A new graphic format to facilitate the understanding of technological innovation models: the seesaw of competitiveness

Many models exist in the literature to explain the success of technological innovation. However, no studies have been made regarding graphic formats representing the technological innovation models and their impact, or on the understanding of these models by non-specialists in technology management. Thus, the main objective of this paper is to propose a new graphic configuration to represent the technological innovation management. Based on the literature, the innovation model is presented in the traditional format. Next, the same model is designed in the graphic format - named `the see-saw of competitiveness` - showing the interfaces among the identified factors. The two graphic formats were compared by a group of graduate students in terms of the ease in understanding the conceptual model of innovation. The statistical analysis shows that the seesaw of competitiveness is preferred.

Differential responses of antioxidant enzymes in pioneer and late-successional tropical tree species grown under sun and shade conditions

To investigate the ability of pioneer and late-successional species to adapt to a strong light environment in a reforestation area, we examined the activities of antioxidant enzymes in relation to photosystem chlorophyll a fluorescence and photosynthetic pigment concentration for eight tropical tree species grown under 100% (sun) and 10% (shade) sunlight irradiation. The pioneer (early-succession) species (PS) were Cecropia pachystachya, Croton urucurana, Croton floribundus and Schinus terebinthifolius. The non-pioneer (late succession) species (LS) were Hymenaea courbaril L var. stilbocarpa, Esenbeckia leiocarpa, Cariniana legalis and Tabebuia roseo-alba. We observed a greater decline in the ratio of variable to maximum chlorophyll a fluorescence (F(v)/F(m)) under full sunlight irradiation in the late-successional species than in the pioneer species. The LS species most sensitive to high irradiance were C. legalis and H. courbaril. In LS species, chlorophyll a, chlorophyll b and total chlorophyll concentrations were higher in the shade-grown plants than in plants that developed under full sunlight, but in the PS species C. floribundus and C. pachystachya, we did not observe significant changes in chlorophyll content when grown in the two contrasting environments. The carotenoids/total chlorophyll ratio increased significantly when plants developed under high-sunlight irradiation, but this response was not observed in the PS species S. terebinthifolius and C. pachystachya. The improved performance of the pioneer species in high sunlight was accompanied by an increase in superoxide dismutase (SOD. EC 1.15.1.1) activity, though no light-dependent increase in the activity of ascorbate peroxidase (APX. EC 1.11.1.11) was observed. The activity of catalase (CAT, EC 1.11.1.6) was reduced by high irradiation in both pioneer and late-successional species. Our results show that pioneer species perform better under high-sunlight irradiation than late-successional species, as indicated by increased SOD activity and a higher F IF,, ratio. C. legalis was the LS species most susceptible to photoinhibition under full sunlight conditions. These results suggest that pioneer plants have more potential tolerance to photo-oxidative damage than late-successional species associated with the higher SOD activity found in pioneer species. Reduced photoinhibition in pioneer species probably results from their higher photosynthetic capacities, as has been observed in a previous survey carried out by our group. (C) 2010 Elsevier B.V. All rights reserved.

