bluuebunny/crossref_metadata_2025 huggingface dataset:
Práticas de Gestão de Inovação Tecnológica: proposição de um modelo para pequenas e médias empresas brasileiras
Authors: Vilha Anapatrícia Morales
Published: September 2013

DOI: http://dx.doi.org/10.13071/regec.2317-5087.2013.2.1.4917.116-146.A competitividade desperta para a necessidade de as empresas estarem atentas ao ambiente externo e perseguirem vantagens baseadas em inovações de difícil imitação pelos competidores. Entretanto, a geração de inovações depende da maneira como a empresa é conduzida, ou seja, seu desempenho depende de mecanismos de gestão para prover inovações alinhadas às estratégias competitivas de empresas que estão pautadas no contexto de mudança. Este trabalho discute as práticas de gestão de inovação em pequenas e médias empresas brasileiras. Para tanto, realizou-se um levantamento da literatura nacional e internacional nas áreas de gestão de empresas, gestão de tecnologia e inovação, e de empreendimentos de pequeno e médio porte, cujo resultado inspirou a construção do modelo de gestão de inovação tecnológica para pequenas e médias empresas proposto neste trabalho.
Microfundamentos para a Inovação Aberta: a efetuação é uma abordagem válida para os gestores da inovação aberta?
Authors: Rondani Bruno , Andreassi Tales , Bernardes Roberto
Published: September 2013

DOI: http://dx.doi.org/10.13071/regec.2317-5087.2013.2.1.4968.94-115.Desde que Chesbrough (2003) cunhou pela primeira vez o conceito de inovação aberta, tem atraído atenção crescente do meio acadêmico e profissional. A pesquisa acadêmica tem espalhado seu foco em temas como gestão da inovação, estratégia de negócios, comportamento organizacional e políticas públicas, enquanto os profissionais têm explorado o conceito de inovação aberta de formas diversas. Levando isso em conta, o artigo propõe microfundamentos para a inovação aberta, relacionando-a à teoria da efetivação, originalmente desenvolvida no campo do empreendedorismo. Nosso objetivo é mostrar que a teoria da efetivação pode proporcionar um forte contributo para a construção, no nível micro, de uma base conceitual consistente para as práticas de inovação aberta.
O Discurso da Sustentabilidade e sua Inserção no Contexto Organizacional
Authors: Coelho Ana Lúcia de Araújo Lima , Coelho Christiano , Godoi Christiane Kleinübing
Published: September 2013

DOI: http://dx.doi.org/10.13071/regec.2317-5087.2013.2.1.5061.147-186.A crítica ao capitalismo industrial e o reconhecimento da importância do meio ambiente na economia mundial foi determinante para o discurso da sustentabilidade ser uma expressão de orde comum no contexto organizacional. Observar a construção do discurso da sustentabilidade torna-se relevante para que se possa estudar o tema no âmbito das organizações. A partir de uma revisão bibliográfica, este estudo busca refletir sobre o discurso da sustentabilidade como um discurso institucional e midiático, e sua inserção no contexto organizacional. Do discurso da sustentabilidade é possível desvelar parte de uma realidade organizacional, evidenciando grupos de interesse, conflitos e relações de poder. O discurso da sustentabilidade e sua inserção no contexto organizacional é construído e constantemente reconstruído num contexto dominado por interesses econômicos.
Expediente
Authors: Santos Glicia Vieira dos
Published: September 2013

DOI: http://dx.doi.org/10.13071/regec.2317-5087.2013.2.1.5927.1-4.Apresenta a 2a. edição da Revista Gestão & Conexões (Management and Connections Journal), v2, n1, jan./jun. 2013.
Editorial
Authors: Santos Glicia Vieira dos
Published: September 2013

DOI: http://dx.doi.org/10.13071/regec.2317-5087.2013.2.1.5928.19-21.Apresenta a 2a. edição da Revista Gestão & Conexões (Management and Connections Journal), v2, n1, jan./jun. 2013.
Informações Editoriais
Authors: Santos Glicia Vieira dos
Published: September 2013

DOI: http://dx.doi.org/10.13071/regec.2317-5087.2013.2.1.5929.5-18.Apresenta as informações de desempenho da Revista Gestão & Conexões em seu primeiro ano de funcionamento (2012):distribuição geográfica da equipe editorial;fluxo editorial (tempo médio que os manuscritos permaneceram no processo de avaliação até à emissão da decisão editorial); nominata dos avaliadores do ano 2012;artigos publicados em jul/dez 2012quantidade de visitantes ao site da Revista no Brasil e no mundo; e,indexação e classificação.
Eurhythmatic analysis: A rhetoric of adaptation
Authors: Wallin Mark Rowell
Published: September 2013

This article proposes that many of the persistent and nagging problems that plague adaptation studies can be solved by consideration of the ancient and modern invocations of the rhetorical term Eurhythmia. Adaptation studies – or the analysis of the ways texts are changed as they are transplanted from mode to mode – constantly struggles to resist the impulse to denigrate new textual instantiations out of hand as ‘less than’ a revered form, bestowing a metaphor of emanation and corruption on the adaptation. A eurhythmatic approach, conversely, advocates the use of rhetorical strategies arising out of considerations of audience, purpose and context, in order to analyse these modal shifts. Being first concerned with ‘the right fit for the right purpose’, eurhythmia gives us the tools to see adaptations in a constellation of textual associations and material contexts that in turn allow us to understand why some adaptations succeed and why others fail.
Wuthering Heights: A radio adaptation
Authors: Gough Lucy
Published: September 2013

