Usefulness of B-type natriuretic peptide in hypertensive patients with exertional dyspnea and normal left ventricular ejection fraction and correlation with new echocardiographic indexes of systolic and diastolic function

B-type natriuretic peptide (BNP) levels increase in systolic heart failure (HF). However, the value of BNP in hypertensive patients with suspected diastolic HF (symptoms suggestive of HF but normal ejection fraction) and its relation to myocardial function in these patients is unclear. We prospectively studied 72 ambulatory hypertensive subjects (40 women, mean age 58 +/- 8 years) with exertional dyspnea and ejection fraction greater than or equal to50%. Diastolic function was evaluated with transmitral and pulmonary venous Doppler, mitral annular velocities (pulsed-wave tissue Doppler), and flow propagation velocity (color M-mode). Systolic function was assessed with strain and strain rate derived from color tissue Doppler imaging. BNP was related to myocardial function and the presence or absence of global diastolic dysfunction. By conventional Doppler criteria, 34 patients had normal left ventricular diastolic function and 38 had isolated diastolic dysfunction. BNP values were higher in patients with diastolic dysfunction (46 +/- 48 vs 20 +/- 20 pg/ml, p = 0.004) and were related independently to blood pressure, systolic strain rate, left atrial function (p < 0.01 for all), and age (p = 0.015). Patients with diastolic dysfunction and pseudonormal filling had higher BNP levels compared with impaired relaxation (89 +/- 47 vs 35 +/- 42 pg/ml, p = 0.001). However, 79% of patients with diastolic dysfunction had BNP levels within the normal range. We conclude that in ambulatory hypertensive patients with symptoms suggestive of mild HF and normal ejection fraction, BNP is related to atrial and ventricular systolic parameters, blood pressure, and age. Although elevated in the presence of diastolic dysfunction, the BNP level mostly is in the normal range and, therefore, has limited diagnostic value in stable patients with suspected diastolic HF. (C) 2003 by Excerpta Medica, Inc.

Usefulness of quantitative echocardiographic techniques to predict recovery of regional and global left ventricular function after acute myocardial infarction

The left ventricular response to dobutamine may be quantified using tissue Doppler measurement of myocardial velocity or displacement or 3-dimensional echocardiography to measure ventricular volume and ejection fraction. This study sought to explore the accuracy of these methods for predicting segmental and global responses to therapy. Standard dobutamine and 3-dimensional echocardiography were performed in 92 consecutive patients with abnormal left ventricular function at rest. Recovery of function was defined by comparison with follow-up echocardiography at rest 5 months later. Segments that showed improved regional function at follow-up showed a higher increment in peak tissue Doppler velocity with dobutamine therapy than in nonviable segments (1.2 +/- 0.4 vs 0.3 +/- 0.2 cm/s, p = 0.001). Similarly, patients who showed a > 5% improvement of ejection fraction at follow-up showed a greater displacement response to dobutamine (6.9 +/- 3.2 vs 2.1 +/- 2.3 mm, p = 0.001), as well as a higher rate of ejection fraction, response to dobutamine (9 +/- 3% vs 2 +/- 2%, p = 0.001). The optimal cutoff values for predicting subsequent recovery of function at rest were an increment of peak velocity > 1 cm/s, >5 mm of displacement, and a >5% improvement of ejection fraction with low-dose dobutamine. (C) 2003 by Excerpta Medica, Inc.

