The Prognostic Impact of Renal Failure in Patients with ST-Segment Elevation Acute Myocardial Infarction

INTRODUCTION: Renal insufficiency (RI) is associated with higher morbidity and mortality in patients (P) with coronary artery disease and in P submitted to angioplasty. In ST-segment elevation acute myocardial infarction (STEAMI), this impact has not been well demonstrated. AIM: To evaluate the impact of RI in P with STEAMI. METHODS: We evaluated 160 P admitted with STEAMI, mean age of 62+/-14 years, 76% male. We determined creatinine levels on admission. RI was defined as a level >1.5 mg/dl. Analysis of clinical, electrocardiographic and laboratory variables was performed, in relation to the endpoint defined as the occurrence of death at 30-day follow-up. RESULTS: There were 16 deaths (10%) at 30-day follow-up. P with RI (n=21) were older (68+/-11 vs 61+/-14 years, p<0.001), more often had diabetes (57 vs 24 %, p=0.004) and presented more often with Killip class > or =2 (57 vs 12%, p<0.001). The use of statins (62 vs 83%, p=0.05) and beta-blockers (24 vs 65%, p<0.001) was lower in P with RI. Mortality was higher in RI P (62 vs 2%, p<0.001). The univariate predictors of death were age > or =75 years, diabetes, Killip class > or =2 on admission, RI, non-use of statins and beta-blockers and use of diuretics. In multivariate analysis, independent predictors of death at 30 days were RI (HR 29.6, 95% CI 6.3-139.9, p<0.001) and non-use of beta-blockers (HR 0.13, 95% CI 0.02-1.01, p=0.01). CONCLUSION: In P admitted for STEAMI, the presence of RI was an independent predictor of death at 30 days whereas the usage of beta-blockers was protective.

Lower Atherosclerotic Burden in Familial Abdominal Aortic Aneurysm

OBJECTIVE: Despite the apparent familial tendency toward abdominal aortic aneurysm (AAA) formation, the genetic causes and underlying molecular mechanisms are still undefined. In this study, we investigated the association between familial AAA (fAAA) and atherosclerosis. METHODS: Data were collected from a prospective database including AAA patients between 2004 and 2012 in the Erasmus University Medical Center, Rotterdam, The Netherlands. Family history was obtained by written questionnaire (93.1% response rate). Patients were classified as fAAA when at least one affected first-degree relative with an aortic aneurysm was reported. Patients without an affected first-degree relative were classified as sporadic AAA (spAAA). A standardized ultrasound measurement of the common carotid intima-media thickness (CIMT), a marker for generalized atherosclerosis, was routinely performed and patients' clinical characteristics (demographics, aneurysm characteristics, cardiovascular comorbidities and risk factors, and medication use) were recorded. Multivariable linear regression analyses were used to assess the mean adjusted difference in CIMT and multivariable logistic regression analysis was used to calculate associations of increased CIMT and clinical characteristics between fAAA and spAAA. RESULTS: A total of 461 AAA patients (85% men, mean age, 70 years) were included in the study; 103 patients (22.3%) were classified as fAAA and 358 patients (77.7%) as spAAA. The mean (standard deviation) CIMT in patients with fAAA was 0.89 (0.24) mm and 1.00 (0.29) mm in patients with spAAA (P = .001). Adjustment for clinical characteristics showed a mean difference in CIMT of 0.09 mm (95% confidence interval, 0.02-0.15; P = .011) between both groups. Increased CIMT, smoking, hypertension, and diabetes mellitus were all less associated with fAAA compared with spAAA. CONCLUSIONS: The current study shows a lower atherosclerotic burden, as reflected by a lower CIMT, in patients with fAAA compared with patients with spAAA, independent of common atherosclerotic risk factors. These results support the hypothesis that although atherosclerosis is a common underlying feature in patients with aneurysms, atherosclerosis is not the primary driving factor in the development of fAAA.