A radio adaptation of Emily Brontë’s Novel Wuthering Heights commissioned by the BBC for the Radio 4 Woman’s Hour series. This adaptation is spread over fifteen episodes and deliberately gives the second half of the book as much time as the more popular first half. This version has also deliberately embraced the medium of radio, hence the house ‘Wuthering Heights’ has been given a voice. Hopefully this brings the world of the book directly into the mind of the listener, with all the brooding passion, cruelty, and darkness it contains. It is a novel of extremes, love and hate, hell and heaven, life and death, man and beast it is also about breaking boundaries and promises. I hope by paring the book back to its bones I have managed to capture some of this in its new form.
Anthony Minghella: Aautobiographical memory and the creation of an adapted screenplay
Authors: Dickenson Sarah Jane
Published: September 2013

The following article uses as its source material interviews with the director and screenwriter Anthony Minghella which I carried out between 2003 and 2006. Minghella approached the adaptation of a novel in a particular way and I would contend he adapted autobiographical memories in the same way he adapted novels. In this article I will consider how Minghella drew on his memories both of the texts he adapted and his autobiographical memories in order to create screenplays.
This side of paradise: Immersion and emersion in S3D and AR
Authors: Asselin Olivier , Auger Louis
Published: September 2013

S3D and AR, emergence and augmentation, have certain similarities, for both call into question the surface of the image on the side of the viewer by introducing virtual elements into real space. A comparative analysis of the two strategies reveals that the mimetic program that largely structures the production and reception of technical images is not centred squarely on illusion, but more generally on immersion and more particularly on egocentric spatial immersion, which perceptually places the viewer at the centre of the virtual world. But at the present time, as they have developed so far, S3D and AR are imperfect responses to this ideal.
Colin Low and Transitions 3D: Innovating immersive cinema
Authors: Smith David Harris
Published: September 2013

Transitions 3D is significant to film scholars because it is the first stereoscopic live-action IMAX film. The film also anchors important histories of Canadian film innovation and culture. From a technical perspective these histories include the development of large format cinema cameras and projection systems, early computer animation, and immersive cinema exhibition architecture. From a cultural perspective, Transitions 3D was the culmination of a prolific and wide flung collaboration of Canadian film-makers and technologists that was forged in response to the cultural mandates of the NFB and the national showcase agendas of successive world expositions. Low’s nuanced modernist ideology coupled with his sustained artistic and technical experimentation were central to these developments, driven in particular by his quest for an immersive cinema that would unite the film viewer and film subject in a stereoscopic cinematic space.
Perceptual artefacts, suspension of disbelief and realism in stereoscopic 3D film
Authors: Allison Robert S. , Wilcox Laurie M. , Kazimi Ali
Published: September 2013

Stereoscopic film has long held an allure as the ultimate in fidelity for cinema and, as such, been a goal for those seeking the most compelling illusion of reality. However, the fundamental and technical limitations of the medium introduce a number of artefacts and imperfections that impact the viewer experience. The renaissance of stereoscopic three-dimensional (S3D) film requires that film-makers revisit assumptions and conventions about factors that influence the visual appreciation and impact of their medium. This article will discuss a variety of these issues from a perceptual standpoint and their implications for depth perception, visual comfort and sense of scale. The impact of these perceptual artefacts on the suspension of disbelief and the creation of alternate realities is discussed as is their deliberate use when artistic considerations demand breaks with realism.
For your glasses only: The Stewardesses and sex in three dimensions
Authors: Duerfahrd Lance
Published: September 2013

The Stewardesses (1969) is an unjustifiably neglected experiment in 3-D cinema. The first in a series of hard- and soft-core pornographic features in three dimensions produced in the 1970s, it provides critical opportunity to review a ‘truism’ of media studies: that pornography drives the invention of new technologies. The Stewardesses unwitting reveals how our desire for technology (our wonder at the capacity of film to reach into our space) is at odds with our desire for what it purveys (bodies in states of desire). The film makes us aware of how a 3-D film arouses our glasses, not our eyes. Since 3-D camera lenses could not provide close-ups, the film works without a key ingredient of the pornographic vocabulary. Through 3-D technology, The Stewardesses produces a strange new genre: pornography that fosters attention to peripheral spaces and that discourages the traditional monomaniacal or cyclopic focus of the spectator of pornography.
The experimental origins of cinema, stereo and their combination
Authors: Wade Nicholas J.
Published: September 2013

The rapid growth in stereoscopic cinema and television might suggest a recent concern with adding stereo depth to apparent motion, but this is not the case. Attempts were carried out by the pioneers of research on stereoscopic vision and apparent motion in the early nineteenth century. This was possible because of the instruments they invented to simulate motion and depth – phenakistiscopes (or stroboscopic discs) and stereoscopes. Sequences of still images could appear to move and paired pictures (with small horizontal disparities and presented to different eyes) were seen in depth. Subsequently, many varieties of stroboscopic discs and stereoscopes were devised and their popularity increased enormously after 1840, when combined with photography. Thereafter, sequences of stereoscopic photographs were presented in instruments called bioscopes or fantascopic stereoscopes so that the apparent motion appeared in depth. Unlike the simulation of motion and depth alone, their combination proved more difficult to achieve.
Avant 3D: Notes on experimental stereoscopic cinema and painting
Authors: Zone Ray
Published: September 2013