Differences in lung function, growth parameters and frequency of hospital admissions between adolescents with cystic fibrosis-related diabetes and controls

As survival of patients with CF increases,glucose intolerance and cystic fibrosisrelated diabetes (CFRD),ar e increasingly recognised common complications. CFRD may be preceded by a pre-diabetic state. Using markers identified as being associated with CFRD may improve targeted screening. Aim: To identify features consistently predicting CFRD in paediatric patients. Patients diagnosed with CFRD between January 1997–January 2002 were compared with age and sex matched controls. Clinical,micr obiological, and hospitalisation data was collected at time of CFRD diagnosis,and at six monthly intervals for 3 yr prior to diagnosis. Eight patients with CFRD were identified,mean age 13.7 yr (S.D. 3.49) at time of diagnosis. Control patients underwent OGTT to ensure normal glucose tolerance. Patients with CFRD had a lower FEV1 up to 12 months prior to diagnosis however, this was only significant at diagnosis. There was no difference in weight and height z scores between the 2 groups; however,the decrease in weight and height z scores in the CFRD group over 3 yr prior to diagnosis was significant. Mean number of days in hospital and admissions per patient significantly increased in the CFRD group,6 months prior to diagnosis. No other significant differences were observed between the 2 groups. Conclusions: This study has shown a difference in lung function,gr owth parameters and frequency of hospital admissions between patients with CFRD and controls. These differences may be utilised as tools for targeted screening in the paediatricyadolescent population. Further larger scale studies are required to improve guidelines for targeted screening in this population.

Alterations of neocortical pyramidal cell phenotype in the Ts65Dn mouse model of Down syndrome: Effects of environmental enrichment

Mental retardation in individuals with Down syndrome (DS) is thought to result from anomalous development and function of the brain; however, the underlying neuropathological processes have yet to be determined. Early implementation of special care programs result in limited, and temporary, cognitive improvements in DS individuals. In the present study, we investigated the possible neural correlates of these limited improvements. More specifically, we studied cortical pyramidal cells in the frontal cortex of Ts65Dn mice, a partial trisomy of murine chromosome 16 (MMU16) model characterized by cognitive deficits, hyperactivity, behavioral disruption and reduced attention levels similar to those observed in DS, and their control littermates. Animals were raised either in a standard or in an enriched environment. Environmental enrichment had a marked effect on pyramidal cell structure in control animals. Pyramidal cells in environmentally enriched control animals were significantly more branched and more spinous than non-enriched controls. However, environmental enrichment had little effect on pyramidal cell structure in Ts65Dn mice. As each dendritic spine receives at least one excitatory input, differences in the number of spines found in the dendritic arbors of pyramidal cells in the two groups reflect differences in the number of excitatory inputs they receive and, consequently, complexity in cortical circuitry. The present results suggest that behavioral deficits demonstrated in the Ts65Dn model could be attributed to abnormal circuit development.

Conformational changes in SP-B as a function of surface pressure

X-ray reflectivity of bovine and sheep surfactant-associated protein B (SP-B) monolayers is used in conjunction with pressure-area isotherms and protein models to suggest that the protein undergoes changes in its tertiary structure at the air/water interface under the influence of surface pressure, indicating the likely importance of such changes to the phenomena of protein squeeze out as well as lipid exchange between the air-water interface and subphase structures. We describe an algorithm based on the well-established box- or layer-models that greatly assists the fitting of such unknown scattering-length density profiles, and which takes the available instrumental resolution into account. Scattering-length density profiles from neutron reflectivity of bovine SP-B monolayers on aqueous subphases are shown to be consistent with the exchange of a large number of labile protons as well as the inclusion of a significant amount of water, which is partly squeezed out of the protein monolayer at elevated surface pressures.

Cortex, cognition and the cell: New insights into the pyramidal neuron and prefrontal function

