Atypical Case of Mediterranean Spotted Fever

The authors present a case of atypical severe (malignant) Mediterranean spotted fever, with a brief review on the subject. Although not previously described in Brazil, the possibility of imported cases, especially from Portuguese tourists, is real. This case report highlights the severe form of the disease and the possibility of atypical presentation with confounding differential diagnosis. A brief review of classical presentation is also done. The authors believe it is a valid paper and a good contribution to your Journal of Infectious Diseases. The content of the manuscript represents the views of the coauthors, and neither the corresponding author nor the coauthors have submitted duplicate or overlapping manuscripts elsewhere.

Análisis de la producción científica visible en internet de los técnicos de salud ambiental del Servicio Andaluz de Salud

Internet it is a powerful interactive communication channel with world scope, through which can be multiplied the visibility of the research of the professionals whose scientific production has a difficult diffusion by the conventionals media. It is presented an analysis of the scientific publications observed in the web in order to understand the different communication processes accomplished by the superior corps of environmental health technical of the Andalusian Health Service. Using the nominal relationship of the professionals, we used Google ‘search engine’ for all scientific publications located in the internet; we were made different bibliometric indicators as of the recovered records and was analyzed the time evolution of the scientific production, documental categories, geografic distribution, language, coauthors and institutional collaboration. It was identified a growing trend in the productivity of the publications in the last decade, mainly through communications to congresses (70.4%) and journals articles (16.9%). The publications mainly are located in spanish journals, that they are indexed on national and international databases. In all the Andalusian provinces was identified some published scientific communication. The indicator of coauthors is very high (95.77%) although the institutional participation is limited mainly to the primary attention districts, occupational centers of each professional (85.21%). The scientific publication patterns visualized in the web represent an important contribution for the knowledge of the characteristics of the environmental health professionals of the Andalusian health service, what provides avaluable information for the support of the information systems in public health.

Combining T2-preparation with spectral and spatial selectivity for improved coronary MRA

