A importância da música a quatro mãos no ensino do piano

Mestrado em Ensino de MúsicaAo longo da minha experiência como pianista a música de conjunto foi ganhando um papel cada vez maior, especialmente aquela composta para piano a quatro mãos e para dois pianos. Ao nível pedagógico, fui notando que a presença no reportório dos meus alunos de obras para piano a quatro mãos tem estado limitada ao período de iniciação ao instrumento. Portanto, achei que esses alunos poderiam beneficiar de uma maior exposição a este reportório. Neste projecto propus abordar o papel da música para piano a quatro mãos na formação do aluno de piano, analisando, principalmente, os possíveis benefícios que se podem tirar desta prática ao nível da leitura e do ritmo, mas também pela introdução de práticas relativas à música de conjunto. Por conseguinte, delineei o presente projecto, que apresento na primeira parte desta dissertação com o título “A importância da música a quatro mãos no ensino do piano”, aplicado na Academia de Música de Espinho. A segunda parte desta dissertação integra o relatório da componente de Prática de Ensino da disciplina de Prática de Ensino Supervisionada. Esta componente foi realizada durante o ano lectivo de 2016/2017 na Academia de Música de Vilar do Paraíso (AMVP), envolvendo a orientadora cooperante Elsa Silva e 4 alunos de piano desta instituição.Throughout my experience as a pianist, ensemble music has been gaining more prominence in my musical life, particularly works composed for piano duet or two pianos. In terms of my pedagogical experience, I have noticed that the presence of four-hand piano music in the repertoire of my students was mostly limited to the period when they began studying the instrument. Therefore, I thought that those students could benefit from a closer exposure to this kind of repertoire. In this project I approach the role of four-hand piano music in the development of the piano student, analyzing the possible benefits from playing this repertoire in improving music reading and rhythm skills, but also from the introduction of ensemble music practices. Therefore, I developed this project, which I expose in the first part of the dissertation with the title “The importance of four-hand piano music in piano teaching”, implemented at the Academia de Música de Espinho. The second part of this dissertation consists of the report of the Teaching Practice component of the Supervised Teaching Practice course. This component was developed during the school year of 2016/2017 at the Academia de Música de Vilar do Paraíso (AMVP), with the collaboration of the co-operative advisor Elsa Silva and 4 students from this institution

Frequência de pneumonite em adultos subnutridos autopsiados

The objective of this study was to investigate whether malnourished autopsied adults would present higher frequency of pneumonitis than non-malnourished ones would. All of the autopsied adults (n = 175; age > 18 years) with complete records, including weight and height data, were included. Pneumonitis was observed more frequently in malnourished individuals (59.1%) than in non-malnourished individuals (41.3%). This study showed that the percentage of pneumonitis among autopsied adults was high, in addition to an increased risk of pneumonitis among these individuals.O objetivo deste estudo foi verificar se adultos subnutridos autopsiados teriam maior freqüência de pneumonite que adultos não-subnutridos. Todos os adultos autopsiados ((nº = 175); idade > 18 anos) com dados completos, incluindo peso e estatura, foram incluídos. Pneumonite foi observada com maior frequência em subnutridos (59,1%) do que em não-subnutridos (41,3%). Este estudo mostrou uma alta porcentagem de pneumonite entre os adultos autopsiados, além do aumento do risco de pneumonite entre estes.(FAPEMIG) Research Support Foundation of the State of Minas GeraisUberaba Teaching and Research Foundatio

Escaras de decúbito em adultos necropsiados com subnutrição - dados preliminares

Escaras de decúbito são comuns em pacientes acamados, idosos e subnutridos e podem ocorrer em pacientes terminais devido à imobilidade, incontinência fecal e urinária e imunodepressão. Além disso, a contaminação das Escaras de decúbito aumentam o risco de sepsis e podem piorar o estado nutricional. O objetivo deste estudo foi comparar a freqüência de Escaras de decúbito entre adultos necropsiados com ou sem subnutrição. MÉTODO: Adultos (n=201) necropsiados no Hospital Escola da FMTM-Uberaba entre 1986 e 1996 foram inicialmente incluídos, sendo registrados os dados demográficos e diagnósticos principais, além de peso e altura corporais. Foram excluídos os casos (n=96) com edema (insuficiência cardíaca ou hepática, síndrome nefrótica) e com úlceras de origem vascular. O indice de massa corporal (IMC = kg/m²) foi utilizado para alocação dos casos em subnutridos (IMC ; 18.5kg/m²) groups. RESULTS: Except for weight (42.5kg; range: 28-57 vs. 60; 36-134.5kg) and BMI (16.9; range: 12.4-18.5 vs. 22.7; range: 18.5-54.6kg/m²), respectively, there were no statistical differences among 43 malnourished and 62 non-malnourished cases in relation to age (54.9 ± 20.4 vs. 52.9 ± 17.9 years), percentage of white persons (74.4 vs. 64.5%), male gender (76.7 vs. 69.3%) and main diagnoses. Five malnourished (11.6%) and 7 (11.5%) non-malnourished cases had pressure sores (p=0.89). CONCLUSION: Pressure sores were equally common findings in necropsied persons with protein-energy malnutrition, as assessed by body mass index

