bluuebunny/crossref_metadata_2025 huggingface dataset:
Mecanismos de governança e o desenho institucional da Secretaria de Saúde do Município do Rio de Janeiro (RJ), Brasil
Authors: Ribeiro José Mendes , Alcoforado Flávio
Published: May 2016

Resumo Neste artigo efetuamos um balanço do debate sobre mecanismos de governança e gestão pública e a sua posição em termos das principais escolas econômicas e políticas que afetam a tomada de decisão por governantes eleitos e as ações de atores e instituições relevantes para a configuração do setor público e o funcionamento do aparelho de Estado. É discutido o caráter pendular das orientações de reforma e o grau de esvaziamento das teses weberianas de burocracia racional. À luz destes elementos conceituais e da trajetória do debate sobre a nova gerência pública e a Reforma do Estado no Brasil desde 1995, analisamos o desenho institucional da Secretaria Municipal de Saúde do Rio de Janeiro após as reformas adotadas em direção ao modelo das organizações sociais e a capacidade regulatória e a sustentabilidade das escolhas governamentais.
Organização dos serviços públicos de saúde bucal para diagnóstico precoce de desordens com potencial de malignização do estado do Rio de Janeiro, Brasil
Authors: Casotti Elisete , Monteiro Ana Beatriz Fonseca , Castro Filho Evelyn Lima de , Santos Manuella Pires dos
Published: May 2016

Resumo Estudo sobre a organização dos serviços públicos de saúde no estado do Rio de Janeiro referente ao diagnóstico precoce de desordens com potencial de malignização (DPM). Foram utilizados os dados secundários do banco do primeiro ciclo do Programa de Melhoria do Acesso e Qualidade da Atenção Básica.Verificou-se a realização de ações nos diferentes níveis de prevenção ao câncer, a disponibilidade de serviços de apoio diagnóstico e sobre a organização da rede de atenção. Os resultados mostram que só 58,8% das equipes de saúde bucal registram e acompanham os casos suspeitos; que somente 47.1% relatam dispor de fluxos preferenciais para encaminhamento e há grande variação nos tempos de espera para confirmação do diagnóstico. Ações gerenciais locais e de apoio regional podem melhorar a organização da rede de cuidado ao câncer bucal no estado.
Gender and obesity interaction in quality of life in adults assisted by family doctor program in Niterói, Brazil
Authors: Torres Karla Dala Paula , Rosa Maria Luiza Garcia , Moscavitch Samuel Datum
Published: May 2016

Abstract Obesity impacts the quality of life (HRQL). Studies about the effects of a possible interaction between gender and body mass are rare. The objective of the present paper is to estimate the biological interaction between gender and obesity on HRQL. This was a cross-sectional study based on data from CAMELIA study with population assisted by the Family Doctor Program of Niteroi visited between June 2006 and December 2007. HRQL was assessed by the SF-36. The exposure categories were: obese women, non-obese women, obese men and non-obese men, the reference category. Obese women showed higher percentages of low overall, physical and mental quality of life with the largest associations in the physical component. The excess risk due to interaction was statistically significant in physical dimension: RERI = 1.97 (0.40-3.52) and RERIa = 1,97 (0.40-1.7). Among the Brazilian population aged 20–64 years, obesity was independently associated with low HRQL. This association differed by gender, being significant for women. The possibility of the combined effect takes greater importance in the context of increasing incidence of obesity globally. Healthcare professionals in primary care settings should pay attention to gender differences in the impact of obesity on HRQL.
Parcerias na saúde: as Organizações Sociais como limites e possibilidades na gerência da Estratégia Saúde da Família
Authors: Silva Vanessa Costa e , Barbosa Pedro Ribeiro , Hortale Virgínia Alonso
Published: May 2016

Resumo Estudo de caso realizado no município do Rio de Janeiro sobre o modelo de gestão por Organizações Sociais na Estratégia Saúde da Família. Os objetivos foram caracterizar e analisar aspectos do sistema de governança adotado pela Secretaria Municipal de Saúde e identificar limites e possibilidades desse modelo como uma alternativa de gestão no Sistema Único de Saúde. O estudo tem abordagem qualitativa, realizado por meio de revisão bibliográfica, análise documental e entrevistas com informantes-chave. A adoção desse modelo de gestão foi facilitadora da expansão do acesso à atenção primária por meio do aumento da cobertura potencial da ESF que passou de 7,2% da população, em 2008, para 45,5% em 2015. Os resultados sugerem que algumas práticas da lógica contratual necessitam ser aperfeiçoadas como a negociação e a responsabilização com autonomia dos prestadores. A avaliação e o controle têm como foco os processos e não os resultados e não houve incremento da transparência e do controle social. O sistema de incentivos ao desempenho foi apontado como indutor de melhorias no processo de trabalho das equipes de saúde. Conclui-se que a capacidade regulatória da gestão municipal necessitaria ser aperfeiçoada, entretanto há um importante aprendizado em curso.
Inovações na Atenção Primária em Saúde: o uso de ferramentas de tecnologia de comunicação e informação para apoio à gestão local
Authors: Pinto Luiz Felipe , Rocha Cristianne Maria Famer
Published: May 2016