Arguably the most complex conical functions are seated in human cognition, the how and why of which have been debated for centuries by theologians, philosophers and scientists alike. In his best-selling book, An Astonishing Hypothesis: A Scientific Search for the Soul, Francis Crick refined the view that these qualities are determined solely by cortical cells and circuitry. Put simply, cognition is nothing more, or less, than a biological function. Accepting this to be the case, it should be possible to identify the mechanisms that subserve cognitive processing. Since the pioneering studies of Lorent de No and Hebb, and the more recent studies of Fuster, Miller and Goldman-Rakic, to mention but a few, much attention has been focused on the role of persistent neural activity in cognitive processes. Application of modern technologies and modelling techniques has led to new hypotheses about the mechanisms of persistent activity. Here I focus on how regional variations in the pyramidal cell phenotype may determine the complexity of cortical circuitry and, in turn, influence neural activity. Data obtained from thousands of individually injected pyramidal cells in sensory, motor, association and executive cortex reveal marked differences in the numbers of putative excitatory inputs received by these cells. Pyramidal cells in prefrontal cortex have, on average, up to 23 times more dendritic spines than those in the primary visual area. I propose that without these specializations in the structure of pyramidal cells, and the circuits they form, human cognitive processing would not have evolved to its present state. I also present data from both New World and Old World monkeys that show varying degrees of complexity in the pyramidal cell phenotype in their prefrontal cortices, suggesting that cortical circuitry and, thus, cognitive styles are evolving independently in different species.

A review of drainage and spontaneous rupture in free standing thin films with tangentially immobile interfaces

A review of spontaneous rupture in thin films with tangentially immobile interfaces is presented that emphasizes the theoretical developments of film drainage and corrugation growth through the linearization of lubrication theory in a cylindrical geometry. Spontaneous rupture occurs when corrugations from adjacent interfaces become unstable and grow to a critical thickness. A corrugated interface is composed of a number of waveforms and each waveform becomes unstable at a unique transition thickness. The onset of instability occurs at the maximum transition thickness, and it is shown that only upper and lower bounds of this thickness can be predicted from linear stability analysis. The upper bound is equivalent to the Freakel criterion and is obtained from the zeroth order approximation of the H-3 term in the evolution equation. This criterion is determined solely by the film radius, interfacial tension and Hamaker constant. The lower bound is obtained from the first order approximation of the H-3 term in the evolution equation and is dependent on the film thinning velocity A semi-empirical equation, referred to as the MTR equation, is obtained by combining the drainage theory of Manev et al. [J. Dispersion Sci. Technol., 18 (1997) 769] and the experimental measurements of Radoev et al. [J. Colloid Interface Sci. 95 (1983) 254] and is shown to provide accurate predictions of film thinning velocity near the critical thickness of rupture. The MTR equation permits the prediction of the lower bound of the maximum transition thickness based entirely on film radius, Plateau border radius, interfacial tension, temperature and Hamaker constant. The MTR equation extrapolates to Reynolds equation under conditions when the Plateau border pressure is small, which provides a lower bound for the maximum transition thickness that is equivalent to the criterion of Gumerman and Homsy [Chem. Eng. Commun. 2 (1975) 27]. The relative accuracy of either bound is thought to be dependent on the amplitude of the hydrodynamic corrugations, and a semiempirical correlation is also obtained that permits the amplitude to be calculated as a function of the upper and lower bound of the maximum transition thickness. The relationship between the evolving theoretical developments is demonstrated by three film thickness master curves, which reduce to simple analytical expressions under limiting conditions when the drainage pressure drop is controlled by either the Plateau border capillary pressure or the van der Waals disjoining pressure. The master curves simplify solution of the various theoretical predictions enormously over the entire range of the linear approximation. Finally, it is shown that when the Frenkel criterion is used to assess film stability, recent studies reach conclusions that are contrary to the relevance of spontaneous rupture as a cell-opening mechanism in foams. (C) 2003 Elsevier Science B.V. All rights reserved.