This article is an historical survey of stereoscopic painting and films and their makers. Additional consideration is given to the use of the third dimension in art and how that has affected public and critical perception of the work.
Stereoscopic media: Scholarship beyond booms and busts
Authors: Gurevitch Leon , Ross Miriam
Published: September 2013

Stereoscopic imaging has had a rich history in photographic, televisual, cinematic, theme-park and gaming form since its emergence in the nineteenth century. Nonetheless, 3D media’s many booms and busts have led it to be treated as a cyclical ‘fad’. Its peak moments suggest a trend of death and rebirth, and stereoscopy has come to be characterized, more than any other media form, by its continual passing. But while scepticism towards this form has become a standard popular and scholarly refrain, less acknowledged is the way in which 3D imaging has remained in public consciousness and at the peripheries of popular visual culture throughout its lengthy history. This article explores the interstitial moments of stereoscopic media’s history and takes account of the determinants that have allowed it to thrive and wane while foregrounding the role that popular imagination has played in allowing it to persist.
Abelian JSJ decomposition of graphs of free abelian groups
Authors: Beeker Benjamin
Published: September 2013

A group G is a vGBS group if it admits a decomposition as a finite graph of groups with all edge and vertex groups finitely generated and free abelian. We construct the JSJ decomposition of a vGBS group over abelian groups. We prove that this decomposition is explicitly computable, and may be obtained by local changes on the initial graph of groups.
Semen analysis: update on clinical value, current needs and future perspectives
Authors: Sánchez Victoria , Wistuba Joachim , Mallidis Con
Published: September 2013

At present, evaluation of male reproductive function consists primarily of routine semen analysis, a collection of conventional microscopic assessments ideally performed following the guidelines set by the World Health Organization. While providing some insight into testicular function, these long-performed tests are limited in the information that they impart; more specifically, they are unable to predict true fertility potential. As a consequence, there is a need for the appraisal and consideration of newer semen parameters that may be more indicative of reproductive success. Although various novel assays have been introduced that broaden the scope of information available to both researcher and clinician, the utility of these tests remains limited due to the lack of standardisation of protocols and the absence of clinically established, dependable reference ranges. As such, it is not surprising that most of these parameters and their associated methods remain recommended for ‘research purposes only’. With the burgeoning ‘omics’ revolution, nanotechnology and the development of new analytical instruments, there is now an opportunity for the identification and measurement of previously unknown features that may prove to be more indicative of each sperm's true functional status and capability. Once optimised, simplified, clinically validated and made more readily accessible, these new approaches hold the promise of forming the fulcrum upon which andrological investigations can enter a new era.
Roles of poly (ADP-ribose) polymerase (PARP1) cleavage in the ovaries of fetal, neonatal, and adult pigs
Authors: Wei Quanwei , Ding Wei , Shi Fangxiong
Published: September 2013

Poly(ADP-ribosylation), which occurs rapidly in cells following DNA damage and is regulated by poly (ADP-ribose) polymerase 1 (PARP1), is a post-translational modification of proteins playing a crucial role in many processes, including DNA repair and cell death. Although PARP1 has recently been implicated in a variety of physiological and pathological processes, its role in the process of follicular development and atresia is not yet completely defined. This study was designed to investigate the cellular expression pattern and immunolocalization of PARP1, cleaved PARP1, caspase 3, and cleaved caspase 3 in fetal, neonatal, and adult porcine ovaries. Our results showed that in fetal and neonatal pigs, PARP1 cleavage is involved in the process of oocyte nest breakdown, primordial follicle formation, and transition to primary follicles. The results of immunohistochemistry indicated that PARP1 cleavage was involved in the process of follicular development and atresia, which was in accordance with our previous study; however, it was noted that cleaved caspase 3 was mainly localized in and around the nucleus of apoptotic granulosa cells (GCs), whereas cleaved PARP1 was mainly localized in the nucleus of the apoptotic GCs. RIA data showed increased serum progesterone and estradiol concentrations with age after birth. Collectively, our findings suggest that the PARP1 signaling pathway is involved in oocyte nest breakdown and primordial follicle formation in fetal and neonatal porcine ovaries, but is different from follicular atresia in adult porcine ovaries that involves cellular apoptosis.
Dietary α-linolenic acid from flaxseed oil improved folliculogenesis and IVF performance in dairy cows, similar to eicosapentaenoic and docosahexaenoic acids from fish oil
Authors: Moallem U , Shafran A , Zachut M , Dekel I , Portnick Y , Arieli A
Published: September 2013

