bluuebunny/crossref_metadata_2025 huggingface dataset:
The interpretation of encapsulating anaphors in Spanish and their functions
Authors: Dam Lotte
Published: July 2014

Encapsulating anaphors differ from other types of anaphor by having one or more situations - not an entity - as its referent. The main aim of the article is to propose a hypothesis for how anaphoric encapsulation is resolved. The hypothesis builds on the cognitive linguistic theory of instructional semantics to suggest that anaphoric encapsulation provides instructions for the interpretive process, leading to the resolution of the anaphoric relation. A secondary aim is to illustrate various functions of this type of anaphor
The birth of a new resultative construction in Spanish: A corpus-based description
Authors: Arrizabalaga Beatriz Rodriguez
Published: July 2014

The Spanish prepositional phrase hasta la muerte ‘to death’, in addition to its emphatic and intensifying function (e.g. Hay que animar al equipo hasta la muerte ‘The team must be supported wholeheartedly (lit. to death)’), over the last few years developed a resultative function (e.g. Las mujeres fueron torturadas hasta la muerte ‘The women were tortured to death’; Lo apedrearon hasta la muerte ‘They stoned him to death’), equivalent to the one displayed by the English resultatives dead and to death (e.g. He shot the president dead; He stabbed the president to death). Until recently, however, the construction containing the prepositional resultative hasta la muerte was considered ungrammatical, a literal calque from English. Its attested presence in the Corpus de Referencia del Español Actual, albeit at low frequency levels, and its frequent occurrence nowadays in the Spanish mass media, clearly show that this construction is now making its way into the Spanish language
Heat kernel and Lipschitz–Besov spaces
Authors: Grigor'yan Alexander , Liu Liguang
Published: July 2014

On a metric measure space (M,ρ,μ) we consider a family
of Lipschitz–Besov spaces

Λ

p
,
q

s

${\Lambda _{p,q}^{s}}$

that is defined only
using the metric ρ and measure μ, and a family of
Besov spaces

B

p
,
q

s

${B_{p,q}^{s}}$

that is defined using
an auxiliary self-adjoint operator L
and the associated heat semigroup. Under certain assumptions about the heat
kernel of L, we prove the identity of the two families of the function
spaces.
Fucoidans as a platform for new anticoagulant drugs discovery
Authors: Ustyuzhanina Nadezhda E. , Ushakova Natalia A. , Preobrazhenskaya Marina E. , Bilan Maria I. , Tsvetkova Eugenia A. , Krylov Vadim B. , Anisimova Natalia A. , Kiselevskiy Mikhail V. , Krukovskaya Nadezhda V. , Li Chunxia , Yu Guangli , Saran Saurabh , Saxena Rajendra K. , Usov Anatolii I. , Nifantiev Nikolay E.
Published: July 2014

Anionic fucose-containing polysaccharides (fucoidans of brown seaweeds, sulfated fucans and fucosylated chondroitin sulfates of invertebrates) are attracting a rapidly growing research interest due to different types of their biological activity discovered in recent years. In particular, algal fucoidans are characterized by large structural variations depending on the species used for their isolation and by the lack of structural regularity due to random distribution of both carbohydrate and non-carbohydrate substituents along the polymer chains. These features make it difficult to find distinct correlations between structural elements and biological properties of polysaccharides. Nevertheless, there is expectation that systematic structural and biochemical studies of fucoidans will form a basis for the development of new drugs. Herewith we summarize our recent results on the influence of fucoidan structure on blood coagulation.
Insights into the extraction behavior of U(VI) in Aliquat-336 based ionic liquids
Authors: Rama R. , Kumaresan R. , Venkatesan K. A. , Antony M. P. , Vasudeva Rao P. R.
Published: July 2014

The extraction behavior of U(VI) in the PUREX solvent namely 1.1 M tri-n-butyl phosphate (TBP) in n-dodecane (n-DD)
was studied in the presence and absence of the ionic liquid, tri-n-octylmethylammonium bis-(2-ethylhexyl)phosphate
([A336]+ [DEHP]
–
). The discrepancy in the extraction behavior observed in these systems was probed by measuring the distribution
ratio of U(VI) as a function of various parameters. The distribution ratio of U(VI) in 0.03 M
[A336]+ [DEHP]
–
/n-DD decreased with increase in the concentration of nitric acid. The extraction of U(VI) was
accompanied by the extraction of nitric acid leading to the formation of ionic liquid constituents namely
tri-n-octylmethylammonium nitrate ([A336]+ [NO3]
–
and bis(2-ethylhexyl)phosphoric acid (HDEHP). Therefore, the
distribution ratio of U(VI) in the PUREX solvent was measured in the presence of these constituents also. The study revealed
that extraction of U(VI) was controlled essentially by the synergistic contribution of TBP and the constituents of ionic liquid.
An attempt to select thermodynamic data and to evaluate the solubility of radioelements with uncertainty under HLW disposal
conditions
Authors: Yamaguchi Tetsuji , Takeda Seiji , Nishimura Yuki , Iida Yoshihisa , Tanaka Tadao
Published: July 2014

