bluuebunny/crossref_metadata_2025 huggingface dataset:
Psychiatrists' and nurses' views of mental health nurse supplementary prescribing: a survey
Authors: Tomar Rahul , Jakovljevic Tina , Brimblecombe Neil
Published: September 2008

Aims and Method

A questionnaire survey of psychiatrists and mental health nurses was conducted to look at their awareness of nurse supplementary prescribing and its impact on patient care.

Results

Response rate was 49.5% for psychiatrists and 23% for nurses. Most nurses (96.2%) and psychiatrists (91%) were aware of nurse supplementary prescribing, but more nurses than psychiatrists felt that it will provide patients quicker access to medication (P=0.023) and improve patient care (P=0.0003). Although two-thirds of the nurses felt confident to be a nurse prescriber, only 13% had actually approached a psychiatrist to be their supervisor. Most psychiatrists (54.4%) did not feel confident to act as supervisors.

Clinical Implications

Unlike nurses, psychiatrists were cautious about potential benefits of nurse supplementary prescribing on patient care. Both nurses and psychiatrists expressed concerns. As the expansion of nurse prescribing occurs, it is important for trusts to work actively with nurses and psychiatrists to address these concerns.
Consultant psychiatrists' knowledge of their role as representatives of the responsible authority at mental health review tribunals
Authors: Nimmagadda Srikanth , Jones Christopher N.
Published: September 2008

Aims and Method

A postal survey of consultant psychiatrists was carried out to assess their level of knowledge about the role of the person representing the responsible authority at a mental health review tribunal (MHRT).

Results

Consultants generally had a low level of knowledge and understanding of their responsibilities as representatives, which increased since appointment and with experience of MHRTs. They thought it appropriate that they continue representing the detaining authority in most cases, but recognised training needs.

Clinical Implications

Postgraduate training and continuing professional development should address the competencies required for the representative role. Trusts should review their practice in respect of legal representation at MHRTs.
Cell therapy for the diseased liver: from stem cell biology to novel models for hepatotropic human pathogens
Authors: Brezillon Nicolas , Kremsdorf Dina , Weiss Mary C.
Published: September 2008

It has long been known that hepatocytes possess the potential to replicate through many cell generations because regeneration can be achieved in rodents after serial two-thirds hepatectomy. It has taken considerable time and effort to harness this potential, with liver regeneration models involving hepatocyte transplantation developing over the past 15 years. This review will describe the experiments that have established the models and methodology for liver repopulation, and the use of cells other than adult hepatocytes in liver repopulation, including hepatic cell lines and hematopoietic, cord blood, hepatic and embryonic stem cells. Emphasis will be placed on the characteristics of the models and how they can influence the outcome of the experiments. Finally, an account of the development of murine models that are competent to accept human hepatocytes is provided. In these models, liver deficiencies are induced in immunodeficient mice, where healthy human cells have a selective advantage. These mice with humanized livers provide a powerful new experimental tool for the study of human hepatotropic pathogens.
mRNA nuclear export and human disease
Authors: Hurt Jessica A. , Silver Pamela A.
Published: September 2008

Export of mRNA from the nucleus is a central process in eukaryotic gene expression that has been implicated in several human diseases. Much of our understanding of how an mRNA is transported to the cytoplasm is derived from studies using yeast and fly models. We present here different mechanisms by which aberrant nuclear retention of mRNA can cause human disease. Emerging evidence that implicates the mRNA export factor GLE1 in two lethal motor neuron disorders is discussed and we highlight surprising links to regulatory mechanisms that were first observed many years ago in yeast. These examples illustrate how model organisms have aided in our elucidation of complex human disorders through analysis of basic cellular processes.
A novel biochemical method to identify target genes of individual microRNAs: Identification of a new Caenorhabditis elegans let-7 target
Authors: Andachi Yoshiki
Published: September 2008

MicroRNAs (miRNAs) are roughly 22-nucleotide regulatory RNAs that play important roles in many developmental and physiological processes. Animal miRNAs down-regulate target genes by forming imperfect base pairs with 3′ untranslated regions (3′ UTRs) of their mRNAs. Thousands of miRNAs have been discovered in several organisms. However, the target genes of almost all of these miRNAs remain to be identified. Here, we describe a method for isolating cDNA clones of target mRNAs that form base pairs in vivo with an endogenous miRNA of interest, in which the cDNAs are synthesized from the mRNAs using the miRNA as a reverse-transcription primer. The application of this method to Caenorhabditis elegans miRNA lin-4 under test conditions yielded many clones of the known target gene lin-14 that correspond to partial sequences 5′ to lin-4 binding sites in the 3′ UTR. The method was also applied to C. elegans miRNA let-7 and a new target gene responsible for the lethal phenotype in let-7 mutants was identified. These results demonstrate that the method is a useful way to identify targets on the basis of base pairing with individual miRNAs.
Kinetic and thermodynamic studies of peptidyltransferase in ribosomes from the extreme thermophile Thermus thermophilus
Authors: Rodriguez-Correa Daniel , Dahlberg Albert E.
Published: September 2008