The objectives of this study were to determine the differential incorporation of various omega-3 (n-3) fatty acids (FAs) supplemented to dairy cows into ovarian compartments and assess the effects on IVF. Forty-two 256-day pregnant cows were supplemented with encapsulated fats, in treatments designated as i) SFA – saturated fat at 240 and 560 g/day per cow, prepartum and post partum (PP) respectively; ii) FLX – flaxseed oil at 300 and 700 g/day per cow prepartum and PP respectively; and iii) FO – fish oil at 300 and 700 g/day per cow prepartum and PP respectively. Commencing at 60 days in lactation, ovum pickup (OPU) was performed twice weekly (20 sessions; five cows per group) and in vitro maturation and IVF were conducted. The proportion of α-linolenic acid (ALA) was greater in follicular fluid (FF), granulosa cells, and cumulus–oocyte complexes (COCs) of FLX cows than in other groups (P<0.001). The proportion of docosahexaenoic acid (DHA) was 6.7 times as great in FF of FO as in other groups (P<0.001); docosapentaenoic acid n-3 and DHA were detected in COCs of FO but not in others. The follicle number during OPU was higher in FLX and FO than in SFA (P<0.05), and the oocyte cleavage rate was higher in FLX and FO than in SFA (P<0.01). Also, the percentage of oocytes that developed to blastocysts tended to be higher in both n-3 groups than in SFA (P<0.1). In conclusion, both dietary n-3 FAs similarly improved folliculogenesis and IVF performance; therefore, ALA-rich botanical n-3 seems to be a satisfactory approach to improve oocyte quality.
KCNH1 potassium channels are expressed in cervical cytologies from pregnant patients and are regulated by progesterone
Authors: Ramírez A , Hinojosa L M , Gonzales J d J , Montante-Montes D , Martínez-Benítez B , Aguilar-Guadarrama R , Gamboa-Domínguez A , Morales F , Carrillo-García A , Lizano M , García-Becerra R , Díaz L , Vázquez-Sánchez A Y , Camacho J
Published: September 2013

Potassium voltage-gated channel, subfamily H (eag-related), member 1 (KCNH1) potassium channels are potential tumour markers and cancer therapeutic targets and are up-regulated by oestrogens and human papilloma virus (HPV) oncogenes. However, the role of KCNH1 in normal tissues is poorly understood, and its expression in pregnancy is unknown. We wondered whether KCNH1 channels are expressed in cervical cells from pregnant patients and whether progesterone (P4) regulates KCNH1. The association with HPV was also investigated. KCNH1 protein expression was studied by immunocytochemistry in liquid-based cervical cytologies; 93 samples were obtained from pregnant patients at different trimesters, and 15 samples were obtained from non-pregnant women (controls). The presence ofHPVwas studied by PCR with direct sequencing and nested multiplex PCR. HeLa cervical cancer cells were transfected with human progesterone receptor-B (PR-B) and treated with P4.KCNH1mRNA expression in these cultures was studied by real-time PCR. KCNH1 protein was detected in 100% of the pregnancy samples and in 26% of the controls. We found 18 pregnant patients infected with HPV and detected 14 types ofHPV. There was no association between the percentage of cells expressing KCNH1 and either the presence or type of HPV. P4induced KCNH1 mRNA and protein expression in cells transfected with human PR-B. No regulation of KCNH1 by P4was observed in non-transfected cells. We show for the first time the expression of an ion channel during human pregnancy at different trimesters and KCNH1 regulation by P4in human cells. These data raise a new research field for KCNH1 channels in human tissues.
Cell-Type–Specific Transcriptional Profiles of the Dimorphic Pathogen Penicillium marneffei Reflect Distinct Reproductive, Morphological, and Environmental Demands
Authors: Pasricha Shivani , Payne Michael , Canovas David , Pase Luke , Ngaosuwankul Nathamon , Beard Sally , Oshlack Alicia , Smyth Gordon K , Chaiyaroj Sansanee C , Boyce Kylie J , Andrianopoulos Alex
Published: September 2013

Penicillium marneffei is an opportunistic human pathogen endemic to Southeast Asia. At 25° P. marneffei grows in a filamentous hyphal form and can undergo asexual development (conidiation) to produce spores (conidia), the infectious agent. At 37° P. marneffei grows in the pathogenic yeast cell form that replicates by fission. Switching between these growth forms, known as dimorphic switching, is dependent on temperature. To understand the process of dimorphic switching and the physiological capacity of the different cell types, two microarray-based profiling experiments covering approximately 42% of the genome were performed. The first experiment compared cells from the hyphal, yeast, and conidiation phases to identify “phase or cell-state–specific” gene expression. The second experiment examined gene expression during the dimorphic switch from one morphological state to another. The data identified a variety of differentially expressed genes that have been organized into metabolic clusters based on predicted function and expression patterns. In particular, C-14 sterol reductase–encoding gene ergM of the ergosterol biosynthesis pathway showed high-level expression throughout yeast morphogenesis compared to hyphal. Deletion of ergM resulted in severe growth defects with increased sensitivity to azole-type antifungal agents but not amphotericin B. The data defined gene classes based on spatio-temporal expression such as those expressed early in the dimorphic switch but not in the terminal cell types and those expressed late. Such classifications have been helpful in linking a given gene of interest to its expression pattern throughout the P. marneffei dimorphic life cycle and its likely role in pathogenicity.
Construction of Reference Chromosome-Scale Pseudomolecules for Potato: Integrating the Potato Genome with Genetic and Physical Maps
Authors: Sharma Sanjeev Kumar , Bolser Daniel , de Boer Jan , Sønderkær Mads , Amoros Walter , Carboni Martin Federico , D’Ambrosio Juan Martín , de la Cruz German , Di Genova Alex , Douches David S , Eguiluz Maria , Guo Xiao , Guzman Frank , Hackett Christine A , Hamilton John P , Li Guangcun , Li Ying , Lozano Roberto , Maass Alejandro , Marshall David , Martinez Diana , McLean Karen , Mejía Nilo , Milne Linda , Munive Susan , Nagy Istvan , Ponce Olga , Ramirez Manuel , Simon Reinhard , Thomson Susan J , Torres Yerisf , Waugh Robbie , Zhang Zhonghua , Huang Sanwen , Visser Richard G F , Bachem Christian W B , Sagredo Boris , Feingold Sergio E , Orjeda Gisella , Veilleux Richard E , Bonierbale Merideth , Jacobs Jeanne M E , Milbourne Dan , Martin David Michael Alan , Bryan Glenn J
Published: September 2013