An attempt was made to select thermodynamic data with
uncertainties and to evaluate the solubility of radioelements with
uncertainties considering the uncertainties of the thermodynamic data and
variation in groundwater chemistry. The thermodynamic data were selected by
reviewing the JAEA-TDB released in 2012 from the viewpoint of consistency of
the data selection process, the conservativeness of the solubility
evaluation and testing up-to-date data. A Monte Carlo-based probabilistic
solubility calculation code, PA-SOL, was used for the uncertainty analysis
of the solubility.
The uncertainty analysis for the solubility of 13 elements showed large
uncertainties for Nb, Tc and U. The variations in pH, pe and total carbonate
concentration assumed in this study induce significant uncertainties to the
evaluated solubility. The reactions whose log K
0 with uncertainties
induce significant uncertainties to the evaluated solubilities were
identified.
Phenotypic bistability in Escherichia coli's central carbon metabolism
Authors: Kotte Oliver , Volkmer Benjamin , Radzikowski Jakub L , Heinemann Matthias
Published: July 2014

Fluctuations in intracellular molecule abundance can lead to distinct, coexisting phenotypes in isogenic populations. Although metabolism continuously adapts to unpredictable environmental changes, and although bistability was found in certain substrate‐uptake pathways, central carbon metabolism is thought to operate deterministically. Here, we combine experiment and theory to demonstrate that a clonal Escherichia coli population splits into two stochastically generated phenotypic subpopulations after glucose‐gluconeogenic substrate shifts. Most cells refrain from growth, entering a dormant persister state that manifests as a lag phase in the population growth curve. The subpopulation‐generating mechanism resides at the metabolic core, overarches the metabolic and transcriptional networks, and only allows the growth of cells initially achieving sufficiently high gluconeogenic flux. Thus, central metabolism does not ensure the gluconeogenic growth of individual cells, but uses a population‐level adaptation resulting in responsive diversification upon nutrient changes.
Longitudinal changes in glucocorticoid metabolism are associated with later development of adverse metabolic phenotype
Authors: Crowley Rachel K , Hughes Beverly , Gray Joanna , McCarthy Theresa , Hughes Susan , Shackleton Cedric H L , Crabtree Nicola , Nightingale Peter , Stewart Paul M , Tomlinson Jeremy W
Published: July 2014

Objective

Dysregulation of enzymes that control local tissue steroid metabolism has been implicated in the pathogenesis of obesity and insulin resistance; however, longitudinal changes in glucocorticoid metabolism have not been investigated. This study was performed to evaluate the role of glucocorticoid metabolism in the development of insulin resistance and obesity and to identify biomarkers for future development of metabolic disease.

Design

This was a prospective longitudinal observation study conducted over 5 years.

Methods

A 24-h collection was used to serially analyze urinary glucocorticoid and mineralocorticoid metabolites in 57 obese and overweight patients with no prior diagnosis of diabetes mellitus, recruited from the community.

Results

Baseline higher 5α-reductase (5αR) activity, but not 11β-hydroxysteroid dehydrogenase type 1 activity, was predictive of increased fasting insulin at final visit (11.4 compared with 7.4 mU/l in subjects with lower 5αR activity, P<0.05), area under the curve insulin response to oral glucose tolerance test (176.7 compared with 89.1 mU/l.h, P<0.01), and homeostasis model assessment (HOMA2-IR; 1.3 compared with 0.8, P<0.01). Higher total glucocorticoid production was associated with abnormal glucose tolerance and increased BMI. During this study, systolic blood pressure increased (equivalent to ∼1 mmHg/year), as did plasma sodium levels; this evidence of increased mineralocorticoid activity was associated with increased aldosterone metabolites and decreased 11β-hydroxysteroid dehydrogenase type 2 activity.

Conclusions

Increased 5αR activity and glucocorticoid secretion rate over time are linked with the development of metabolic disease, and may represent targets for therapeutic intervention, which merits further study.
Postprandial gallbladder emptying in patients with type 2 diabetes: potential implications for bile-induced secretion of glucagon-like peptide 1
Authors: Sonne David P , Rehfeld Jens F , Holst Jens J , Vilsbøll Tina , Knop Filip K
Published: July 2014

Objective

Recent preclinical work has suggested that postprandial flow of bile acids into the small intestine potentiates nutrient-induced glucagon-like peptide 1 (GLP1) secretion via bile acid-induced activation of the G protein-coupled receptor TGR5 in intestinal L cells. The notion of bile-induced GLP1 secretion combined with the findings of reduced postprandial gallbladder emptying in patients with type 2 diabetes (T2DM) led us to speculate whether reduced postprandial GLP1 responses in some patients with T2DM arise as a consequence of diabetic gallbladder dysmotility.

Design and methods

In a randomised design, 15 patients with long-standing T2DM and 15 healthy age-, gender- and BMI-matched control subjects were studied during 75-g oral glucose tolerance test (OGTT) and three isocaloric (500 kcal) and isovolaemic (350 ml) liquid meals: i) 2.5 g fat, 107 g carbohydrate and 13 g protein; ii) 10 g fat, 93 g carbohydrate and 11 g protein; and iii) 40 g fat, 32 g carbohydrate and 3 g protein. Basal and postprandial plasma concentrations of glucose, insulin, C-peptide, glucagon, GLP1, glucose-dependent insulinotropic polypeptide (GIP), cholecystokinin and gastrin were measured. Furthermore, gallbladder emptying and gastric emptying were examined.

Results

Gallbladder emptying increased with increasing meal fat content, but no intergroup differences were demonstrated. GIP and GLP1 responses were comparable among the groups with GIP levels being higher following high-fat meals, whereas GLP1 secretion was similar after both OGTT and meals.