Speleothem U-series dating of semi-synchronous climate oscillations during the last deglaciation

Evidence for nearly synchronous climate oscillations during the last deglaciation has been found throughout the Northern Hemisphere but few records are based on independent time scales of calendar years. We present a rare uranium-series dated oxygen-carbon isotope record for a speleothem from Tangshan Cave, China, which demonstrates that abrupt deglacial climatic oscillations from 16 800 to 10 500 yr BP are semi-synchronous with those found in Greenland ice core records. Relatively rapid shifts in speleothem oxygen isotope ratios demonstrate that the intensity of the East Asian monsoon switched in parallel with the abrupt transitions separating the Bolling-Allerod, Younger Dryas, and pre-Boreal climatic reversals. However, the dated isotopic transitions appear to have lasted longer. Our results demonstrate the dominant role of atmospheric teleconnections in the rapid propagation of deglacial climatic signals on a hemispheric scale, and highlight the importance of U-series dated speleothems in the timing and characterization of abrupt climate change. (C) 2003 Elsevier B.V. All rights reserved.

Utiliza????o do QFD: Quality Function Deployment como ferramenta de planejamento

A utiliza????o da matriz do QFD (em portugu??s, Desdobramento da Fun????o Qualidade) como entrada para o planejamento estrat??gico regional solidificou o entendimento da Diretoria Regional sobre as expectativas dos clientes ante seus principais processos, avaliados por meio de pesquisa externa realizada bianualmente. Direcionou as a????es a serem tomadas por meio da prioriza????o, da tradu????o e do desdobramento dos requisitos mais importantes para os clientes em todos os n??veis dos processos, alinhando essas a????es com as estrat??gias, a pol??tica da qualidade e o or??amento. Da mesma forma, serviu para estabelecer metas globais de satisfa????o por segmento, de forma mais estruturada, sistematizando a avalia????o dos resultados e focando sempre a satisfa????o dos clientes cujos resultados j?? se comprovaram: ??ndice de 8,6 em 2000 para 9,2 em 2004

Conselhos municipais de pol??ticas p??blicas: uma an??lise explorat??ria

Os Conselhos Gestores s??o f??runs h??bridos onde se viabiliza a participa????o popular no desenho das pol??ticas p??blicas, nas negocia????es de interesses da coletividade, na elabora????o de programas e projetos sociais e na fiscaliza????o das a????es governamentais. O significado e a dimens??o dos Conselhos para a democracia participativa s??o enormes, justificando a import??ncia da realiza????o deste estudo, que se baseou na an??lise explorat??ria de 12 Conselhos locais do munic??pio mineiro de Vi??osa, com o objetivo de avaliar o desempenho dos mesmos. A avalia????o do desempenho levou em considera????o os mesmos par??metros dimensionais, tanto para a coleta de dados prim??rios quanto para a coleta secund??ria. A coleta de dados prim??rios foi realizada a partir da aplica????o de question??rios semi-estruturados aos presidentes dos Conselhos em an??lise. Utilizou-se o programa SPSS, vers??o 15.0, para an??lise estat??stica das quest??es objetivas dos question??rios e a t??cnica de an??lise de conte??do para exame das quest??es abertas. Ap??s essa etapa, realizou-se um workshop com os presidentes dos Conselhos, visando ?? obten????o de novos dados e informa????es. Os Conselhos municipais analisados apresentaram resultados pouco discrepantes entre a teoria aplicada ao tema e a sua efetiva pr??tica no campo p??blico. Contudo, a pesquisa revelou que o grau de desenvolvimento institucional dos Conselhos n??o ?? homog??neo, ou seja, h?? alguns melhores gestores que outros. A escolha independente e democr??tica dos membros n??o-governamentais dos Conselhos em Vi??osa revelou o seu grau de independ??ncia do Poder Executivo. Por??m, a capacita????o de conselheiros precisa ser implementada para evitar uma desfigura????o dos Conselhos. No que tange ?? governan??a, destacouse em Vi??osa o seu grau e formas de aplicabilidade observadas na gest??o de v??rias pol??ticas. Da mesma forma, foi observado um n??vel de governabilidade que confere legitimidade ??s pol??ticas implementadas. Por fim, verificou-se que a efetividade da accountability societal tem sido instrumentalizada pelos Conselhos no ??mbito das diversas pol??ticas setoriais. J?? os dados secund??rios da an??lise foram obtidos por meio das s??nteses dos relat??rios de fiscaliza????o de munic??pios do Estado de Minas Gerais, realizadas pela Controladoria Geral da Uni??o. Foram identificados todos os registros pertinentes aos Conselhos Gestores Municipais do Estado de Minas Gerais, no per??odo de 2003 a 2006. Verificou-se que os maiores problemas se referem aos Conselhos Municipais de Sa??de e Assist??ncia Social. Entre as in??meras falhas apontadas, destacam-se problemas graves na constitui????o e operacionaliza????o dos Conselhos, resultando na inoper??ncia desses mecanismos nos munic??pios fiscalizados. A avalia????o do desempenho dos Conselhos locais de Vi??osa possibilitou concluir que esses mecanismos apresentaram um desempenho bem satisfat??rio na gest??o e controle das pol??ticas p??blicas no munic??pio.