The genome of potato, a major global food crop, was recently sequenced. The work presented here details the integration of the potato reference genome (DM) with a new sequence-tagged site marker−based linkage map and other physical and genetic maps of potato and the closely related species tomato. Primary anchoring of the DM genome assembly was accomplished by the use of a diploid segregating population, which was genotyped with several types of molecular genetic markers to construct a new ~936 cM linkage map comprising 2469 marker loci. In silico anchoring approaches used genetic and physical maps from the diploid potato genotype RH89-039-16 (RH) and tomato. This combined approach has allowed 951 superscaffolds to be ordered into pseudomolecules corresponding to the 12 potato chromosomes. These pseudomolecules represent 674 Mb (~93%) of the 723 Mb genome assembly and 37,482 (~96%) of the 39,031 predicted genes. The superscaffold order and orientation within the pseudomolecules are closely collinear with independently constructed high density linkage maps. Comparisons between marker distribution and physical location reveal regions of greater and lesser recombination, as well as regions exhibiting significant segregation distortion. The work presented here has led to a greatly improved ordering of the potato reference genome superscaffolds into chromosomal “pseudomolecules”.
A Mutation in the FHA Domain ofCoprinus cinereusNbs1 Leads to Spo11-Independent Meiotic Recombination and Chromosome Segregation
Authors: Crown K Nicole , Savytskyy Oleksandr P , Malik Shehre-Banoo , Logsdon John , Williams R Scott , Tainer John A , Zolan Miriam E
Published: September 2013

Nbs1, a core component of the Mre11-Rad50-Nbs1 complex, plays an essential role in the cellular response to DNA double-strand breaks (DSBs) and poorly understood roles in meiosis. We used the basidiomycete Coprinus cinereus to examine the meiotic roles of Nbs1. We identified the C. cinereus nbs1 gene and demonstrated that it corresponds to a complementation group previously known as rad3. One allele, nbs1-2, harbors a point mutation in the Nbs1 FHA domain and has a mild spore viability defect, increased frequency of meiosis I nondisjunction, and an altered crossover distribution. The nbs1-2 strain enters meiosis with increased levels of phosphorylated H2AX, which we hypothesize represent unrepaired DSBs formed during premeiotic replication. In nbs1-2, there is no apparent induction of Spo11-dependent DSBs during prophase. We propose that replication-dependent DSBs, resulting from defective replication fork protection and processing by the Mre11-Rad50-Nbs1 complex, are competent to form meiotic crossovers in C. cinereus, and that these crossovers lead to high levels of faithful chromosome segregation. In addition, although crossover distribution is altered in nbs1-2, the majority of crossovers were found in subtelomeric regions, as in wild-type. Therefore, the location of crossovers in C. cinereus is maintained when DSBs are induced via a Spo11-independent mechanism.
Bariatric Surgery for Severe Obesity in Two Adolescents With Type 1 Diabetes
Authors: Chuang Janet , Zeller Meg H. , Inge Thomas , Crimmins Nancy
Published: September 2013

Bariatric surgery has been effective in treating type 2 diabetes mellitus (T2DM); it has not been used frequently in obese patients with type 1 diabetes mellitus (T1DM). This is the first case series reporting on the effect of bariatric surgery on diabetes control in adolescents with T1DM. Patient A is a 19-year-old obese man with T1DM who underwent vertical sleeve gastrectomy. At 12 months after surgery he demonstrated 28% reduction in BMI. His daily total insulin requirement had decreased; however, hemoglobin A1c remained primarily unchanged at 8.8%. Patient B is a 13-year-old obese girl with an initial clinical diagnosis of T2DM controlled on only metformin. She underwent Roux-en-Y gastric bypass; at 1 month after surgery she presented in diabetic ketoacidosis and was found to have positive islet cell antibodies, which were also present before surgery. Her diagnosis was revised to T1DM, and she was started on insulin. By 28 months after surgery her BMI had decreased by 42%. Since initiation of insulin, her daily total insulin requirement had decreased, but hemoglobin A1c had significantly worsened from 6.3% to 10%. We found that despite significant weight loss, improvements in cardiovascular risk factors (dyslipidemia and obstructive sleep apnea), and quality of life in our patients, bariatric surgery does not necessarily lead to improved glycemic control of T1DM. Patients with T1DM have ongoing dependency on exogenous insulin, and optimal glycemic control still depends on patient compliance with diabetes care.
Prediction of Neonatal Outcomes in Extremely Preterm Neonates
Authors: Ge Wen J. , Mirea Lucia , Yang Junmin , Bassil Kate L. , Lee Shoo K. , Shah Prakeshkumar S.
Published: September 2013

OBJECTIVE:

To develop and validate a statistical prediction model spanning the severity range of neonatal outcomes in infants born at ≤30 weeks’ gestation.

METHODS:

A national cohort of infants, born at 23 to 30 weeks’ gestation and admitted to level III NICUs in Canada in 2010–2011, was identified from the Canadian Neonatal Network database. A multinomial logistic regression model was developed to predict survival without morbidities, mild morbidities, severe morbidities, or mortality, using maternal, obstetric, and infant characteristics available within the first day of NICU admission. Discrimination and calibration were assessed using a concordance C-statistic and the Cg goodness-of-fit test, respectively. Internal validation was performed using a bootstrap approach.