Conclusions

In conclusion, patients with T2DM exhibited normal gallbladder emptying to meals with a wide range of fat content. Incretin responses were similar to that in controls, and an association with postprandial gallbladder contraction could not be demonstrated.
Nonconformity in the clinical practice guidelines for subclinical Cushing's syndrome: which guidelines are trustworthy?
Authors: Shen Jing , Sun Mingfang , Zhou Bo , Yan Juping
Published: July 2014

Objective

This study aimed to systematically evaluate the quality of clinical practice guidelines (CPGs) and to compare their recommendations for managing subclinical Cushing's syndrome (SCS) to assist practitioners in making rapid clinical decisions.

Design and methods

SCS management guidelines were retrieved from electronic databases. The Appraisal of Guidelines Research and Evaluation II (AGREE-II) tool and the Institute of Medicine (IOM) criteria were used to evaluate the quality of the selected guidelines. In addition, we further compared recommendations, cited references and levels of evidence between the SCS management guidelines.

Results

We included five guidelines that were obtained through the literature selection process. On the basis of the AGREE-II and IOM criteria, none of the selected guidelines were satisfactory in all aspects. However, the Italian Association of Clinical Endocrinologists (IACE) guidelines demonstrated slightly higher scores than did the other guidelines, so this guideline was recommended (with certain modifications for several domains). Regarding the content of the CPGs, we found considerable differences in the recommendations for managing SCS. These differences were derived from citation selection bias, evidence interpretation bias, differences in the composition of the guidelines' workgroups and the omission of guidelines for updating and externally reviewing the recommendations.

Conclusions

There is generally poor guideline quality among different organisations, and remarkable differences exist in the recommendations for the same clinical subject. Therefore, future guideline development should be performed in strict accordance with the AGREE-II and IOM criteria.
Role of compensatory meiosis mechanisms in human spermatogenesis
Authors: Borgers Mareike , Wolter Martin , Hentrich Anna , Bergmann Martin , Stammler Angelika , Konrad Lutz
Published: July 2014

Disturbances of checkpoints in distinct stages of spermatogenesis (mitosis, meiosis, and spermiogenesis) contribute to impaired spermatogenesis; however, the efficiency of meiotic entry has not been investigated in more detail. In this study, we analyzed azoospermic patients with defined spermatogenic defects by the use of octamer-binding protein 2 for type A spermatogonia, sarcoma antigen 1 for mitosis–meiosis transition and SMAD3 for pachytene spermatocytes. Especially patients with maturation arrest (MA) at the level of primary spermatocytes showed significantly reduced numbers of spermatogonia compared with patients with histologically intact spermatogenesis or patients with hypospermatogenesis (Hyp). For a detailed individual classification of the patients, we distinguished between ‘high efficiency of meiotic entry’ (high numbers of pachytene spermatocytes) and ‘low efficiency of meiotic entry’ (low numbers of pachytene spermatocytes). Only patients with histologically normal spermatogenesis (Nsp) and patients with Hyp showed normal numbers of spermatogonia and a high efficiency of meiotic entry. Of note, only patients with histologically Nsp or patients with Hyp could compensate low numbers of spermatogonia with a high efficiency of meiotic entry. In contrast, patients with MA always showed a low efficiency of meiotic entry. This is the first report on patients with impaired spermatogenesis, showing that half of the patients with Hyp but all patients with MA cannot compensate reduced numbers in spermatogonia with a highly efficient meiosis. Thus, we suggest that compensatory meiosis mechanisms in human spermatogenesis exist.
Safety of Vaccines Used for Routine Immunization of US Children: A Systematic Review
Authors: Maglione Margaret A. , Das Lopamudra , Raaen Laura , Smith Alexandria , Chari Ramya , Newberry Sydne , Shanman Roberta , Perry Tanja , Goetz Matthew Bidwell , Gidengil Courtney
Published: July 2014

BACKGROUND:

Concerns about vaccine safety have led some parents to decline recommended vaccination of their children, leading to the resurgence of diseases. Reassurance of vaccine safety remains critical for population health. This study systematically reviewed the literature on the safety of routine vaccines recommended for children in the United States.

METHODS:

Data sources included PubMed, Advisory Committee on Immunization Practices statements, package inserts, existing reviews, manufacturer information packets, and the 2011 Institute of Medicine consensus report on vaccine safety. We augmented the Institute of Medicine report with more recent studies and increased the scope to include more vaccines. Only studies that used active surveillance and had a control mechanism were included. Formulations not used in the United States were excluded. Adverse events and patient and vaccine characteristics were abstracted. Adverse event collection and reporting was evaluated by using the McHarm scale. We were unable to pool results. Strength of evidence was rated as high, moderate, low, or insufficient.

RESULTS:

Of 20 478 titles identified, 67 were included. Strength of evidence was high for measles/mumps/rubella (MMR) vaccine and febrile seizures; the varicella vaccine was associated with complications in immunodeficient individuals. There is strong evidence that MMR vaccine is not associated with autism. There is moderate evidence that rotavirus vaccines are associated with intussusception. Limitations of the study include that the majority of studies did not investigate or identify risk factors for AEs; and the severity of AEs was inconsistently reported.

