Vícios comuns de inconstitucionalidade da contribuição para o custeio da iluminação pública instituída por diversos municípios mineiros

Analisa a legislação atinente à contribuição para o custeio da iluminação pública presente na Constituição brasileira de 1988 e sua instituição pelos municípios competentes, tendo em vista a ofensa ao princípio da legalidade e a inobservância do princípio da isonomia

Best Practices for Occupational Therapy Fellowship and Physical Therapy Residency Programs: A Mixed Method Study

ABSTRACT Purpose: The purpose of this sequential mixed methods study was to investigate occupational therapy fellowship and physical therapy residency directors’ perceptions of components of a successful residency program. Methods: A pilot survey was administered to occupational therapy fellowship and physical therapy residency directors prior to the study. A 17-item self-report survey was used to gather fellowship and residency director perceptions on the success of their respective programs. Directors of approved occupational therapy fellowship programs and accredited physical therapy residency programs were invited to participate. Following completion of the survey, follow-up interviews were conducted to deepen the understanding of director perceptions. Quantitative data was entered into Statistical Package for the Social Sciences (SPSS) and descriptive statistics were conducted. Qualitative data underwent thematic analysis. Results: Fellowship and residency director surveys (n=76) and interviews (n=7) highlighted program components that attributed to program success. While engagement in research was reported as only somewhat important, the other six components examined were rated as either important or very important. Research was not valued as highly as other components due to the nature of fellowship and residency programs and their focus on practical application of didactic components translating to clinical skill enhancement. Components not highlighted by the authors in the survey were then supplied by program directors in interviews: administration time, resident feedback, networking opportunities, rotation through the healthcare continuum, the opportunity to assist with teaching in an entry level program, and consistent feedback from mentors. Three themes emerged from interview data: importance of program components, fellow/resident characteristics, and program evaluation/changes. Conclusion: While some differences between occupational therapy fellowship and physical therapy residency programs were found, there were more similar components that contributed to program and participant success. Further research is necessary for the continued development and quality assurance of fellowship and residency programs

CD4+CD8+ lymphocytosis and pleural and pericardiac effusions in a patient with chronic myelogenous leukemia in chronic phase treated with dasatinib due to imatinib failure

Stosowanie inhibitorów kinaz tyrozynowych u chorych na przewlekłą białaczkę szpikową (CML) może prowadzić do zmian w układzie immunologicznym. W pracy przedstawiono przebieg choroby u pacjenta w fazie przewlekłej CML leczonego interferonem a, a następnie — z powodu utraty większej odpowiedzi cytogenetycznej — imatynibem (IM). Po 4 latach leczenia za pomocą IM, mimo uprzedniego uzyskania większej odpowiedzi molekularnej (MMR), potwierdzono utratę całkowitej odpowiedzi cytogenetycznej (oporność mutacyjna, M244V BCR/ABL1). Zastosowanie w kolejnej linii leczenia dazatynibu w dawce 100 mg/dobę pozwoliło na uzyskanie głębokiej odpowiedzi molekularnej (DMR). W trakcie pierwszych 9 miesięcy terapii tolerancja leczenia była dobra. Później pojawiły się objawy ogólne (stany podgorączkowe, nadmierne poty), nieżyt błony śluzowej nosa, a we krwi obwodowej — leukocytoza z bezwzględną limfocytozą CD3+, CD8+, HLA-DR+. Po 2 latach, z powodu nasilenia się wyżej wymienionych dolegliwości, dawkę leku zmniejszono do 80 mg/dobę. Przyniosło to ustąpienie wymienionych dolegliwości oraz normalizację liczby leuko- i limfocytów we krwi. Zmniejszenie dawki leku doprowadziło jednak do utraty MMR. Powrót do wyjściowej dawki dazatynibu pozwolił ponownie uzyskać DMR. Poprawie jakości odpowiedzi molekularnej towarzyszył nawrót dolegliwości ogólnych oraz ponowny wzrost limfocytozy we krwi. Po kilku miesiącach leczenia dazatynibem wystąpiły wymagające hospitalizacji objawy wysiękowego zapalenia opłucnej i osierdzia. Po ustabilizowaniu stanu chorego zdecydowano o zastosowaniu nilotynibu. W trakcie 12-miesięcznego okresu obserwacji tolerancja leczenia była dobra. Stosowanie nilotynibu doprowadziło do szybkiego ustąpienia objawów ogólnych oraz limfocytozy, a także ponownego uzyskania DMR.Using tyrosine kinase inhibitors in chronic myelogenous leukemia (CML) patients may have resulted in abnormalities of the immune system. The paper is showing disease outcome in a patient with CML in chronic phase treated with interpheron a, and thereafter with imatinib (IM) due to loss of major cytogenetic response. After 4 years of IM treatment, despite previous major molecular response (MMR) obtained, loss of complete cytogenetic response was documented (mutational resistance, M244V BCR/ABL1). Administering 100 mg dasatinib daily in consecutive treatment line allowed obtaining deep molecular response (DMR). During initial 9 months of the treatment, tolerance was good. Thereafter, the general symptoms could be observed (subfebrile states, excessive sweets), rhinitis and leukocytosis with absolute lymphocytosis CD3+, CD8+, HLA-DR in the peripheral blood. After two years, due to an increase in symptoms intensity, the dose of the drug was reduced to 80 mg daily. It was related with symptoms release and normalization of leuko- and lymphocyte count in the blood. Drug dose reduction, however, resulted in loss of MMR. Increasing the dose to the initial one allowed re-obtaining DMR. Improvement in molecular response quality was associated with reccurrence of general symptoms and lymphocytosis in the peripheral blood. After a few months, pleural/pericardial effusion symptoms were noted. Patient required hospitalization and therapeutic paracentesis. After normalization of the general patient status, the decision about nilotinib treatment was taken. During 12 months follow-up, the drug tolerance was good. Nilotinib treatment resulted in fast disappearance of general symptoms and lymphocytosis, and achievement of DMR

