Avaliação da consulta médica realizada por ingressantes na residência de Pediatria

Diversos autores relatam que a consulta médica se associa a melhores resultados quando se adota como referencial o modelo centrado no paciente. OBJETIVO: Avaliar se os médicos ingressantes na residência de Pediatria realizam consultas ambulatoriais segundo pressupostos do modelo centrado no paciente. MÉTODO: Em 2007, no início de seu estágio de ambulatório, dez residentes foram selecionados aleatoriamente para serem filmados durante a realização de uma consulta. Adotando-se como referencial teórico pressupostos do modelo centrado no paciente, os dados foram analisados por meio de metodologia qualitativa, por meio da técnica exploratória, com três juízes independentes. RESULTADOS: A maioria dos residentes explora precocemente a primeira queixa referida pelos pais, assumindo-a como principal; não explora outras queixas; decide e faz orientações terapêuticas de modo não compartilhado; conversa pouco com as crianças; cria longos momentos de silêncio durante a consulta; não explica o exame físico e às vezes utiliza o prontuário como a principal fonte de informação. CONCLUSÃO: Os residentes realizam consultas sem a inclusão da perspectiva dos pais e, portanto, não atendem segundo pressupostos do modelo centrado no paciente.

Weight of evidence

Evidence-based Medicine (EBM) has become a major source of medical knowledge. It handles complexities of virtually every method or technique used in research. The knowledge on how the EBM researcher retrieves information, judges for relevance and analyzes derived data is invaluable for the skillful reader of medical scientific reports.

Meat Quality of Lambs Fed on Palm Kernel Meal, a By-product of Biodiesel Production

This study aimed to establish the optimum level of palm kernel meal in the diet of Santa Ines lambs based on the sensorial characteristics and fatty acid profile of the meat. We used 32 lambs with a starting age of 4 to 6 months and mean weight of 22 2.75 kg, kept in individual stalls. The animals were fed with Tifton-85 hay and a concentrate mixed with 0.0, 6.5, 13.0 or 19.5% of palm kernel meal based on the dry mass of the complete diet. These levels formed the treatments. Confinement lasted 80 days and on the last day the animals were fasted and slaughtered. After slaughter, carcasses were weighed and sectioned longitudinally, along the median line, into two antimeres. Half-carcasses were then sliced between the 12th and 13th ribs to collect the loin (longissimus dorsi), which was used to determine the sensorial characteristics and fatty acid profile of the meat. For sensorial evaluation, samples of meat were given to 54 judges who evaluated the tenderness, juiciness, appearance, aroma and flavor of the meat using a hedonic scale. Fatty acids were determined by gas chromatography. The addition of palm kernel meal to the diet had no effect on the sensorial characteristics of meat juiciness, appearance, aroma or flavor. However, tenderness showed a quadratic relationship with the addition of the meal to the diet. The concentration of fatty acids C12:0, C14:0 and C16:0 increased with the addition of palm kernel meal, as did the sum of medium-chain fatty acids and the atherogenicity index. Up to of 19.5% of the diet of Santa Ines lambs can be made up of palm kernel meal without causing significant changes in sensorial characteristics. However, the fatty acid profile of the meat was altered.

Influence of storage temperature on cooling intensity of topical emulsions containing encapsulated menthol

The cooling intensity of topical emulsions added with encapsulated or free menthol was evaluated by a screened and trained panel recruited based on the American Society for Testing and Materials method. A sensory panel composed of 10 trained judges performed the evaluation of samples stored at 22 +/- 2C for 24 h and, after 28 days of storage, at 37.0 +/- 0.5C. The obtained data were analyzed by analysis of variance and Tukey`s test. The results showed an increase of cooling intensity as a function of encapsulated menthol concentration. The opposite was observed in samples added with free menthol, which may have caused sensory fatigue. Storage at 37 +/- 0.5C for 28 days had no impact on the cooling intensity of emulsions containing encapsulated menthol, demonstrating high stability and suggesting its application in cooling skin care products. In contrast, emulsions added with free menthol showed a drastic decrease of cooling intensity at 37 +/- 0.5C..