The HIF1A Functional Genetic Polymorphism at Locus +1772 Associates with Progression to Metastatic Prostate Cancer and Refractoriness to Hormonal Castration

The hypoxia inducible factor 1 alpha (HIF1a) is a key regulator of tumour cell response to hypoxia, orchestrating mechanisms known to be involved in cancer aggressiveness and metastatic behaviour. In this study we sought to evaluate the association of a functional genetic polymorphism in HIF1A with overall and metastatic prostate cancer (PCa) risk and with response to androgen deprivation therapy (ADT). The HIF1A +1772 C>T (rs11549465) polymorphism was genotyped, using DNA isolated from peripheral blood, in 1490 male subjects (754 with prostate cancer and 736 controls cancer-free) through Real-Time PCR. A nested group of cancer patients who were eligible for androgen deprivation therapy was followed up. Univariate and multivariate models were used to analyse the response to hormonal treatment and the risk for developing distant metastasis. Age-adjusted odds ratios were calculated to evaluate prostate cancer risk. Our results showed that patients under ADT carrying the HIF1A +1772 T-allele have increased risk for developing distant metastasis (OR, 2.0; 95%CI, 1.1-3.9) and an independent 6-fold increased risk for resistance to ADT after multivariate analysis (OR, 6.0; 95%CI, 2.2-16.8). This polymorphism was not associated with increased risk for being diagnosed with prostate cancer (OR, 0.9; 95%CI, 0.7-1.2). The HIF1A +1772 genetic polymorphism predicts a more aggressive prostate cancer behaviour, supporting the involvement of HIF1a in prostate cancer biological progression and ADT resistance. Molecular profiles using hypoxia markers may help predict clinically relevant prostate cancer and response to ADT.

Conscientious objection and ideological impositions: The Drift of The Mayflower

This article discusses the problematic and evading development of conscientiousobjection in the context of the Colombian constitutional jurisprudence. From a historical allusion to the famous case of the “Mayflower Pilgrims” –which serve as areference to the central problems that faces the objector–, it seeks to define the scopeof conscientious objection as a fundamental right (as a fundamental justice claim)in regard to the “factual” and “legal” possibilities for its exercise, for which there willbe a brief contrast between the most representative cases decided by the ColombianConstitutional Court in such matter. The core of the article is the idea that thereis an ideological prevalence that, unjustifiably, makes it difficult and in some casesdenies the exercise of the right to object in consciousness, particularly when it comes tothe right of life in regard to the abortion case.

Novas Tecnologias da Informação e Comunicação e a construção do conhecimento : implicações e possibilidades na Escola Pública

A sociedade moderna atual aponta para a necessidade de ajustar a educação ao novo cenário social que se configura. Com o advento tecnológico cada vez mais coevo e necessário é significante somar esforços para ampliar e validar as discussões sobre as Novas Tecnologias da Informação e Comunicação (NTIC), com mais expressividade a Internet, como um dos elementos potencializador do processo de construção do conhecimento na escola. Nesse contexto, o objetivo basilar do presente estudo repousou na compreensão das implicações das NTIC para a construção do conhecimento na esfera educacional. Para tanto, foi realizado um survey com professores e estudantes do Ensino Médio no setor público estadual, Escola Quintino Bocaiúva, em Camocim de São Félix-PE. Foram elaborados questionários com escala Likert, destinados aos 176 estudantes colaboradores, e uma entrevista na modalidade grupo focal, com a participação de 6 docentes. Os dados recolhidos através dos questionários receberam tratamento estatístico em um diálogo comparativo-explicativo com diversos estudos consolidados na literatura científica em diferentes países para aprofundar a visão crítica da inserção das tecnologias na escola. Nesse sentido, os resultados mais expressivos demonstram que a maioria dos estudantes utiliza à Internet com as finalidades de acessar redes sociais (62,6%), participar de chats (50%) e pesquisar conteúdos escolares (58,6%), porém, nesse tipo de atividade, copiar e colar são as estratégias mais usuais (53,4%), sinalizando o baixo nível de criticidade (32,8%) por parte do grupo investigado. Quanto ao material recolhido através da entrevista foi organizado conforme preconiza a Análise de Conteúdo de Bardin e interpretado notadamente à luz da teoria da razão comunicativa de Jünger Habermas. Os achados destacam a pouca utilização das novas tecnologias em contexto pedagógico, notadamente em atividades de estímulo ou criação de estratégias centradas na (re)significação do conhecimento, além de indicar que as condições e as circunstâncias de uso das tecnologias são fatores preditivos para potencializar a construção do conhecimento no processo de escolarização, apenas quando estão intrinsecamente associadas ao uso pedagógico para promoção de sujeitos críticos que sejam capazes de ir além da instrumentalização das tecnologias ou da reprodução da informação para se colocar como produtores de conhecimento.