Throughout evolution, emerging organisms survived by adapting existing biochemical processes to new reaction conditions. Simple protein enzymes balanced changes in structural stability with changes that permitted optimal catalysis by adjustments in both entropic and enthalpic contributions to the free energy of activation for the reaction. Study of adaptive mechanisms by large multicomponent enzymes such as the ribosome has been largely unexplored. Here we have determined the kinetic and thermodynamic parameters of peptidyltransferase in ribosomes from the extreme thermophile Thermus thermophilus. Activity of thermophilic enzymes can be assayed over a wide range of temperatures, enabling one to measure accurate catalytic rates and determine enthalpic and entropic contributions to the free energy of activation of the reaction. Differences in the reaction conditions used here and in published studies on mesophilic ribosomes prevent direct comparison, but our data on Thermus ribosomes suggest that these ribosomes have adapted to changing environments using the same strategies as simple protein enzymes, balancing stability and flexibility without loss of catalytic rate. This strategy must be a very ancient process, perhaps first used by primitive ribosomes in the RNA World.
A finite-element analysis study of the metatarsophalangeal joint of the hallux rigidus
Authors: Flavin R. , Halpin T. , O’Sullivan R. , FitzPatrick D. , Ivankovic A. , Stephens M. M.
Published: September 2008

Hallux rigidus was first described in 1887. Many aetiological factors have been postulated, but none has been supported by scientific evidence. We have examined the static and dynamic imbalances in the first metatarsophalangeal joint which we postulated could be the cause of this condition. We performed a finite-element analysis study on a male subject and calculated a mathematical model of the joint when subjected to both normal and abnormal physiological loads.

The results gave statistically significant evidence for an increase in tension of the plantar fascia as the cause of abnormal stress on the articular cartilage rather than mismatch of the articular surfaces or subclinical muscle contractures. Our study indicated a clinical potential cause of hallux rigidus and challenged the many aetiological theories. It could influence the choice of surgical procedure for the treatment of early grades of hallux rigidus.
Proximal femoral geometry in cerebral palsy
Authors: Robin J. , Graham H. Kerr , Selber P. , Dobson F. , Smith K. , Baker R.
Published: September 2008

There is much debate about the nature and extent of deformities in the proximal femur in children with cerebral palsy. Most authorities accept that increased femoral anteversion is common, but its incidence, severity and clinical significance are less clear. Coxa valga is more controversial and many authorities state that it is a radiological artefact rather than a true deformity.

We measured femoral anteversion clinically and the neck-shaft angle radiologically in 292 children with cerebral palsy. This represented 78% of a large, population-based cohort of children with cerebral palsy which included all motor types, topographical distributions and functional levels as determined by the gross motor function classification system.

The mean femoral neck anteversion was 36.5° (11° to 67.5°) and the mean neck-shaft angle 147.5° (130° to 178°). These were both increased compared with values in normally developing children. The mean femoral neck anteversion was 30.4° (11° to 50°) at gross motor function classification system level I, 35.5° (8° to 65°) at level II and then plateaued at approximately 40.0° (25° to 67.5°) at levels III, IV and V. The mean neck-shaft angle increased in a step-wise manner from 135.9° (130° to 145°) at gross motor function classification system level I to 163.0° (151° to 178°) at level V. The migration percentage increased in a similar pattern and was closely related to femoral deformity.

Based on these findings we believe that displacement of the hip in patients with cerebral palsy can be explained mainly by the abnormal shape of the proximal femur, as a result of delayed walking, limited walking or inability to walk. This has clinical implications for the management of hip displacement in children with cerebral palsy.
The pathophysiology of disc degeneration
Authors: Hadjipavlou A. G. , Tzermiadianos M. N. , Bogduk N. , Zindrick M. R.
Published: September 2008

The pathophysiology of intervertebral disc degeneration has been extensively studied. Various factors have been suggested as influencing its aetiology, including mechanical factors, such as compressive loading, shear stress and vibration, as well as ageing, genetic, systemic and toxic factors, which can lead to degeneration of the disc through biochemical reactions. How are these factors linked? What is their individual importance? There is no clear evidence indicating whether ageing in the presence of repetitive injury or repetitive injury in the absence of ageing plays a greater role in the degenerative process. Mechanical factors can trigger biochemical reactions which, in turn, may promote the normal biological changes of ageing, which can also be accelerated by genetic factors. Degradation of the molecular structure of the disc during ageing renders it more susceptible to superimposed mechanical injuries.

This review supports the theory that degeneration of the disc has a complex multifactorial aetiology. Which factors initiate the events in the degenerative cascade is a question that remains unanswered, but most evidence points to an age-related process influenced primarily by mechanical and genetic factors.
Chondrocyte Phenotype and Ectopic Ossification in Collagenase-induced Tendon Degeneration
Authors: Lui Pauline Po-yee , Fu Sai-chuen , Chan Lai-shan , Hung Leung-kim , Chan Kai-ming
Published: September 2008

We report chondrocyte phenotype and ectopic ossification in a collagenase-induced patellar tendon injury model. Collagenase or saline was injected intratendinously in one limb. The patella tendon was harvested for assessment at different times. There was an increase in cellularity, vascularity, and loss of matrix organization with time after collagenase injection. The tendon did not heal histologically until week 32. Ectopic mineralization as indicated by von Kossa staining started from week 8. Tendon calcification was mediated by endochondral ossification, as shown by expression of type X collagen. viva CT imaging and polarization microscopy showed characteristic bony porous structures and collagen fiber arrangement, respectively, in the calcific regions. Marrow-like cells and blood vessels were observed inside calcific deposits. Chondrocyte-like cells as indicated by morphology, expression of type II collagen, and sox 9 were seen around and embedded inside the calcific deposits. Fibroblast-like cells expressed type II collagen and sox 9 at earlier times, suggesting that erroneous differentiation of healing tendon fibroblasts may account for failed healing and ossification in collagenase-induced tendon degeneration. Because this animal model replicates key histopathological changes in calcific tendinopathy, it can be used as a model for the study of its pathogenesis at the patellar tendon.
Radiation detector materials: An overview
Authors: Milbrath B.D. , Peurrung A.J. , Bliss M. , Weber W.J.
Published: September 2008