Teaching Psychodynamics to Psychiatric Residents through Psychiatric Outpatient Interviews

Objective: This study evaluates whether a course that was designed for first-year psychiatric residents and that specifically addressed psychodynamic principles fostered residents` progress in knowledge, skills, and attitudes regarding these concepts. Methods: The course was given in the 2005 academic year to all residents (N = 18) in their first psychiatric postgraduate year at the Department and Institute of Psychiatry, University of Sao Paulo, Brazil. The residents were assessed in the first and last sessions of the course through a written test that was blindly rated by two independent judges. Residents were also interviewed to observe whether psychodynamic concepts had been integrated into actual practice. Their responses were subjected to content analysis. Significance was tested using analysis of variance or nonparametric tests when necessary. Agreement between the judges was tested using intraclass correlation coefficients. Results: The judges demonstrated a high level of agreement. The difference in mean scores before and after the course was such that the total score increased by a mean of 2.5 points (total test score was 10 points). Additionally, residents started to undergo personal psychotherapy after the course. They reported that this course had markedly improved their relationship with patients. They emphasized the opportunities for self-reflection and gaining insights into themselves and patient treatment issues. Conclusion: This initial study indicates that this educational method can effectively promote psychodynamic knowledge, skills, and appropriate attitudes for managing psychiatric outpatients among residents. The course was very well received by the residents, and a similar method can easily be instituted within other residency programs that pursue integrated teaching methods.

The role of the church in developing the law

The church and other community organisations have a legitimate role to play in influencing public policy. However, intervention by the church and other religious bodies in recent litigation in Australia and the United Kingdom raises questions about the appropriateness of such bodies being permitted to intervene directly in the court process as amici curiae. We argue that there are dangers in such bodies insinuating their doctrine under the guise of legal argument in civil proceedings, but find it difficult to enunciate a principled distinction between doctrine and legal argument. We advise that judges should exercise caution in dealing with amicus submissions.

Perception or synthesized voice quality in connected speech by Cantonese speakers

Perceptual voice analysis is a subjective process. However, despite reports of varying degrees of intrajudge and interjudge reliability, it is widely used in clinical voice evaluation. One of the ways to improve the reliability of this procedure is to provide judges with signals as external standards so that comparison can be made in relation to these anchor signals. The present study used a Klatt speech synthesizer to create a set of speech signals with varying degree of three different voice qualities based on a Cantonese sentence. The primary objective of the study was to determine whether different abnormal voice qualities could be synthesized using the built-in synthesis parameters using a perceptual study. The second objective was to determine the relationship between acoustic characteristics of the synthesized signals and perceptual judgment. Twenty Cantonese-speaking speech pathologists with at least three years of clinical experience in perceptual voice evaluation were asked to undertake two tasks. The first was to decide whether the voice quality of the synthesized signals was normal or not. The second was to decide whether the abnormal signals should be described as rough, breathy, or vocal fry. The results showed that signals generated with a small degree of aspiration noise were perceived as breathiness while signals with a small degree of flutter or double pulsing were perceived as roughness. When the flutter or double pulsing increased further, tremor and vocal fry, rather than roughness, were perceived. Furthermore, the amount of aspiration noise, flutter, or double pulsing required for male voice stimuli was different from that required for the female voice stimuli with a similar level of perceptual breathiness and roughness. These findings showed that changes in perceived vocal quality could be achieved by systematic modifications of synthesis parameters. This opens up the possibility of using synthesized voice signals as external standards or anchors to improve the reliability of clinical perceptual voice evaluation. (C) 2002 Acoustical Society of America.

Australian Broadcasting Corporation v Lenah Game Meats Pty Ltd

Principle issues considered in Australian Broadcasting Corporation v Lenah Game Meats Pty Ltd - whether it was necessary to show a cause of action for an interlocutory injunction to be granted - whether a right to privacy existed - whether the ABC was protected in this case by an implied constitutional freedom - majority rejected a wide interpretation on grounds upon which an interlocutory injunction could be granted - recognition of the possibility of a tort of invasion of privacy under Australian law by five of the six judges.

Defining quality of life for Chinese elderly stroke survivors

Purpose: This study aimed to identify the constituents and conceptual characteristics of the quality of life (QOL) of Chinese elderly stroke survivors. living in the community in Hong Kong. Method: A triangulated approach was used to identify the QOL components for this population. This process involved a comparison of QOL components gathered from three different methods, namely, focus group interviews, review of the literature and the contents of the generic Hong Kong Chinese version of the World Health Organization Quality of Life Scale (CWHOQOL-HK). Five health professionals were involved in the comparison process. A percentage of inter-judge agreement was used to determine the reliability of the comparisons made between the judges. Results: This study identified 36 components considered to contribute to the QOL of Chinese elderly stroke survivors in Hona Kong. The conceptual characteristics of their QOL generally concurred with those identified in the literature. Conclusion: Both similarities and differences were found in the QOL components identified in this study when compared to those identified in studies of Western populations who are elderly and had a stroke. The contents of the CWHOQOL-HK scale were found to lack adequacy in representing the QOL of Chinese elderly stroke survivors in Hong Kong. Recommendations are given, based on the findings of this study, to overcome this limitation for its application as a QOL measure for this population.