Mental health and socio-economic variations in Australian suicide

This paper investigates the relationship between suicide rates and prevalence of mental disorder and suicide attempts, across socio-economic status (SES) groups based on area of residence. Australian suicide data (1996-1998) were analysed in conjunction with area-based prevalences of mental disorder derived from the National Survey of Mental Health and Well-Being (1997). Poisson regression models of suicide risk included age, quintile of area-based SES, urban-rural residence, and country of birth (COB), with males and females analysed separately. Analysis focussed on the association between suicide and prevalences of (ICD-10) affective disorders, anxiety disorders, substance use disorders and suicide attempts by SES group. Prevalences of other psychiatric symptomatology, substance use problems, health service utilisation, stressful life-events and personality were also investigated. Significant increasing gradients were evident from high to low SES groups for prevalences of affective disorders, anxiety disorders (females only), and substance use disorders (males only); sub-threshold drug and alcohol problems and depression; and suicide attempts and suicide (males only). Prevalences of mental disorder, other sub-threshold mental health items and suicide attempts were significantly associated with suicide, but in most cases associations were reduced in magnitude and became statistically non-significant after adjustment for COB, urban-rural residence, and SES. For male suicide the relative risk (RR) in the lowest SES group compared to the highest was 1.40 (95% CI 1.29-1.52, p < 0.001) for all ages, and 1.46 (95% CI 1.27-1.67, p < 0.001) for male youth (20-34 years). This relationship was not substantially modified in males when regression models included prevalences of affective disorders, and other selected mental health variables and demographic factors. From a population perspective, SES remained significantly associated with suicide after controlling for the prevalence of mental disorders and other psychiatric symptomatology. Mental conditions and previous suicidal behaviour may play an intermediary role between SES and suicide, but this study suggests that an independent relationship between suicide and SES also exists. (c) 2005 Elsevier Ltd. All rights reserved.

Diagnostic transitions in mild cognitive impairment subtypes

Background: At least for a subset of patients, the clinical diagnosis of mild cognitive impairment (MCI) may represent an intermediate stage between normal aging and dementia. Nevertheless, the patterns of transition of cognitive states between normal cognitive aging and MCI to dementia are not well established. In this study we address the pattern of transitions between cognitive states in patients with MCI and healthy controls, prior to the conversion to dementia. Methods: 139 subjects (78% women, mean age, 68.5 +/- 6.1 years; mean educational level, 11.7 +/- 5.4 years) were consecutively assessed in a memory clinic with a standardized clinical and neuropsychological protocol, and classified as cognitively healthy (normal controls) or with MCI (including subtypes) at baseline. These subjects underwent annual reassessments (mean duration of follow-up: 2.7 +/- 1.1 years), in which cognitive state was ascertained independently of prior diagnoses. The pattern of transitions of the cognitive state was determined by Markov chain analysis. Results: The transitions from one cognitive state to another varied substantially between MCI subtypes. Single-domain MCI (amnestic and non-amnestic) more frequently returned to normal cognitive state upon follow-up (22.5% and 21%, respectively). Among subjects who progressed to Alzheimer`s disease (AD), the most common diagnosis immediately prior conversion was multiple-domain MCI (85%). Conclusion: The clinical diagnosis of MCI and its subtypes yields groups of patients with heterogeneous patterns of transitions between one given cognitive state to another. The presence of more severe and widespread cognitive deficits, as indicated by the group of multiple-domain amnestic MCI may be a better predictor of AD than single-domain amnestic or non-amnestic deficits. These higher-risk individuals could probably be the best candidates for the development of preventive strategies and early treatment for the disease.

A critical view on biaxial and short-beam uniaxial flexural strength tests applied to resin composites using Weibull, fractographic and finite element analyses

Objective. To evaluate the biaxial and short-beam uniaxial strength tests applied to resin composites based upon their Weibull parameters, fractographic features and stress distribution. Methods. Disk- (15 mm x 1 mm) and beam-shaped specimens (10 mm x 2 mm x 1 mm) of three commercial composites (Concept/Vigodent, CA; Heliomolar/Ivoclar-Vivadent, HE; Z250/3M ESPE, FZ) were prepared. After 48h dry storage at 37 degrees C, disks and beams were submitted to piston-on-three-balls (BI) and three-point bending (UNI) tests, respectively. Data were analyzed by Weibull statistics. Fractured surfaces were observed under stereomicroscope and scanning electron microscope. Maximum principal stress (sigma(1)) distribution was determined by finite element analysis (FEA). Maximum sigma(1-BI) and sigma(1-UNI) were compared to FZ strengths calculated by applying the average failure loads to the analytical equations (sigma(a-BI) and sigma(a-UNI)). Results. For BI, characteristic strengths were: 169.9a (FZ), 122.4b (CA) and 104.8c (HE), and for UNI were: 160.3a (FZ), 98.2b (CA) and 91.6b (HE). Weibull moduli ( m) were similar within the same test. CA and HE presented statistically higher m for BI. Surface pores ( BI) and edge flaws ( UNI) were the most frequent fracture origins. sigma(1-BI) was 14% lower than sigma(a-BI.) sigma(1-UNI) was 43% higher than sigma(a-UNI). Significance. Compared to the short-beam uniaxial test, the biaxial test detected more differences among composites and displayed less data scattering for two of the tested materials. Also, biaxial strength was closer to the material`s strength estimated by FEA. (C) 2009 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.

