Side-stream lignins: Potential antioxidant and antimicrobial agents in milk.

In recent years, lignin has drawn increasing attention due to its intrinsic antibacterial and antioxidant activities, biodegradability, and biocompatibility. Yet, like several other biogenic structures, its compositional heterogeneity represents a challenge to overcome. In addition, there are few studies regarding food applications of lignin. Herein, we evaluate the antimicrobial and antioxidant effects of lignin from two different sources. These lignins were characterized by attenuated total reflectance Fourier-transform infrared (ATR-FTIR) and hydrogen nuclear magnetic resonance (1H NMR) spectroscopies. Their antibacterial and antioxidant capacities (DPPH and Folin-Ciocalteu methods) were also investigated. Susceptibility tests were performed with the minimal inhibitory (MIC) and bactericidal (MBC) concentrations using the micro-broth dilution technique. Kraft lignin presented higher radical-scavenging and antibacterial activities than alkali lignin, indicating the dependence of antioxidant and antibacterial activities on the precursor biomass. Scanning electron microscopy shows morphologic changes in the bacteria after exposure to lignin, while confocal microscopy suggests that kraft lignin has affinity towards bacterial surfaces and the ability to cause cell membrane destabilization. Lignin inhibited the growth of Staphylococcus aureus and Salmonella Enteritidis in skimmed milk, herein taken as food model. Our results suggest that lignins are promising candidates for green additives to improve quality and safety within the food chain.

COVID-19: Impact of Original, Gamma, Delta, and Omicron Variants of SARS-CoV-2 in Vaccinated and Unvaccinated Pregnant and Postpartum Women.

This study compares the clinical characteristics and disease progression among vaccinated and unvaccinated pregnant and postpartum women who tested positive for different variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) using the Brazilian epidemiological data. Data of pregnant or postpartum patients testing positive for SARS-CoV-2 and presenting with coronavirus disease 2019 (COVID-19) from February 2020 to July 2022 were extracted from Brazilian national database. The patients were grouped based on vaccination status and viral variant (original, Gamma, Delta, and Omicron variants), and their demographics, clinical characteristics, comorbidities, symptoms, and outcomes were compared retrospectively. Data of 10,003 pregnant and 2361 postpartum women were extracted from the database. For unvaccinated postpartum women, intensive care unit (ICU) admission was more likely; invasive ventilation need was more probable if they tested positive for the original, Gamma, and Omicron variants; and chances of death were higher when infected with the original and Gamma variants than when infected with other variants. Vaccinated patients had reduced adverse outcome probability, including ICU admission, invasive ventilation requirement, and death. Postpartum women showed worse outcomes, particularly when unvaccinated, than pregnant women. Hence, vaccination of pregnant and postpartum women should be given top priority.

Influence of cover crops with allelopathic potential and their reduction of herbicide use for soybean productivity.

The allelophaty expressed by soil cover crops over weed varies according to species, quality and quantity of material produced. The purpose of this study was to evaluate the potential of cover crops and in the management of weeds and their effects on soybean yield. The experiment was laid in tri-factorial randomized block design with four replication. Factor A was cover crops (oats, forage chicory, quinoa and fallow), factor B was application of paraquat 400 g i.a ha-1, glyphosate 1200 g i.a ha-1 and mowing and factor C was one and two applications of post-emergent herbicide (glyphosate). For cover crops, the percentage of soil cover was evaluated at 53 DAE (days after emergence) of soybean. Weed species and their densities at 53 DAE of soybean were identified. At the end of the experiment, soybean yield was evaluated. The data were analyzed by the F test and comparison between means by the Tukey test (P ≤ 0.05). Oats are the best option for weed inhibition and early soybean development. Quinoa and forage chicory were slow to cover the soil, but weed inhibition occurred. There were no large variations in post-emergence herbicide applications, which made possible to reduce an application without compromising the expected result.

COVID-19 outcomes in hospitalized puerperal, pregnant, and neither pregnant nor puerperal women.