RESULTS:

Of 6106 eligible infants, 2280 (37%) survived without morbidities, 1964 (32%) and 1251 (21%) survived with mild and severe morbidities, respectively, and 611 (10%) died. Predictors in the model were gestational age, small (<10th percentile) for gestational age, gender, Score for Neonatal Acute Physiology version II >20, outborn status, use of antenatal corticosteroids, and receipt of surfactant and mechanical ventilation on the first day of admission. High model discrimination was confirmed by internal bootstrap validation (bias-corrected C-statistic = 0.899, 95% confidence interval = 0.894–0.903). Predicted probabilities were consistent with the observed outcomes (Cg P value = .96).

CONCLUSIONS:

Neonatal outcomes ranging from mortality to survival without morbidity in extremely preterm infants can be predicted on their first day in the NICU by using a multinomial model with good discrimination and calibration. The prediction model requires additional external validation.
Breastfeeding Concerns at 3 and 7 Days Postpartum and Feeding Status at 2 Months
Authors: Wagner Erin A. , Chantry Caroline J. , Dewey Kathryn G. , Nommsen-Rivers Laurie A.
Published: September 2013

OBJECTIVE:

We characterized breastfeeding concerns from open-text maternal responses and determined their association with stopping breastfeeding by 60 days (stopping breastfeeding) and feeding any formula between 30 and 60 days (formula use).

METHODS:

We assessed breastfeeding support, intentions, and concerns in 532 expectant primiparas and conducted follow-up interviews at 0, 3, 7, 14, 30, and 60 days postpartum. We calculated adjusted relative risk (ARR) and adjusted population attributable risk (PAR) for feeding outcomes by concern category and day, adjusted for feeding intentions and education.

RESULTS:

In 2946 interviews, 4179 breastfeeding concerns were reported, comprising 49 subcategories and 9 main categories. Ninety-two percent of participants reported ≥1 concern at day 3, with the most predominant being difficulty with infant feeding at breast (52%), breastfeeding pain (44%), and milk quantity (40%). Concerns at any postpartum interview were significantly associated with increased risk of stopping breastfeeding and formula use, with peak ARR at day 3 (eg, stopping breastfeeding ARR [95% confidence interval] = 9.2 [3.0–infinity]). The concerns yielding the largest adjusted PAR for stopping breastfeeding were day 7 “infant feeding difficulty” (adjusted PAR = 32%) and day 14 “milk quantity” (adjusted PAR = 23%).

CONCLUSIONS:

Breastfeeding concerns are highly prevalent and associated with stopping breastfeeding. Priority should be given to developing strategies for lowering the overall occurrence of breastfeeding concerns and resolving, in particular, infant feeding and milk quantity concerns occurring within the first 14 days postpartum.
Quality Indicators for High Acuity Pediatric Conditions
Authors: Stang Antonia S. , Straus Sharon E. , Crotts Jennifer , Johnson David W. , Guttmann Astrid
Published: September 2013

OBJECTIVE:

Identifying gaps in care and improving outcomes for severely ill children requires the development of evidence-based performance measures. We used a systematic process involving multiple stakeholders to identify and develop evidence-based quality indicators for high acuity pediatric conditions relevant to any emergency department (ED) setting where children are seen.

METHODS:

A prioritized list of clinical conditions was selected by an advisory panel. A systematic review of the literature was conducted to identify existing indicators, as well as guidelines and evidence that could be used to inform the creation of new indicators. A multiphase, Rand-modified Delphi method consisting of anonymous questionnaires and a face-to-face meeting of an expert panel was used for indicator selection. Measure specifications and evidence grading were created for each indicator, and the feasibility and reliability of measurement was assessed in a tertiary care pediatric ED.

RESULTS:

The conditions selected for indicator development were diabetic ketoacidosis, status asthmaticus, anaphylaxis, status epilepticus, severe head injury, and sepsis. The majority of the 62 selected indicators reflect ED processes (84%) with few indicators reflecting structures (11%) or outcomes (5%). Thirty-seven percent (n = 23) of the selected indicators are based on moderate or high quality evidence. Data were available and interrater reliability acceptable for the majority of indicators.

CONCLUSIONS:

A systematic process involving multiple stakeholders was used to develop evidence-based quality indicators for high acuity pediatric conditions. Future work will test the reliability and feasibility of data collection on these indicators across the spectrum of ED settings that provide care for children.
Trends in Child Protection and Out-of-Home Care
Authors: Conn Anne-Marie , Szilagyi Moira A. , Franke Todd M. , Albertin Christina S. , Blumkin Aaron K. , Szilagyi Peter G.
Published: September 2013

BACKGROUND:

Over the past decades, increased knowledge about childhood abuse and trauma have prompted changes in child welfare policy, and practice that may have affected the out-of-home (OOH) care population. However, little is known about recent national trends in child maltreatment, OOH placement, or characteristics of children in OOH care. The objective of this study was to examine trends in child maltreatment and characteristics of children in OOH care.

METHODS:

We analyzed 2 federal administrative databases to identify and characterize US children who were maltreated (National Child Abuse and Neglect Data System) or in OOH care (Adoption and Foster Care Analysis and Reporting System). We assessed trends between 2000 and 2010.

RESULTS:

The number of suspected maltreatment cases increased 17% from 2000 to 2010, yet the number of substantiated cases decreased 7% and the number of children in OOH care decreased 25%. Despite the decrease in OOH placements, we found a 19% increase in the number of children who entered OOH care because of maltreatment (vs other causes), a 36% increase in the number of children with multiple (vs single) types of maltreatment, and a 60% increase in the number of children in OOH care identified as emotionally disturbed.