GABAergic antagonist blocks the reduction of tonic immobility behavior induced by activation of 5-HT(2) receptors in the basolateral nucleus of the amygdala in guinea pigs

Tonic immobility (TI) is a temporary state of profound motor inhibition induced by situations that generate intense fear, with the objective of protecting an animal from attacks by predators. A preliminary study by our group demonstrated that microinjection into the basolateral nucleus of the amygdala (BLA) of an agonist to 5-HT(1A) and 5-HT(2) receptors promoted a decrease in TI duration. In the current study, the effects of GABAergic stimulation of the BLA and the possible interaction between GABA(A) and 5-HT(2) receptors on TI modulation were investigated. Observation revealed that GABAergic agonist muscimol (0.26 nmol) reduced the duration of TI episodes, while microinjection of the GABAergic antagonist bicuculline (1 nmol) increased TI duration. Additionally, microinjection of 5-HT(2) agonist receptors (alpha-methyl-5-HT, 0.32 nmol) into the BLA decreased TI duration, an effect reversed by pretreatment with bicuculline (at the dose that had no effect per se, 0.2 nmol). Moreover, the activation of GABA(A) and 5-HT(2) receptors in the BLA did not alter the spontaneous motor activity in the open field test. These experiments demonstrated that the activation of GABA(A) and 5-HT(2) receptors of the BLA possibly produce a reduction in unconditioned fear that decreases the TI duration in guinea pigs, but this is not due to increased spontaneous motor activity, which could affect a TI episode nonspecifically. Furthermore, these results suggest an interaction between GABAergic and serotoninergic mechanisms mediated by GABA(A) and 5-HT(2) receptors. In addition, the GABAergic circuit of the BLA presents a tonic inhibitory influence on TI duration. (C) 2009 Elsevier Inc. All rights reserved.

Self-awareness of Prospective Memory Failure in Adults with Traumatic Brain Injury

The frequency of prospective memory failure in individuals with severe traumatic brain injury (TBI) was investigated by comparison with a non-brain-injured control group. Self-awareness of prospective memory function was also assessed by comparing self-ratings with ratings by significant others. Study participants included 33 individuals with severe TBI and 29 non-brain-injured persons. Each participant nominated a close friend or relative who completed the informant's version of the questionnaire. Participants and their significant others both rated the participants' frequency of prospective memory lapses using the Comprehensive Assessment of Prospective Memory (CAPM). An independent groups design was adopted to compare the TBI and control groups. No significant difference was found between the TBI and control participants' self-ratings of frequency of prospective memory failure, but ratings by significant others were significantly different. The TBI group demonstrated less self-awareness (i.e. underestimated the frequency of prospective memory failure compared to significant others) than the control group.