OBJECTIVE: To compare hospitalized reproductive age women with COVID-19 who were pregnant, puerperal, or neither one nor the other in terms of demographic and clinical characteristics and disease progression using Brazilian epidemiological data. METHODS: A retrospective analysis of the records of the Information System of the Epidemiological Surveillance of Influenza of the Health Ministry of Brazil was performed. It included the data of female patients aged 10 to 49 years hospitalized because of severe COVID-19 disease (RT-PCR+ for SARS-CoV-2), from February 17, 2020 to January 02, 2021. They were separated into 3 groups: pregnant, puerperal, and neither pregnant nor puerperal. General comparisons and then adjustments for confounding variables (propensity score matching [PSM]) were made, using demographic and clinical characteristics, disease progression (admission to the intensive care unit [ICU] and invasive or noninvasive ventilatory support), and outcome (cure or death). Deaths were analyzed in each group according to comorbidities, invasive or noninvasive ventilatory support, and admission to the ICU. RESULTS: As many as 40,640 reproductive age women hospitalized for COVID-19 were identified: 3,372 were pregnant, 794 were puerperal, and 36,474 were neither pregnant nor puerperal. Groups were significantly different in terms of demographic data and comorbidities (p<0.0001). Pregnant and puerperal women were less likely to be symptomatic than the women who were neither one nor the other (72.1%, 69.7% and 88.8%, respectively). Pregnant women, however, had a higher frequency of anosmia, and ageusia than the others. After PSM, puerperal women had a worse prognosis than pregnant women with respect to admission to the ICU, invasive ventilatory support, and death, with OR (95% CI) 1.97 (1.55 - 2.50), 2.71 (1.78 - 4.13), and 2.51 (1.79 - 3.52), respectively. CONCLUSION: Puerperal women were at a higher risk for serious outcomes (need for the ICU, need for invasive and noninvasive ventilatory support, and death) than pregnant women.

The effect of bovine vaccines against respiratory viruses administered either intranasal or intramuscular on broncho-alveolar fluid cells of heifers.

BACKGROUND: The knowledge on bovine vaccines against respiratory viruses on bronchoalveolar fluid cells is scarce. OBJECTIVE: To compare the effects of a commercial intranasal (IN) and intramuscular (IM) vaccine against bovine respiratory disease (BRD) complex viruses on bronchoalveolar fluid cells of healthy heifers. METHODS: 21 healthy heifers were assigned to three treatment groups: control (CO, N = 7), intranasally vaccinated (IN) (n = 7), and intramuscularly vaccinated (IM) (n = 7). The IN group received 1 mL of the commercial vaccine in each nostril once containing attenuated BoHV-1, bPIV-3, and BRSV. The IM group was vaccinated with two doses of 2 mL with an interval of 21 days of the commercial vaccine containing attenuated BoHV-1, bPIV-3, and BRSV plus inactivated BVDV. At day 0 (D0), before the first vaccine dose, and at D3, D7, and D21, after the last vaccine dose, airway bronchoscopy was performed to observe local irritation and collect bronchoalveolar lavage fluid (BALF). The bronchoalveolar count, cytological evaluation, bronchoalveolar cell oxidative metabolism, and total bronchoalveolar IgA and IgG were measured. RESULTS: The IN vaccine increased neutrophil cellularity at D7 and D21 and total IgA at D3 in BALF. Total IgA in BALF also increased at D3 and oxidative metabolism of bronchoalveolar cells at D21 lowered compared to the CO group. Following IM vaccination there was no alteration of immunoglobulins or cell oxidative metabolism in BALF. Both vaccines reduced the number of alveolar macrophages. CONCLUSION: Both vaccines induced bronchoalveolar inflammation during the establishment of the vaccine immunity, which was more expressive in the IN protocol.

Joint report of SBI (Brazilian Society of Infectious Diseases), FEBRASGO (Brazilian Federation of Gynecology and Obstetrics Associations), SBU (Brazilian Society of Urology) and SBPC/ML (Brazilian Society of Clinical Pathology/Laboratory Medicine): recommendations for the clinical management of lower urinary tract infections in pregnant and non-pregnant women.