CONCLUSIONS:

We found evidence that some vaccines are associated with serious AEs; however, these events are extremely rare and must be weighed against the protective benefits that vaccines provide.
Increased Molybdenum Loading for Vitrified High Level Waste
Authors: Gribble Nick R. , Short Rick J , Dunnett Barbara F. , Steele Carl J.
Published: July 2014

The solubility of molybdenum in borosilicate glasses is low. The UK National Nuclear Laboratory has developed a new glass formulation containing calcium and zinc for the vitrification of high molybdenum containing waste arising from the Post Operational Clean Out of the Highly Active Storage Tanks at Sellafield that will decrease the number of product containers required, reducing both production and disposal costs. The new formulation increases the quantity of molybdenum that can be vitrified through the formation of a durable CaMoO4 phase once the solubility limit of molybdenum in the glass has been exceeded. Extensive laboratory trials confirmed the potential to increase the Mo loading significantly. Recently full scale testing has been performed on the Vitrification Test Rig using highly active liquor simulants to determine the maximum MoO3 loading that can be achieved. This paper explores the full scale testing and product quality of the glass manufactured during this study.
Estimation of the long term helium production in high burn-up spent fuel due to alpha decay and consequences for the canister
Authors: Valls Alba , Grivé Mireia , Riba Olga , Morales Maita , Spahiu Kastriot
Published: July 2014

In the KBS-3 repository concept and safety analysis, the copper container with a cast iron insert plays a central role in assuring isolation of the waste from the surrounding during long periods of time. All processes that affect its stability are thoroughly analysed, including potential detrimental processes inside the canister. For this reason, an estimation of the helium produced during the long term decay of alpha emitters in the spent fuel is necessary to evaluate if the pressures generated inside can have consequences for the canister.

The spent nuclear fuel to be disposed of in Sweden is mainly LWR fuel. The maximum burn-up expected is 60 MWd/kg U for BWR and PWR. A small quantity of BWR MOX is expected to be stored with a maximum burn-up of 50 MWd/kg U.

This work has focused on carrying out calculations of the amounts of He generated during more than 1 million years in Swedish spent nuclear fuels with a benchmarking exercise by using both codes AMBER and Origen-ARP. The performance and agreement of the codes in the He generation from α-decay have been checked and validated against data reported in literature [1].

In the calculation of the maximal pressure inside the canister, the quantity of helium used to pre-pressurise the fuel rods has been accounted for. The pressure inside the canister due to He generation is at all times much lower than the hydrostatic pressure and/or the bentonite swelling pressure outside the canister.
A Century of NU-Muhammadiyah in Indonesia: The Failure of Islamic Modernism?
Authors: Hasbullah Moeflich
Published: July 2014

Islamic modernism represented by Muhammadiyah and Persatuan Islam and Islamic traditionalism symbolized by Nahdlatul Ulama have lasted a century old in Indonesian history (1912-2014). The unavoidable tensions and conflicts between these two contrast Islamic movements occurred in various fields. The modernist hasbeen trying to promote their modern views and to eradicate tradition. On the contrary, the traditionalist has been working hard to maintain their Islamic tradition and fight for the modernist mission in disseminating their ideas. To some extent, the modernist is quite successful, however by comparative study methods applied in this article to see the result of these two Islamic streams, I argue that in common Islamic modernism has failed to weaken and to eradicate tradition as it was firstly introduced by their initiators over a century ago. The modernist is only successful in its attempt to build its own empire of modernism but without vanishing tradition. Rather than weakening, let alone disappearing, what has been occuring shows the opposite result. Islamic traditionalism even grows larger than modernist group and develops more dynamic in various fields. More than that, Islamic neo-traditionalism has emerged as its new variant, an intellectual movement that found a new land on the problems of modern spiritual drought.
Islamic Party Survives in 2014 Legislative Election? (The Case of PKS)
Authors: Nurdin Ahmad Ali
Published: July 2014

This paper examines performances of PKS in the last 2009 election, West java and DKI Jakarta gubernatorial elections and the current 2014 legislative election to answer whether PKS looses or survives their political support from Indonesian people in the 2014 election. Although the cadres of PKS is still solid compare to that of other parties, there are a variety of reasons why the popularity of PKS slightly declined in the 2014 election compared to that of 2009 election. The involvement of the former president of PKS, Luthfi Hasan Ishak, in the case of beef graft has lessened the confidence of Indonesian people to the integrity of PKS in eradicating corruption in Indonesia. Thus, many Indonesians have doubt and less confidence in the capacity of PKS to solve other national problems. In addition, the weak and the least possible figure of PKS to be nominated as a president candidate is another reason why PKS cannot become a champion in the 2014 presidential election. Looking at the quick count result done by several survey institutions, however, PKS is considered to be survived in the 2014 election. They successfully maintain and strengthen their cadres’ solidity. Their leading figures were quite successful in rebuilding trust not only for their loyal cadres but also public in general that they are really ‘clean’ and ‘professional’ and ready to combat corruption in the country. PKS proved to the public that the case of their former president was ‘the only corruption case’ done by ‘personally individual’ (oknum) whom they will not tolerate.
Islamic Philanthropy and the Third Sector: The Portrait of Zakat Organizations in Indonesia
Authors: Muhtada Dani
Published: July 2014

This paper discusses the role of zakat organizations as the emerging Third Sector in Indonesia. It presents the profiles of three currently leading zakat organizations: Rumah Zakat Indonesia (RZI), Dompet Dhuafa (DD), and Pos Keadilan Peduli Ummat (PKPU). This paper highlights that the zakat organizations play an important role in serving public needs in Indonesia. They offer many services in such areas as health, economy, education, agriculture, and disaster reliefs. Competition does exist among zakat organizations, particularly if they operate in the same areas and target the same segment of donors (e.g., wealthy Muslims in urban areas). This paper argues that some more efforts are still needed to strengthen the roles of zakat organizations as part of the Indonesian third sector. This could be achieved through strengthening the accountability and the transparency of zakat management as well as by encouraging zakat organizations to allocate more funds for economic development programs. Allocating more funds for economic development programs would make zakat organizations more powerful in promoting social welfare in the society.
The Challenge of Democracy in Indonesia: The Case of Salafi Movement
Authors: Wahid Din
Published: July 2014