Due to events of the past two decades, there has been new and increased usage of radiation-detection technologies for applications in homeland security, nonproliferation, and national defense. As a result, there has been renewed realization of the materials limitations of these technologies and greater demand for the development of next-generation radiation-detection materials. This review describes the current state of radiation-detection material science, with particular emphasis on national security needs and the goal of identifying the challenges and opportunities that this area represents for the materials-science community. Radiation-detector materials physics is reviewed, which sets the stage for performance metrics that determine the relative merit of existing and new materials. Semiconductors and scintillators represent the two primary classes of radiation detector materials that are of interest. The state-of-the-art and limitations for each of these materials classes are presented, along with possible avenues of research. Novel materials that could overcome the need for single crystals will also be discussed. Finally, new methods of material discovery and development are put forward, the goal being to provide more predictive guidance and faster screening of candidate materials and thus, ultimately, the faster development of superior radiation-detection materials.
Shear deformation capability of different metallic glasses
Authors: Wu F.F. , Zhang Z.F. , Shen J. , Mao S.X.
Published: September 2008

The mechanical properties of Zr52.5Ni14.6Al10Cu17.9Ti5 and Ti40Zr25Ni3Cu12Be20 metallic glasses were investigated under uniaxial compressive loading and small punch loading, respectively. The Zr-based metallic glass displays higher density of shear bands, larger critical shear offsets and higher energy absorbing capability than the Ti-based metallic glass under the small punch tests. A concept of critical shear offset is proposed to explain the difference in shear deformation abilities or plasticity of different metallic glasses. The current experiments demonstrate that, in contrast with the small difference between the responses of the Zr- and Ti-based metallic glasses under uniaxial compressive loading, the biaxial tension produced by the small punch test is an effective way to evaluate the difference in shear deformation abilities and can be used to distinguish the brittleness or plasticity of various metallic glasses.
A peculiar composite structure of carbon nanofibers growing on a microsized tin whisker
Authors: Chen Chih-ming , Shih Po-yuan
Published: September 2008

In this work, we report a method to synthesize a peculiar composite structure of tubular carbon nanofibers (CNFs) growing on a microsized tin (Sn) whisker. The material used is a commercially available copper clad laminate (CCL). The CCL is composed of a surface copper (Cu) layer and a bottom polymer (phenol-formaldehyde resin) board, in which the polymer board is used as the carbon source. Using lithography and lift-off techniques, the Cu layer was patterned to a stripelike Cu trace. A Sn thin film was then evaporated on the polymer board near the Cu trace. To release the residue stress that resulted from the evaporation; Sn whiskers with diameters of about 2 to 5 μm were formed on the Sn thin film after evaporation. By passing an electric current through the Cu trace, the Cu trace was heated due to Joule heating and served as a heating source for the thermal decomposition of phenol-formaldehyde. After heat treatment, the CNFs grew on the surface of the Sn whiskers with tubular hollow-cored structure. The diameter of the tubular CNFs is about hundreds of nanometers and their length can reach several micrometers. The growth mechanism of the brushlike composite structure is also discussed.
Effects of electromigration on the growth of intermetallic compounds in Cu/SnBi/Cu solder joints
Authors: Gu X. , Yang D. , Chan Y.C. , Wu B.Y.
Published: September 2008

In this study, the effects of electromigration (EM) on the growth of Cu–Sn intermetallic compounds (IMCs) in Cu/SnBi/Cu solder joints under 5 × 103 A/cm2 direct current stressing at 308, 328, and 348 K were investigated. For each Cu/SnBi/Cu solder joint under current stressing, the IMCs at the cathode side grew faster than that at the anode side. The growth of these IMCs at the anode side and the cathode side were enhanced by electric current. The growth of these IMCs at the cathode followed a parabolic growth law. The kinetics parameters of the growth of the IMCs were calculated from the thickness data of the IMCs at the cathode side at different ambient temperatures. The calculated intrinsic diffusivity (D0) of the Cu–Sn IMCs was 9.91 × 10−5 m2/s, and the activation energy of the growth of the total Cu–Sn IMC layer was 89.2 kJ/mol (0.92 eV).
Influence of casting temperature on the thermal stability of Cu- and Zr-based metallic glasses: Theoretical analysis and experiments
Authors: Zhu Z.W. , Zhang H.F. , Wang H. , Ding B.Z. , Hu Z.Q.
Published: September 2008