Germline BRCA1 promoter deletions in UK and Australian familial breast cancer patients: Identification of a novel deletion consistent with BRCA1 :psi VBRCA1 recombination

Inherited susceptibility to breast cancer results from germline mutations in one of a number of genes including BRCA1. A significant number of BRCA1-linked familial breast cancer patients, however, have no detectable BRCA1 mutation. This could be due in part to the inability of commonly used mutation-detection techniques to identify mutations outside the BRCA1 coding region. This paper addresses the hypothesis that non coding region mutations, specifically in the BRCA1 promoter, account for some of these cases. We describe a new and detailed restriction map of the 5' region of the BRCA1 gene including the nearby NBR2, psiBRCA1, and NBR1 genes and the isolation of a number of new informative hybridization probes suitable for Southern analysis. Using this information we screened DNA from lymphoblastoid cell-lines made from 114 UK familial breast cancer patients and detected one large deletion in the 5' region of BRCA1. We show that the breakpoints for this deletion are in BRCA1 intron 2 and between NBR2 and exon 2 of psiBRCA1, raising the possibility that this deletion arose via a novel mechanism involving BRCA1:psiBRCA1 recombination. We have also screened 60 familial breast cancer patients from the Australian population, using an amplification refractory mutation system (ARMS) technique described previously by our group, and found one patient with a genotype consistent with a BRCA1 promoter deletion. These findings indicate that germline BRCA1 promoter deletions are a rare and yet significant mutation event and that they could arise via a novel genetic mechanism. Hum Mutat 19:435-442, 2002. (C) 2002 Wiley-Liss, Inc.

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.

Padrões espaço-temporais da mortalidade por câncer de mama em mulheres no Estado do Espírito Santo - um estudo ecológico

O câncer de mama é a principal neoplasia maligna que acomete o sexo feminino no Brasil. O câncer de mama é hoje uma doença de extrema importância para a saúde pública nacional, motivando ampla discussão em torno das medidas que promova o seu diagnóstico precoce, a redução em sua morbidade e mortalidade. A presente pesquisa possui três objetivos, cujos resultados encontram-se organizados em artigos. O primeiro objetivo buscou analisar a completude dos dados do Sistema de Informação de Mortalidade sobre os óbitos por câncer de mama em mulheres no Espírito Santo, Sudeste e Brasil (1998 a 2007). Realizou-se um estudo descritivo analítico baseado em dados secundários, onde foi analisado o número absoluto e percentual de não preenchimento das variáveis nas declarações de óbitos. Adotou-se escore para avaliar os graus de não completude. Os resultados para as variáveis sexo e idade foram excelentes tanto para o Espírito Santo, Sudeste e Brasil. O preenchimento das variáveis raça/cor, grau de escolaridade e estado civil apresentam problemas no Espírito Santo. Enquanto no Sudeste e Brasil as variáveis raça/cor e escolaridade têm tendência decrescente para a não completude, no Espírito Santo a tendência se mantém estável. Para a variável estado civil, a não completude tem tendência crescente no Estado do Espírito Santo. O segundo objetivo foi analisar a evolução das taxas de mortalidade por câncer de mama, em mulheres no Espírito Santo no período de 1980 a 2007. Estudo de série temporal, cujos dados sobre óbitos foram obtidos do Sistema de Informação de Mortalidade e as estimativas populacionais segundo idade e anos-calendário, do Instituto Brasileiro Geografia e Estatística. Os coeficientes específicos 9 de mortalidade, segundo faixa etária, foram calculados anualmente. A análise de tendência foi realizada por meio da padronização das taxas de mortalidade pelo método direto, em que a população do senso IBGE-2000, foi considerada padrão. No período de estudo, ocorreram 2.736 óbitos por câncer de mama. O coeficiente de mortalidade neste período variou de 3,41 a 10,99 por 100.000 mulheres. Os resultados indicam que há tendência de mortalidade por câncer de mama ao longo da série (p=0,001 com crescimento de 75,42%). Todas as faixas etárias a partir de 30 anos apresentaram tendência de crescimento da mortalidade estatisticamente significante (p=0,001). Os percentuais de crescimento foram aumentando, segundo as idades mais avançadas, sendo 48,4% na faixa de 40 a 49 anos, chegando a 92,3%, na faixa de 80 anos e mais. O terceiro objetivo foi realizar a análise espacial dos óbitos em mulheres por câncer de mama no estado do Espírito Santo, nos anos de 2003 a 2007, com análise das correlações espaciais dessa mortalidade e componentes do município. O cenário foi o Estado do Espírito Santo, composto por 78 municípios. Para análise dos dados, utilizou-se a abordagem bayesiana (métodos EBest Global e EBest Local) para correção de taxas epidemiológicas. Calculou-se o índice I de Moran, para dependência espacial em nível global e a estatística Moran Local. As maiores taxas estão concentradas em 19 municípios pertencentes às Microrregiões: Metropolitana (Fundão, Vitória, Vila Velha, Viana, Cariacica e Guarapari), Metrópole Expandida Sul (Anchieta, Alfredo Chaves), Pólo Cachoeiro (Vargem Alta, Rio Novo do Sul, Mimoso do Sul, Cachoeiro de Itapemirim, Castelo, Jerônimo Monteiro, Bom Jesus do Norte, Apiacá e Muqui) e Caparaó (Alegre e São José do Calçado). Os resultados da Estimação Bayesiana (Índice de Moran) dos óbitos por câncer de mama em mulheres ocorridos no estado do Espírito Santo, segundo os dados brutos e 10 ajustados indicam a existência de correlação espacial significativa para o mapa Local (I = 0,573; p = 0,001) e Global (I = 0,118; p = 0,039). Os dados brutos não apresentam correlação espacial (I = 0,075; p = 0,142).