Intraempreendedorismo e a inova????o na gest??o p??blica federal

O objetivo deste artigo ?? apresentar tr??s a????es empreendedoras em organiza????es p??blicas premiadas pela ENAP no concurso Inova????o na Gest??o P??blica Federal. A partir da revis??o de literatura e estudo de caso, ser??o confrontados os diversos tipos e modelos de processos de inova????o, para identificar as dificuldades apontadas e as solu????es adotadas nas a????es premiadas. Foram selecionados tr??s casos de iniciativas inovadoras no INSS, apontando a origem, caracter??sticas, amplitude e o modelo do processo. Nosso quadro te??rico de refer??ncia est?? estruturado no sentido de aprofundar a percep????o, bem como nos dar condi????es de comparar alguns estudos e apontar lacunas, se existentes. A pesquisa foi realizada por meio de metodologia qualitativa, explorat??ria e adotando a estrat??gia de investiga????o do estudo de caso. A revis??o de literatura teve como objetivo identificar o que se encontra dispon??vel em livros, artigos, teses e, inclusive, experi??ncias. A conclus??o alcan??ada no artigo ?? a de que, apesar dos alegados entraves e limita????es, o intraempreendedorismo se faz presente nas organiza????es p??blicas e vem crescentemente sendo adotado pelas chefias ou mesmo por funcion??rios sem nenhum tipo de fun????o comissionada, como relatado em um dos casos. A inova????o nas organiza????es p??blicas, representada pelo intraempreendedorismo das experi??ncias premiadas pelo concurso, confirma nosso quadro te??rico na medida em que a????es empreendedoras geradoras de inova????o se fazem presentes nas organiza????es p??blicas, em todos os seus processos e meios.

An analysis of helium primordial nucleosynthesis with a variable cosmological coupling

The synthesis of helium in the early Universe depends on many input parameters, including the value of the gravitational coupling during the period when the nucleosynthesis takes place. We compute the primordial abundance of helium as function of the gravitational coupling, using a semi-analytical method, in order to track the influence of G in the primordial nucleosynthesis. To be specific, we construct a cosmological model with varying G, using the Brans-Dicke theory. The greater the value of G at nucleosynthesis period, the greater the predicted abundance of helium. Using the observational data for the abundance of primordial helium, constraints for the time variation of G are established.