Influence of casting temperature on the thermal stability of Cu- and Zr-based metallic glasses (MGs) was analyzed based on the monomer-cluster structural model using the Johnson–Mehl–Avrami (JMA) equation. The result indicates that increasing the casting temperature can enhance the thermal stability of MGs. It is suggested that it be attributed to the decrease in the amount of the local ordering clusters induced by the elevating casting temperature. The prediction is confirmed by continuous heating transformation diagrams constructed for the Cu- and Zr-amorphous samples obtained under different casting temperatures.
Fabrication and characterization of metal-ferroelectric-insulator-Si diodes and transistors with different HfSiON buffer layer thickness
Authors: Lu Xubing , Ishiwara Hiroshi , Maruyama Kenji
Published: September 2008

Metal-ferroelectric-insulator-Si (MFIS) structures using HfSiON as buffer layers were fabricated, and the impact of buffer layer thickness on the electrical properties of the MFIS devices was investigated. HfSiON films with thickness ranging from 1 to 4 nm were deposited by electron beam evaporation, which exhibited much reduced leakage current when compared to that of SiO2 with the same equivalent oxide thickness. From the viewpoint of polarization and charge injection, the flatband voltage and memory window width dependent on the sweeping voltages were discussed for the MFIS diodes with 1-, 2-, and 4-nm-thick HfSiON buffer layers. Small leakage current as well as excellent long-term data retention characteristics were found for all of these samples. It was also found that MFIS diodes with 2-nm-thick HfSiON buffer layer have the largest memory window width. Ferroelectric-gate transistors fabricated with a Pt/SBT(300nm)/HfSiON (2 nm)/Si gate structure showed a memory window of 0.8 V and a high drain current on/off ratio of 108 for the gate voltage sweep between +4 and −4 V. All of these excellent electrical properties proved that HfSiON acts as an excellent barrier for suppressing both leakage current and atomic interdiffusion.
Effect of atomic scale plasticity on hydrogen diffusion in iron: Quantum mechanically informed and on-the-fly kinetic Monte Carlo simulations
Authors: Ramasubramaniam A. , Itakura M. , Ortiz M. , Carter E.A.
Published: September 2008

We present an off-lattice, on-the-fly kinetic Monte Carlo (KMC) model for simulating stress-assisted diffusion and trapping of hydrogen by crystalline defects in iron. Given an embedded atom (EAM) potential as input, energy barriers for diffusion are ascertained on the fly from the local environments of H atoms. To reduce computational cost, on-the-fly calculations are supplemented with precomputed strain-dependent energy barriers in defect-free parts of the crystal. These precomputed barriers, obtained with high-accuracy density functional theory calculations, are used to ascertain the veracity of the EAM barriers and correct them when necessary. Examples of bulk diffusion in crystals containing a screw dipole and vacancies are presented. Effective diffusivities obtained from KMC simulations are found to be in good agreement with theory. Our model provides an avenue for simulating the interaction of hydrogen with cracks, dislocations, grain boundaries, and other lattice defects, over extended time scales, albeit at atomistic length scales.
Ingestão alcoólica em vítimas de causas externas atendidas em um hospital geral universitário
Authors: Freitas Efigênia Aparecida Maciel de , Mendes Ismênia Diniz , Oliveira Luiz Carlos Marques de
Published: September 2008

OBJETIVO: Estimar a freqüência de ingestão alcoólica em vítimas de causas externas atendidas em hospital. MÉTODOS: Estudo realizado com vítimas atendidas em um hospital geral universitário em Uberlândia (MG), de fevereiro a agosto de 2004. A alcoolemia foi determinada em 85 pacientes no pronto-socorro e entrevistaram-se outros 301 internados nas enfermarias sobre possível ingestão alcoólica previamente ao trauma; em ambos os grupos foi aplicado o questionário Cut-down, Annoyed by criticism, Guilty and Eye-opener (CAGE). Para as comparações das freqüências foi utilizado o teste exato de Fisher. RESULTADOS: A alcoolemia foi positiva em 31,8% dos pacientes testados, os quais mais freqüentemente necessitaram de internação (70,4% versus 37,9%; p<0,05). Proporcionalmente, alcoolemia positiva foi mais freqüente (p<0,05) entre as vítimas de agressão física (57,1%) do que as de queda (18,2%) ou de acidente de trânsito (29,3%). Nas enfermarias, 29,9% dos pacientes referiram ingestão alcoólica, proporcionalmente mais freqüente (p<0,01) entre as vítimas de agressão física (67,4%) do que entre as de acidente de trânsito (27,8%) ou queda (19,3%). Entre aqueles que ingeriram álcool, abordados no pronto-socorro e nas enfermarias, observou-se, respectivamente: que a maioria era homens (85,2% e 80,4%), a ocorrência de trauma foi maior (p<0,05) nos finais de semana (63% e 57,8%) e no período noturno (59,3% e 57,8%), e o questionário CAGE foi positivo em 81,5% e 82,2%. CONCLUSÕES: Cerca de um terço dos pacientes ingeriu bebidas alcoólicas previamente ao trauma e, entre eles, a maioria era homens. Proporcionalmente, a ingestão prévia de bebidas alcoólicas foi mais freqüente entre os pacientes vítimas de violência. Os resultados da aplicação do CAGE mostra que a maioria dos pacientes vítimas de causas externas após ingestão etílica não era alcoolista ocasional, e sim provável usuário crônico ou dependente de álcool.
Medicalização social e medicina alternativa e complementar: pluralização terapêutica do Sistema Único de Saúde
Authors: Tesser Charles Dalcanale , Barros Nelson Filice de
Published: September 2008