Evaluation of DNA primase DnaG as a potential target for antibiotics

Mycobacteria contain genes for several DNA-dependent RNA primases, including dnaG, which encodes an essential replication enzyme that has been proposed as a target for antituberculosis compounds. An in silico analysis revealed that mycobacteria also possess archaeo-eukaryotic superfamily primases (AEPs) of unknown function. Using a homologous recombination system, we obtained direct evidence that wild-type dnaG cannot be deleted from the chromosome of Mycobacterium smegmatis without disrupting viability, even in backgrounds in which mycobacterial AEPs are overexpressed. In contrast, single-deletion AEP mutants or mutants defective for all four identified M. smegmatis AEP genes did not exhibit growth defects under standard laboratory conditions. Deletion of native dnaG in M. smegmatis was tolerated only after the integration of an extra intact copy of the M. smegmatis or Mycobacterium tuberculosis dnaG gene, under the control of chemically inducible promoters, into the attB site of the chromosome. M. tuberculosis and M. smegmatis DnaG proteins were overproduced and purified, and their primase activities were confirmed using radioactive RNA synthesis assays. The enzymes appeared to be sensitive to known inhibitors (suramin and doxorubicin) of DnaG. Notably, M. smegmatis bacilli appeared to be sensitive to doxorubicin and resistant to suramin. The growth and survival of conditional mutant mycobacterial strains in which DnaG was significantly depleted were only slightly affected under standard laboratory conditions. Thus, although DnaG is essential for mycobacterial viability, only low levels of protein are required for growth. This suggests that very efficient inhibition of enzyme activity would be required for mycobacterial DnaG to be useful as an antibiotic target

A biophysical model of prokaryotic diversity in geothermal hot springs

Recent field investigations of photosynthetic bacteria living in geothermal hot spring environments have revealed surprisingly complex ecosystems, with an unexpected level of genetic diversity. One case of particular interest involves the distribution along hot spring thermal gradients of genetically distinct bacterial strains that differ in their preferred temperatures for reproduction and photosynthesis. In such systems, a single variable, temperature, defines the relevant environmental variation. In spite of this, each region along the thermal gradient exhibits multiple strains of photosynthetic bacteria adapted to several distinct thermal optima, rather than the expected single thermal strain adapted to the local environmental temperature. Here we analyze microbiology data from several ecological studies to show that the thermal distribution field data exhibit several universal features independent of location and specific bacterial strain. These include the distribution of optimal temperatures of different thermal strains and the functional dependence of the net population density on temperature. Further, we present a simple population dynamics model of these systems that is highly constrained by biophysical data and by physical features of the environment. This model can explain in detail the observed diversity of different strains of the photosynthetic bacteria. It also reproduces the observed thermal population distributions, as well as certain features of population dynamics observed in laboratory studies of the same organisms

Factors Associated with Preoperative Magnetic Resonance Imaging Use among Medicare Beneficiaries with Nonmetastatic Breast Cancer

Preoperative breast magnetic resonance imaging (MRI) use among Medicare beneficiaries with breast cancer has substantially increased from 2005 to 2009. We sought to identify factors associated with preoperative breast MRI use among women diagnosed with ductal carcinoma in situ (DCIS) or stage I-III invasive breast cancer (IBC)

An evaluation and comparison of conservation guidelines for an at-risk migratory songbird