Resumo As mídias sociais têm sido utilizadas em diversos contextos como forma de dinamizar o fluxo de dados e informações para a tomada de decisão, contribuindo para a questão da produção do conhecimento em redes e a ampliação dos canais de comunicação para acesso aos serviços de saúde. O artigo descreve os resultados da implementação da Rede de 16 Observatórios de Tecnologias de Informação e Comunicação em Serviços de Saúde – Rede OTICS-RIO – pela Secretaria Municipal de Saúde do Rio de Janeiro no apoio à integração da atenção primária, vigilância e promoção da saúde. Trata-se de um estudo de caso de caráter descritivo. Os resultados obtidos relacionam-se ao apoio na formação dos trabalhadores, na disseminação de dados, comunicação, qualificação e gestão da informação em atenção primária em saúde. Essa forma inovadora de comunicação em saúde, com custo muito reduzido para o Sistema Único de Saúde (SUS), permitiu o registro semanal do processo de trabalho das equipes de 193 unidades de atenção primária em saúde (APS) em blogs, cujo total de acessos alcançou a marca de sete milhões em meados de 2015. Como perspectivas, a possibilidade de uso de ferramentas de EAD pode auxiliar nos processos de formação e de educação permanente dos profissionais das equipes de Saúde da Família.
Avaliação dos usuários crianças e adultos quanto ao grau de orientação para Atenção Primária à Saúde na cidade do Rio de Janeiro, Brasil
Authors: Harzheim Erno , Pinto Luiz Felipe , Hauser Lisiane , Soranz Daniel
Published: May 2016

Resumo No 1º semestre de 2014, 6.675 usuários adultos e cuidadores de crianças usuárias dos serviços de Atenção Primária à Saúde (APS) do Rio de Janeiro foram entrevistados por meio do Instrumento de Avaliação da APS, Primary Care Assessment Tool, o PCATool-Brasil. O objetivo era ter um panorama rigoroso, por meio da experiência real dos usuários, do grau de extensão dos atributos essenciais e derivados da APS para todas as Áreas de Planejamento (AP) da Secretaria Municipal de Saúde (SMS). A pesquisa teve um desenho de estudo transversal, com amostras aleatórias independentes de usuários (crianças e adultos) dos serviços e os resultados mensurados por escores dos atributos da APS. As unidades tipo A – Centros Municipais de Saúde e Clínicas da Família que possuem apenas Equipes de Saúde da Família - obtiveram desempenho superior quando comparadas às unidades tipo B, na avaliação de adultos e crianças que utilizam os serviços de APS. Os escores dos atributos “acesso – primeiro contato/acessibilidade”, “integralidade – serviços prestados”, “orientação comunitária” e “orientação familiar” ainda precisam obter melhor desempenho. Por outro lado, a “coordenação do cuidado” e “longitudinalidade” encontram-se em trajetória de qualidade, pois invariavelmente obtiveram escores próximos ou superiores a 6,0.
Response of phytoplankton to an experimental fish culture in net cages in a subtropical reservoir
Authors: Bartozek E. C. R. , Bueno N. C. , Feiden A. , Rodrigues L. C.
Published: May 2016

Abstract This study aimed to evaluate nutrients concentration and spatial-temporal changes in phytoplankton biovolume during an experimental fish culture in net cages in a lateral arm of Salto Caxias reservoir, Brazil. Two sampling stations were placed in the affected lateral arm and other two in a cageless lateral arm. Neither abiotic variables nor phytoplankton biovolume presented significant differences between the treatments. Only temporal changes were confirmed by the analysis performed. Both lateral arms were classified as oligotrophic, reflecting low influence of the net cages. Phytoplankton growth seems to be limited by nitrogen. Biovolume values were, in general, low and five major functional groups were recognized (E, F, G, K and P). In summer higher biovolume values were observed and representatives of Chlorophyceae and Cyanobacteria belonging to the functional groups F and K, respectively, were the most important. In winter phytoplankton was mainly composed by Bacillariophyceae taxa from P group. G group was also restricted to winter and E group occurred in winter and summer. The variations recorded in phytoplankton structure appear to have been mainly influenced by seasonal changes in temperature, precipitation and nutrients availability. The effects of net cages on the abiotic variables and phytoplankton biovolume appear to have been small, probably due to the small number of net cages employed and the system dilution capacity. However, a permanent monitoring of phytoplankton is recommended, since this environment has a carrying capacity, from which the trophic state may increase.
Lexical analysis of the Code of Medical Ethics of the Federal Council of Medicine
Authors: Andrade Jr. Edson de Oliveira , Andrade Edson de Oliveira
Published: May 2016

Summary Introduction: The Code of Medical Ethics (CME) of the Federal Council of Medicine is the legal document that exposes the moral discourse of Brazilian physicians to society and the profession. It is a set of propositions based on which doctors say they are committed to values of conduct aimed at fair and proper professional practice. Objectives: To verify through lexical analysis of the CME corpus if the goals presented in the arguments of the resolution that established the code are properly addressed in these regulations. Methods: This is a quantitative and qualitative study of descriptive nature, aiming at a lexical analysis of the CME. The lexical analysis was performed using a method of Top-Down Hierarchical Classification of vocabulary, as described by Reinert in 1987, assuming that words used in similar contexts are associated with a single lexical world. In addition to the analysis of results, an improved representation of the charts related with Factorial and Similitude Analyses was made. Results: Six clusters were extracted, leading to the identification of three major branches: health care, professional practice and research. These branches revolve around the figures of physician and patient. The similitude analysis revealed a complementarity status between these two figures. Conclusion: The lexical analysis showed that the purposes contained in the resolution that established the CME were adequately represented in the document body.
Cardiovascular risk assessment according to the Framingham score and abdominal obesity in individuals seen by a clinical school of nutrition
Authors: Oliveira Alane Cabral Menezes de , Ferreira Raphaela Costa , Santos Arianne Albuquerque
Published: May 2016