A medicalização social transforma a cultura, diminui o manejo autônomo de parte dos problemas de saúde e gera excessiva demanda ao Sistema Único de Saúde. Uma alternativa à medicalização social no âmbito da atenção à saúde é a pluralização terapêutica das instituições de saúde, ou seja, a valorização e o oferecimento de práticas e medicinas alternativas e complementares. O objetivo do artigo foi analisar potencialidades e dificuldades de práticas e medicinas alternativas e complementares a partir de experiências clínico-institucionais e da literatura especializada. Conclui-se que tal estratégia tem um limitado potencial "desmedicalizante" e deve ser assumida pelo Sistema Único de Saúde. Ressalta-se ainda que devem ser observadas a hegemonia político-epistemológica da Biociência e a disputa mercadológica atual no campo da saúde, cuja tendência é transformar qualquer saber/prática estruturado do processo saúde-doença em mercadorias ou procedimentos a serem consumidos, reforçando a heteronomia e a medicalização.
Prevalência de quedas em idosos asilados do município de Rio Grande, RS
Authors: Gonçalves Lílian Gatto , Vieira Simone Theodosio , Siqueira Fernando Vinholes , Hallal Pedro Curi
Published: September 2008

OBJETIVO: O aumento da expectativa de vida nos países em desenvolvimento tem provocado preocupação com a qualidade de vida e o bem-estar dos idosos, principalmente a ocorrência de quedas. Nesse sentido, o objetivo do estudo foi descrever a prevalência de quedas em idosos que vivem em asilos e fatores associados. MÉTODOS: Estudo de delineamento transversal na cidade de Rio Grande (RS), em 2007. Participaram 180 indivíduos idosos (65 anos ou mais) residentes em asilos para acolhimento. Em entrevista, os idosos responderam a questões de instrumento pré-testado sobre a ocorrência de quedas. Além de análise bivariada (Wald), foi realizada análise por regressão de Poisson com cálculo de razões de prevalência e intervalos de confiança de 95%, ajustada para as variáveis de confusão. RESULTADOS: A prevalência de quedas entre os idosos asilados estudados foi de 38,3%. As quedas foram mais comuns no ambiente do asilo (62,3%), sendo o quarto o ambiente onde ocorreu o maior número de quedas (23%). Na análise ajustada, as quedas se mantiveram associadas com cor da pele branca, com os idosos separados e divorciados, com depressão, e maior quantidade referida de medicamentos para uso contínuo. CONCLUSÕES: O estudo mostra que a prevalência de quedas entre idosos asilados é alta. Embora alguns dos possíveis fatores associados sejam passíveis de prevenção, ainda ocorrem quedas em locais que deveriam ser considerados seguros, como o quarto do idoso.
Redes: um olhar sistêmico para a epidemiologia de doenças transmissíveis
Authors: Codeço Cláudia Torres , Coelho Flávio Codeço
Published: September 2008

A necessidade do contato físico entre pessoas (direta ou indiretamente) para a transmissão de agentes infecciosos trouxe para a epidemiologia, desde seus primórdios, a necessidade de compreender e descrever o processo de encontro entre pessoas. É neste espaço de encontros que a transmissão flui pela população e emerge, a nível sistêmico, na forma de epidemias. Durante todo o século XX, intenso esforço foi dedicado ao desvendamento dos fatores populacionais que favoreceriam ou não o surgimento de epidemias, sua temporalidade e espacialidade. Este caminho tem como inspiração inicial a física, com modelos de natureza quantitativa, nos quais a população é vista como um todo sem estrutura. Posteriormente, vê-se necessário incluir as estruturas sociais que compõem a população: grupos sociais, redes sociais, coesão social tornam-se conceitos de interesse no estudo quantitativo das epidemias. A integração com a sociologia torna-se óbvia, na medida em que seus conceitos interagem cada vez mais. É um breve olhar sobre esta jornada o objetivo deste ensaio.
Gasto energético em adultos do município de Niterói, Rio de Janeiro: resultados da Pesquisa de Nutrição, Atividade Física e Saúde - PNAFS
Authors: Anjos Luiz Antonio dos , Ferreira Bianca Catarina Miranda , Vasconcellos Mauricio Teixeira Leite de , Wahrlich Vivian
Published: September 2008

Conhecer o gasto energético (GE) e o nível de atividade física (NAF) serve como base para o estabelecimento dos requerimentos energéticos (RE) de populações. Pouco se conhece sobre o GE da população brasileira, lacuna que deve ser preenchida visto o quadro de transição nutricional presente no país. Assim, o objetivo deste trabalho foi avaliar o GE e o NAF da população adulta (> 20 anos) do município de Niterói, RJ. Para a obtenção do tempo de duração das atividades cotidianas, usou-se um questionário de orçamento do tempo das atividades cotidianas. O custo energético (CE) das atividades foi obtido na tabela da FAO de 2004 como múltiplo da taxa metabólica basal (TMB). O GE total diário (GETD) foi computado como o somatório do GE de todas as atividades de um dia típico. O GETD foi maior nos homens (2382,0 + 38,0) do que nas mulheres (1987,1 + 22,9 kcal.dia-1) mas as mulheres apresentaram NAF maiores. O RE usando o valor de NAF de 1,40 foi o que melhor estimou o GETD na população em todas as categorias de estado nutricional. Parece ser prudente utilizar valores menores de NAF para a estimativa dos RE na população adulta de Niterói. Fica evidente a necessidade de se obter mais dados de CE de atividades para, junto com estimativas adequadas da TMB, se poder determinar os RE da população brasileira.
Assimetria nas relações internacionais, propriedade industrial e medicamentos anti-aids
Authors: Costa-Couto Maria Helena , Nascimento Álvaro César
Published: September 2008