CONCLUSIONS:

From 2000 to 2010, fewer suspected cases of maltreatment were substantiated, despite increased investigations, and fewer maltreated children were placed in OOH care. These changes may have led to a smaller but more complex OOH care population with substantial previous trauma and emotional problems.
Damning with faint praise: How homoeopaths talk about conventional medicine with their patients
Authors: Chatwin John
Published: September 2013

Homoeopathy is one of the most widely used forms of complementary medicine in the West. However, its methods and philosophical underpinnings are basically polarized in relation to those of conventional medicine. Many homoeopathic patients choose to continue using conventional medicine while they receive homoeopathy, but from a homoeopathic perspective, these treatments are often regarded as undesirable or even damaging. This article will utilize the principles of conversation analysis (CA) to explore points in homoeopathic consultations where practitioners address their patients’ use of conventional medications. It will be suggested that approaches which display a degree of incorporation are preferred to those which imply categorical rejection. By not emphasizing the underlying tensions between conventional and homoeopathic paradigms, and displaying an adaptive and inclusive approach, homoeopathy essentially sets itself up as a parallel (i.e. equal) system, rather than one that is purely in opposition to the dominant medical model.
Role of Islamic religious and cultural beliefs regarding intellectual impairment and service use: A South Asian parental perspective
Authors: Kaur-Bola Kulwinder , Randhawa Gurch
Published: September 2013

Empirical research has shown that some South Asian families from Muslim backgrounds may use fewer additional support services for their severely impaired children compared to other non-Muslim families. Often this has been attributed to socioeconomic factors and stereotypical views such as ‘the family's faith prohibits the use of specific services’. This paper focuses on clarifying what Islam purports to say about impairment and considers how cultural influences may inadvertently influence some South Asian parents’ decisions to use services for their severely impaired children. This work aims to improve professional-parent/patient communication by enhancing better understanding of Islam on impairment, and supporting non-Muslim professionals to appreciate the differences between Islamic religion and general South Asian cultural beliefs regarding disability. Fourteen parents from ten Pakistani and Bangladeshi families took part in semi-structured open-ended interviews. Grounded theory was used to analyse the data. The emerging theory suggested most first generation Muslim families from rural villages were unable to distinguish between Islamic religious and cultural beliefs on impairment, and risked missing out on essential services due to poor professional-parent/patient communication.
Feedback and common ground in conversational storytelling involving people with Alzheimer's disease
Authors: Hydén Lars-Christer , Plejert Charlotta , Samuelsson Christina , Örulv Linda
Published: September 2013

The present article focuses on feedback in storytelling involving people with Alzheimer's disease (AD), and how feedback is related to the ways participants establish a common ground (Clark 1996) in interaction. The establishment of common ground is important in all kinds of interaction and becomes an especially intricate process if participants have AD, since the achievement of common ground requires the ability to draw from knowledge and experiences relating to past as well as present events; an ability that is often hampered by the disease. Analyses show that other aspects than the actual content of the conversation are important for the participants – for instance being together, supporting the positive identities both presented in the story and embodied in the socially rewarding activity that they manage to engage in, implying that the participants create and sustain a common ground not so much about the story-layer as of the storytelling activity.
Correlação entre a composição corporal e força, resistência da musculatura respiratória e capacidade de exercício em pacientes com doença pulmonar obstrutiva crônica
Authors: Aquino Evanirso da Silva , Peres Thais Miranda , Lopes Isabel Bernardes de Vasconcellos , Castro Fernanda de Moraes Resgalla e , Coelho Cristiane Cenachi , Cunha Filho Inácio Teixeira
Published: September 2013

Este estudo buscou correlações entre a composição corporal (aferida por métodos indiretos) e força, resistência da musculatura respiratória e capacidade de exercício em portadores de doença pulmonar obstrutiva crônica (DPOC). Os 30 voluntários, idosos, foram divididos em três grupos, dois de pacientes com DPOC, estáveis e controlados clinicamente, e um grupo controle, com indivíduos sem doenças pulmonares, selecionados na mesma faixa etária e biótipo daqueles com DPOC. Todos foram submetidos a espirometria e medidas das pressões respiratórias máximas para avaliação da força dos músculos respiratórios, teste de resistência dos músculos respiratórios, teste de caminhada de seis minutos (TC6'), medidas de dobras cutâneas e índice de massa corporal (IMC). Os sujeitos (6 mulheres e 24 homens) foram divididos em: grupo A, n=11, com DPOC moderado a grave (idade 69,5±10,5 anos, IMC 24,00±3,66 kg/m²); grupo B, n=10, com DPOC leve (71,1±8,1 anos, IMC 24,41±0,58 kg/m²); e grupo C controle, n=9 (70,1±5,9 anos, IMC 27,44±1,33 kg/m²). Apenas os valores de porcentagem de gordura corporal e distância caminhada (no TC6') apresentaram diferenças significativas entre os grupos. Os resultados não indicaram correlação significativa entre as variáveis analisadas. Embora a literatura aponte o estado nutricional como um dos fatores do comprometimento respiratório na DPOC, não foi encontrada correlação entre a composição corporal e os parâmetros respiratórios nos pacientes estudados.
Equilíbrio, controle postural e força muscular em idosas osteoporóticas com e sem quedas
Authors: Meneses Sarah Rubia Ferreira de , Burke Thomaz Nogueira , Marques Amélia Pasqual
Published: September 2013

