) were gathered, of which only 623 (16.8%) had ants, which is equivalent to a density of 0.22 nests per m². Seventy species have been found. The predominant genera were Pheidole (Westwood), Crematogaster (Lund), and Solenopsis (Westwood). For most species, many of the nests found had only workers and brood, suggesting that colonies either use multiple twigs to nest or do not live exclusively in the twigs, using other types of substrate (e.g., leaf-litter, soil, fruit pods) to nest. Most colonized twigs were hollow or partially hollow inside and relatively easy to break apart. There were significant differences among species with respect to the size (diameter) of twig used as nest. No correlation was found between the number of twigs available and the number colonized by ants, suggesting that ant populations were not limited by the amount of nesting sites (twigs). The three most common Pheidole species had small colonies with less than 200 workers. Colony size was not related to twig size (volume), for any of these three species.

Distribuição de abundância e tamanho do corpo de invertebrados do folhiço em uma floresta de terra firme na Amazônia Central, Brasil

Abundace and body size distribution of invertebrates of leaf litter in Amazonian forest, Brazil. Based on 605 invertebrates sampled of the litter in an Amazonian Forest, some basic macroecological patterns for this assemblage were described. The relationship between abundance and body size, at logarithmic scale, was triangular, and the distribution of species was constrained in an asymmetric triangular envelope, that was tested using null model procedures in ECOSIM (P= 0,0002). The most abundant species were at an intermediated body size. The relationship between maximum abundance with different mean body size classes confirmed the Energetic Equivalent Rule (b = -1,069; t-0,75 = -2,13; P = 0.079). This way, species tend to consume energy from the community independent of their body size, since requirements are compensated by local population density.