Este artigo analisa a assimetria nas relações internacionais entre países no que diz respeito ao reconhecimento da propriedade industrial no setor específico da indústria farmacêutica. O foco é o impacto destas relações no acesso a medicamentos anti-retrovirais (ARV), questão de interesse mundial em face da sua relação com o desenvolvimento das nações. A disputa de interesses no campo e o posicionamento de alguns países frente às leis patentárias, ao longo do tempo, apontam um cenário pouco favorável para acesso aos medicamentos anti-aids pelos países que não pertencem ao núcleo do sistema mundial. O sucesso do programa brasileiro de Doenças Sexualmente Transmissíveis (DSTs) e Aids nas negociações dos preços dos ARV, ao contrário, aponta para novas possibilidades de enfrentamento desta realidade. A saída parece ser o fortalecimento interno dos Estados Nacionais e um papel ativo das Agências do Sistema das Nações Unidas na defesa dos interesses humanos coletivos.
Avaliação da descentralização da vigilância epidemiológica para a Equipe de Saúde da Família
Authors: Santos Silvone Santa Bárbara da Silva , Melo Cristina Maria Meira de
Published: September 2008

Este estudo avalia a implantação da descentralização das ações de vigilância epidemiológica para a equipe do Programa de Saúde da Família em um município da Bahia. Trata-se de uma pesquisa avaliativa através de um estudo de caso, com uso de técnicas adaptadas de análise temática e avaliativa, e adoção do modelo político da análise de implantação. Os dados primários foram obtidos através de entrevista semi-estruturada com os gestores da Secretaria Municipal da Saúde e trabalhadores do Programa de Saúde da Família e os dados secundários, através da análise de documentos. A pesquisa demonstrou que a vigilância epidemiológica é compreendida como uma prática voltada para o poder de polícia médica; como uma vigilância voltada para o controle das doenças transmissíveis e como vigilância de riscos e danos. Quanto à capacidade de intervenção, confirma-se um desempenho positivo da equipe no Programa de Saúde da Família, ainda que relacionada à detecção da doença e adoção de medidas de controle. Conclui-se que é possível descentralizar a vigilância epidemiológica para a equipe do Programa de Saúde da Família, muito embora esta ainda não tenha ocorrido efetivamente, se caracterizando muito mais como uma desconcentração de atividades, por razões políticas.
Coagulopathy and inhospital deaths in patients with acute subdural hematoma
Authors: Bershad Eric M. , Farhadi Saeid , Suri M. Fareed K. , Feen Eliahu S. , Hernandez Olga H. , Selman Warren R. , Suarez Jose I.
Published: September 2008

Object

Acute subdural hematoma (SDH) is one of the most lethal forms of intracranial injury; several risk factors predictive of a worse outcome have been identified. Emerging research suggests that patients with coagulopathy and intracerebral hemorrhage have a worse outcome than patients without coagulopathy but with intracerebral hemorrhage. The authors sought to determine if such a relationship exists for patients with acute SDH.

Methods

The authors conducted a retrospective analysis of consecutive patients admitted to a neurosciences intensive care unit with acute SDH over a 4-year period (January 1997–December 2001). Demographic data, laboratory values, admission source, prior functional status, medical comorbidities, treatments received, and discharge disposition were recorded, as were scores on the Acute Physiology, Age, and Chronic Health Evaluation III (APACHE III). Coagulopathy was defined as an internal normalized ratio > 1.2 or a prothrombin time ≥12.7 seconds. Univariate and multivariate analyses were performed on 244 patients to determine factors associated with worse short-term outcomes.

Results

The authors identified 248 patients with acute SDH admitted to the neurointensive care unit during the study period, of which 244 had complete data. Most were male (61%), and the mean age of the study population was 71.3 ± 15 years (range 20–95 years). Fifty-three patients (22%) had coagulopathy. The median APACHE III score was 43 (range 11–119). Twenty-nine patients (12%) died in the hospital. Independent predictors of inhospital death included APACHE III score (odds ratio [OR] 4.4, 95% confidence interval [CI] 1.4–13.4, p = 0.011) and coagulopathy (OR 2.7, 95% CI 1.1–7.1, p = 0.037). Surgical evacuation of acute SDH was associated with reduced inhospital deaths (OR 0.2, 95% CI 0.1–0.6, p = 0.003).

Conclusions

Coagulopathy is independently associated with inhospital death in patients with acute SDH. Time to treatment to correct coagulopathy using fresh frozen plasma and/or vitamin K was prolonged.
Dosing and safety of cyclosporine in patients with severe brain injury
Authors: Hatton Jimmi , Rosbolt Bonnie , Empey Philip , Kryscio Richard , Young Byron
Published: September 2008

Object

Cyclosporine neuroprotection has been reported in brain injury models but safety and dosing guidelines have not been determined in humans with severe traumatic brain injury (TBI). The purpose of this investigation was to establish the safety of cyclosporine using 4 clinically relevant dosing schemes.