Optimização do posicionamento de câmaras de vídeo-vigilância

Dissertação de Mestrado em Engenharia de Redes de Comunicação e Multimédia

Sistema de recomendação para plataformas de e-learning

O aumento do número de recursos digitais disponíveis dificulta a tarefa de pesquisa dos recursos mais relevantes, no sentido de se obter o que é mais relevante. Assim sendo, um novo tipo de ferramentas, capaz de recomendar os recursos mais apropriados às necessidades do utilizador, torna-se cada vez mais necessário. O objetivo deste trabalho de I&D é o de implementar um módulo de recomendação inteligente para plataformas de e-learning. As recomendações baseiam-se, por um lado, no perfil do utilizador durante o processo de formação e, por outro lado, nos pedidos efetuados pelo utilizador, através de pesquisas [Tavares, Faria e Martins, 2012]. O e-learning 3.0 é um projeto QREN desenvolvido por um conjunto de organizações e tem com objetivo principal implementar uma plataforma de e-learning. Este trabalho encontra-se inserido no projeto e-learning 3.0 e consiste no desenvolvimento de um módulo de recomendação inteligente (MRI). O MRI utiliza diferentes técnicas de recomendação já aplicadas noutros sistemas de recomendação. Estas técnicas são utilizadas para criar um sistema de recomendação híbrido direcionado para a plataforma de e-learning. Para representar a informação relevante, sobre cada utilizador, foi construído um modelo de utilizador. Toda a informação necessária para efetuar a recomendação será representada no modelo do utilizador, sendo este modelo atualizado sempre que necessário. Os dados existentes no modelo de utilizador serão utilizados para personalizar as recomendações produzidas. As recomendações estão divididas em dois tipos, a formal e a não formal. Na recomendação formal o objetivo é fazer sugestões relacionadas a um curso específico. Na recomendação não-formal, o objetivo é fazer sugestões mais abrangentes onde as recomendações não estão associadas a nenhum curso. O sistema proposto é capaz de sugerir recursos de aprendizagem, com base no perfil do utilizador, através da combinação de técnicas de similaridade de palavras, um algoritmo de clustering e técnicas de filtragem [Tavares, Faria e Martins, 2012].