Urinary tract infection (UTI) is a common condition in women. There is an increased concern on reduction of bacterial susceptibility resulting from wrongly prescribing antimicrobials. This paper summarizes the recommendations of four Brazilian medical societies (SBI - Brazilian Society of Infectious Diseases, FEBRASGO - Brazilian Federation of Gynecology and Obstetrics Associations, SBU - Brazilian Society of Urology, and SBPC/ML - Brazilian Society of Clinical Pathology/Laboratory Medicine) on the management of urinary tract infection in women. Asymptomatic bacteriuria should be screened at least twice during pregnancy (early and in the 3rd trimester). All cases of significant bacteriuria (≥105CFU/mL in middle stream sample) should be treated with antimicrobials considering safety and susceptibility profile. In women with typical symptoms of cystitis, dipsticks are not necessary for diagnosis. Urine cultures should be collected in pregnant women, recurrent UTI, atypical cases, and if there is suspicion of pyelonephritis. First line antimicrobials for cystitis are fosfomycin trometamol in a single dose and nitrofurantoin, 100mg every 6hours for five days. Second line drugs are cefuroxime or amoxicillin-clavulanate for seven days. During pregnancy, amoxicillin and other cephalosporins may be used, but with a higher chance of therapeutic failure. In recurrent UTI, all episodes should be confirmed by urine culture. Treatment should be initiated only after urine sampling and with the same regimens indicated for isolated episodes. Prophylaxis options of recurrent UTI are behavioral measures, non-antimicrobial and antimicrobial prophylaxis. Vaginal estrogens may be recommended for postmenopausal women. Other non-antimicrobial prophylaxis, including cranberry and immunoprophylaxis, have weak evidence supporting their use. Antimicrobial prophylaxis may be offered as a continuous or postcoital scheme. In pregnant women, options are cephalexin, 250-500mg and nitrofurantoin, 100mg (contraindicated after 37 weeks of pregnancy). Nonpregnant women may use fosfomycin trometamol, 3g every 10 days, or nitrofurantoin, 100mg (continuous or postcoital).

Joint report of SBI (Brazilian Society of Infectious Diseases), FEBRASGO (Brazilian Federation of Gynecology and Obstetrics Associations), SBU (Brazilian Society of Urology) and SBPC/ML (Brazilian Society of Clinical Pathology/Laboratory Medicine): recommendations for the clinical management of lower urinary tract infections in pregnant and non-pregnant women

Urinary tract infection (UTI) is a common condition in women. There is an increased concern on reduction of bacterial susceptibility resulting from wrongly prescribing antimicrobials. This paper summarizes the recommendations of four Brazilian medical societies (SBI ­ Brazilian Society of Infectious Diseases, FEBRASGO ­ Brazilian Federation of Gynecology and Obstetrics Associations, SBU ­ Brazilian Society of Urology, and SBPC/ML ­ Brazilian Society of Clinical Pathology/Laboratory Medicine) on the management of urinary tract infection in women. Asymptomatic bacteriuria should be screened at least twice during pregnancy (early and in the 3rd trimester). All cases of significant bacteriuria (≥105 CFU/mL in middle stream sample) should be treated with antimicrobials considering safety and susceptibility profile. In women with typical symptoms of cystitis, dipsticks are not necessary for diagnosis. Urine cultures should be collected in pregnant women, recurrent UTI, atypical cases, and if there is suspicion of pyelonephritis. First line antimicrobials for cystitis are fosfomycin trometamol in a single dose and nitrofurantoin, 100 mg every 6 hours for five days. Second line drugs are cefuroxime or amoxicillin-clavulanate for seven days. During pregnancy, amoxicillin and other cephalosporins may be used, but with a higher chance of therapeutic failure. In recurrent UTI, all episodes should be confirmed by urine culture. Treatment should be initiated only after urine sampling and with the same regimens indicated for isolated episodes. Prophylaxis options of recurrent UTI are behavioral measures, nonantimicrobial and antimicrobial prophylaxis. Vaginal estrogens may be recommended for postmenopausal women. Other non-antimicrobial prophylaxis, including cranberry and immunoprophylaxis, have weak evidence supporting their use. Antimicrobial prophylaxis may be offered as a continuous or postcoital scheme. In pregnant women, options are cephalexin, 250­500 mg and nitrofurantoin, 100 mg (contraindicated after 37 weeks of pregnancy). Nonpregnant women may use fosfomycin trometamol, 3 g every 10 days, or nitrofurantoin, 100 mg (continuous or postcoital)