Methods

The authors performed a prospective, blinded, placebo-controlled, randomized, dose-escalation trial of cyclosporine administration initiated within 8 hours of TBI (Glasgow Coma Scale score range 4–8; motor score range 2–5). Four dosing cohorts (8 patients treated with cyclosporine and 2 receiving placebo treatment per cohort) received cyclosporine (1.25–5 mg/kg/day) or placebo in 2 divided doses (Cohorts I–III) or continuous infusion (Cohort IV) over 72 hours. Adverse events and outcome were monitored for 6 months.

Results

Forty patients were enrolled over 3 years (cyclosporine cohorts, 24 male and 8 female patients; placebo group, 8 male patients). Systemic trough concentrations were below 250 ng/ml during intermittent doses. Higher blood concentrations were observed in Cohorts III and IV. There was no significant difference in immunological effects, adverse events, infection, renal dysfunction, or seizures. Mortality rate was not affected by cyclosporine administration, independent of dose, compared with placebo (6 of 32 patients receiving cyclosporine and 2 of 8 receiving placebo died, p > 0.05). At 6 months, a dose-related improvement in favorable outcome was observed in cyclosporine-treated patients (p < 0.05).

Conclusions

In patients with acute TBI who received cyclosporine at doses up to 5 mg/kg/day, administered intravenously, with treatment initiated within 8 hours of injury, the rate of mortality or other adverse events was not significantly different from that of the placebo group.
Risk factors for neurosurgical site infections: an 18-month prospective survey
Authors: Lietard Claire , Thébaud Véronique , Besson Gérard , Lejeune Benoist
Published: September 2008

Object

The purpose of this study was to determine the incidence rate and risk factors of surgical site infections (SSIs) in neurosurgery for any type of surgery and any American Society of Anesthesiologists class.

Methods

The authors undertook an exhaustive 18-month prospective survey including patients who underwent neurosurgery. In particular, a 30-day follow-up was completed in patients whose surgery did not involve placement of a prosthesis or implant, and 1-year follow-up was completed for patients who underwent surgery to place a prosthesis or implant. The Centers for Disease Control definition of SSI was used. Univariate and multivariate analyses were conducted; all dependent variables found in univariate analysis were entered in the multiple regression model. A stepwise multiple logistic regression method was used.

Results

Of the 844 patients studied, 35 SSIs were diagnosed, yielding an incidence rate of 4.1% (95% confidence interval 3.6–4.5). Independent predictive risk factors for infection were cerebrospinal fluid leakage, external shunt, Altemeier class, and further neurosurgery. A lack of antibiotic prophylaxis was not found to be a risk factor.

Conclusions

Infection risk factors occur mainly during the postoperative period.
The legendary contributions of Thomas Willis (1621–1675): the arterial circle and beyond
Authors: Rengachary Setti S. , Xavier Andrew , Manjila Sunil , Smerdon Usha , Parker Brandon , Hadwan Suzan , Guthikonda Murali
Published: September 2008

Thomas Willis established neurology as a distinct discipline and made significant original contributions to many related fields including anatomy, pathology, cardiology, endocrinology, and gastroenterology. He is most remembered for his work in elucidating the function and anatomy of the circle of Willis. Willis' accomplishments and research methods can be credited in large part to his unconventional medical education which did not include traditional teachings, but rather emphasized learning through clinical practice. Although Willis was not the first to describe the arterial circle, he was the first to describe its function and provide a complete, undisputed illustration through his own innovative use of dye studies. The Willis classification of cranial nerves was still in use over 100 years after its original description. He has also described several disease entities and named many brain structures. Willis' accomplishments in comparative anatomy and understanding the pathophysiology of various diseases through original multidisciplinary experimental work in a clinical setting reveal that he was a true pioneer in translational research.
Relationships within the supply chain: A case study
Authors: Lindgreen Adam , Palmer Roger , Trienekens Jacques
Published: September 2008

In an effort to clarify and reconcile different perspectives of transactional and relational marketing practices the 'Contemporary Marketing Practice' (CMP) group developed a classification scheme of marketing practices. Research by the CMP group identifies that in any particular context there are multiple exchange paradigms present. That is, different combinations of marketing practices are possible. The food supply chain is characterized by highly interdependent partnerships and a span of relationship types (Hogarth-Scott, 1999). The aim of this study is to compare and contrast transactional and relational marketing practices within the Dutch pork supply chain and to consider the contextual factors influencing such practices. The year of reference for this study is 2003-2004. Using a case study approach, we identify that all chain players practice transactional and relational marketing practices concurrently. Previous studies have indicated that the Dutch pork supply chain can be characterized by general mistrust; our study indicates that the lack of trust is primarily towards slaughterhouses and retailers. In line with the literature on business relationships this can be explained by a power imbalance and information asymmetry in the supply chain.
A theoretical framework of chain management
Authors: Hanf Jon , Dautzenberg Kirsti
Published: September 2008