Do impulsivity and alexithymia predict aggressiveness in institutionalized older adults?

Resumo: Introdução: A alexitimia e a impulsividade estão relacionadas e predizem a agressividade em adultos mais novos, especialmente em contextos forenses. No entanto, pouco se sabe sobre esta relação em adultos mais velhos, especialmente em contextos de institucionalização geriátrica, onde a agressividade apresenta uma prevalência alta. Assim, o nosso objetivo foi analisar o impacto da impulsividade e alexitimia na agressividade de pessoas idosas institucionalizadas, depois de examinarmos as relações entre essas variáveis. Variáveis relevantes foram controladas nestas relações. Métodos: Noventa e sete participantes institucionalizados (60–94 anos; 70,1% mulheres; 59,8% residentes em estruturas residenciais para idosos) foram avaliados com o Buss-Perry Aggression Questionnaire-SF, Toronto Alexithymia Scale-20 e Barratt’s Impulsiveness Scale-15. Resultados: O nível de agressividade autorreportado foi baixo na nossa amostra. A agressividade correlacionou-se e foi predita pela alexitimia (R2=17.6%; β=0.24, p<.05) e pela impulsividade (R2=17.6%; β=0.34, p<.01). Conclusão: Apesar dos baixos níveis de agressividade (potencialmente explicados pelos níveis de medicação, mais supervisão e mais fragilidade), os nossos resultados com pessoas idosas institucionalizadas demonstram a relevância da alexitimia e da impulsividade para a compreensão da agressividade em adultos mais velhos, juntando-se a estudos anteriores com outros tipos de populações. Nessa linha, fornecemos orientações para estratégias psicoterapêuticas. / Introduction: Alexithymia and impulsivity are related and predict aggressiveness in younger adults, especially in forensic contexts. However, little is known about this relationship in older adults, especially in geriatric institutionalized settings, where aggressiveness presents a high prevalence. Thus, we aimed to analyze the impact of impulsivity and alexithymia in institutionalized older adults’ aggressiveness after examining the relationships between these variables. Relevant variables were controlled for in these relations. Methods: Ninety-seven institutionalized participants (60–94 years, 70.1% women, 59.8% nursing homes’ residents) were assessed with the Buss-Perry Aggression Questionnaire-SF, Toronto Alexithymia Scale-20, and Barratt’s Impulsiveness Scale-15. Results: The self-reported level of aggressiveness was low in our sample. Aggressiveness correlated with and was predicted by alexithymia (R2=17.6%; β=0.24, p<.05) and impulsiveness (R2=17.6%; β=0.34, p<.01). Conclusion: Despite the low levels of aggressiveness (potentially explained by levels of medication, more supervision, and more frailty), our findings with institutionalized older adults demonstrate the relevance of alexithymia and impulsiveness for understanding aggressiveness in older adults, adding to previous studies with other types of populations. We provide directions for psychotherapeutic strategies

Analysis of Systemic and Cutaneous Inflammatory Immune Response in Canine Atopic Dermatitis