Cardiovascular disease is the leading cause of death worldwide. Within this subset, coronary artery disease (CAD) is the most prevalent. Magnetic resonance angiography (MRA) is an emerging technique that provides a safe, non-invasive way of assessing CAD progression. To generate contrast between tissues, MR images are weighted according to the magnetic properties of those tissues. In cardiac MRI, T2 contrast, which is governed by the rate of transverse signal loss, is often created through the use of a T2-Preparation module. T2-Preparation, or T2-Prep, is a magnetization preparation scheme used to improve blood/myocardium contrast in cardiac MRI. T2-Prep methods generally use a non-selective +90°, 180°, 180°, -90° train of radiofrequency (RF) pulses (or variant thereof), to tip magnetization into the transverse plane, allow it to evolve, and then to restore it to the longitudinal plane. A key feature in this process is the combination of a +90° and -90° RF pulse. By changing either one of these, a mismatch occurs between signal excitation and restoration. This feature can be exploited to provide additional spectral or spatial selectivity. In this work, both of these possibilities are explored. The first - spectral selectivity - has been examined as a method of improving fat saturation in coronary MRA. The second - spatial selectivity - has been examined as a means of reducing imaging time by decreasing the field of view, and as a method of reducing artefacts originating from the tissues surrounding the heart. Two additional applications, parallel imaging and self-navigation, are also presented. This thesis is thus composed of four sections. The first, "A Fat Signal Suppression for Coronary MRA at 3T using a Water-Selective Adiabatic T2-Preparation Technique", was originally published in the journal Magnetic Resonance in Medicine (MRM) with co-authors Ruud B. van Heeswijk and Matthias Stuber. The second, "Combined T2-Preparation and 2D Pencil Beam Inner Volume Selection", again with co-authors Ruud van Heeswijk and Matthias Stuber, was also published in the journal MRM. The third, "A cylindrical, inner volume selecting 2D-T2-Prep improves GRAPPA-accelerated image quality in MRA of the right coronary artery", written with co-authors Jerome Yerly and Matthias Stuber, has been submitted to the "Journal of Cardiovascular Magnetic Resonance", and the fourth, "Combined respiratory self-navigation and 'pencil-beam' 2D-T2 -Prep for free-breathing, whole-heart coronary MRA", with co¬authors Jerome Chaptinel, Giulia Ginami, Gabriele Bonanno, Simone Coppo, Ruud van Heeswijk, Davide Piccini, and Matthias Stuber, is undergoing internal review prior to submission to the journal MRM. -- Les maladies cardiovasculaires sont la cause principale de décès dans le monde : parmi celles-ci, les maladies coronariennes sont les plus répandues. L'angiographie par résonance magnétique (ARM) est une technique émergente qui fournit une manière sûre, non invasive d'évaluer la progression de la coronaropathie. Pour obtenir un contraste entre les tissus, les images d'IRM sont pondérées en fonction des propriétés magnétiques de ces tissus. En IRM cardiaque, le contraste en T2, qui est lié à la décroissance du signal transversal, est souvent créé grâce à l'utilisàtion d'un module de préparation T2. La préparation T2, ou T2-Prep, est un système de préparation de l'aimantation qui est utilisé pour améliorer le contraste entre le sang et le myocarde lors d'une IRM cardiaque. Les méthodes de T2-Prep utilisent généralement une série non-sélective d'impulsions de radiofréquence (RF), typiquement [+ 90°, 180°, 180°, -90°] ou une variante, qui bascule l'aimantation dans le plan transversal, lui permet d'évoluer, puis la restaure dans le plan longitudinal. Un élément clé de ce processus est la combinaison des impulsions RF de +90° et -90°. En changeant l'une ou l'autre des impulsions, un décalage se produit entre l'excitation du signal et de la restauration. Cette fonction peut être exploitée pour fournir une sélectivité spectrale ou spatiale. Dans cette thèse, les deux possibilités sont explorées. La première - la sélectivité spectrale - a été examinée comme une méthode d'améliorer la saturation de la graisse dans l'IRM coronarienne. La deuxième - la sélectivité spatiale - a été étudiée comme un moyen de réduire le temps d'imagerie en diminuant le champ de vue, et comme une méthode de réduction des artefacts provenant des tissus entourant le coeur. Deux applications supplémentaires, l'imagerie parallèle et la self-navigation, sont également présentées. Cette thèse est ainsi composée de quatre sections. La première, "A Fat Signal Suppression for Coronary MRA at 3T using a Water-Selective Adiabatic T2-Preparation Technique", a été publiée dans la revue médicale Magnetic Resonance .in Medicine (MRM) avec les co-auteurs Ruud B. van Heeswijk et Matthias Stuber. La deuxième, Combined T2-Preparation and 2D Pencil Beam Inner Volume Selection", encore une fois avec les co-auteurs Ruud van Heeswijk et Matthias Stuber, a également été publiée dans le journal MRM. La troisième, "A cylindrical, inner volume selecting 2D-T2-Prep improves GRAPPA- accelerated image quality in MRA of the right coronary artery", écrite avec les co-auteurs Jérôme Yerly et Matthias Stuber, a été présentée au "Journal of Cardiovascular Magnetic Resonance", et la quatrième, "Combined respiratory self-navigation and 'pencil-beam' 2D-T2 -Prep for free-breathing, whole-heart coronary MRA", avec les co-auteurs Jérôme Chaptinel, Giulia Ginami, Gabriele Bonanno , Simone Coppo, Ruud van Heeswijk, Davide Piccini, et Matthias Stuber, subit un examen interne avant la soumission à la revue MRM.

A safe place /

This study is an effort to give voice to an experience. The experience in question is the decision of a student to trust a practitioner. The study also describes the features which led the student to believe that the practitioner would provide a "safe place" for interaction around matters of a delicate or personal nature. This study is the gift oftwo coauthors, each with a unique story which offers description of critical incidents, and what made these events meaningful. At the heart of the study is the potential for education and its professionals to provide safe places for students. Analysis of the data determines that a safe place involves two parties, one seeking a safe place and another who provides the safe place-in this study, the student and the practitioner. The student, with urgency, seeks a safe place to disclose personal information. In this urgency the student is confronted with features of control, comfort, respect, felt sense, and nonjudgemental listening. These features are the constitutive elements of a Safe Place. Capacity to recognize and construct safe places is a competency which the existing school lifeworld demands of today's practitioners. Understanding what are deemed to be safe places and how practitioners might work to create them are the extended outcomes of this study.