Summary Objective: To analyze the relation of abdominal obesity on cardiovascular risk in individuals seen by a clinic school of nutrition, classifying them based on Framingham score. Methods: Cross-sectional study, conducted at the nutrition clinic of a private college in the city of Maceió, Alagoas. We included randomly selected adults and elderly individuals with abdominal obesity, of both sexes, treated from August to December of 2009, with no history of cardiomyopathy or cardiovascular events. To determine the cardiovascular risk, the Framingham score was calculated. All analyzes were performed with SPSS software version 20.0, with p <0.05 as significative. Results: We studied 54 subjects, 83% female, the mean age was 48 years old, ranging from 31 to 73 years. No correlation was observed between measurements of waist circumference and cardiovascular risk in the subjects studied (r=0.065, p=0.048), and there was no relationship between these parameters. Conclusion: Abdominal fat distribution was weakly related to cardiovascular risk in patients seen by a clinical school of nutrition.
Functional lung rejuvenation in obese patients after bariatric surgery
Authors: Melo Saulo Maia Davila , Argentino Pedro Alves , Oliveira Murilo Matos de Santana , Melo Gabriela Nabuco Chaves , Souza Neto Gildo Lima
Published: May 2016

Summary Objective: To determine the lung age (LA) in obese people before and after bariatric surgery, compare the LA with the chronological age (CA) before and after the peration, and verify whether there was a functional pulmonary rejuvenation after it. Methods: A prospective longitudinal study including 43 morbidly obese patients who underwent bariatric surgery. The patients underwent clinical and spirometric evaluation in two stages, before and after the surgery. In both stages, LA, CA and spirometric variables were measured. Results: A significant improvement in the spirometric variables (FVC; FEV1; and FEV1/FVC ratio) was found after the operation (p≤ 0.0001). Comparing the LA before (50.93±13.36 years) and after the surgery (39.02±12.95 years), there was an important reduction of 11.90±9.12 years (95CI:9.10-14.71; p≤0.0001) in LA after surgery. The difference between LA and CA before surgery was 12.20± 11.71 years (95CI:8.60-15.81) with significant difference (p≤0.0001), and the difference between LA and CA after surgery was -1.95±11.83 years (95CI: -5.59-1.69) with no significant difference (p≤0.28). Regarding LA, we observed a pulmonary aging of 12.20±11.71 years before the surgery and a pulmonary rejuvenation of 11.90±9.12 years after it. Conclusion: Morbid obesity is responsible for early damage and functional accelerated pulmonary aging. After the correction of the body weight by surgery, there is a functional pulmonary rejuvenation demonstrated by the normalization of LA in relation to CA.
Sociodemographic and clinical characteristics of patients with diabetic foot ulcer
Authors: Pedras Susana , Carvalho Rui , Pereira Maria da Graça
Published: May 2016

Summary Introduction: Diabetic foot is one of the most serious complications of diabetes affecting about 15% of all diabetes patients, and it is the leading cause of nontraumatic lower limb amputations. This study presents a sociodemographic and clinical characterization of patients with diabetic foot ulcer indicated for amputation surgery. Methods: A cross-sectional study with 206 patients with type 2 diabetes and a diabetic foot ulcer indicated for amputation surgery. Patients were assessed on sociodemographic and clinical characteristics, pain intensity and pain interference, after answering the Brief Pain Inventory, and on pain descriptors according to the Douleur Neuropathique 4. Results: Most patients were male, with little formal education and a mean age of 66 years. They had been diagnosed with type 2 diabetes for 18 years on average, and with diabetic foot ulcer on average 4 years prior to the assessment. About 59% of patients experienced pain in the lower limb that significantly affect all areas of their functioning. Conclusion: The social demographic variables play an important role in diabetic foot ulceration. Given that the neuropathic ulcers are more easily preventable, systematic monitoring of patients with neuropathy is important. In patients with neuroischemic foot, strategies to cope or manage more efficiently the pain are paramount. Intervention should be multidisciplinary and take into account sociodemographic and clinical factors, as well as the presence, intensity and interference of pain in the patient's daily life activities and whether the patient has family or caregiver support.
Cardiovascular effects of radiotherapy on the patient with cancer
Authors: Moreira Leonardo Augusto Robert , Silva Eduardo Nani , Ribeiro Mario Luiz , Martins Wolney de Andrade
Published: May 2016

Summary The incidence of cancer (CA) has increased globally and radiotherapy (RT) is a vital component in its treatment. Cardiovascular injuries induced by RT in the treatment of thoracic and cervical CA have been causing problems in clinical practice for decades, and are among the most serious adverse effects of radiation experienced by the growing number of cancer survivors. This article presentes a review on the Lilacs, Scielo and Pubmed databases of the main cardiovascular injuries, their mechanisms, clinical presentations, treatments and prevention proposals. Injuries caused by RT include diseases of the pericardium, coronary artery disease, valvular disease, myocardial disease with systolic and diastolic dysfunction, conduction disorders, and carotid artery and great vessels disease. Thoracic and cervical irradiation increases cardiovascular morbidity and mortality. Despite the great progress in the improvement of RT techniques, totally excluding prime areas of the cardiovascular system from the irradiation field is not yet possible. Guidelines must be created for monitoring, diagnosis and treatment of patients with CA treated with RT.
El juego contemporáneo y las nuevas plataformas: la construcción de nuevos espacios de juego y de interacción
Authors: Duek Carolina
Published: May 2016