Chlamydia trachomatis dapF Encodes a Bifunctional Enzyme Capable of Both d-Glutamate Racemase and Diaminopimelate Epimerase Activities.

Peptidoglycan is a sugar/amino acid polymer unique to bacteria and essential for division and cell shape maintenance. The d-amino acids that make up its cross-linked stem peptides are not abundant in nature and must be synthesized by bacteria de novo d-Glutamate is present at the second position of the pentapeptide stem and is strictly conserved in all bacterial species. In Gram-negative bacteria, d-glutamate is generated via the racemization of l-glutamate by glutamate racemase (MurI). Chlamydia trachomatis is the leading cause of infectious blindness and sexually transmitted bacterial infections worldwide. While its genome encodes a majority of the enzymes involved in peptidoglycan synthesis, no murI homologue has ever been annotated. Recent studies have revealed the presence of peptidoglycan in C. trachomatis and confirmed that its pentapeptide includes d-glutamate. In this study, we show that C. trachomatis synthesizes d-glutamate by utilizing a novel, bifunctional homologue of diaminopimelate epimerase (DapF). DapF catalyzes the final step in the synthesis of meso-diaminopimelate, another amino acid unique to peptidoglycan. Genetic complementation of an Escherichia coli murI mutant demonstrated that Chlamydia DapF can generate d-glutamate. Biochemical analysis showed robust activity, but unlike canonical glutamate racemases, activity was dependent on the cofactor pyridoxal phosphate. Genetic complementation, enzymatic characterization, and bioinformatic analyses indicate that chlamydial DapF shares characteristics with other promiscuous/primordial enzymes, presenting a potential mechanism for d-glutamate synthesis not only in Chlamydia but also numerous other genera within the Planctomycetes-Verrucomicrobiae-Chlamydiae superphylum that lack recognized glutamate racemases.IMPORTANCE Here we describe one of the last remaining "missing" steps in peptidoglycan synthesis in pathogenic Chlamydia species, the synthesis of d-glutamate. We have determined that the diaminopimelate epimerase (DapF) encoded by Chlamydia trachomatis is capable of carrying out both the epimerization of DAP and the pyridoxal phosphate-dependent racemization of glutamate. Enzyme promiscuity is thought to be the hallmark of early microbial life on this planet, and there is currently an active debate as to whether "moonlighting enzymes" represent primordial evolutionary relics or are a product of more recent reductionist evolutionary pressures. Given the large number of Chlamydia species (as well as members of the Planctomycetes-Verrucomicrobiae-Chlamydiae superphylum) that possess DapF but lack homologues of MurI, it is likely that DapF is a primordial isomerase that functions as both racemase and epimerase in these organisms, suggesting that specialized d-glutamate racemase enzymes never evolved in these microbes.

Renewable Resources and a Recycled Polymer as Raw Materials: Mats from Electrospinning of Lignocellulosic Biomass and PET Solutions.