A presença da colaboração científica em pesquisas brasileiras: um estudo nas áreas de ciência da informação, matemática e odontologia

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Urinary diversion: how experts divert

OBJECTIVE To determine the rates of the available urinary diversion options for patients treated with radical cystectomy for bladder cancer in different settings (pioneering institutions, leading urologic oncology centers, and population based). METHODS Population-based data from the literature included all patients (n = 7608) treated in Sweden during the period 1964-2008, from Germany (n = 14,200) for the years 2008 and 2011, US patients (identified from National Inpatient Sample during 1998-2005, 35,370 patients and 2001-2008, 55,187 patients), and from Medicare (n = 22,600) for the years 1992, 1995, 1998, and 2001. After the International Consultation on Urologic Diseases-European Association of Urology International Consultation on Bladder Cancer 2012, the urinary diversion committee members disclosed data from their home institutions (n = 15,867), including the pioneering institutions and the leading urologic oncology centers. They are the coauthors of this report. RESULTS The receipt of continent urinary diversion in Sweden and the United States is <15%, whereas in the German high-volume setting, 30% of patients receive a neobladder. At leading urologic oncology centers, this rate is also 30%. At pioneering institutions up to 75% of patients receive an orthotopic reconstruction. Anal diversion is <1%. Continent cutaneous diversion is the second choice. CONCLUSION Enormous variations in urinary diversion exist for >2 decades. Increased attention in expanding the use of continent reconstruction may help to reduce these disparities for patients undergoing radical cystectomy for bladder cancer. Continent reconstruction should not be the exclusive domain of cystectomy centers. Efforts to increase rates of this complex reconstruction must concentrate on better definition of the quality-of-life impact, technique dissemination, and the centralization of radical cystectomy.

Geochemistry of Lesser Antilles forearc sediments

Oceanic sediments contain the products of erosion of continental crust, biologic activity and chemical precipitation. These processes create a large diversity of their chemical and isotopic compositions. Here we focus on the influence of the distance from a continental platform on the trace element and isotopic compositions of sediments deposited on the ocean floor and highlight the role of zircons in decoupling high-field strength elements and Hf isotopic compositions from other trace elements and Nd isotopic compositions. We report major and trace element concentrations as well as Sr and Hf isotopic data for 80 sediments from the Lesser Antilles forearc region. The trace-element characteristics and the Sr and Hf isotopic compositions are generally dominated by detrital material from the continental crust but are also variably influenced by chemical or biogenic carbonate and pure biogenic silica. Next to the South American continent, at DSDP Site 144 and on Barbados Island, sediments, coarse quartz arenites, exhibit marked Zr and Hf excesses that we attribute to the presence of zircon. In contrast, the sediments from DSDP Site 543, which were deposited farther away from the continental platform, consist of fine clay and they show strong deficiencies in Zr and Hf. The enrichment or depletion of Zr-Hf is coupled to large changes in Hf isotopic compositions (-30 < epsilon-Hf < +4) that vary independently from the Nd isotopes. We interpret this feature as a clear expression of the "zircon effect" suggested by Patchett and coauthors in 1984. Zircon-rich sediments deposited next to the South American continent have very low epsilon-Hf values inherited from old zircons. In contrast, in detrital clay-rich sediments deposited a few hundred kilometers farther north, the mineral fraction is devoid of zircon and they have drastically higher epsilon-Hf values inherited from finer, clay-rich continental material. In the two DSDP sites, average Hf isotopes are very unradiogenic relative to other oceanic sediments worldwide (epsilon-Hf = -14.4 and -7.4) and they define the low Hf end member of the sedimentary field in Hf-Nd space. Their compositions correspond to end members that, when mixed with mantle, are able to reproduce the pattern of volcanic rocks from the Lesser Antilles. More generally, we find a relationship between Nb/Zr ratios and the vertical deviation of Hf isotope ratios from the Nd-Hf terrestrial array and we suggest that this relationship can be used as a tool to distinguish sediment input from fractionation during melting during the formation of arc lavas.