Um dos maiores problemas de saúde pública na população idosa são as quedas, agravando-se quando relacionadas à presença de osteoporose. Dentre os vários fatores de risco, destacam-se a diminuição do equilíbrio, controle postural e força muscular. O objetivo deste trabalho foi comparar o equilíbrio, o controle postural e a força muscular em idosas osteoporóticas com e sem quedas referidas no último ano. Foram avaliadas 45 mulheres entre 65 e 85 anos, divididas em dois grupos com base no relato de quedas nos 12 meses anteriores à avaliação: grupo com quedas (GCQ; n=21) e grupo sem quedas (GSQ; n=24). O equilíbrio foi avaliado por meio da escala de equilíbrio de Berg; o controle postural pelo teste clínico modificado de interação sensorial no equilíbrio (mCTSIB), realizado no equipamento Balance Master®; e a força muscular dos flexores e extensores de joelho e dorsiflexores de tornozelo, com dinamômetro EMG System do Brasil®. Foi considerado nível de significância α=0,05. Houve diferença significativa no equilíbrio (p<0,01) e na velocidade de oscilação do Centro de Pressão (CP) durante o teste mCTSIB nas condições olhos fechados superfície estável (p=0,05) e olhos abertos superfície instável (p<0,01), com valores maiores para o GCQ. Os grupos foram semelhantes entre si em relação à força muscular (p>0,05). Nossos resultados indicam que idosas osteoporóticas com histórico de quedas nos últimos 12 meses possuem pior equilíbrio e controle postural em relação às osteoporóticas sem quedas referidas.
Confiabilidade intra-avaliador da medida de amplitude de movimento da flexão e extensão do joelho pelo método de fotogrametria
Authors: César Eurico Peixoto , Gomes Paulo Sergio Chagas , Marques Caroline Lopes , Domingos Bruno D'Ávila Palmeira , Santos Tony Meireles dos
Published: September 2013

Apesar de existirem diversos métodos para a determinação da amplitude de movimento (ADM), a baixa confiabilidade, a pouca sensibilidade, a subjetividade ou a ausência de valores do erro típico da medida (ETM) de alguns desses métodos comprometem a interpretação adequada dos resultados. O objetivo deste estudo foi determinar a confiabilidade intra-avaliador da medida e do método de fotogrametria para a ADM de extensão ativa e flexão passiva do joelho (FPJ), realizada no mesmo dia (consistência interna) e em dias diferentes (estabilidade). Participaram 18 sujeitos do sexo masculino (24,5±3,7 anos, 79,3±10,1 kg e 174,8±4,2 cm). Após a marcação dos pontos anatômicos de referência, a angulação dos movimentos foi registrada em fotografia, por meio da ferramenta de dimensão angular no software CorelDRAW®. A confiabilidade da medida e do instrumento foi estabelecida pelo coeficiente de correlação intraclasse (CCI) e pelo cálculo do ETM. A distribuição dos erros dos dados foi verificada pela representação gráfica de Bland e Altman. O método apresentou confiabilidade perfeita (ETM=0,01 e CCI=1,0) para ambos os movimentos. Para a confiabilidade da medida, foram encontrados os valores 0,97 e 0,93 para consistência interna e 0,96 e 0,83 para estabilidade (ETM=2,9 e 4,0%; p<0,001) na extensão e flexão do joelho, respectivamente. O método mostrou excelente confiabilidade e baixo erro na determinação da ADM de extensão e flexão do joelho, sendo assim, adequado para a aplicação em dimensão clínica e de pesquisa.
Tabagismo não limita o incremento da força muscular respiratória em pacientes submetidos ao treinamento muscular inspiratório pré-esofagectomia
Authors: Ramos Marisa de Carvalho , Agrelli Taciana Freitas , Carneiro Élida Mara , Crema Eduardo
Published: September 2013

Um programa de treinamento muscular respiratório (TMR) para pacientes tabagistas no pré-operatório ambulatorial pode melhorar a força muscular e a capacidade funcional respiratória, evitando complicações que aumentem a permanência do paciente no hospital. O objetivo deste trabalho foi avaliar a eficácia do treinamento muscular inspiratório (TMI) em pacientes tabagistas e não tabagistas que seriam submetidos à cirurgia do megaesôfago. Foram estudados 17 pessoas, divididas em dois grupos: o tabagista (GT), composto por 10 pacientes (58,82%), e o não tabagista (GNT), com 7 pacientes (41,18%). A análise dos dados relacionando os dois foi expressa da seguinte forma: os valores de idade e as medidas antropométricas foram comparadas pelo teste t de Student e os valores da pressão inspiratória máxima (PImáx) e da pressão expiratória máxima (PEmáx) pelo teste t de Student pareado. Os dados foram expressos em média±desvio-padrão quando verificada a normalidade. Consideraram-se diferenças estatisticamente significativas se p<0,05. Na análise comparativa, observou-se aumento significativo da PImáx após as 4 semanas do TMI, como se segue: PImáx no GT de -57,20±18,76 para -79,00±15,38 e no GNT de -52,00±18,76 para -72,66±19,33. A fisioterapia profilática no pré-operatório ambulatorial proporcionou aumento significativo na força dos músculos inspiratórios em ambos os grupos, evidenciada pelo acréscimo na PImáx com consequente melhora da capacidade ventilatória.