Strictly coordinated chain organisations have been in place in the agri-food business for many years. The majority of them are collaborative. These organisations have a pyramidal-hierarchical structure. A focal firm, which is centrally located, coordinates the network firms in a hierarchical style. Our paper aims to develop a managerial framework for networks, and we address cooperation as well as coordination. Gulati et al. (2005) conclude that even though cooperation may be achieved, i.e., the interests of the individual actors are aligned, coordination problems may persist. Thus, both the alignment of interests and the alignment of actions must be simultaneously achieved to create a successful partnership; they can be viewed as two sides of the same coin. Duysters et al. (2004) have shown that the management of alliances must be analysed on three levels: the firm, dyadic, and network levels. We have therefore combined the aspects of cooperation and coordination with these three levels. Because the focus of our paper is on the development of a theoretical chain management concept, we applied this concept to a case study. We are aware that this is not empirical evidence, but nonetheless it confirmed our findings. The case of a supply chain network of a German premium pasta manufacturer showed that the combination of cooperation and coordination with a differentiated view of the various network levels corresponds with the demands of real business life.
Governance for quality management in tropical food chains
Authors: van Tilburg Aad , Trienekens Jacques , Ruben Ruerd , van Boekel Martinus
Published: September 2008

This paper provides a framework that focuses on the linkages between several key dimensions of supply chain organisation and performance of perishable tropical food products. The focus is on the relationship between governance regime and quality management, however, two other related variables are also taken into account because they impact this relationship: channel choice and value added distribution in the supply chain. Governance regimes focus on how to enhance coordination and trust amongst supply chain partners and how to reduce transaction costs. Quality management deals with how to manage food technology processes such that required quality levels can be improved and variability in quality of natural products can be exploited. Governance regimes in relation to quality management practices are discussed to the extent that supply chain partners are able, or are enabled, to invest in required quality improvements. Reduction of transaction costs, creation of trust-based networks and proper trade-offs between direct and future gains may offer substantial contributions to effective quality management and enforcement. This framework has been applied to nine case studies about food supply chains originating from developing countries (Ruben et al., 2007). Three of these case studies are summarised in this paper to illustrate what challenges can be derived from this study. These selected case studies concern fish caught in Kenya, mangoes grown in Costa Rica and vegetables produced in China.
Generic model for the prediction of remaining shelf life in support of cold chain management in pork and poultry supply chains
Authors: Raab Verena , Bruckner Stefanie , Beierle Eva , Kampmann Yvonne , Petersen Brigitte , Kreyenschmidt Judith
Published: September 2008

An overall concept for a generic model to predict the remaining shelf life of meat in different steps of the supply chain was developed. It consists of three models: a shelf life model, an inter-organisational cold chain model and a temperature mapping model that includes a heat transfer model. In this concept, shelf life is predicted based on the growth of Pseudomonas sp., taking into account organisational structure, inspection scheme, technical circumstances and temperature conditions in different supply chains. Whereas the shelf life model is almost complete, further work is required to develop the two other models.
Mutagenic and epigenetic mechanisms of zearalenone: prevention by Vitamin E
Authors: Ouanes-Ben Othmen Z. , Essefi S. , Bacha H.
Published: September 2008

It has been suggested that zearalenone, a non-steroidal estrogenic mycotoxin produced by Fusarium graminearium, causes DNA damage. However, the mutagenic properties of this toxin are controversial. The purpose of this study was to investigate both genotoxic and epigenetic effects of zearalenone in vitro. The effects of zearalenone on unscheduled DNA synthesis (UDS), induction of chromosome aberrations and inhibition of gap junctional intercellular communication were determined using Vero cells. The results show that in Vero cells, zearalenone treatment caused a concentration-dependent increase in UDS, induced chromosome aberrations and inhibited gap junctional intercellular communication. All of these effects were either prevented or reduced by co-treatment with the antioxidant vitamin E. The results support the hypothesis that in Vero cells zearalenone-induced oxidative stress is involved in and precedes all of the studied effects.
Quantitative detection of Fusarium spp. and its correlation with fumonisin content in maize from South African subsistence farmers
Authors: Waalwijk C. , Koch S. , Ncube E. , Allwood J. , Flett B. , de Vries I. , Kema G.
Published: September 2008

A quantitative detection tool was developed to enable the monitoring of fumonisin-producing fungi in food and
feed commodities. To this end, a quantitative PCR (TaqMan) was developed that targets a conserved region in the
polyketide synthase gene fum1, which is involved in the biosynthesis of fumonisin. Hence, this method specifically
detected isolates from the fumonisin-producing species Fusarium verticillioides, F. proliferatum, F. nygamai and
F. globosum whereas isolates of the fumonisin non-producing species F. equiseti, F. graminearum, F. oxysporum,
F. semitectum and F. subglutinans that commonly occur on maize were not detected. Moreover, a few fumonisin
non-producing F. verticillioides isolates did not generate any fluorescent signals and were therefore not detected.
The correlation between quantitative PCR and mycotoxin content was determined using field samples collected at
homestead farms in South Africa. Among 40 samples from the Eastern Cape collected in 2005 a good correlation
(R2=0.8303) was found between pg fungal DNA and fumonisin content. A similar correlation (R2=0.8658) was found among 126 samples collected from four provinces in South Africa in 2007. These observations indicate that
samples containing ≥ 40 pg fungal DNA/mg sample are suspected of also exceeding the 1 mg/kg total fumonisin
level and therefore do not comply with the European Commission limit for fumonisins B1+B2 for maize intended for direct human consumption that applies from 1 October 2007. Combined with the very high maize intake, our
results indicate that fumonisin levels in maize from South African homesteads regularly exceed the tolerable daily
intake for fumonisins.