Racionalidade comunicativa e educação : um estudo sobre o pensamento de Jürgen Habermas enfatizando a formação da competência interativa como aprendizado da razão comunicacional

A presente dissertação tem como propósito, a partir do estudo e apropriação reflexiva da Teoria do Agir Comunicativo de Jürgen Habermas, identificar espaços alternativos no ambiente escolar através dos quais possamos implementar ações didático-pedagógicas e administrativas que oportunizem o aprendizado da razão comunicativa, bem como favoreçam o desenvolvimento de competências alicerçadas na interatividade. Para tanto, partimos de uma abordagem sobre a modernidade, enquanto contextualização geral, enfatizando os movimentos filosóficos através dos quais se criaram as condições que permitiram a formulação do paradigma da subjetividade. Visando desocultar a gênese da alienação nossa reflexão esteve atenta aos elementos que oportunizaram a transformação da razão emancipatória em razão instrumental, ou seja, os motivos circunstanciais que tornaram possível a geração de patologias e a obstrução dos canais da comunicação na sociedade capitalista ocidental. A racionalidade comunicativa, como resultado da reviravolta lingüística, representa uma formulação reflexiva e crítica da razão capaz de oferecer alternativas de ação que possibilitem o resgate, a renovação e a promoção da racionalidade na sua multiplicidade de formas e vozes. Constitui-se num novo paradigma através do qual torna-se viável a análise crítica das patologias sociais e escolares oriundas do processo de racionalização das relações sociais e produtivas, assim como das imagens religiosas e metafísicas do mundo. A racionalidade comunicativa, pelo fato de privilegiar a dialogicidade intersubjetivo-argumentativa, fecunda o mundo escolar com múltiplas possibilidades de ação calcadas no desenvolvimento de competências interativas via aprendizado da racionalidade.

A atitude como linha de ação do endomarketing: um estudo de caso sobre as possibilidades de aprendizagem para o hospital geral de Santo Antônio do Porto em Portugal

o objetivo deste estudo é verificar até que ponto o Endomarketing, por intermédio da sua linha de ação da atitude, pode contribuir para a expansão de um serviço orientado para o paciente, por parte dos funcionários do Hospital Geral de Santo António. Para responder a essa questão, analisamos a teoria do Endomarketing, sob o ponto de vista do seu criador (Saul Faingaus Bekin) e de outros autores, fazendo o seu contexto temporal e refletindo acerca da sua importância no setor público de saúde português. Os dados foram obtidos mediante uma pesquisa bibliográfica e documental e por intennédio da aplicação de um questionário a alguns funcionários da instituição analisada. Os resultados da pesquisa demonstram que, nessa instituição, já existe uma consciência em tomo da pertinência de um serviço orientado para o paciente, porém essa consciência deve ser mais efetiva e só pode ser realmente implantada com a aplicação do Endomarketing. Embora, para a maioria das pessoas inquiridas, comprometer, envolver, valorizar e qualificar ajudem a expandir um serviço orientado para o paciente, esses fatores não parecem ser os mais importantes para elas, o que nos leva a crer que talvez isto ocorra por esses fatores não serem levados em consideração o suficiente ao longo do seu cotidiano profissional, razão pela qual o Endomarketing se torna importante. Finalmente, foram detectadas grandes falhas ao nível da comunicação interna da instituição, o que também torna pertinente a aplicação de uma estratégia de Endomarketing.