In spite of strong support of the majority of Muslims in Indonesia to democratic system, there are small numbers of Muslim who reject the democratic system. To name a few, I can mention here some groups of Muslims who oppose the democracy, such as Hizbut Tahrir Indonesia (HTI), Majelis Mujahidin Indonesia (MMI) and Salafis. These groups maintain that democracy is against Islam, because Islam does not recognize democracy. Democracy as symbolized by “the power of people” contradicts the basic doctrine of Islam concerning the sovereignty. In Islam, they maintain, the power or sovereignty belongs to God only. This essential concept creates various consequences dealing with governance of the ruled. This paper discusses the views of Salafis in Indonesia on the democracy. Despite their resistance of democracy, the Salafis consider a ruler resulted from democracy is valid, and Muslims should obey him: they are not allowed to criticize him publicly, and are not allowed to rebel against him.
Small fiber dysfunction in patients with Wilson's disease
Authors: Gondim Francisco de Assis A. , Araújo Davi F. , Oliveira Ítalo S. , Vale Otoni Cardoso do
Published: July 2014

Objective: Patients with Wilson’s disease (WD) may develop a wide variety of neuropsychiatric symptoms, but there are few reports of autonomic dysfunction. Here, we described evidence of small fiber and/or autonomic dysfunction in 4 patients with WD and levodopa-responsive parkinsonism. Method: We reviewed the charts of 4 patients with WD who underwent evaluation for the presence of neuromuscular dysfunction and water-induced skin wrinkling test (SWT). Results: Two men and 2 women (33±3.5 years) with WD were evaluated. They all had parkinsonism at some point during their disease course. Parkinsonism on patient 4 almost completely subsided with treatment of WD. Two patients had significant sensory and 2 significant autonomic complaints, including syncopal spells. NCS/EMG was normal in all but SWT was abnormal in half of them (mean 4-digit wrinkling of 0.25 and 1). Discussion: A subset of patients with WD exhibit evidence of abnormal skin wrinkling test (small fiber neuropathy).
Validation of an instrument for investigating knowledge on the initial assistance to burns victims
Authors: Balan Marli Aparecida Joaquim , Meschial William Campo , Santana Rosangela Geritana , Suzuki Simone Mancini Liduário , Oliveira Magda Lúcia Félix de
Published: July 2014

This study featured a methodological quantitative approach and its objective was to validate an instrument on the initial assistance given to burns victims, on medical and nursing knowledge, using the theoretical stage of Pasquali's model. The data were collected in June - August 2008, in two parts: analysis of face validity and content validity by 18 judges; and analysis of internal consistency, undertaken through Item Response Theory, by 42 doctors and nurses from a teaching hospital in the North-West region of the Brazilian state of Paraná. Following the judges' analysis, 35 questions regarding general, medical and nursing knowledge showed agreement above 80% for the concepts. Through the internal consistency analysis applied to the general knowledge questions, three were discarded due to not being correlated with the construct. The remaining seven questions (70%) presented low discrimination of the respondents, varying levels of difficulty, and similar probabilities of correct random guesses. The final instrument contains 32 questions and is available for use.
Decision-making of the nursing team after the revitalization of a decentralized management model
Authors: Hayashida Karen Yukari , Bernardes Andrea , Maziero Vanessa Gomes , Gabriel Carmen Silvia
Published: July 2014

This study's objective was to identify changes in decision-making arising from the revitalization of the participatory management model and how these changes impacted the daily work of the nursing staff, as well as to identify potential difficulties. This qualitative case study was conducted in a public hospital in the State of São Paulo, Brazil. Participant observation and semi-structured interviews were conducted with 23 nursing workers and the Health Technical Assistant. We used thematic content analysis for data analysis. The revitalization of the management model was not comprehensive because many professionals were oblivious to the process. Shared actions did not occur and adherence to the model was hampered because the workers were not fully informed of the assumptions concerning this management model. For the implementation of this model to be effective, teamwork and the inclusion of all the stakeholders should be reviewed in order to achieve more cooperative and qualified work.
Reflection about systematic review in public health
Authors: Mamede Fabiana Villela
Published: July 2014

This study is a reflection on conducting a systematic review in public health. Systematic reviews of public health are fraught with challenges. Complexity is inherent and this may be due to multi-component interventions, diverse study populations, multiple outcomes measured, mixed study designs, or implementation and effectiveness of the review. For policy makers and practitioners to use systematic reviews to implement effective systematic reviews of public health program, the reviews must include this information, which seeks to answer the questions posed by decision-makers, including recipients of the program. We discuss methodological and practice issues that need to be considered when undertaking systematic reviews in this field, including recommendations to reviewers on the issues to address within a systematic public health review and, indirectly, provides advice to researchers on the reporting requirements of primary studies for the production of high quality systematic reviews.
Measurement of fatigue in children and adolescents with cancer: an integrative review
Authors: Nunes Michelle Darezzo Rodrigues , Silva Michele Cristina Miyauti , Rocha Ester Leonardo , Lima Regina Aparecida Garcia de , Nascimento Lucila Castanheira
Published: July 2014