Interest in the use of renewable raw materials in the preparation of materials has been growing uninterruptedly in recent decades. The aim of this strategy is to offer alternatives to the use of fossil fuel-based raw materials and to meet the demand for materials that are less detrimental to the environment after disposal. In this context, several studies have been carried out on the use of lignocellulosic biomass and its main components (cellulose, hemicelluloses, and lignin) as raw materials for polymeric materials. Lignocellulosic fibers have a high content of cellulose, but there has been a notable lack of investigations on application of the electrospinning technique for solutions prepared from raw lignocellulosic biomass, even though the presence of cellulose favors the alignment of the fiber chains during electrospinning. In this investigation, ultrathin (submicrometric) and nanoscale aligned fibers were successfully prepared via electrospinning (room temperature) of solutions prepared with different contents of lignocellulosic sisal fibers combined with recycled poly(ethylene terephthalate) (PET) using trifluoroacetic acid (TFA) as solvent. The "macro" fibers were deconstructed by the action of TFA, resulting in solutions containing their constituents, i.e., cellulose, hemicelluloses, and lignin, in addition to PET. The "macro" sisal fibers were reconstructed at the nanometer and submicrometric scale from these solutions. The SEM micrographs of the mats containing the components of sisal showed distinct fiber networks, likely due to differences in the solubility of these components in TFA and in their dielectric constants. The mechanical properties of the mats (dynamic mechanical analysis, DMA, and tensile properties) were evaluated with the samples positioned both in the direction (dir) of and in opposition (op) to the alignment of the nano and ultrathin fibers, which can be considered a novelty in the analysis of this type of material. DMA showed superior values of storage modulus (E' at 30 °C) for the mats characterized in the preferential direction of fiber alignment. For example, for mats obtained from solutions prepared from a 0.4 ratio of sisal fibers/PET, Sisal/PET0.40dir presented a high E' value of 765 MPa compared to Sisal/PET0.40op that presented an E' value of 88.4 MPa. The fiber alignment did not influence the Tg values (from tan δ peak) of electrospun mats with the same compositions, as they presented similar values for this property. The tensile properties of the electrospun mats were significantly impacted by the alignment of the fibers: e.g., Sisal/PET0.40dir presented a high tensile strength value of 15.72 MPa, and Sisal/PET0.40op presented a value of approximately 2.5 MPa. An opposite trend was observed regarding the values of elongation at break for these materials. Other properties of the mats are also discussed; such as the index of fiber alignment, average porosity, and surface contact angle. To our knowledge, this is the first time that the influence of fiber alignment on the properties of electrospun mats based on untreated lignocellulosic biomass combined with a recycled polymer, such as PET, has been evaluated. The mats obtained in this study have potential for diversified applications, such as reinforcement for polymeric matrices in nanocomposites, membranes for filtration, and support for enzymes, wherein the fiber alignment, together with other evaluated properties, can impact their effectiveness in these applications.

All Together Now: Impact of a Regionalization and Bedside Rounding Initiative on the Efficiency and Inclusiveness of Clinical Rounds.

BACKGROUND: Attending rounds at academic medical centers are often disconnected from patients and team members who are not physicians. Regionalization of care teams may facilitate bedside rounding and more frequent interactions among doctors, nurses, and patients. OBJECTIVE: We used time-motion analysis to investigate how regionalization of medical teams and encouragement of bedside rounds affect participants on rounds and rounding time. DESIGN AND SETTING: We used pre-post analysis to study the effects of care redesign on teams' daily rounds on a general medicine service at an academic medical center. PARTICIPANTS: Four general medical teams were evaluated before the intervention and 5 teams afterward. INTERVENTIONS: General medical teams were regionalized to specific units, the admitting structure was changed to facilitate regionalization, and teams were encouraged to round bedside. MEASUREMENTS: Primary outcomes included proportion of time each team member was present on rounds and proportion of bedside rounding time. Secondary outcomes included round duration and non-patient time during rounds. RESULTS: Proportion of time the nurse was present on rounds increased from 24.1% to 67.8% (P ⟨ 0.001), and proportion of total bedside rounding time increased from 39.9% to 55.8% (P ⟨ 0.001). Mean total rounding time decreased from 3.0 hours to 2.4 hours (P = 0.01), despite a higher patient census. CONCLUSIONS: Creating regionalized care teams and encouraging interdisciplinary bedside rounds increased the proportion of bedside rounding time and the presence of nurses on rounds while decreasing total rounding time. Journal of Hospital Medicine 2017;12:150-156.