A decisão intuitiva nas organizações formais contemporaneas : uma analise de suas possibilidades

Jà há algum tempo o ocidente se vê questionado nos fundamentos que estruturam o saber e, consequentemente. o universo das ciências . ... A chamada razão. até então o pardigma absoluto. vem sendo contraposta a intuição como forma igualmente válida de alicerçar a ação humana na busca do conhecimento verdadeiro. Na Administração, tanto quanto em outros campos do conhecimento. a intuição vem sendo abordada por diversos estudiosos das organizações no seu ponto mais nevrálgico: a decisão gerencial. O presente trabalho discute esta questão a partir de uma análise crítica dos modelos racionais de decisão preconizados. estes fundamentados sobre uma compreensão funcionalista de organização e intenciona acrescentar às discussões já existentes a noção de intuição como método de pensamento do humano, portanto tão lógico quanto a dedução. Para tal, este estudo se vale de alguns referenciais postos por pensadores mais contemporâneos, destacando a Fenomenologia de Edmund Husserl. São abordados ainda estruturadas na direção fundamento da ação humana, à compreensão husserliana algumas configurações organizacionais da validação da intuição também como mesmo que nao necessariamente atreladas de intuição. O trabalho ainda defende a noção de supra-realidade, noção esta que traduz a síntese das diversas lógicas e não a mera agregação delas. Procura, assim. abrir espaço para reflexões na direção da necessidade da construção de novos arranjos organizacionais que reflitam essa síntese.

Política de atenção à saúde do idoso em Mossoró/RN: potencialidades e possibilidades para promoção do envelhecimento saudável no estado do Rio Grande do Norte

It discusses the Health Care of the Elderly in the town of Mossoró, traversing the paths that discussed the history of health care, which has been altered by the new (con) formation and required adjustments of society which led the development and implementation of the National Health Care for the Elderly with the backdrop of the guiding principles of the Health System - SUS. The goals outlined were: To map the implementation of the policy of health care for the elderly in Mossoró considering whether this is based on the principles and guidelines of the NHS and National Health Policy of the Elderly; Check if health promotion is seen as a strategy that favors the elderly mossoroenses the possibility of healthy aging; identify the discourse of the elderly about the aging process and the strategies you use to take care of your needs. Applies as a methodological strategy BOAS, complemented by interviews with twenty (20) elderly residents of Mossoró with a view to understand the objective elements, and the political and subjective traits that express a regularity which marks the area of health care mossoroense elderly. The data were tabulated and the BOAS divided into nine sections for analysis. The speeches were transcribed seized and subjected to a thorough reading that allowed the visualization of issues that have been examined with theoretical and methodological support to the model proposed by Boaventura de Souza Santos (2006) designated this cosmopolitan reason being supported by three meta-sociological procedures, namely, the sociology of absences, the sociology of translation work and emergencies. It appears as a result the exclusion and discrimination of the elderly in different social settings, a condition that prevents them from being aware of their importance as citizens deserving of decent treatment and respect for the family, society and the government, when addressing health the elderly said the need to propose alternative models of care that has the paradigm of health promotion. We conclude that in these areas, meetings are held, to draw lines that were heterogeneous because they were built by the dissimilarities that engender incessantly and show that although we have advanced regarding the attention of the elderly in Mossoró there is still a long way to go in order to meet the needs revealed by the elderly. It is suggested that the practice of trial-creation-differentiation, while highlighting the historical and procedural dimension, deconstructions and negotiations with collective effects. A democratic paradigm and analytical creeps: the constitution are moments of Health Care for the Elderly shaping a new landscape in the town of Mossoró.

Prazer com razão: análise e crítica da ética sexual Kantiana

This work aims to present the foundations of Kantian ethics concerning to moral judgments about sexual practices. It shows that the sexual act, for the philosopher, inevitably degrades individuals who are taking part of it, given its objectifying nature, manifested in the usage of individuals as mere means to obtain pleasure. To solve this quandary of nature since humanity is an end in itself, by the virtue of being bearer of rationality and cannot, therefore, be treated as mere means Kant claims that marriage is morally the appropriate locus for the exercise of sexuality, given the reciprocity forged there, preventing degradation. In marriage, the bond established between the impulse of nature to the conservation of the species achieved through the sexual intercourse opened to procreation and the duty of man in regarding himself as an animal being preserving the species without degrading the person is accomplished in a fully moral way. This text clarifies that the justification for the assumption of this solution is fixed at two developments of the categorical imperative: the formulas of the law of nature and humanity. Despite the fact the first brings significant contributions to human relations through the concept of reciprocity, the second establishes a normative role for the teleological argument of sexuality, becoming an obstacle in kantian's practical philosophy. To overcome that obstacle, we outline a critics which relies on the studies of Michel Foucault about sex and the power techniques related to them, producer of a scientia sexualis in the Western, demonstrating that the moral of the philosopher from Königsberg is also present in this project somehow. Finally, in a foucaultian's reading of kantian Aufklärung, we recognize that, to propose new ethical possibilities of the experience of sexuality, it is necessary to think and create new relational spaces in which the subject takes autonomously the government of self.