This study analyzed scientific production on the measurement of fatigue in children and adolescents with cancer, particularly the instruments used. Integrative review, searching in PubMed, PsycINFO, Web of Science, CINAHL, LILACS, SciELO, IBECS and COCHRANE, without any time restriction, using key words and descriptors in different combinations. The review sample comprised 21 references. The results composed two categories: instrument development and validation and fatigue measurement. American nurses developed most studies, between 2002 and 2011, using two scales. The studies assessed the children and adolescents' self-reports and the parents' reports. They also associated fatigue with sleep pattern, quality of life, depression, survival and dexamethasone use. The importance of research on this theme is evidenced, including studies that apply these instruments in practice. The gap in knowledge production on this theme is highlighted in the Brazilian context.
Prevalence of normal electrocardiograms in primary care patients
Authors: Marcolino Milena Soriano , Palhares Daniel Moore Freitas , Alkmim Maria Beatriz Moreira , Ribeiro Antonio Luiz
Published: July 2014

Objective: Knowing the proportion the proportion of normal and abnormal electrocardiograms (ECGs) in primary care patients allows us to estimate the proportion of exams that can be analyzed by the general practitioner with minimal training in ECG interpretation, in addition to being epidemiologically relevant. The objective of this study is to assess the prevalence of normal ECGs in primary care patients. Methods: all digital ECGs analyzed by the cardiologists of Telehealth Network of Minas Gerais (TNMG) in 2011 were evaluated. TNMG is a public telehealth service that provides support to primary care professionals in 662 municipalities in the state of Minas Gerais, Brazil. Results: during the study period, 290,795 ECGs were analyzed (mean age 51 ± 19 years), 57.6% were normal. This proportion was higher in women (60.1 vs 57.6%, p <0.001) and lower in patients with hypertension (45.8% vs 63.2%, p <0.001) or diabetes (43.3% vs 63.2%, p <0.001). A progressive reduction in the prevalence of normal ECG with increasing age was observed. Among the ECGs of patients under investigation for chest pain, 58.7% showed no abnormalities. Conclusion: the prevalence of normal ECGs in primary care patients is higher than 50% and this proportion decreases with age and comorbidities. Most ECGs performed for investigation of chest pain in primary care shows no abnormality.
Translation, cultural adaptation to Brazil and validation of the venous leg ulcer quality of life questionnaire (VLU-QoL-Br)
Authors: Araújo Renata Boldrin de , Fortes Maria Rita Parise , Abbade Luciana Patrícia Fernandes , Miot Hélio Amante
Published: July 2014

Objective: translating the Venous leg ulcer quality of life questionnaire (VLU-QoL), and culturally adapting it to Brazilian Portuguese and validate it with patients at the Hospital das Clínicas of the Botucatu Medical School - Unesp. Methods: the questionnaire was translated by a professional translator and two dermatologists specialized in the area of venous ulcers (VU), reformulated in a meeting of the three translators. The construct (VLU-QoL-Br) was submitted to pre-interviews with ten VU patients for adaptation of the language. Subsequently, it was applied to patients at the HC-Unesp, and for test-retest reliability for verification of its reproducibility. Results: 82 patients were evaluated, with 56 (68%) women. The age average was 67.3 years. The questionnaire was translated, adapted and applied to the patients. The construct presented high internal consistency (alpha = 0.94) and adequate item-total correlation. When the 32 retests were evaluated, an intra-class correlation was noted for concordance of 0.78 (p<0.01), indicating good reproducibility of the construct. The confirmatory factor analysis corroborated the dimensions of the original questionnaire: activities, psychologies, and symptoms. VLU-QoL-Br scores were associated, independently, to the total area of the ulcers and a lower education level of the subjects (p<0.01). Conclusion: the translation, adaptation and validation of the VLU-QoL-Br questionnaire were concluded, demonstrating good psychometric performance, and enabling its clinical use in Brazil. It is important to evaluate its performance in other regions and different samples of individuals.
As representações como suporte do raciocínio matemático dos alunos quando exploram atividades de investigação
Authors: Henriques Ana , Ponte João Pedro da
Published: July 2014

Neste artigo, analisamos os modos de representação e os processos de raciocínio de alunos do 2.º ano do ensino superior na exploração de atividades de investigação propostas numa experiência de ensino na disciplina de Análise Numérica. O objetivo é compreender o modo como as representações escolhidas pelos alunos no decorrer das suas explorações suportam o seu raciocínio. O estudo segue uma metodologia de investigação qualitativa e interpretativa, baseada em três estudos de caso, e utiliza diversas fontes de dados. Os resultados mostram que os alunos usam tanto raciocínio indutivo como dedutivo, mas sugerem a necessidade de dar maior atenção aos dois processos de raciocínio em que se verificam dificuldades significativas - generalização e justificação. Os alunos recorrem a uma diversidade de representações para compreensão, exploração, registro e avaliação, mas usam-nas de modo pouco flexível ao longo do processo de exploração, o que limita o seu raciocínio.
Las matemáticas para la enseñanza en una formación del profesorado basada en el estudio de cuestiones
Authors: Olarría Alicia Ruiz , Delgado Tomás Ángel Sierra , Casabò Marianna Bosch , Pérez Josep Gascón
Published: July 2014

