L'emploi des bombardiers d'eau : l'attaque initiale

International audienc

Relato de caso: Diabetes tipo LADA ou “Double Diabetes” ? Nem todo diabético é Tipo 1 ou Tipo 2

O diabetes é uma doença endócrina com múltiplas vias patogênicas altamente prevalente em todo o mundo. A mais recente expressão “Double Diabetes” (DD) veio caracterizar uma nova forma de diabetes que é essencialmente composta por uma intersecção de características clínicas do diabetes tipo 1 (DM1) e tipo 2 (DM2). Entretanto, na prática clínica, existem outros fenótipos da doença que dificultam o diagnóstico, como o Diabetes latente autoimune do adulto (LADA). O vigente esquema de classificação não contempla as novas evidências científicas sobre esta patologia endócrina, contribuindo assim, para condutas equivocadas que levam à um mau controle glicêmico predispondo à complicações micro e macrovasculares. Este relato de caso tem como objetivo chamar atenção para a importância da investigação diagnóstica de um quadro clínico de diabetes imuno mediado. Outro aspecto importante, é a necessidade de revisar os critérios diagnósticos que por vezes são inconclusivos. Relata-se o caso de uma paciente de 44 anos que foi diagnosticada com diabetes aos 24 anos durante o pré-natal, porém somente iniciou o tratamento com insulina após 2 anos, mediante um quadro de perda de peso, diplopia e polidpsia, tendo na ocasião sido diagnosticada como DM1. A paciente apresenta síndrome metabólica, dislipidemia, sobrepeso (IMC:26,7), anti-GAD positivo (159,6) e história familiar paterna de DM2. O caso clínico contempla ainda, outra doença autoimune: o hipotireoidismo (Tireoidite de Hashimoto), possibilitando o diagnóstico de síndrome poliglandular do tipo 3. Esta paciente preenche critérios tanto para LADA quanto para DD, como positividade de anticorpo contra células β e aumento do IMC. Porém, o que mais os distingue, com base em características clínicas, é a faixa etária >30 anos para LADA e o período de infância e juventude para o DD. Mais pesquisas devem ser realizadas com o intuito de melhorar o diagnóstico e consequentemente o tratamento dessa enfermidade crônica extremamente prevalente. Os moldes terapêuticos atuais que priorizam esquemas baseados na doença e não no paciente, são questionáveis e as novas tendências apontam para uma abordagem mais ampla vendo as drogas como opções terapêuticas adjuvantes. Embora seja uma das doenças mais estudadas no mundo, a cada nova evidência científica um antigo conceito “cai por terra” e percebe-se o quão leigos ainda somos quando se trata de diabetes

A complementary systems account of word learning: neural and behavioural evidence

In this paper we present a novel theory of the cognitive and neural processes by which adults learn new spoken words. This proposal builds on neurocomputational accounts of lexical processing and spoken word recognition and complementary learning systems (CLS) models of memory. We review evidence from behavioural studies of word learning that, consistent with the CLS account, show two stages of lexical acquisition: rapid initial familiarization followed by slow lexical consolidation. These stages map broadly onto two systems involved in different aspects of word learning: (i) rapid, initial acquisition supported by medial temporal and hippocampal learning, (ii) slower neocortical learning achieved by offline consolidation of previously acquired information. We review behavioural and neuroscientific evidence consistent with this account, including a meta-analysis of PET and functional Magnetic Resonance Imaging (fMRI) studies that contrast responses to spoken words and pseudowords. From this meta-analysis we derive predictions for the location and direction of cortical response changes following familiarization with pseudowords. This allows us to assess evidence for learning-induced changes that convert pseudoword responses into real word responses. Results provide unique support for the CLS account since hippocampal responses change during initial learning, whereas cortical responses to pseudowords only become word-like if overnight consolidation follows initial learning

Cloud computing in industrial SMEs: Identification of the barriers to its adoption and effects of its application