Background: Canine atopic dermatitis (CAD) is a chronic and inflammatory disease present in veterinary dermatological practice. The inflammation in CAD is triggered by environmental allergens and skin microorganisms, which are responsible for the worsening of cutaneous lesions. This continuous activation of skin inflammatory process can induce the production of free radicals that also contribute to cellular damage and ultimately leads to changes in blood parameters in dogs with CAD. Although there are reports of inflammatory parameters in CAD, there are a lack of studies correlating skin lesions, blood leukocytes and oxidative stress. Based on that,this study aimed to evaluate the integumentary and systemic inflammatory response in dogs with atopic dermatitis. Materials, Methods & Results: Dogs with confirmed diagnosis of canine atopic dermatitis (n = 10) were divided in two groups according to CADESI-IV: AI, with CADESI between 0-10, AII, with CADESI between 10-34, and control group (n = 5). Blood-biochemical and histological analysis were performed to access systemic and cutaneous inflammatory response. AII group tended to higher neutrophil and eosinophil counts, as well as neutrophil/lymphocyte ratio (NLR) when compared to AI. The albumin was lower in AII compared to AI and control (P < 0.05), while total bilirubin and malondialdehyde (MDA) did not differ between groups. NLR (r = 0.64 and P = 0.04) and MDA (r = 0.54 and P = 0.1) were positively correlated with CADESI, while albumin was negatively correlated with CADESI (r = -0.79 and P = 0.005). Histopathological analysis revealed a larger number of neutrophils, macrophages and mast cells in AI and AII than in control group (P < 0.05). Discussion: In this study it was possible to evaluate the systemic and cutaneous leukocyte dynamics in CAD. Skin inflammation induces the production of chemotactic molecules contribute to neutrophil outflow from blood vessel toward the affected tissue, which can be visualized as perivascular inflammatory infiltrate and exocytosis. At systemic level, there was a tendency to increase in total leukocytes and circulating neutrophil count in group AII, as well as in neutrophil/lymphocyte ratio (NLR), when compared to AI. The NLR is a widely available and inexpensive laboratory biomarker that quantifies systemic inflammation, being used in human medicine to evaluate prognosis in different types of cancer. In our study, dogs in AII group showed an increased NLR compared to AI and control, which demonstrates the influence of skin injury in systemic parameters. Furthermore, AII group is composed of dogs with greater lesion state, which reflects in higher NLR values. Since this disease is known by its chronicity and may remain stable for years, NLR may be a novel biomarker to evaluate acute exacerbation in CAD and could potentially explain why some patients have longer crisis duration and frequent flares. The maintenance of the inflammatory state also induces the production of oxidizing substances, which possibly exceed the total antioxidant capacity, generating a situation of oxidative stress, which can result in damage to membrane lipids and release of their products. MDA is reliable and is the most commonly used marker of the overall lipid peroxidation level and the presence of oxidative stress. This result may be related with the antioxidant system, such as albumin and bilirubin, which was able to promote an efficient control of oxidant substances. In conclusion, the presented data demonstrated an inflammatory process progression as well as introduced NLR as a potential marker of disease exacerbation in CAD

Glossite atrófica e estado nutricional de alcoolistas hospitalizados

BACKGROUND: Atrophy of the papillae, mucosa, and dorsum of the tongue are considered classical signs of nutritional deficiencies. OBJECTIVE: To assess the nutritional status of hospitalized alcoholics with or without papillary atrophy of the tongue. METHODS: This study was performed with 21 hospitalized alcoholics divided into Atrophic Glossitis Group (n=13) and Normal Tongue Group (n=8). Healthy, non-alcoholic volunteers composed the Control Group (n=8). Anthropometry and bioelectric impedance were performed, and serum vitamins A, E, and B12 were determined. RESULTS: There were no statistical differences in relation to age (46.7±8.7 vs. 46.8±15.8 years) or gender (92.3% vs. 87.5% male), respectively. Control Group volunteers were also paired in relation to age (47.5±3.1 years) and male predominance (62.5%). In relation to hospitalized alcoholics without atrophic lesions of the tongue and Control Group, patients with papillary atrophy showed lower BMI (18.6 ± 2,5 vs 23.8 ± 3.5 vs 26.7 ± 3,6 kg/m² ) and body fat content 7.6 ± 3.5 vs 13.3 ± 6.5 vs 19.5 ± 4,9 kg). When compared with the Control Group, alcoholic patients with or without papillary atrophy of the tongue showed lower values of red blood cells (10.8 ± 2.2 vs 11.8 ± 2.2 vs 14.5 ± 1,6g/dL) and albumin (3.6 ± 0.9 vs 3.6 ± 0.8 vs 4.4 ± 0.2g/dL). The seric levels of vitamins A, E, and B12 were similar amongst the groups. CONCLUSION: Hospitalized alcoholics with papillary atrophy of the tongue had lower BMI and fat body stores than controls, without associated hypovitaminosis

Avaliação do estado nutricional de pacientes com pênfigo foliáceo sob corticoterapia prolongada