Fotofísica de enodionas

Em 1906, Albrecht obteve a primeira enodiona conhecida, ao reagir benzoquinona com ciclopentadieno. A estrutura desta enodiona somente foi elucidada em 1928, por Diels e Alder que, entretanto, perceberam ser possív.el existirem dois diferentes isômeros para o composto em questão: endo e exo. A descoberta, em 1958, da reação de fotocilização deste aduto de Diels-Alder, por Cookson e colaboradores, demonstrou que se tratava do isômero endo e esta reação passou a ser utilizada para se comprovar a configuração endo de vários compostos de estrutura análoga. Porém, apesar de sua importância histórica como método para comprovar a configuração dos adutos de Diels-Alder, os dados disponíveis até hoje são insuficientes para o esclarecimento dos processos subjacentes à fotociclização desses compostos, especialmente porque hoje sabemos que existem adutos de configuração endo que não fotociclizam. Visando aumentar o conhecimento sobre o comportamento destes adutos frente à reação de fotociclização, determinaram-se seus espectros de absorção (na região do UVNisível) e de emissão de luminescência e concluiu-se, com base em nossos resultados e daqueles relatados na literatura, que o fato de não ocorrer a fotociclização de alguns adutos de configuração endo não depende exclusivamente da estabilidade dos estados excitados envolvidos, ainda que essa característica e a natureza destes certamente afete os rendimentos quânticos da reação. Antes, parece-nos que estruturas que permitam deslocalizar um dos elétrons do birradical intermediariamente formado neste processo propiciam a reversão deste intermediário ao reagente, ao invés de se formar o produto de fotociclização. Alem disso, reinvestigamos a reação de fotoisomerização endo → exo do aduto de benzoquinona e ciclopentadieno, por irradiação em etanol/trietil-amina, relatada por Pandey e colaboradores em 1990, tendo verificado que tal isomerização não ocorre nas condições descritas na literatura, obtendo-se, ao invés disso, principalmente o tautômero aromático da enodiona e seu produto de fotociclização. Por outro lado, descobrimos que, deixar em repouso, no escuro, o aduto de benzoquinona e ciclopentadieno em etanol/trietil-amina conduz,a um dímero deste aduto, não descrito previamente.

Bangladesh, a country study /

"Research completed September 1988."

Transition for disadvantaged students.

Coauthors: Toni McCarty Warren, Donella Hess-Grabill.

Midline rectovaginal fascial plication for repair of rectocele and obstructed defecation

OBJECTIVE: To estimate the efficacy of midline fascial plication of the posterior vaginal wall in women with rectoceles and obstructed defecation. METHODS: Prospective evaluation of 38 consecutive women with symptomatic rectoceles (stage II or greater) and obstructed defecation included pre- and postoperative standardized pelvic floor questions, pelvic organ prolapse quantification measurements, validated bowel function questionnaires, defecating proctogram, and patient satisfaction. Reviews were conducted by nonsurgical coauthors. RESULTS: The median follow-up was 12.5 months (range 2.5-26 months). The subjective success rates were 97% (95% confidence interval [CI] 0.83-1.00%) at 12 months and 89% (95% CI 0.55-0.98%) at 24 months. The objective success rates were 87% (95% CI 0.64-0.96%) at 12 months and 79% (95% CI 0.51-0.92%) at 24 months. The average points, Ap and Bp, were significantly reduced from -0.1 (range -2 to 3) and 1.1 (range -1 to 8), preoperatively, to -2.6 (range -3 to -1) and -2.5 (range -3 to 0), postoperatively, respectively (P

A CONSTRUÇÃO DO CURRÍCULO HUMANIZADOR NA EDUCAÇÃO INFANTIL: um estudo a partir de experiências concretas

O presente trabalho procura analisar e avaliar os mecanismos que favorecem ou dificultam a participação de famílias e outros atores que compõem o cenário educativo como coautores no processo de construção do projeto político pedagógico das instituições de educação infantil, bem como identificar e analisar práticas educacionais democráticas voltadas à garantia de uma escola pública de qualidade para a infância. O estudo bibliográfico apresenta reflexões sobre os impactos dos condicionantes sociais, culturais e econômicos da sociedade contemporânea na construção dos currículos escolares. Procura também analisar a contribuição da educação escolar na construção e na consolidação dos princípios da sociedade democrática. A pesquisa de campo lança mão de relato de quatro experiências concretas (denominadas "episódios") sobre trabalho coletivo, vivenciadas pela autora em diferentes espaços e tempos, todas na educação pública no município de São Paulo. Embora cada episódio esteja contextualizado em determinado tempo e espaço, envolvendo ainda a singularidade de seus atores sociais, são retomados neste trabalho os princípios convergentes que nortearam cada experiência a partir das categorias visão totalizadora, visão interdisciplinar, visão holística e visão heurística. Complementarmente, a análise documental utilizou as atas do Conselho de Escola do período 2007-2011 de uma Escola Municipal de Educação Infantil do município de São Paulo. A opção por estes documentos como instrumentos para análise justifica-se por se constituir o Conselho de Escola um dos espaços institucionalizados de discussão e tomada de decisões em que todos os segmentos da escola encontram-se representados. Assim, tendo como pano de fundo deste estudo a prática da gestão democrática, a análise de tais documentos permite melhor compreensão sobre as possibilidades e os limites que se estabelecem num colegiado de caráter deliberativo, diante de sua sujeição à administração pública. Os procedimentos metodológicos foram pensados no sentido de se identificar, compreender e compartilhar práticas que colaborem para a construção de uma pedagogia humanizadora, levando em conta as dimensões humanas em toda a sua complexidade.  