Voice and speech characteristics and vocal hygiene in novice and professional voice broadcast journalists

Knowledge of differences in voice and speech characteristics between novice and professional broadcasters is essential for effective education of broadcast journalism students. Because newsreaders rely on optimal voice production, information pertaining to vocal hygiene is also important. The first aim of this study was to compare the voice and speech characteristics of professional newsreaders, student newsreaders and control participants. The second aim was to compare the awareness and use of vocal hygiene across these groups. Professional radio newsreaders, broadcast journalism students and two matched control groups were included in the study. Each participant recorded a news bulletin and completed a questionnaire on vocal hygiene. Data analysis of the recording included objective analysis and perceptual ratings by a panel of three judges. Significant student-professional differences were found. Compared to both the students and the control groups, the professional newsreaders had greater variation in speaking fundamental frequency, a faster rate of speech, fewer pronunciation errors and higher perceptual ratings on vocal quality, emphasis, continuity, phrasing and style of newsreading. Female professional newsreaders had a higher speaking fundamental frequency than both their control participants and the student newsreaders. Comparison of vocal hygiene awareness revealed few significant differences between any of the groups.

Reforma judici??ria e democratiza????o na Am??rica Latina

Este texto reflete a necessidade de uma reforma profunda nos sistemas judici??rios nos pa??ses da Am??rica Latina. O autor enumera os mais consider??veis eventos pol??ticos ocorridos na regi??o ap??s a d??cada de 60, principalmente durante o per??odo dos governos militares, com ??nfase nos modelos judici??rios prevalecentes ??? comumente dependentes, manipulados e fr??geis ??? bem como nos problemas enfrentados pelos ju??zes e serventu??rios da justi??a em muitos pa??ses. Ele tamb??m descreve v??rios movimentos pela reforma legal observados em dois diferentes momentos ??? do fim da d??cada de 60 e come??o da de 70, e depois, durante a d??cada de 80, comparando seus sucessos e fracassos e enumerando uma quantidade de seguidores nacionais e internacionais. Finalmente, o leitor deparar-se-?? com uma an??lise das mudan??as econ??micas e pol??ticas que t??m incentivado esta nova preocupa????o por justi??a e pela reforma das institui????es legais, dentre outras, na Am??rica Latina, assim como as dificuldades que esse movimento deve enfrentar no sentido de alcan??ar um Estado descentralizado, eficiente e democr??tico.

Caracterização físico química, perfil sensorial e aceitação de morangos submetidos à irradiação