Our objective was to compare food intake and nutritional status of Pemphigus Foliaceus patients (PG) on long term glucocorticoid therapy to a Control Group (CG). Fourteen PG female inpatients receiving prednisone (0.33 ± 0.22mg/kg) for at least 12 months and twelve CG subjects were submitted to nutritional evaluation, including anthropometry, urinary creatinine determination and serum biochemical measurements, besides 48-h-based food intake records. Groups were compared by Chi-square, Mann-Whitney and "t" tests. PG patients and CG were paired, respectively, in relation to age (24.7 ± 14.1 vs. 22.0 ± 12.0 years), body mass index (25.8 ± 6.4 vs. 24.0 ± 5.6kg/m2), daily protein intake (132.9 ± 49.8 vs. 95.2 ± 58.9g), and serum albumin (median; range) (3.8; 3.5-4.1 vs. 3.8; 3.6-5.0g/dl). However, PG patients had lower height-creatinine index (64.8 ± 17.6 vs. 90.1 ± 33.4%), and higher daily energy (3080 ± 1099 vs. 2187 ± 702kcal) and carbohydrate (376.8 ± 135.8 vs. 242.0 ± 80.7g) intakes. Despite high food, protein and energy consumption, PG patients on long term glucocorticoid therapy had lower body muscle mass than controls, while showing high body fat stores. These findings are possibly related to combined metabolic effects of long term corticotherapy and inflammatory disease plus corticosteroid-induced increased appetite.O objetivo deste trabalho foi comparar o estado nutricional e dados de ingestão alimentar de pacientes com Pênfigo Foliáceo (PF, n=14) sob corticoterapia prolongada (prednisona, 0,33 ± 0,22mg/kg/dia há mais de 12 meses) com um Grupo Controle (GC, n=12). A avaliação constou de inquérito alimentar de 48 horas, antropometria e determinação de creatinina urinária de 24h e albumina sérica. Os grupos PF e GC foram pareados, respectivamente, quanto à idade (24,7 ± 14,1 vs 22,0 ± 12,0 anos), índice de massa corporal (25,8 ± 6,4 vs 24,0 ± 5,6kg/m2), ingestão diária de proteína (132,9 ± 49,8 vs 95,2 ± 58,9g) e albumina sérica (mediana;faixa de variação) (3,8;3,5-4,1 vs 3,8;3,6-5,0g/dl). Pacientes com pênfigo apresentaram menor índice creatinina-altura (64,8 ± 17,6 vs 90,1 ± 33,4%) e maior ingestão de energia (3080 ± 1099 vs 2187 ± 702kcal/dia) e carboidratos (376,8 ± 135,8 vs 242,0 ± 80,7g/dia). Apesar do maior consumo de alimentos, os pacientes com pênfigo apresentaram menor massa muscular que os controles, achados possivelmente relacionados ao aumento do apetite e efeitos metabólicos combinados da corticoterapia e da doença inflamatória crônica

Gerenciamento de comitês de bacia: desafios e potencialidades

Increased environmental degradation leads to the search for new management methods aimed at sustainable development. In this context, arise river basin committees, which are provided for in the National Water Resources Management, which is the system created by the National Water Resources. The committees are collegiate bodies which are discussed regional issues related to water management as part of this system representatives of the Union, the states and the Federal District whose territories are situated, even partially, in their respective areas, the municipalities located in whole or in part, in its area of operation, the water users in its area of operation and civil entities of water resources with proven activities in the basin. The committees have multiple assignments, which are described in art. 19 of the State Law 10.350/94 - in the case of water resources policy of the State of Rio Grande do Sul fitting highlight its function of resolving conflicts. Possessing the potential to synthesize the guidelines, the committee set up in an institutional space which can be characterized as a decision-making arena for sharing interests and political integration of the sectors of water users and civil society. Thus, the success of its operation to some extent means the success of own water policy, especially with regard to the management decentralized and participatory. The challenge is that these spaces are effectively public, both in its format as the results, and such committees must undergo continuous evaluation of their social structure, from an analysis of their actions while organs that must function as a forum integrator policies, promoting the integrated and sustainable management of natural resources of the watershed, according to the guidelines of Water Resources.O aumento da degradação ambiental leva a busca por novas metodologias de gestão que visem o desenvolvimento sustentável. Nesse contexto, surgem os comitês de bacia hidrográfica, os quais estão previstos no Sistema Nacional de Gerenciamento de Recursos Hídricos, sendo este sistema instituído pela Política Nacional de Recursos Hídricos. Os comitês são órgãos colegiados onde são debatidas as questões regionais referentes à gestão das águas, fazendo parte desse sistema representantes da União, dos Estados e do Distrito Federal cujos territórios se situem, ainda que parcialmente, em suas respectivas áreas de atuação, dos Municípios situados, no todo ou em parte, em sua área de atuação, dos usuários das águas de sua área de atuação e das entidades civis de recursos hídricos com atuação comprovada na bacia. Os comitês possuem várias atribuições, as quais estão descritas no art. 19 da Lei Estadual nº 10.350/94 – no caso da Política de Recursos Hídricos do Estado do Rio Grande do Sul cabendo destacar a sua função de dirimir conflitos. Possuindo o potencial de sintetizar as diretrizes, o comitê configura-se em um espaço institucional o qual pode ser caracterizado como uma arena de tomada de decisões para o compartilhamento de interesses e integração de políticas dos setores usuários da água e da sociedade civil. Assim, o êxito de seu funcionamento em certa medida significa o êxito da própria política das águas, principalmente no que se refere á gestão descentralizada e participativa. O grande desafio é que esses espaços sejam efetivamente públicos, tanto no seu formato quanto nos resultados, e para tal os comitês devem passar por uma avaliação contínua de sua estrutura social, a partir de uma análise de suas ações enquanto órgãos que devem funcionar como um fórum integrador de políticas, promovendo a gestão integrada e sustentável dos recursos naturais da bacia hidrográfica, conforme as diretrizes da Política de Recursos Hídricos