Broadening the evidence base and the mind when thinking about mixed methods research

On behalf of my coauthors, Dr Michael Larkin and Professor Paul Flowers, and I would like to thank Dr Pierre Pluye for his letter in response to our article.1 Dr Pluye supported our argument that a broader evidence base is needed in evidence-based healthcare. He provided the readers of this journal with important additional information which updates them on the progress in the area of mixed studies reviews and further detail about the Mixed Methods Appraisal Tool (MMAT).2 Since writing our …

Asymptotic Change-Point Analysis of the Dependencies in Time Series

In recent papers, Wied and his coauthors have introduced change-point procedures to detect and estimate structural breaks in the correlation between time series. To prove the asymptotic distribution of the test statistic and stopping time as well as the change-point estimation rate, they use an extended functional Delta method and assume nearly constant expectations and variances of the time series. In this thesis, we allow asymptotically infinitely many structural breaks in the means and variances of the time series. For this setting, we present test statistics and stopping times which are used to determine whether or not the correlation between two time series is and stays constant, respectively. Additionally, we consider estimates for change-points in the correlations. The employed nonparametric statistics depend on the means and variances. These (nuisance) parameters are replaced by estimates in the course of this thesis. We avoid assuming a fixed form of these estimates but rather we use "blackbox" estimates, i.e. we derive results under assumptions that these estimates fulfill. These results are supplement with examples. This thesis is organized in seven sections. In Section 1, we motivate the issue and present the mathematical model. In Section 2, we consider a posteriori and sequential testing procedures, and investigate convergence rates for change-point estimation, always assuming that the means and the variances of the time series are known. In the following sections, the assumptions of known means and variances are relaxed. In Section 3, we present the assumptions for the mean and variance estimates that we will use for the mean in Section 4, for the variance in Section 5, and for both parameters in Section 6. Finally, in Section 7, a simulation study illustrates the finite sample behaviors of some testing procedures and estimates.

Economic Development of Urban Areas

In this dissertation I study the development of urban areas. At the aggregate level I investigate how they may be affected by climate change policies and by being designated the seat of governmental power. At the household level I study with coauthors how microfinance could improve the health of urban residents. In Chapter 1, I investigate how local employment may be affected by electricity price increases, which is a likely consequence of climate change policies. I outline how previous studies that find large, negative effects may be biased. To overcome these biases I develop a novel estimation strategy that blends border-pair regressions with the synthetic control methodology. I show the conditions for consistent estimation. Using this estimator, I find no effect of contemporaneous price changes on employment. Consistent with the longer time-frame for manufacturing decisions, I do find evidence for negative effects from perceived permanent price shocks. These estimates are much smaller than previous research has found. National capital cities are often substantially larger than other cities in their countries. In Chapter 2, I investigate whether there is a causal effect from being a capital by studying the 1960 relocation of the Brazilian capital from Rio de Janeiro to Brasília. Using a synthetic controls strategy I find that losing the capital had no significant effects on Rio de Janeiro in terms of population, employment, or gross domestic product (GDP). I find that Brasília experienced large and significant increases in population, employment, and GDP. I find evidence of large spillovers from the public to the private sector. Chapter 3 investigates how microfinance could increase the uptake of costly health goods. We study the effect of time payments (micro-loans or micro-savings) on willingness-to-pay (WTP) for a water filter among households in the slums of Dhaka, Bangladesh. We find that time payments significantly increase WTP: compared to a lump-sum up-front purchase, median WTP increases 83% with a six-month loan and 115% with a 12-month loan. We find that households are quite patient with respect to consumption of health inputs. We find evidence for the presence of credit and savings constraints.