A irradiação de alimentos é um método de conservação não térmico utilizado em diferentes alimentos e em diferentes doses. Sabe-se que, dependendo da dose aplicada, esse método pode ocasionar alterações nas características físico-químicas e sensoriais, que afetam a qualidade do produto. Portanto, um dos objetivos deste estudo foi analisar o efeito da irradiação nas características físico-químicas e sensoriais de morangos irradiados. A irradiação das amostras de morango ocorreu um dia após a colheita e foi realizada no Laboratório de Radiação Gama do Centro de Desenvolvimento da Tecnologia Nuclear (CDTN), em Belo Horizonte-MG. As doses utilizadas foram 1 kGy, 2 kGy, 3 kGy e 4 kGy e a amostra controle (0 kGy). Foram avaliados pH, acidez total titulável, sólidos solúveis, ratio (relação entre teor de sólidos solúveis e acidez total titulável), açúcares redutores, totais e não redutores, pectina, ácido ascórbico, firmeza, cor, antocianinas, compostos fenólicos e capacidade antioxidante. Para a caracterização sensorial das amostras, foi utilizado o método Perfil Descritivo Otimizado (PDO), sendo avaliados os atributos sensoriais cor, sabor adocicado, gosto ácido, firmeza e suculência, por 15 julgadores previamente selecionados. Além da caracterização sensorial, foi realizada a análise de aceitação sensorial por 60 consumidores de morango em duas sessões. A irradiação não alterou significativamente a maioria das características físico-químicas analisadas, ao comparar todas as doses empregadas, incluindo o morango controle (não irradiado); apenas a firmeza apresentou valores diferentes estatisticamente: com o aumento da dose, houve diminuição da firmeza do fruto. No PDO, as amostras diferiram quanto à cor, sabor adocicado, firmeza e suculência, sendo que a amostra controle e a amostra irradiada com 1 kGy tiveram maiores valores de firmeza e menores de suculência e sabor adocicado. Em relação à aceitação, a amostra controle e a amostra irradiada com 1 kGy não diferiram estatisticamente pelo teste Tukey a 5%, mas diferiram das amostras irradiadas com doses de 3 kGy e de 4 kGy; no entanto, a amostra irradiada a 2 kGy não diferiu de nenhuma outra dose. Foram realizados estudos de correlações entre os dados físico-químicos de pH, acidez total titulável (ATT), sólidos solúveis (SS), açúcares totais e açúcares não redutores, antocianina (método pH diferencial), pectina, firmeza instrumental, relação entre SS/ATT (ratio) e alguns parâmetros de cor (a*, b*, c* e L), e os dados do teste sensorial descritivo, ou seja, os atributos de firmeza, suculência, sabor adocicado e gosto ácido. Os resultados obtidos foram correlações significativamente positivas entre pH e ratio, sólidos solúveis e pectina, antocianinas e parâmetros de cor (a* e c*), açúcares e parâmetros de cor (b* e c*), firmeza sensorial e firmeza instrumental, suculência e sabor xvi adocicado e firmeza sensorial e gosto ácido. Já as correlações negativas foram entre acidez e ratio, sólidos solúveis e firmeza, antocianina e L*, firmeza sensorial e sabor adocicado e suculência com: firmeza instrumental, firmeza sensorial e gosto ácido. Neste trabalho, também foi realizada a caracterização físico-química e sensorial de morangos irradiados nas doses determinadas por Lima Filho et al. (2014) como sendo correspondentes ao limiar de detecção (LD) sensorial (0,405 kGy) e ao limiar de rejeição (LR) sensorial (3,6 kGy) para morangos irradiados. Além disso, foi verificada a influência da embalagem na aceitação sensorial de morangos irradiados na dose 3,6 kGy. Todas as medidas físico-químicas apresentaram pequena variação entre as amostras controle (0 kGy) e o LD e o LR. Não houve diferença significativa em relação à aceitação da amostra irradiada na ausência e na presença da embalagem, provavelmente devido ao grau de conhecimento do painel de consumidores em relação ao processo de irradiação de alimentos. Conclui-se que a irradiação é um método de conservação que pode ser utilizado em morangos, uma vez que exerce pouca influência, no período de tempo estudado, nas suas características físico-químicas e sensoriais.

Carta aberta aos presidentes Obama e Putin pelo avião abatido

A negligência é punível e não pode deixar de ser punível. É urgente a investigação, é urgente a acusação e o julgamento escorreito desse conjunto de energúmenos que, por puro dolo, ou puro atrofiamento mental, foram capazes de tais acções ou omissões. Caso não haja qualquer outra hipótese em termos legais internacionais, deverá ser criado – se for necessário, adequado e proporcional - um Tribunal had hoc internacional que julgue com especificidade este caso concreto. Basta de impunidade perante situações injustas como esta, onde tudo acaba por terminar no esquecimento. Abstract: Negligence is punishable and can only be punishable. There is an urgent investigation, it is urgent to prosecution and the trial this group of lunatics who, by pure malice, or pure mental atrophy, were capable of such acts or omissions. If there is no other choice in international law, should be created - if necessary, appropriate and proportionate - a Court had international hoc judges with this specific case. No more impunity unjust situations like this, where everything turns out to finish the wayside.

Inadmissível pressão sobre Magistrados-Juízes e Ministério Público

Assiste-se, contudo, a uma inadmissível pressão sobre Magistrados judiciais e do M.P., querendo responsabilizá-los dum Portugal corrupto. Como se a legislação em vigor não fizesse tudo – há que dizê-lo duma vez por todas – para que ocorram prescrições em série. Abstract: We are witnessing, however, an unacceptable pressure on judicial magistrates and prosecutors, wanting to blame them of a corrupt Portugal. As if the legislation does not do everything - it should say it once and for all - to occur prescriptions/requirements in series.

"Procedural Strategy" by Carlos Pinto de Abreu, lawyer

Como Carlos Pinto de Abreu refere e bem, no seu livro e no seminário, entre juízes, partes ou sujeitos processuais, advogados ou solicitadores, magistrados do Ministério Público ou testemunhas, peritos ou funcionários, encontramos “pessoas que podem ser mais ou menos sérias”, por sinal “motivadas por outros interesses que não os de servir a Verdade e a Justiça”; Abstract: Carlos Pinto de Abreu as regards and well in his book and seminar, between judges, parties or procedural subject, lawyers or solicitors, prosecutors and witnesses, experts or officials, found "people who may be more or less serious" , by the way "motivated by interests other than those serving the Truth and Justice".