Mecanismos de governança corporativa na pequena empresa familiar

Esta dissertação tem como objetivo descrever e analisar como o fenômeno da governança corporativa articula mecanismos de gestão e impacta na dinâmica de uma pequena organização familiar. Para isso, utilizou-se as perspectivas de Fan (2001) e Silva Junior (2006), que tratam da governança corporativa, e de Chandler (1994), para empresas familiares. Através de abordagem qualitativa com ênfase em um estudo de caso, uma triangulação de dados foi realizada, utilizando a entrevista semiestruturada, observação assistemática ou livre e pesquisa de documentos, e a análise dos dados foi realizada por análise de conteúdo. Verificou-se a presença do fenômeno da governança por intermédio da identificação dos fatores de diferenciação, resultando na implantação de mecanismos de governança ao longo do ciclo de vida da organização familiar, o que possibilitou mudanças em seu controle, no seu processo sucessório e na sua profissionalização. Quanto ao controle, foram verificados que os mecanismos de “manutenção do status quo”, “aconselhamento profissional”, “sinergia de interesses”, “regulamentação financeira da sociedade”, “atribuições e responsabilidades”, “alinhamento de interesses do negócio” e “proteção do empreendimento familiar” possibilitaram a modificação e manutenção do controle da empresa com os sócios. Quanto ao eixo da profissionalização, foi verificado que os mecanismos de “regulamentação financeira da sociedade”, “atribuições e responsabilidades”, “alinhamento de interesses do negócio”, “proteção do empreendimento familiar” e “atenção aos interesses dos stakeholders” foram responsáveis por prover as modificações neste quesito e indicar que a empresa caminha no sentido de se profissionalizar. Quanto ao processo sucessório, verificou-se que a terceira geração não tem interesse na empresa, o que podem resultar na contratação de um profissional externo para gerir a mesma, respeitando a questão dos valores familiares e a cultura organizacional ou conduzir à sucessão recursiva. Aparentemente, observou-se que a segunda questão foi mais evidente, visto que a saída do último irmão do negócio culmina com a venda da empresa familiar, gerando duas alternativas: a compra da empresa por um grupo de sócios ou outra empresa não familiar, o que resultaria na “morte” da empresa enquanto empresa familiar; ou a sua compra por outra família ou empresa familiar, preservando sua classificação inicial.

Lucidez-Embriaguez, movimento e arrebatamento: homens,(Semi)deuses que perambulam e a educação menor num bairro de uma rede municipal

A tese afirma a vida por meio das biopotências que se manifestam em movimentações invisíveis aos olhos acostumados a permitir o ver, o julgar e o falar. Foca o tempo presente, na comunicação em redes, traz em si a potência de reatar a multidão, com a capacidade de sondar possibilidades mostrando o que antes parecia opaco e impossível. Perambular é ligar nas redes quentes de um bairro com/no/do território ao privilegiar o movimento, o processo, sempre caminhando pelas vias e conexões abertas, aposta estética-ética-política nos paradoxos sem superação e não hierarquizados. Toma como método de pesquisa-intervenção elementos de uma cartografia de movimentos e devires, traçando um perambular rizomático em que são problematizados a constituição do problema de pesquisa, que considera a construção do conhecimento diversificada, descentralizada e horizontalizada. Problematiza as práticas discursivas de si em suas relações com a biopolítica, a governabilidade e a biopolítica das populações. O que está(rá) rolando nesse bairro, no que foi chamado de criança, adolescente, escola, compor para que as coisas apareçam, junto com outros que vivem a loucura em duplas e trios. A tese é a possibilidade da existência de uma educação menor na periferia para as populações marginalizadas, muçulmanizadas. Educação menor, da sala de aula, do bairro, do cotidiano de professores, familiares e alunos. Educação que permite revolucionários, na medida em que alguma revolução ainda faz sentido na educação nesses dias. A educação menor constitui-se, assim, num empreendimento de militância, de professores militantes. Plano das afecções em que não há unidades, apenas intensidade. A tese fala do processo, de como reproduzir, ou não, os modos de subjetividade dominante, não se trata de medidas - "menor" ou "pequeno". Nesse sentido, é preciso considerar os efeitos de produção de subjetividade e a incorporação dos fatos à própria vida. A tese analisa movimentos instituintes buscando reconhecê-los em sua natureza contestatória e transgressora e ter conhecimento de como se organiza na escola e muito além dela. Discutindo a produtividade dessa coreografia do perambular, esboçamos movimentos que denominamos: estradas que levam a nada, além muro