Presentamos una propuesta para la formación del profesorado de Secundaria en matemáticas para la enseñanza que se sitúa en el marco de la teoría antropológica de lo didáctico. De acuerdo con Gisèle Cirade (2006), basamos dicha formación en el estudio de un conjunto de cuestiones que pone de manifiesto el carácter problemático de la matemática escolar y, consiguientemente, en la construcción, como respuestas provisionales, de ciertas praxeologías matemáticas para la enseñanza. Las primeras experimentaciones llevadas a cabo en España en el recién implantado máster en formación del profesorado de secundaria nos han permitido empezar a calibrar posibilidades de esta formación y algunas de las restricciones que se alzan como dificultades para su desarrollo.
Socioepistemología y empoderamiento: la profesionalización docente desde la problematización del saber matemático
Authors: Reyes-Gasperini Daniela , Cantoral Ricardo
Published: July 2014

La Matemática Educativa, como disciplina académica, se propone un objetivo mayor: democratizar el aprendizaje de las matemáticas. Para alcanzarlo, habrá que transitar de una perspectiva platónica, centrada en objetos abstractos ajenos a la realidad, hacia una visión socioepistemológica que asume a las prácticas sociales como la base de la construcción del conocimiento matemático de toda persona. Esto precisa de numerosas restructuraciones del sistema educativo, una de ellas es la profesionalización docente. En este artículo, postulamos al empoderamiento como el proceso que atiende a la profesionalización docente desde una mirada socioepistemológica a través de la problematización del saber matemático escolar.
SURGICAL OUTCOMES AND PROGNOSTIC FACTORS IN PATIENTS WITH SYNCHRONOUS COLORECTAL LIVER METASTASES
Authors: FONTANA Rafael , HERMAN Paulo , PUGLIESE Vincenzo , PERINI Marcos Vinicius , COELHO Fabricio Ferreira , CECCONELLO Ivan
Published: July 2014

Context Colorectal cancer is the second most prevalent cancer worldwide, and the liver is the most common site of metastases. Surgical resection of colorectal liver metastases provides the sole possibility of cure and the best odds of long-term survival. Objectives To describe surgical outcomes and identify features associated with disease prognosis in patients submitted to synchronous colorectal cancer liver metastasis resection. Methods Retrospective study of 59 patients who underwent surgery for synchronous colorectal cancer liver metastasis. Actuarial survival and disease-free survival were assessed, depending on the prognostic variable of interest. Results Postoperative mortality and morbidity rates were 3.38% and 30.50% respectively. Five-year disease-free survival was estimated at 23.96%, and 5-year overall survival, at 38.45%. Carcinoembryonic antigen levels ≥50 ng/mL and presence of three or more liver metastasis were limiting factors for disease-free survival, but did not affect late survival. No patient with liver metastases and extrahepatic disease had disease-free interval longer than 20 months, but this had no significance or impact on long-term survival. None of the prognostic factors assessed had an impact on late survival, although no patients with more than three liver metastases survived beyond 40 months. Conclusions Although Carcinoembryonic antigen levels and number of metastases are prognostic factors that limit disease-free survival, they had no impact on 5-year survival and, therefore, should not determine exclusion from surgical treatment. Resection is the best treatment option for synchronous colorectal liver metastases, and even for patients with multiple metastases, large tumors and extrahepatic disease, it can provide long-term survival rates over 38%.
LOW MORTALITY RATE IN 97 CONSECUTIVE PANCREATICODUODENECTOMIES: the experience of a group
Authors: FONTES Paulo Roberto Ott , WAECHTER Fábio Luiz , NECTOUX Mauro , SAMPAIO José Artur , TEIXEIRA Uirá Fernandes , PEREIRA-LIMA Luiz
Published: July 2014

Context Pancreaticoduodenectomy is the procedure of choice for resectable cancer of the periampullary region. These tumors account for 4% of deaths from cancer, being referred to as one of the lowest survival rates at 5 years. Surgery remains a complex procedure with substantial morbidity and mortality. Despite reports of up to 30% mortality rates, in centers of excellence it have been identified as less than 5%. Recent studies show that pancreaticojejunostomy represents the “Achilles’ heel” of the procedure. Objective To evaluate the post-operative 30 days morbidity and mortality rates. Methods Retrospective analysis of 97 consecutive resected patients between July, 2000 and December, 2012. All patients were managed by the same group, and data were obtained from specific database service. The main objective was to evaluate the 30-day mortality rate, but we also studied data of surgical specimen, need for vascular resection and postoperative complications (gastric stasis, pancreatic fistula, pneumonia and reoperation rate). Results Thirty-day mortality rate was 2.1% (two patients). Complete resection with no microscopic residual tumor was obtained in 93.8% of patients, and in 67.3% of cases pathology did not detected metastatic nodes. Among postoperative complications were reported 6% of prolonged gastric stasis, 10.3% of pneumonia, 10.3% of pancreatic fistula and 1% of infection in the drain pathway. Two patients underwent reoperation due to bleeding and infected hematoma caused by pancreatic fistula, and another for intestinal obstruction because of adhesions at postoperative day 12. Conclusions The pancreaticoduodenectomy as treatment procedure for periampullary cancers has a low morbidity and mortality rate in services with experience in Hepato-Pancreato-Biliary surgery, remaining as first-line treatment in resectable patients.
ANALYSIS OF THE SURVIVAL OF CIRRHOTIC PATIENTS ENLISTED FOR LIVER TRANSPLANTATION IN THE PRE- AND POST-MELD ERA IN SOUTHERN BRAZIL
Authors: MATTOS Ângelo Zambam de , MATTOS Angelo Alves de , SACCO Fernanda Karlinski Fernandes , HOPPE Lísia , OLIVEIRA Denise Maria Sarti de
Published: July 2014