Structural and functional analysis of the GerD spore germination protein of Bacillus species.

Spore germination in Bacillus species represents an excellent model system with which to study the molecular mechanisms underlying the nutritional control of growth and development. Binding of specific chemical nutrients to their cognate receptors located in the spore inner membrane triggers the germination process that leads to a resumption of metabolism in spore outgrowth. Recent studies suggest that the inner membrane GerD lipoprotein plays a critical role in the receptor-mediated activation of downstream germination events. The 121-residue core polypeptide of GerD (GerD6°â»¹8°) from Geobacillus stearothermophilus forms a stable α-helical trimer in aqueous solution. The 2.3-Å-resolution crystal structure of the trimer reveals a neatly twisted superhelical rope, with unusual supercoiling induced by parallel triple-helix interactions. The overall geometry comprises three interleaved hydrophobic screws of interacting helices linked by short turns that have not been seen before. Using complementation analysis in a series of Bacillus subtilis gerD mutants, we demonstrated that alterations in the GerD trimer structure have profound effects on nutrient germination. This important structure-function relationship of trimeric GerD is supported by our identification of a dominant negative gerD mutation in B. subtilis. These results and those of others lead us to propose that GerD mediates clustering of germination proteins in the inner membrane of dormant spores and thus promotes the rapid and cooperative germination response to nutrients.

Dança e deficiência: uma revisão bibliográfica em teses e dissertações nacionais / Dance and disabilities: a bibliographic study in theses and dissertations from Brazil / Danza y discapacidad: una revisión bibliográfica en las tesis y disertaciones brasileñas

Este estudo tem como objetivo identificar e analisar a produção científica acerca da dança para pessoas com deficiência em teses e dissertações nacionais. Os resultados demonstraram: aumento na produção nos últimos cinco anos; prevalência de estudos junto à população de adultos com deficiência física; predominância de pesquisas envolvendo estudo de caso e Laban como aporte teórico; quanto ao eixo temático, prepondera o processo de ensino-aprendizagem da dança para as pessoas com deficiência; é dada maior evidência à dança contemporânea e dança em cadeira de rodas. Assim, foi possível reconhecer as principais tendências científicas envolvendo a interface dança e pessoas com deficiência

This study aims to identify and analyze the scientific production related to dance for physically disabled persons in nationwide thesis and dissertations. The results demonstrate: an increase in production during the past 5 years; a prevalence of studies involving the population of physically disabled adults; a predominance of research involving case study and Laban as theoretical contribution; concerning thematic line, the teaching-learning process of dance for disabled persons prevails; greater emphasis is given to contemporary dance and wheelchair dance. Therefore, it was possible to recognize the leading scientific tendencies related to dance for physically disabled persons

Este estudio tiene como objetivo identificar y analizar la producción científica sobre la danza para personas con discapacidad en las tesis y disertaciones brasileñas. Los resultados mostraran: aumento de la producción en los ultimos cinco años; mayoría de estudios con la población de adultos con discapacidades físicas; predominio de la investigación con estudio de casos y Labán como apoyo teórico; como el tema principal, prepondera la enseñanza y el aprendizaje de la danza; mayor evidencia a la danza contemporánea y la danza en silla de ruedas. Fue posible reconocer las principales tendencias científicas que involucran danza y discapacidad

Categorização da quarta sessão de psicoterapias bem e mal sucedidas / Categorization of the fourth session of successful and unsuccessful psychotherapies