Resumen El objetivo de este artículo es explorar la relación entre los juegos y los niños en la actualidad. El texto parte de considerar al juego como una práctica significativa para, luego, focalizar en las formas que adquiere vinculado con las nuevas Tecnologías de la Información y de la Comunicación. A lo largo de la investigación, Facebook fue identificado como el espacio más importante que los niños y niñas asocian con sus juegos. Es por ello que el rol que "juega" Facebook organiza los ejes de este trabajo: los usos de la red social, los juegos y las articulaciones más relevantes entre los niños y niñas, la socialización y Facebook. No es nuestro objetivo analizar los juegos en profundidad sino ingresar al universo en el que se construyen los vínculos entre los niños y niñas, las representaciones, los medios y los adultos. En este camino, analizamos Facebook como la plataforma desde la cual la socialización, la exhibición y la competencia son construidas por los informantes.
A SAÚDE NA PERSPECTIVA DA ‘ONTOLOGIA DO SER SOCIAL’
Authors: Souza Diego de Oliveira
Published: May 2016

Resumo Neste ensaio, desenvolvemos uma discussão a respeito da saúde como processo objetivo, constituído da (e na) universalidade do ser social. Dialogamos com autores da medicina social latino-americana e da saúde coletiva, porquanto foram pioneiros nesse debate, utilizando o referencial teórico marxista. Procuramos contribuir ao trazer a ‘ontologia’ de Lukács como referencial teórico, ainda pouco utilizado no campo da saúde. Constatamos que a abordagem ontológica contribui para uma apreensão mais precisa da saúde como processo social e práxis (numa perspectiva contra-hegemônica), abrindo o caminho para se compreenderem os atuais desafios do campo, bem como se vislumbrarem seus limites e possibilidades.
Assessment of Patient, Family and Staff Satisfaction in a Mental Health Service
Authors: Resende Kênia Izabel David Silva de , Bandeira Marina , Oliveira Daniela Carine Ramires
Published: May 2016

Abstract Psychosocial Care Centers (CAPS) provide care to people with psychiatric disorders and aim to reinsert them into the community. Assessing these services is important to maintaining quality. This study assessed the satisfaction level of 84 patients, 84 family caregivers and 67 professionals from a large center of mental health care center (CAPS-III). Structured interviews were individually held by applying the Satisfaction with Mental Health Services Scales (SATIS-BR) and socio-demographic questionnaires. Overall scores were high for family caregivers and moderate for the patients and professionals. The family caregivers were satisfied with all the service's dimensions; patients were satisfied with help received, and professionals were satisfied with their relationships with co-workers. Patients were dissatisfied with the service's infrastructure, while professionals were dissatisfied with working conditions and infrastructure. The results indicate a need for investment in the service's infrastructure and to improve working conditions.
Pleural tuberculosis in the state of Roraima, Brazil, between 2005 and 2013: quality of diagnosis
Authors: Machado Tao , Fonseca Allex Jardim da , Buenafuente Sandra Maria Franco
Published: May 2016

Objective: To evaluate the quality of diagnosis and the epidemiological profile of patients with pleural tuberculosis in the state of Roraima, Brazil, in order to provide technical support for the development and implementation of public policies to combat the disease. Methods: This was a cross-sectional study designed to determine the prevalence of pleural forms of tuberculosis in Roraima between 2005 and 2013 and to evaluate the diagnostic criteria used, as well as their determinants. This study was based on secondary data from the Brazilian Case Registry Database, including all reported cases of pleural tuberculosis in the state during the study period. Diagnoses based on bacteriological or histopathological confirmation were defined as high-quality diagnoses. Results: Among the 1,395 cases of tuberculosis reported during the study period, 116 (8.3%) were cases of pleural tuberculosis, accounting for 38.9% of all cases of extrapulmonary tuberculosis in the sample. The incidence rate of pleural tuberculosis did not follow the downward trend observed for the pulmonary form of the disease during the same period. The prevalence of cases with a high-quality diagnosis was 28.5% (95% CI: 20.4-37.6%). In a univariate analysis, none of the demographic or clinical characteristics collected from the database were found to have a significant impact on the outcome (as explanatory variables). Conclusions: The quality of the diagnoses in our study sample was considered unsatisfactory. Limited access to specific diagnostic methods might have contributed to these results.
Ex vivo lung perfusion in Brazil
Authors: Abdalla Luis Gustavo , Braga Karina Andrighetti de Oliveira , Nepomuceno Natalia Aparecida , Fernandes Lucas Matos , Samano Marcos Naoyuki , Pêgo-Fernandes Paulo Manuel
Published: May 2016