ABSTRACT: Cloud computing is a new technological paradigm that may revolutionize how organizations use IT by facilitating delivery of all technology as a service. In the literature, the Cloud is treated mainly through a technological approach focused on the concept definition, service models, infrastructures for its evelopment and security problems. However, there is an important lack of works which analyze this paradigm adoption in SMEs and its results, with a gap between the technological development and its adoption by organizations. This paper uses a qualitative technique methodology -group meetings with managers- and a quantitative one-survey- and identifies which factors act as barriers to Cloud adoption and which positive effects its application generates in 94 industrial SMEs. The conclusion is that the main barriers are of a cultural type and that the positive effects go well beyond reducing costs

Benefits and problems of electronic information exchange as perceived by health care professionals: an interview study

<p>Abstract</p> <p>Background</p> <p>Various countries are currently implementing a national electronic patient record (n-EPR). Despite the assumed positive effects of n-EPRs, their overall adoption remains low and meets resistance from health care providers. This study aims to increase our understanding of health care providers' attitude towards the n-EPR, by investigating their perceptions of the benefits and problems of electronic information exchange in health care and the n-EPR in particular.</p> <p>Methods</p> <p>The study was conducted in three Dutch health care settings: acute care, diabetes care, and ambulatory mental health care. Two health care organisations were included per setting. Between January and June 2010, interviews were conducted with 17 stakeholders working in these organisations. Relevant themes were deduced by means of thematic qualitative analysis.</p> <p>Results</p> <p>Health care providers perceived electronic information exchange to promote the efficiency and quality of care. The problems they perceived in electronic information exchange mainly concerned the confidentiality and safety of information exchange and the reliability and quality of patient data. Many problems perceived by health care providers did not specifically apply to the n-EPR, but to electronic information exchange in general.</p> <p>Conclusions</p> <p>The implementation of the Dutch n-EPR has mainly followed a top-down approach, thereby neglecting the fact that the perceptions and preferences of its users (health care providers) need to be addressed in order to achieve successful implementation. The results of this study provide valuable suggestions about how to promote health care providers' willingness to adopt electronic information exchange, which can be useful for other countries currently implementing an n-EPR. Apart from providing information about the benefits and usefulness of electronic information exchange, efforts should be focused on minimising the problems as perceived by health care providers. The safety and confidentiality of electronic information exchange can be improved by developing tools to evaluate the legitimacy of access to electronic records, by increasing health care providers' awareness of the need to be careful when using patient data, and by measures to limit access to sensitive patient data. Improving health care providers' recording behaviour is important to improve the reliability and quality of electronically exchanged patient data.</p

La Relación Entre la Motivación Docente y Variables de la Organización: Revisión de la Literatura

Abstract Teacher motivation plays a central role in education because ofitsimpacton student motivation. Previous reviews of teacher motivation have focused on individual variables and psychopathology indicators. However, it is also important to understand the effect of organizational variableson teacher motivationbecause these highlightthe contextthat the teacher is a part of(i.e.,the school). The literature review in this paper analysed studies related to teacher motivation and a pre-defined group of organizational variablesthat werepublished between 1990 and 2014 in several electronic databases.The study found that organizational culture was the most studied variable associated with teacher motivationand most studies in this area were published between 2010 and 2014.Further,there was a prevalence of quantitative studies. This paper concludes with the theoreticaland practical implications of the results,as well assuggestions for future research directions

Tryptophan Scanning Analysis of the Membrane Domain of CTR-Copper Transporters

Membrane proteins of the CTR family mediate cellular copper uptake in all eukaryotic cells and have been shown to participate in uptake of platinum-based anticancer drugs. Despite their importance for life and the clinical treatment of malignancies, directed biochemical studies of CTR proteins have been difficult because high-resolution structural information is missing. Building on our recent 7Å structure of the human copper transporter hCTR1, we present the results of an extensive tryptophan-scanning analysis of hCTR1 and its distant relative, yeast CTR3. The comparative analysis supports our previous assignment of the transmembrane helices and shows that most functionally and structurally important residues are clustered around the threefold axis of CTR trimers or engage in helix packing interactions. The scan also identified residues that may play roles in interactions between CTR trimers and suggested that the first transmembrane helix serves as an adaptor that allows evolutionarily diverse CTRs to adopt the same overall structure. Together with previous biochemical and biophysical data, the results of the tryptophan scan are consistent with a mechanistic model in which copper transport occurs along the center of the trimer