For at-risk wildlife species, it is important to consider conservation within the process of adaptive management. Golden-winged Warblers (Vermivora chrysoptera) are Neotropical migratory songbirds that are experiencing long-term population declines due in part to the loss of early-successional nesting habitat. Recently-developed Golden-winged Warbler habitat management guidelines are being implemented by USDA: Natural Resource Conservation Service (2014) and its partners through the Working Lands For Wildlife (WLFW) program. During 2012–2014, we studied the nesting ecology of Golden-winged Warblers in managed habitats of the eastern US that conformed to WLFW conservation practices. We evaluated five NRCS “management scenarios” with respect to nesting success and attainment of recommended nest site vegetation conditions outlined in the Golden-winged Warbler breeding habitat guidelines. Using estimates of territory density, pairing rate, nest survival, and clutch size, we also estimated fledglingproductivity (number of fledglings/ha) for each management scenario. In general, Golden-winged Warbler nest survival declined as each breeding season advanced, but nest survival was similar across management scenarios. Within each management scenario, vegetation variables had little influence on nest survival. Still, percent Rubus cover and density of \u3e2 m tall shrubs were relevant in some management scenarios. All five management scenarios rarely attained recommended levels of nest site vegetation conditions for Golden-winged, yet nest survival was high. Fledgling productivity estimates for each management scenario ranged from 2.1 to 8.6 fledglings/10 hectares. Our results indicate that targeted habitat management for Golden-winged Warblers using a variety of management techniques on private lands has the capability to yield high nest survival and fledgling productivity, and thus have the potential to contribute to the species recovery

National Performance Benchmarks for Modern Screening Digital Mammography: Update from the Breast Cancer Surveillance Consortium

Purpose To establish performance benchmarks for modern screening digital mammography and assess performance trends over time in U.S. community practice. Materials and Methods This HIPAA-compliant, institutional review board-approved study measured the performance of digital screening mammography interpreted by 359 radiologists across 95 facilities in six Breast Cancer Surveillance Consortium (BCSC) registries. The study included 1 682 504 digital screening mammograms performed between 2007 and 2013 in 792 808 women. Performance measures were calculated according to the American College of Radiology Breast Imaging Reporting and Data System, 5th edition, and were compared with published benchmarks by the BCSC, the National Mammography Database, and performance recommendations by expert opinion. Benchmarks were derived from the distribution of performance metrics across radiologists and were presented as 50th (median), 10th, 25th, 75th, and 90th percentiles, with graphic presentations using smoothed curves. Results Mean screening performance measures were as follows: abnormal interpretation rate (AIR), 11.6 (95% confidence interval [CI]: 11.5, 11.6); cancers detected per 1000 screens, or cancer detection rate (CDR), 5.1 (95% CI: 5.0, 5.2); sensitivity, 86.9% (95% CI: 86.3%, 87.6%); specificity, 88.9% (95% CI: 88.8%, 88.9%); false-negative rate per 1000 screens, 0.8 (95% CI: 0.7, 0.8); positive predictive value (PPV) 1, 4.4% (95% CI: 4.3%, 4.5%); PPV2, 25.6% (95% CI: 25.1%, 26.1%); PPV3, 28.6% (95% CI: 28.0%, 29.3%); cancers stage 0 or 1, 76.9%; minimal cancers, 57.7%; and node-negative invasive cancers, 79.4%. Recommended CDRs were achieved by 92.1% of radiologists in community practice, and 97.1% achieved recommended ranges for sensitivity. Only 59.0% of radiologists achieved recommended AIRs, and only 63.0% achieved recommended levels of specificity. Conclusion The majority of radiologists in the BCSC surpass cancer detection recommendations for screening mammography; however, AIRs continue to be higher than the recommended rate for almost half of radiologists interpreting screening mammograms. © RSNA, 2016 Online supplemental material is available for this article

Research priorities in advanced heart failure: James Lind alliance priority setting partnership.

OBJECTIVE: To determine research priorities in advanced heart failure (HF) for patients, carers and healthcare professionals. METHODS: Priority setting partnership using the systematic James Lind Alliance method for ranking and setting research priorities. An initial open survey of patients, carers and healthcare professionals identified respondents' questions, which were categorised to produce a list of summary research questions; questions already answered in existing literature were removed. In a second survey of patients, carers and healthcare professionals, respondents ranked the summary research questions in order of priority. The top 25 unanswered research priorities were then considered at a face-to-face workshop using nominal group technique to agree on a 'top 10'. RESULTS: 192 respondents submitted 489 responses each containing one or more research uncertainty. Out-of-scope questions (35) were removed, and collating the responses produced 80 summary questions. Questions already answered in the literature (15) were removed. In the second survey, 65 questions were ranked by 128 respondents. The top 10 priorities were developed at a consensus meeting of stakeholders and included a focus on quality of life, psychological support, the impact on carers, role of the charity sector and managing prognostic uncertainty. Ranked priorities by physicians and patients were remarkably divergent. CONCLUSIONS: Engaging stakeholders in setting research priorities led to a novel set of research questions that might not have otherwise been considered. These priorities can be used by researchers and funders to direct future research towards the areas which matter most to people living with advanced HF