Objective: To evaluate the use of ex vivo lung perfusion (EVLP) clinically to prepare donor lungs for transplantation. Methods: A prospective study involving EVLP for the reconditioning of extended-criteria donor lungs, the criteria for which include aspects such as a PaO2/FiO2 ratio < 300 mmHg. Between February of 2013 and February of 2014, the lungs of five donors were submitted to EVLP for up to 4 h each. During EVLP, respiratory mechanics were continuously evaluated. Once every hour during the procedure, samples of the perfusate were collected and the function of the lungs was evaluated. Results: The mean PaO2 of the recovered lungs was 262.9 ± 119.7 mmHg at baseline, compared with 357.0 ± 108.5 mmHg after 3 h of EVLP. The mean oxygenation capacity of the lungs improved slightly over the first 3 h of EVLP-246.1 ± 35.1, 257.9 ± 48.9, and 288.8 ± 120.5 mmHg after 1, 2, and 3 h, respectively-without significant differences among the time points (p = 0.508). The mean static compliance was 63.0 ± 18.7 mmHg, 75.6 ± 25.4 mmHg, and 70.4 ± 28.0 mmHg after 1, 2, and 3 h, respectively, with a significant improvement from hour 1 to hour 2 (p = 0.029) but not from hour 2 to hour 3 (p = 0.059). Pulmonary vascular resistance remained stable during EVLP, with no differences among time points (p = 0.284). Conclusions: Although the lungs evaluated remained under physiological conditions, the EVLP protocol did not effectively improve lung function, thus precluding transplantation.
Association between physical activity in daily life and pulmonary function in adult smokers
Authors: Barboza Miriane Lilian , Barbosa Alan Carlos Brisola , Spina Giovanna Domingues , Sperandio Evandro Fornias , Arantes Rodolfo Leite , Gagliardi Antonio Ricardo de Toledo , Romiti Marcello , Dourado Victor Zuniga
Published: May 2016

Objective: To determine whether the level of physical activity in daily life (PADL) is associated with pulmonary function in adult smokers. Methods: We selected 62 adult smokers from among the participants of an epidemiological study conducted in the city of Santos, Brazil. The subjects underwent forced spirometry for pulmonary function assessment. The level of PADL was assessed by the International Physical Activity Questionnaire and triaxial accelerometry, the device being used for seven days. The minimum level of PADL, in terms of quantity and intensity, was defined as 150 min/week of moderate to vigorous physical activity. Correlations between the studied variables were tested with Pearson's or Spearman's correlation coefficient, depending on the distribution of the variables. We used linear multiple regression in order to analyze the influence of PADL on the spirometric variables. The level of significance was set at 5%. Results: Evaluating all predictors, corrected for confounding factors, and using pulmonary function data as outcome variables, we found no significant associations between physical inactivity, as determined by accelerometry, and spirometric indices. The values for FVC were lower among the participants with arterial hypertension, and FEV1/FVC ratios were lower among those with diabetes mellitus. Obese participants and those with dyslipidemia presented with lower values for FVC and FEV1. Conclusions: Our results suggest that there is no consistent association between physical inactivity and pulmonary function in adult smokers. Smoking history should be given special attention in COPD prevention strategies, as should cardiovascular and metabolic comorbidities.
Correlation between the severity of critically ill patients and clinical predictors of bronchial aspiration
Authors: Medeiros Gisele Chagas de , Sassi Fernanda Chiarion , Zambom Lucas Santos , Andrade Claudia Regina Furquim de
Published: May 2016

Objective: To determine whether the severity of non-neurological critically ill patients correlates with clinical predictors of bronchial aspiration. Methods: We evaluated adults undergoing prolonged orotracheal intubation (> 48 h) and bedside swallowing assessment within the first 48 h after extubation. We collected data regarding the risk of bronchial aspiration performed by a speech-language pathologist, whereas data regarding the functional level of swallowing were collected with the American Speech-Language-Hearing Association National Outcome Measurement System (ASHA NOMS) scale and those regarding health status were collected with the Sequential Organ Failure Assessment (SOFA). Results: The study sample comprised 150 patients. For statistical analyses, the patients were grouped by ASHA NOMS score: ASHA1 (levels 1 and 2), ASHA2 (levels 3 to 5); and ASHA3 (levels 6 and 7). In comparison with the other patients, those in the ASHA3 group were significantly younger, remained intubated for fewer days, and less severe overall clinical health status (SOFA score). The clinical predictors of bronchial aspiration that best characterized the groups were abnormal cervical auscultation findings and cough after swallowing. None of the patients in the ASHA 3 group presented with either of those signs. Conclusions: Critically ill patients 55 years of age or older who undergo prolonged orotracheal intubation (≥ 6 days), have a SOFA score ≥ 5, have a Glasgow Coma Scale score ≤ 14, and present with abnormal cervical auscultation findings or cough after swallowing should be prioritized for a full speech pathology assessment.
Influence of age and gender on the profile of exhaled volatile organic compounds analyzed by an electronic nose
Authors: Dragonieri Silvano , Quaranta Vitaliano Nicola , Carratu Pierluigi , Ranieri Teresa , Resta Onofrio
Published: May 2016

We aimed to investigate the effects of age and gender on the profile of exhaled volatile organic compounds. We evaluated 68 healthy adult never-smokers, comparing them by age and by gender. Exhaled breath samples were analyzed by an electronic nose (e-nose), resulting in "breathprints". Principal component analysis and canonical discriminant analysis showed that older subjects (≥ 50 years of age) could not be distinguished from younger subjects on the basis of their breathprints, as well as that the breathprints of males could not distinguished from those of females (cross-validated accuracy, 60.3% and 57.4%, respectively).Therefore, age and gender do not seem to affect the overall profile of exhaled volatile organic compounds measured by an e-nose.
Распространенные проблемы при обучении вокалу на начальном этапе
Authors: Ренева Анна Николаевна
Published: May 2016

В статье отмечаются наиболее распространенные проблемы при обучении вокалу молодежь: зажатый звук, неумение смешивать регистры и пр. В обучении пению, считает автор, очень важна этапность развития техники.
Isolated extramedullary relapse of acute myelocytic leukemia after bone marrow transplantation affecting left ventricle and right atrium in an adult
Authors: Kong Ling Yun , Liu Min , Li De Peng , Lv Xiu Zhang
Published: May 2016