O corpo no pensamento de Epicuro: limites e possibilidades

The theme that fits the perspective of this thesis comes from the interest of treating, in the Epicurean corpus, about the importance of the body and its manners of realization for understanding the thought of Epicurus of Samos. Based on the inferences contained in the texts that remained from Epicurus, we did an analysis of the aspects that characterize Epicurism as a thought that makes repeated references to the body as an instance of sensitivity. It was necessary, therefore, to discuss how the body is linked to the possibility of thought, and how the latter can be admitted as a body element. It is further understood that the atomistic physics converges to the idea that asserts natural phenomena as likely to be contained and explained by the observations that come from the senses which are manifested through the body. For this reason, it was also pertinent to reflect on the admission of the body as a key element for the interpretation of Epicurean thought, even under the constitution of language. The Epicurean construction about body image was also used for the interpretation and questioning of the dynamics that define the relationships between individuals, characterizing the koinonía of the garden through the notion of corporeal unity. It was defined, therefore, that the characterization of the action field of individuals who lived in the Epicurean garden revolves around the use of logos, with the dialogues coming from the exercise of philosophy for therapeutic purposes, which were able to introduce a specific mode of political action marked by the absence of strange interests of the notion of philía

Cinema, educação e filosofia: possibilidades de uma poética no ensino

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Necessidades atuais para a educação ambiental: serão possibilidades?

This study had two objectives: to build theoretically the hypothetical landmarks of the environmental crisis and to conjecture new horizons or utopias which can fulfill themselves in the future in search of another being of the man in the world. Therefore, a bibliographic research has been done and, as methodology of analysis, a dialectic critical method has been used to understand the reality in its contradictions and in the totality of the history, through some suggestions, going toward the domain of the state of things which we can verify in the world nowadays. It has been observed that the hypothetical landmarks of the environmental crisis had and have its origins in the Jewish-Christian monotheism, in the exacerbation of the reason as the only way of knowledge and in the process of capitalist accumulation. Therefore, these landmarks, in almost their totality, have historically been built even before the advent of the capitalism. From this point, three suggestions were launched as questions, or so, possibilities, to open a discussion about the construction of another paradigm: Is it necessary another sense of religion? Is it necessary another sense of reason? Is it necessary another sense of sustainable development? Thus, these questions which have been launched, were thought as the current necessities for the environmental education and they implicate in another historical condition to the mankind.

Possibilidades e limitações no uso da temperatura em cromatografia líquida de fase reversa

High-temperature liquid chromatography (HTLC) is a technique that presents a series of advantages in liquid phase separations, such as: reduced analysis time, reduced pressure drop, reduced asymmetry factors, modified retentions, controlled selectivities, better efficiencies and improved detectivities, as well as permitting green chromatography. The practical limitations that relate to instrumentation and to stationary phase instability are being resolved and this technique is now ready to be applied for routine determinations.

Pesquisa qualitativa em Educação Física: possibilidades de construção de conhecimento a partir do referencial cultural

This work indicates presuppositions for the qualitative research in Physical Education, starting with a literature review based on the cultural frame of reference. Firstly, we introduce the debate concerning the natural and the human sciences and implications for the Physical Education; we then use a cultural axis as a ground basis for the research in the area, proposing the 'dense description' as a possibility for knowledge building; finally, we bring up examples of studies conducted with such an approach. This theoretical methodological approach allows the study of the human being as a cultural being, thus opposed to the naturalised view of a human - predominant in Physical Education.