O Sistema Multidimensional de Categorização de Comportamentos na Interação Terapêutica (SiMCCIT) desenvolvido por Zamignani e Meyer em 2007 pretende descrever o que ocorre em sessões de psicoterapias por meio de categorias de comportamentos de terapeutas e clientes. A pergunta que o presente estudo pretendeu responder é se o eixo correspondente ao comportamento verbal vocal desse sistema é capaz de identificar diferenças entre terapias bem e mal sucedidas quando aplicado às quartas sessões. A avaliação das terapias foi feita com um critério misto definido por: a) os resultados do Inventário de Aliança Terapêutica (WAI), b) presença de comportamentos de melhoras e de análise e c) relato de outras mudanças de comportamentos do cliente. De um total de 25 terapias com as quatro primeiras sessões gravadas em áudio, seis foram consideradas bem sucedidas, seis mal sucedidas e 13 foram consideradas terapias com resultados intermediários. Foi realizada a categorização da quarta sessão das terapias bem sucedidas e das terapias mal sucedidas. Os dados sugerem a existência de algumas diferenças entre as sessões das terapias bem e mal sucedidas, embora não significativas estatisticamente. Nas sessões das terapias bem sucedidas observou-se que: a categoria Solicitação de Relato tendeu a ser um pouco mais frequente em todos os casos; a categoria Solicitação apresentou uma porcentagem discretamente maior e ocorreu uma correlação positiva entre facilitação e empatia. (...)

... Nas sessões das terapias mal sucedidas constatou-se que: a categoria relato ou foi menos frequente ou mais frequente que nas sessões das Terapias Bem Sucedidas; quanto mais os clientes relatavam mais os terapeutas facilitavam seus relatos e que quanto mais os terapeutas solicitavam reflexões, mais metas os clientes se propunham a realizar. Como as diferenças da categorização não foram estatisticamente significativas em casos julgados diferentes concluiu-se que o eixo de comportamento verbal vocal do SiMCCIT diferenciou pouco as terapias bem e mal sucedidas. Algumas variáveis dificultaram a observação da capacidade do sistema de diferenciar as sessões das terapias bem e mal sucedidas: o número reduzido da amostra e o uso de apenas um dos eixos do sistema. Discutiu-se assim a necessidade de ampliar a amostra e utilizar outros eixos do sistema, como o de temas

The Multidimensional System for coding Behaviors in Therapist-Client Interaction (SiMCCIT), developed by Zamignani and Meyer, intend to describe what happens in psychotherapy sessions using behavioral categories of therapists and clients. The question that this study intended to answer was if this system is able to identify differences between successful and unsuccessful therapies. The assessment of therapy success was made with a mixed criterion defined by: (a) the results of the Working Alliance Inventory (WAI); (b) presence of improved behavior and analysis and (c) report of other changes in client behavior. In the total of 25 therapies with the first four sessions audio recorded, six were considered successful, six unsuccessful and 13 intermediate. The fourth sessions of successful and unsuccessful therapies were categorized. The data suggest some differences between the successful and unsuccessful therapy sessions, although not statistically significant. In the successful therapy sessions it was noted that: the category Request Report tended to be slightly more frequent in all sessions, the category Request showed a slightly higher percentage, and there was a positive correlation between Facilitation and Empathy. In the sessions of unsuccessful therapies it was found that: clients reported more or less than in successful therapies, the more clients reported more therapists facilitated their reports and that the more therapist asked reflections, the more goals clients proposed to undertake. Because the differences in categorization were not statistically significant in cases considered different it was concluded that the axis of vocal verbal behavior of SiMCCIT did not differentiate the successful from unsuccessful therapies. Some variables hampered the ability of the system to differentiate between sessions of successful and unsuccessful therapies: the reduced number of the sample and the use of only one of the axes of the system. It (...)

... was discussed the need to expand the sample and use other axes of the system, such as themes

Canais mandibulares bifurcados: análise em radiografias panorâmicas / Bifid mandibular canals: panoramic radiographic analysis