Isolated extramedullary relapse (IEMR) of acute leukemia after bone marrow transplantation is rare, particularly the heart. We report a case in a female patient which involved both the right atrium in the form of a mass and the left ventricle as asymmetric infiltrative hypertrophy.
Beyond the Coronary Arteries: Evolving Applications of Multi-detector Cardiac Computed Tomography in the Assessment of Non-coronary Structures
Authors: Xu Bo , Seneviratne Sujith , Nasis Arthur
Published: May 2016

Beyond the assessment of coronary artery anatomy, multi-detector computed tomography (MDCT) can be used to provide detailed structural evaluation of multiple non-coronary structures. The purpose of this review is to provide a clinical update on the evolving niche applications of MDCT in the assessment of non-coronary structures, including the assessment of the left ventricle for perfusion and scar, the evaluation of the right ventricle, pericardium and coronary anomalies. Additionally, the roles of MDCT in the assessment of congenital heart disease and intra-cardiac masses will be reviewed.
Desirable Characteristics of Consulting Cardiologists for Sustained Referrals by Primary Care Physicians
Authors: Ribeiro Phillip , Patel Swetal , Carlos Krystal , Sehgal Sumit , Pai Ramdas , Ribeiro Paulo
Published: May 2016

Accountable care organization and high quality affordable patient care requires impeccable team work between primary and specialist care physicians. Limited data exists on evaluation of factors that lead to termination of referrals between primary care physicians and cardiologists.  Using an 11 point questionnaire of potential factors for cause of termination of referrals to cardiologists, 103 primary care providers were interviewed. Out of 103 primary care providers interviewed in Little Rock, Arkansas and Chicago, Illinois, 84 providers were practicing in the city limits and 19 in the rural areas. The most important factors that result in termination of referrals between primary care physicians and cardiologists include cardiologist's bedside manners as perceived by the patient, poor feedback to the primary care provider from the cardiologist, and the patients not getting their questions fully answered by the cardiologist during the visit.
Percutaneous Coronary Intervention versus Coronary Artery Bypass Graft Among Patients with Coronary Artery Disease and Left Ventricular Systolic Dysfunction: a Meta-analysis
Authors: Huang Fang-Yang , Huang Bao-Tao , Peng Yong , Liu Wei , Wang Peng-Ju , Chen Mao , Zhu Ye
Published: May 2016

Background: There is an absence of randomized controlled trials (RCTs) comparing types of revascularization in patients with coronary artery disease (CAD) in the presence of left ventricular systolic dysfunction (LVSD). Our aim was to compare the outcomes of percutaneous coronary intervention (PCI) versus coronary artery graft bypass (CABG) among patients with CAD and LVSD.

Methods: The PubMed online database (from 1976 to November, 2014) and EMbase (from 1974 to November, 2014) were searched. Studies comparing the outcomes of PCI versus CABG among patients with left ventricular dysfunction (ejection fraction <50%) were included. Random- and fixed-effect models were used depending on between-study heterogeneity.

Results: Due to absence of RCTs on this topic, twelve observational studies including 5,494 patients were included. PCI was associated with a lower risk of short-term mortality (Risk ratio [RR], 0.51, 95% confidence interval [CI], 0.26-1.00) but a higher risk of long-term mortality (RR, 1.21, 95%CI, 1.05-1.40) and repeat revascularization (RR, 4.18, 95%CI, 1.92-9.12) compared with CABG. No significant difference in composite outcomes (RR, 1.26, 95%CI, 0.92-1.73), myocardial infarction (RR, 0.63, 95% CI, 0.17-2.41) and cerebrovascular accident ((RR, 0.61, 95%CI, 0.18-2.01) was observed between PCI vs. CABG.

Conclusions: Due to the absence of any RCTs on this topic, a meta-analysis of observational studies was performed. It suggested PCI was associated with a better short-term prognosis but an increased risk of long-term mortality compared with CABG. Further well-designed RCT’s are needed to verify this conclusion.
Una reflexión sobre la participación de los individuos en la creación de derecho comunitario a través de la Iniciativa Ciudadana Europea y sobre su alcance en derecho internacional
Authors: Espaliú Berdud Carlos
Published: May 2016

El Tratado de Lisboa introdujo en el Derecho de la Unión Europea (UE) la figura de la iniciativa ciudadana europea, con el objetivo de mejorar el funcionamiento democrático de la UE. Desde la perspectiva más amplia del Derecho Internacional, es una institución única en el derecho de las organizaciones internacionales, teniendo en cuenta que, hasta ahora, no existe ninguna institución similar en ninguna otra organización internacional en el mundo. Además, este paso parece implicar, potencialmente, un impulso importante en la creciente subjetividad internacional del individuo. En efecto, al asociar a los ciudadanos europeos en la formación de importantes resoluciones de la UE, la iniciativa ciudadana permite participar a los ciudadanos en la creación, al menos de un modo indirecto, del Derecho Comunitario. Sin embargo, esta potencialidad se ha visto debilitada por el escaso resultado obtenido hasta ahora en la práctica en los primeros tres años de ejercicio de este derecho.

