962 resultados para Withholding and withdrawing treatment


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The investigation is focused on the wear behaviour at elevated test temperature of composite Ni–P/SiC deposit, with varying concentration of the reinforcing SiC particles. The phase evolution measured by X-ray diffraction suggests slight crystallisation during wear testing at 200 °C. In coating without reinforcing particles, adhesive wear is accompanied by microcracks. The thermal heat generated and the cyclic loading could have induced sub-surface microcracks. Owing to the effective matrix-ceramics system in composite coatings, fine grooves, abrasive polishing and uniform wearing are observed. Reinforcing particles in the matrix hinder microcrack formation and significantly reduce the wear rate. Triboxidation is confirmed from energy dispersive X-ray spectrometry.

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Background: In Portugal, the routine clinical practice of speech and language therapists (SLTs) in treating children with all types of speech sound disorder (SSD) continues to be articulation therapy (AT). There is limited use of phonological therapy (PT) or phonological awareness training in Portugal. Additionally, at an international level there is a focus on collecting information on and differentiating between the effectiveness of PT and AT for children with different types of phonologically based SSD, as well as on the role of phonological awareness in remediating SSD. It is important to collect more evidence for the most effective and efficient type of intervention approach for different SSDs and for these data to be collected from diverse linguistic and cultural perspectives. Aims: To evaluate the effectiveness of a PT and AT approach for treatment of 14 Portuguese children, aged 4.0–6.7 years, with a phonologically based SSD. Methods & Procedures: The children were randomly assigned to one of the two treatment approaches (seven children in each group). All children were treated by the same SLT, blind to the aims of the study, over three blocks of a total of 25 weekly sessions of intervention. Outcome measures of phonological ability (percentage of consonants correct (PCC), percentage occurrence of different phonological processes and phonetic inventory) were taken before and after intervention. A qualitative assessment of intervention effectiveness from the perspective of the parents of participants was included. Outcomes & Results: Both treatments were effective in improving the participants’ speech, with the children receiving PT showing a more significant improvement in PCC score than those receiving the AT. Children in the PT group also showed greater generalization to untreated words than those receiving AT. Parents reported both intervention approaches to be as effective in improving their children’s speech. Conclusions & Implications: The PT (combination of expressive phonological tasks, phonological awareness, listening and discrimination activities) proved to be an effective integrated method of improving phonological SSD in children. These findings provide some evidence for Portuguese SLTs to employ PT with children with phonologically based SSD

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PRINCIPLES: This retrospective study analyzes the long-term results of endoscopic and surgical treatment of vesico-ureteral reflux in children. METHODS: A cohort of 130 patients, 67 girls and 63 boys with a mean age of 30 months were treated either by endoscopic subureteral collagen injection (SCIN) in 92 and by Cohen reimplantation surgery in 123 refluxing ureteral units. Mean follow-up was 4.2 years varying from 1 to 8.7 years. Reflux recurrence, urinary tract infection (UTI) and renal function were evaluated. RESULTS: After SCIN reflux was absent in 64% at 6 months. 20% of the initially 92 refluxing ureters were injected twice. After one or two injections reflux was absent in 71%. In 21% recurrent reflux was of grade I or II, not requiring further treatment. UTI was observed in 27%. After Cohen ureteral reimplantation reflux was absent in 96% at 6 months. UTI was observed in 23%. Renal function at diagnosis and follow-up was compared in children with bilateral grade III reflux only. In patients treated with SCIN it was normal in 77% preoperatively and in 90% at follow-up. In patients treated by open surgery it was normal in 47% preoperatively and in 76% at follow-up. CONCLUSION: For high-grade vesico-ureteral reflux re-implantation surgery remains the gold standard. SCIN is indicated for low and medium grade reflux. Recurrent bacteriuria was observed more often after SCIN and pyelonephritis more often after open surgery. The renal function seems to be preserved with both techniques.

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Affiliation: Pierre Dagenais : Hôpital Maisonneuve-Rosemont, Faculté de médecine, Université de Montréal

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The microalgae gained importance as food and feed as well as source of fine chemicals since the l960’s. Spirulina became the trend setter due to its easily culturable properties as well as nutritional composition. A rapid expansion of microalgal industry occurred in the Asia-Pacific region as microalgae came to stay as a health food supplement. Microalgae have been an integral component of oxidation ponds usually incorporated with wastewater treatment. Over the last few decades, efforts have been made to apply intensive microalgal cultures to perform biological tertiary treatment of secondary effluents. Given the limited number of species still available for commercial exploitation, it is imperative to isolate and cultivate those photosynthetic organisms with high growth rate and biomass accumulation, which could play the dual role of cleaning the wastewater and also providing useful biomass. This has been the objective of this study ie. 0 To develop pure cultures of local isolates of Cyanobacteria for extraction of biochemicals of commercial value 0 To couple biomass production with effluent treatment

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This article aims to present an approach to the issue of farm or rural zone workers, including a labour law study of agrarian legal decisions, so as to demonstrate their importance in respect to social, economic and cultural rights in Colombia. The study will serve to illustrate through the history, the applicable law and the jurisprudence, the different ways in which farmers have been treated from the time of the origin until the arrival of modern systems of industrialization. It calls into question the effectiveness of existing laws and the role of the courts, in spite of globalization, to maintain the minimum rights and guarantees of farm workers who are considered to be a vulnerable population. In conclusion, this study seeks to illustrate the current role of the Labor law and the National Health Service in the area of demonstrating of the existence or absence of mechanisms to protect workers in rural areas and the need to create some mechanisms that involve social justice given its prime importance in the Constitution of 1991.

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A clinical case of compulsive gambling is exposed in this article. The subject’s playing behaviour had both positive and negative consequences. The subject tried to practice control over the urge to play. As shown in the functional analysis, the failure to control the urge despite the best efforts worsened the problem due to its negative consequences. A variation of acceptance and commitment therapy (ACT) was applied in order to break down the fight-surrender vicious circle of the playing behaviour. Two treatment strategies were agreed upon: acceptance of the fact that both playing and not playing had negatives consequences and commitment to one of these options despite its disadvantages. Finally, it is proposed that this acceptance and commitment therapy is a useful therapeutic process as it decreases the suffering subject and eliminates the problem: playing bahaviour.

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Fibre, crude protein and tannin concentrations were measured in browse species from the semi-arid region of Northeast Brazil during the dry and wet seasons. The effects of oven-, sun- and shade-drying and of urea treatment were also determined. Crude protein (CP) content varied from 103 to 161 g/kg dry matter (DM) and the browses had similar CP content in the two seasons (during 2002) (102-161 and 107-153 g/kg DM in the wet and dry seasons, respectively). Total tannin concentrations ranged from 13 to 201 g/kg DM amongst the browses and were higher in the dry season. A 30-d treatment with urea reduced extractable tannins significantly (P < 0.05). The urea treatment was also most effective at reducing the in vitro effects of tannins compared to the other drying treatments. This was demonstrated by measuring the effect of polyethylene glycol (PEG) on gas production. Addition of PEG increased gas production of oven- (81.4%), sun- (78.5%) and shade-dried (76.7%) samples much more compared to urea treated samples (10.9%). (c) 2005 Elsevier B.V. All rights reserved.