Avaliação morfológica e morfométrica das ilhotas pancreáticas na fase crônica da doença de Chagas

PURPOSE: Hyperglycemia and abnormal glucose tolerance tests observed in some patients with chronic Chagas' disease suggest the possibility of morphological changes in pancreatic islets and/or denervation. The purpose of this study was to describe the morphology and morphometry of pancreatic islets in chronic Chagas' disease. METHODS: Morphologic and computerized morphometric studies were performed in fragments of the head, body, and tail regions of the pancreas obtained at necropsies of 8 normal controls and 17 patients with chronic Chagas' disease: 8 with the digestive form (Megas) and 9 with the congestive heart failure form. RESULTS: The Megas group had a larger (p < 0.05) pancreatic islet area in the tail of the pancreas (10649.3 ± 4408.8 µm²) than the normal control (9481.8 ± 3242.4 µm²) and congestive heart failure (9475.1 ± 2104.9 µm²) groups; likewise, the density of the pancreatic islets (PI) was greater (1.2 ± 0.7 vs. 0.9 ± 0.6 vs. 1.9 ± 1.0 PI/mm², respectively). In the tail region of the pancreas of patients with the Megas form, there was a significant and positive correlation (r = +0.73) between the area and density of pancreatic islets. Discrete fibrosis and leukocytic infiltrates were found in pancreatic ganglia and pancreatic islets of the patients with Chagas' disease. Trypanosoma cruzi nests were not observed in the examined sections. Individuals with the Megas form of Chagas' disease showed increased area and density of pancreatic islets in the tail of the pancreas. CONCLUSION: The observed morphometric and morphologic alterations are consistent with functional changes in the pancreas, including glycemia and insulin disturbances.OBJETIVO: Hiperglicemia e anormalidades em testes de tolerância à glicose, observadas em alguns pacientes chagásicos crônicos, sugerem um possível papel de alterações morfológicas e desnervação de ilhotas pancreáticas (IP). Nosso objetivo foi descrever a morfologia e a morfometria de ilhotas pancreáticas na doença de Chagas crônica. MÉTODOS: Estudo morfológico e morfometria computadorizada foram realizados em fragmentos da cabeça, corpo e cauda de pâncreas obtidos em necropsias de oito controles normais e dezessete pacientes chagásicos crônicos; oito com a forma digestiva (Megas) e nove com o quadro clínico de insuficiência cardíaca congestiva. RESULTADOS: O grupo Megas mostrou ilhotas pancreáticas de maior (p < 0,05) área na cauda do pâncreas (10.649,3 ± 4.408,8 µm²) do que os controles normais (9.481,8 ± 3.242,4 µm²) e que o grupo com insuficiência cardíaca congestiva (9.475,1 ± 2.104,9 µm²); o mesmo ocorrendo com a densidade das ilhotas na cauda do pâncreas (respectivamente, 1,2 ± 0,7 vs. 0,9 ± 0,6 vs. 1,9 ± 1,0 IP/mm²). Na cauda do pâncreas dos casos com Megas, houve correlação positiva e significante (r = + 0,73) entre a área e a densidade das ilhotas pancreáticas. Discreta fibrose e infiltrados leucocitários foram vistos nas ilhotas e em gânglios pancreáticos dos pacientes chagásicos. Ninhos de Trypanosoma cruzi não foram observados nos cortes examinados. Indivíduos com a forma Megas da doença de Chagas mostraram aumento da área e da densidade das ilhotas na cauda do pâncreas. CONCLUSÃO: As alterações morfológicas e morfométricas observadas são consistentes com alterações funcionais do pâncreas, incluindo distúrbios da glicemia e da insulinemia