Recibido: 11.11.2015
Aceptado: 11.01.2016
QualisSUS-Redes e as proposições do Banco Mundial: problematizações críticas
Authors: De Castro e Castro Marina Monteiro
Published: May 2016

O presente artigo tem por objetivo apresentar problematizações críticas acerca do QualiSUs-Redes - programa do Ministério da Saúde financiado pelo Banco Mundial. Através de uma pesquisa junto aos documentos que subsidiam o programa e às referências teóricas que tratam do mesmo, foi realizada uma apreciação das principais propostas do Programa. O estudo demonstrou que, apesar do QualiSUS-Redes ter em sua composição direcionamentos que buscam avanços na qualificação dos serviços públicos de saúde, é necessário problematizar o alinhamento aos ditames do Banco Mundial, em um  contexto de ataque às políticas públicas de saúde, para desmistificar os fundamentos políticos e econômicos dos programas governamentais.
Sobre la responsabilidad penal de las personas jurídicas y su incidencia en Colombia
Authors: Tolosa Russi Daniel
Published: May 2016

En un mundo globalizado, la criminalidad de empresa ha crecido de una forma excepcional, creando nuevos desafíos para que el Derecho penal pueda proteger bienes jurídicos de nuevas formas de lesión, provenientes de nuevos actores del mundo social. Esto ha llevado a que en el Derecho comparado se encuentran varios ejemplos en los cuales las personas jurídicas son consideradas como capaces de responder penalmente. Es por esto que resulta pertinente realizar un análisis teórico y práctico sobre la creación de un Derecho penal para las empresas en nuestro ordenamiento jurídico nacional. En el presente artículo encontraremos respuesta a criterios dogmáticos sobre los cuales se fundamenta, desde una visión colombiana, la necesidad de implantar una responsabilidad penal de las personas jurídicas. También hallaremos aspectos sobre su capacidad de acción y su capacidad de culpabilidad. Al final se presentará una propuesta que contenga los parámetros más generales, sobre los cuales proponer una consagración legal en el Derecho positivo.
Soberanía, globalización y la constitución de significado
Authors: Benavides Vanegas Farid Samir
Published: May 2016

En este ensayo pretendo demostrar cómo la pérdida de soberanía del Derecho y de la nación ha implicado la emergencia de nuevos lugares de construcción de la identidad y cómo estas nuevas identidades han llegado a ser globales, debido a la pérdida de centralidad del Estado-Nación como lugar de producción de significado. Mediante el análisis del concepto de soberanía y de su relación con el poder de nombrar que posee el Estado, ejercido a través de la ley, quiero mostrar cómo en una sociedad del espectáculo este poder es quitado al Estado y dado a otros lugares que puedan garantizar la pasividad de los espectadores y, por tanto, la ausencia de resistencia en la construcción del significado. Esto lo haré mediante el análisis de una telenovela colombiana y su manejo del concepto de corrupción para mostrar de qué manera el significado legal fue superado por aquel construido en los medios de comunicación.
El bien jurídico y las funciones del Derecho penal
Authors: Leyva Estupiñán Manuel Alberto , Lugo Arteaga Larisbel
Published: May 2016

La dogmática penal referida a las funciones del Derecho penal y el bien jurídico penal es amplia y diversa. Con el liberalismo penal comenzó un proceso de construcción teórica del objeto de tutela del Derecho penal, que no ha concluido. La mayoría de los penalistas contemporáneos, salvo pocas excepciones, coinciden en señalar que el Derecho penal protege bienes jurídicos; sin embargo, al definir qué se entiende por bien jurídico es cuando comienzan las divergencias teóricas. El rol de la Constitución como norma suprema del ordenamiento jurídico de un país, la derivación de esta del objeto de protección del Derecho Penal y las complejas interrelaciones que se establecen entre poder estatal, protección penal, delimitación del bien jurídico etc., constituyen algunos de los temas presentes del Derecho penal y la Filosofía penal contemporánea.
Preparing Students for Education, Work, and Community: Activity Theory in Task-Based Curriculum Design
Authors: Campbell Chris , MacPherson Seonaigh , Sawkins Tanis
Published: May 2016

This case study describes how sociocultural and activity theory were applied in the design of a publicly funded, Canadian Language Benchmark (CLB)-based English as a Second Language (ESL) credential program and curriculum for immigrant and international students in postsecondary institutions in British Columbia, Canada. The ESL Pathways Project was conceived to prepare immigrant students to navigate the multiple pathways in the settlement process from postsecondary education to the workplace, community participation, and citizenship. The innovation in curriculum design resulted from the systematic reinterpretation of situated cognition and task-based design using activity theory. Given that both situated and task-based learning share intersecting theoretical lineages with activity theory, this reinterpretation was more a deepening and improvement than a reconceptualization process. The ensuing units were defined by the real-world activities and contexts of target communities of practice, with relevant instructional topics, tasks, genres, skills, and outcomes presented in a systematic manner to support learners to participate, ultimately, in those target communities. This process contrasts with traditional ad hoc forms of task-based curriculum design in ESL and EAP (English for Academic Purposes).Cette étude de cas décrit dans quelle mesure la théorie socioculturelle et la théorie de l’activité ont joué un rôle dans la conception d’un programme d’étude à crédits pour l’anglais langue seconde reposant sur les niveaux de compétence canadiens et visant les immigrants et les étudiants internationaux dans les institutions postsecondaires en Colombie britannique au Canada. Le projet « ESL Pathways » (Parcours en anglais langue seconde) a été conçu pour aider les étudiants immigrants à naviguer les divers parcours que présente le processus d’établissement, depuis les études postsecondaires à la citoyenneté en passant par le milieu du travail et la participation communautaire. Le programme novateur résulte d’une réinterprétation systématique, par le biais de la théorie de l’activité, de la conception située et centrée sur les tâches. Puisque la cognition située et l’apprentissage basé sur les tâches partagent des éléments de la théorie de l’activité, cette réinterprétation représente plutôt un approfondissement et une amélioration qu’une reconceptualisation. Les unités qui en découlent reposent sur des activités réelles et des communautés de pratiques cibles, et elles présentent des thèmes, des tâches, des genres, des habiletés et des résultats de façon systématique de sorte à favoriser la participation des apprenants à ces communautés. Ce processus se distingue des formes traditionnelles et ad hoc de conception des programmes d’étude en anglais langue seconde et en anglais académique.
PBLA: Moving Toward Sustainability
Authors: Holmes Tara
Published: May 2016