Context Transplantation is the only cure for decompensated cirrhosis. Model for End-Stage Liver Disease (MELD) is used in liver allocation. Objectives Comparing survival of enlisted populations in pre- and post-MELD eras and estimating their long-term survival. Methods This is a retrospective study of cirrhotics enlisted for transplantation during pre- and post-MELD eras. Survival curves were generated using Kaplan-Meier’s model. Cox’s model was used to determine risk factors for mortality. Exponential, Weibull’s, normal-log and Gompertz’s models were used to estimate long-term survival. Results The study included 162 patients enlisted in pre-MELD era and 184 in post-MELD period. Kaplan-Meier’s survival curve of patients enlisted in post-MELD era was better than that of pre-MELD period (P = 0.009). This difference remained for long-term estimates, with a survival of 53.54% in 5 years and 44.64% in 10 years for patients enlisted in post-MELD era and of 43.17% and 41.75% for pre-MELD period. Era in which patients had been enlisted (P = 0.010) and MELD score at enlistment (P<0.001) were independently associated to survival with hazard ratios of 0.664 (95% CI-confidence interval = 0.487-0.906) and 1.069 (95% CI = 1.043-1.095). Conclusions MELD-based transplantation policy is superior to chronology-based one, promoting better survival for enlisted patients, even in long-term.
BILIARY ATRESIA: evaluation on two distinct periods at a reference pediatric service
Authors: QUEIROZ Thais Costa Nascentes , FERREIRA Alexandre Rodrigues , FAGUNDES Eleonora Druve Tavares , ROQUETE Mariza Leitão Valadares , PENNA Francisco José
Published: July 2014

Context Biliary atresia is a progressive, idiopathic, fibro-obliterative disease of the extrahepatic biliary tree that presents with biliary obstruction exclusively in the neonatal period. Objectives To assess the differences regarding age at referral, age at surgery, duration of propaedeutics and waiting time for surgery between two groups of infants in different periods. Methods Retrospective study of infants diagnosed with biliary atresia on two periods: 1983-1993 and 1998-2011. Results Biliary atresia was diagnosed in 129 infants, being 48 in casuistic I and 81 in casuistic II. The median age at admission was 94 and 60 days, respectively (P = 0.0001). On evaluating patients who had undergone portoenterostomy before 120 days of age, no difference was observed regarding the duration of propaedeutics or waiting time for surgery (P = 0.15), but difference was found when comparing the age at surgery (P = 0.002). Among those infants with no biliary flow and without liver transplantation or death after 18 post-operative months, the estimated probability of survival was 44.6% and 38.7% in casuistics I and II, respectively. In casuistic I, all infants who showed biliary flow were alive during the observation period and, in casuistic II, 80.3% were alive after 7 years of follow-up. Conclusions Even though patients were admitted and treated earlier, it is clear that surgery could be done sooner. Delay in referral and timely propaedeutics were the main contributors.
TESTOSTERONE CHANGES IN PATIENTS WITH LIVER CIRRHOSIS BEFORE AND AFTER ORTHOTOPIC LIVER TRANSPLANTATION AND ITS CORRELATION WITH MELD
Authors: NITSCHE Rodrigo , COELHO Júlio Cezar Uili , FREITAS Alexandre Coutinho Teixeira de , ZENI NETO Clementino , MARTINS Eduardo
Published: July 2014

Context Hypogonadism is a common clinical situation in male patients with liver cirrhosis. Objectives The aim of the present study was to evaluate the effects of orthotopic liver transplantation on testosterone, free testosterone and sex hormone-binding globulin in male with advanced liver disease and also to determine the relationship of these changes with Model for End-stage Liver Disease (MELD) score. Methods In a prospective study, serum levels of testosterone, free testosterone and sex hormone-binding globulin of 30 male adult patients with end-stage liver disease were measured 2 to 4 hours before and 6 months after orthotopic liver transplantation. Results Total testosterone levels increased after orthotopic liver transplantation and the number of patients with normal testosterone levels increased from 18 to 24. Free testosterone mean level in the pre-transplant group was 7.8 pg/mL and increased to 11.5 pg/mL (P = 0.10) and sex hormone-binding globulin level decreased after orthotopic liver transplantation returning to normal levels in MELD ≤18 - group (A) (P<0.05). Conclusions Serum level changes of testosterone, free testosterone and sex hormone-binding globulin are more pronounced in cirrhotic males with MELD ≤18. Serum levels of testosterone and free testosterone increase and serum levels of sex hormone-binding globulin decrease after orthotopic liver transplantation.
Mudanças estratégicas em organizações hospitalares: uma abordagem contextual e processual
Authors: Pereira Maurício Fernandes
Published: July 2014

O objetivo central do artigo consiste em verificar como ocorreu o processo de mudança estratégica em uma organização hospitalar. Analisam-se, de forma empírica, as mudanças estratégicas ocorridas nos últimos 20 anos no Hospital CBS. São identificadas as condições objetivas do setor - ambiente real, arena cognitiva - como ambiente percebido e a rede de colaboradores que dão suporte às atividades do hospital. O período de mais transformações foi o de 1991 a 1995, e as principais mudanças foram na cultura do hospital, na filosofia de trabalho dos médicos e funcionários, na forma de treinamento dos funcionários, na estrutura organizacional, nos processos e na tecnologia. Detectou-se que a coalizão dominante do hospital sofre apenas influência externa em razão das mudanças tecnológicas e que, internamente, o corpo clínico tem controle sobre o processo de tomada de decisões.