Objetivo O objetivo deste estudo foi verificar, por meio da observação em radiografias panorâmicas, a presença de variações anatômicas do canal mandibular, assim como analisar e classificar seus diferentes trajetos. Métodos Foram analisadas quinhentas radiografias panorâmicas de pacientes dos gêneros masculino e feminino. Nas imagens radiográficas, cada lado da mandíbula foi analisado separadamente. As imagens foram observadas sob iluminação adequada, com negatoscópio e máscara de proteção para eliminar o excesso de luz. A classificação das variações anatômicas foi baseada no estudo de Langlais et al. Resultados Canais mandibulares bifurcados foram encontrados em 43 radiografias (8,6%); deste total, 18 (41,9%) foram classificadas como Tipo 1, dez (23,3%) como Tipo 2, 15 (34,9%) como Tipo 4 e nenhuma como Tipo 3. Conclusão Os canais mandibulares bifurcados apareceram tanto unilateralmente quanto bilateralmente, no entanto não foi observada diferença significativa quanto à presença destes canais nos lados direito ou esquerdo..Também não houve prevalência significativa de canais bifurcados em nenhum dos tipos utilizados para classificação, assim como entre os gêneros masculino e feminino.

Objective The objectives of this work were to verify if there are anatomical variations of the mandibular canal and also to analyze and classify its different routes using panoramic radiographs. Methods Five hundred panoramic radiographs of male and female patients were analyzed. Each side of the lower jaw was analyzed separately in these radiographs. The images were studied under proper ambient light level, film viewer and protection mask to eliminate excess light. The anatomic variants were classified using the classifications suggested by Langlais et al. Results Bifid mandibular canals were found in 43 (8.6%) radiographs. Of these, 18 (41.9%) canals were classified as type 1; 10 (23.3%) as type 2, none as type 3 and 15 (34.9%) as type 4. Conclusion Bifid mandibular canals occurred unilaterally and bilaterally but their presence did not differ statistically between the right or left sides. There was no significant prevalence of canal types or gender-related prevalences.

Implementing clinical pathways for patients admitted to a medical service: lessons learned.

In an attempt to improve quality of care for patients admitted to our medical service we have implemented the use of pathways. These are printed standards of care and a mechanism for daily multidisciplinary documentation. The goals of our pathways are to: improve quality using printed standards of care; improve documentation of the care delivered; improve communication about daily goals between all team members, patients and families; standardize our in-patient chart format throughout the hospital; and increase efficiency of care. Pathways were designed to provide physicians and nurses with the standards for care and provide a mechanism for multidisciplinary documentation on our in-patient charts. We now have 2 pathways in use on our medical service. One is a clinical care plan (CCP) and the other is a Pancreatitis Pathway (PP) for patients admitted with acute pancreatitis and the other a guideline for care for all patients. The pathways were developed by teams including attending physicians (General Internists and Gastroenterologists), medicine house officers, nurses, and care coordinators. The pathways are used for all patients admitted to our medical service if they are admitted to one of 2 floors. This paper includes a comparison of outcomes for our first 9 patients who were managed using the pancreatitis pathway versus 7 patients cared for without the pathway. Significant differences in the pancreatitis pathway treated patients included: 1) less intense pain on day 2, (P = 0.04); 2) less pain on day of refeeding (P = 0.004); and 3) less IV fluids administered (P = 0.05). We also describe several lessons we have learned about using pathways for in-patients on a medical service in an academic medical center. We have learned the following lessons. Nursing documentation is improved. Physicians need ongoing encouragement and education about the value of pathways. There is considerable work involved for unit coordinators, care coordinators, and nursing in using pathways on a medical-surgical floor. There must be physician and nurse champions. There must be ongoing feedback to users. There must be input from users and edits. We believe the use of pathways as a process to remind clinicians of quality standards will improve the care of our patients by decreasing variation, improving team communication, and enhancing patient and family education.

Clinical outcome of fascial slings for female stress incontinence.

We studied 27 women with urodynamically proven stress urinary incontinence who had undergone surgery using fascial sling technique. During a mean follow-up of 20 months, all patients were continent. We observed a significant statistical reduction of urge symptoms. De novo detrusor hyperactivity and sensitive urgency were observed in 7.4% and 3.7% of patients, respectively. Two patients developed urinary flow problems. One patient had a bladder perforation during dissection. Urinary retention was observed in 3.7% and resolved spontaneously in 48 hours. We conclude that in the treatment of female urinary stress incontinence, slings promote clinical cure with few complications.