The introduction of Portfolio-Based Language Assessment (PBLA) into federally funded Language Instruction for Newcomers to Canada (LINC) programs is a major national initiative. This comprehensive approach to classroom-based assessment, aligned to the Canadian Language Benchmarks standards, incorpo- rates current perspectives on assessment and draws heavily on Assessment for Learning (AfL) research and principles. This article describes the PBLA initiative in relation to the research that informs it and outlines the approach that is being used to introduce PBLA into adult ESL programs. The article introduces a model of sustainability proposed by researchers who have led AfL initiatives internationally. Key learning from these initiatives points to implications for PBLA; the author suggests directions for PBLA moving forward. L’intégration de l’évaluation linguistique basée sur le portefeuille (Portfolio- Based Language Assessment - PBLA) dans les programmes subventionnés par le gouvernement fédéral des Cours de langue pour les immigrants au Canada (CLIC) représente une l’initiative nationale majeure. Ce e approche globale à l’évaluation en classe, conforme aux niveaux de compétence linguistique canadien, intègre les perspectives actuelles sur l’évaluation et s’appuie fortement sur la recherche et les principes de l’évaluation au service de l’apprentissage (AfL). Cet article décrit l’intiative de la PBLA par rapport à la recherche qui l’éclaire, et dresse les grandes lignes de l’approche employée pour l’intégrer aux programmes d’ALS pour adultes. De plus, on y présente un modèle de durabilité proposé par les chercheurs qui ont mené des initiatives d’AfL sur le plan international. Les principales leçons de ces initiatives comprennent des incidences pour la PBLA et l’auteure proposent des pistes pour la faire progresser.
Species introductions and the phylogenetic and functional structure of California's grasses
Authors: Sandel Brody , Tsirogiannis Constantinos
Published: May 2016

Many species assemblages represent a nonrandom subset of a larger species pool. When an assemblage tends to contain close evolutionary relatives or species with similar functional traits, it can be described as phylogenetically or functionally clustered. Clustering is often interpreted as evidence for filtering by some combination of environmental and biotic factors. At sufficiently large spatial extents, however, biogeographic barriers can also lead to strong clustering. Here, we suggest that the breakdown of biogeographic barriers associated with human introductions of exotic species can be used as an unintentional experiment to assess their importance in driving phylogenetic and functional structure. An important role of biogeographic barriers would be revealed by a breakdown in clustering, particularly phylogenetic clustering, following species introductions. On the other hand, a role of filtering can be supported by similar patterns of clustering in the native and exotic assemblages along environmental gradients. We test these predictions using the grasses of California, a diverse group including many introduced species. Native grass assemblages in the state are highly clustered with respect to the global grass species pool, both phylogenetically and functionally. Within the state, variation in the strength of clustering is well explained by climatic variables, suggesting an important role for environmental‐biotic filtering. Further, subregions within the state with highly clustered native assemblages also contain highly clustered exotic assemblages. Contrary to expectation, though, the introduction of exotic species led to even more strongly clustered assemblages. We conclude that biogeographic barriers have generally not excluded the major grass lineages (e.g., tribes) from the state and likely act only on finer taxonomic scales (for example, excluding particular genera). Our approach should prove broadly applicable and contribute to improved understanding of broad‐scale patterns of assemblage structure.
Bottom‐up and top‐down human impacts interact to affect a protected coastal Chilean marsh
Authors: Fariña José M. , He Qiang , Silliman Brian R. , Bertness Mark D.
Published: May 2016

Many ecosystems, even in protected areas, experience multiple anthropogenic impacts. While anthropogenic modification of bottom‐up (e.g., eutrophication) and top‐down (e.g., livestock grazing) forcing often co‐occurs, whether these factors counteract or have additive or synergistic effects on ecosystems is poorly understood. In a Chilean bio‐reserve, we examined the interactive impacts of eutrophication and illegal livestock grazing on plant growth with a 4‐yr fertilization by cattle exclusion experiment. Cattle grazing generally decreased plant biomass, but had synergistic, additive, and antagonistic interactions with fertilization in the low, middle, and high marsh zones, respectively. In the low marsh, fertilization increased plant biomass by 112%, cattle grazing decreased it by 96%, and together they decreased plant biomass by 77%. In the middle marsh, fertilization increased plant biomass by 47%, cattle grazing decreased it by 37%, and together they did not affect plant biomass. In the high marsh, fertilization and cattle grazing decreased plant biomass by 81% and 92%, respectively, but together they increased plant biomass by 42%. These interactions were also found to be species specific. Different responses of plants to fertilization and cattle grazing were likely responsible for these variable interactions. Thus, common bottom‐up and top‐down human impacts can interact in different ways to affect communities even within a single ecosystem. Incorporating this knowledge into conservation actions will improve ecosystem management in a time when ecosystems are increasingly challenged by multiple interacting human impacts.