Project, modelling and simulation of air stripping columns for the treatment of groundwater contaminated with volatile organic compounds

Volatile organic compounds are a common source of groundwater contamination that can be easily removed by air stripping in columns with random packing and using a counter-current flow between the phases. This work proposes a new methodology for the column design for any particular type of packing and contaminant avoiding the necessity of a pre-defined diameter used in the classical approach. It also renders unnecessary the employment of the graphical Eckert generalized correlation for pressure drop estimates. The hydraulic features are previously chosen as a project criterion and only afterwards the mass transfer phenomena are incorporated, in opposition to conventional approach. The design procedure was translated into a convenient algorithm using C++ as programming language. A column was built in order to test the models used either in the design or in the simulation of the column performance. The experiments were fulfilled using a solution of chloroform in distilled water. Another model was built to simulate the operational performance of the column, both in steady state and in transient conditions. It consists in a system of two partial non linear differential equations (distributed parameters). Nevertheless, when flows are steady, the system became linear, although there is not an evident solution in analytical terms. In steady state the resulting system of ODE can be solved, allowing for the calculation of the concentration profile in both phases inside the column. In transient state the system of PDE was numerically solved by finite differences, after a previous linearization.

A New Approach in the Design of Air Stripping Columns for the Treatment of Groundwater Contaminated With Volatile Organic Compounds

Volatile organic compounds are a common source of groundwater contamination that can be easily removed by air stripping in columns with random packing and using a counter-current flow between the phases. This work proposes a new methodology for column design for any type of packing and contaminant which avoids the necessity of an arbitrary chosen diameter. It also avoids the employment of the usual graphical Eckert correlations for pressure drop. The hydraulic features are previously chosen as a project criterion. The design procedure was translated into a convenient algorithm in C++ language. A column was built in order to test the design, the theoretical steady-state and dynamic behaviour. The experiments were conducted using a solution of chloroform in distilled water. The results allowed for a correction in the theoretical global mass transfer coefficient previously estimated by the Onda correlations, which depend on several parameters that are not easy to control in experiments. For best describe the column behaviour in stationary and dynamic conditions, an original mathematical model was developed. It consists in a system of two partial non linear differential equations (distributed parameters). Nevertheless, when flows are steady, the system became linear, although there is not an evident solution in analytical terms. In steady state the resulting ODE can be solved by analytical methods, and in dynamic state the discretization of the PDE by finite differences allows for the overcoming of this difficulty. To estimate the contaminant concentrations in both phases in the column, a numerical algorithm was used. The high number of resulting algebraic equations and the impossibility of generating a recursive procedure did not allow the construction of a generalized programme. But an iterative procedure developed in an electronic worksheet allowed for the simulation. The solution is stable only for similar discretizations values. If different values for time/space discretization parameters are used, the solution easily becomes unstable. The system dynamic behaviour was simulated for the common liquid phase perturbations: step, impulse, rectangular pulse and sinusoidal. The final results do not configure strange or non-predictable behaviours.

Renal involvement in prolonged salmonella bacteremia: the role of schistosomal glomerulopathy

Renal involvement has been well documented in patients with hepatosplenic schistosomiasis and in patients with prolonged salmonella bacteremia (PSB). Whether there is a specific renal lesion related to PSB or the chronic bacterial infection aggravates a pre-existing schistosomal glomerulopathy has been a matter of controversy. To analyze the clinical manifestations and histopathological findings of the renal involvement, 8 patients with hepatosplenic schistosomiasis and PSB (group I) were compared with 8 patients with schistosomal glomerulopathy (group II) matched by sex and glomerular disease. The mean age in group I was 17.7 years. All patients presented with hematuria, in 4 cases associated with non-nephrotic proteinuria. In group II the mean age was 23 years; nephrotic syndrome was the clinical presentation in 7 of the 8 patients in the group. All patients in group I experienced remission of the clinical and laboratory abnormalities as the salmonella infection was cured; in group II the patients had persistent, steroid-resistant, nephrotic syndrome. On histological examination, no difference was noted between the two groups, except for pronounced glomerular hypercellularity and interstitial mononuclear cell infiltration in group I. These observations strongly suggest that PSB exacerbates a pre-existing sub-clinical schistosomal glomerulopathy by the addition of active lesions directly related to the prolonged bacteremia