The Canadian C-Spine Rule

Description: The Canadian C-Spine Rule was designed in 2001 to assist clinicians assess the need for imaging in people who present to the emergency department with a cervical spine injury following blunt trauma. Specifically, this clinical decision rule was developed for use in adults who are alert (score of 15 on the Glasgow Coma Scale), stable and in whom a clinically important cervical spine injury is a concern (eg, unstable fracture, dislocation).1Instructions and scoring: The Canadian C-Spine Rule is based on three high-risk criteria (age ≥ 65 years, dangerous injury mechanism, paresthesia in extremities), five low-risk criteria (simple rear-end motor vehicle collision, sitting position in the emergency department, ambulatory at any time, delayed onset of neck pain; absence of midline cervical-spine tenderness), and the ability of the person to rotate their neck.2Reliability, validity and sensitivity to change: The Canadian C-Spine Rule has good-to-excellent inter-rater reliability when applied by physicians (kappa = 0.63), nurses (kappa = 0.80) and paramedics (kappa = 0.93).2, 3 The sensitivity of the Canadian C-Spine Rule has been reported to range from 90 to 100%, whereas specificity has ranged from 1 to 77%.4 The large range in specificity reflects the heterogeneity between studies in the number of people who unnecessarily receive imaging (ie, people who do not have a serious cervical spine injury but are still referred for imaging). However, the rule itself errs on the side of caution, as clinicians will not miss a clinically important cervical spine injury. In the only direct comparison, the Canadian C-Spine Rule was found to have better diagnostic accuracy than the National Emergency X-Radiography Utilization Study (NEXUS) criteria,5 which form another widely used clinical decision rule.

Knowledge and people management : a challenge for public organizations

Orientadores: Maria Beatriz Machado Bonacelli, Debora Luz de MelloDissertação (mestrado) - Universidade Estadual de Campinas, Instituto de GeocienciasResumo: O objetivo desta dissertação é analisar como a Secretaria de Estado de Saúde de Mato Grosso (SES/MT) - uma organização da Administração Direta - tem se posicionado frente às novas tendências apresentadas à Administração Pública contemporânea, particularmente às relativas à gestão de pessoas e de conhecimentos. Para tanto, num primeiro momento, discutem-se as mudanças na organização do trabalho, a emergência de "novas" formas de gerenciar pessoas (como o modelo de Gestão de Pessoas por Competências) e as contribuições dos estudos sobre Gestão do Conhecimento. Na seqüência, são trazidas, também, para o centro da análise as Reformas do Estado brasileiro e as transformações na gestão das organizações públicas durante o século XX. Por fim, analisa-se se os desdobramentos de tais tendências, para uma organização pública (a SES/MT), se configuram como inovações organizacionais. Os resultados do estudo empírico mostraram que os elementos fundamentais dessas novas tendências estão sendo incorporados de forma muito tímida na burocracia da SES/MT.Abstract: This study aims to analyze how Mato Grosso State Secretariat of Health (SES/MT) - an organization attached to the Direct State Administration - has faced the new tendencies presented to the contemporary Public Administration, especially related to people and knowledge management. At first, we discuss job organization changes, the emergence of "new" practices of managing people (as the model of People Management based on Competences) and the contributions of the Knowledge Management model. Secondly, these new practices are brought to the center of the analysis of Brazilian State Reformation and the transformation of the public organizations during the 20th Century. Finally, we analyzed if those transformations may be taken as an organizational innovation. The results of this empirical study show that the basic elements of these new tendencies are being incorporated in a very shy manner in the SES/MT bureaucracy.MestradoMestre em Política Científica e Tecnológic

Effect of temperature on the moisture adsorption process in brewers’ spent grains / Efeito da temperatura sobre o processo de adsorção de água em bagaço de malte

In order to reduce the water activity of brewers’ spent grains (BSG), drying processes are a viable alternative to this demand, since this residue has a high moisture content, which can contribute to deterioration processes to occur with more easiness. Thus, the objective of this work was to study the drying kinetics for BSG and optimize its dehydration process through mathematical models and statistical analysis. A 22 factorial design was used, where the factors of drying temperature and layer thickness were varied, in order to optimize the drying time at the lowest possible value. In addition, five drying kinetic models were used to determine model parameters. The kinetic model of Page was the one that best fit most of the data obtained in this study and through statistical analysis it was possible to conclude that the drying process occurs more efficiently when the process temperatures are higher, not depending on the thickness of the layer of material

Anesthetic efficacy of uni and multilamelar liposomal mepivacaine formulations in infraorbital and inferior alveolar nerve blocks and subcutaneous infiltration in surgical wound, in rats

Orientador: Maria Cristina Volpato, Francisco Carlos GroppoDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de PiracicabaResumo: Este estudo teve como objetivo avaliar a eficácia anestésica de duas formulações de mepivacaína encapsulada em lipossomas (uni e multilamelar) com concentração lipídica 8 mM, comparando-as com solução de mepivacaína com epinefrina em três modelos: bloqueio do nervo infraorbital (BNIO), bloqueio do nervo alveolar inferior (BNAI) e infiltração subcutânea em ferida cirúrgica (ISFC), em ratos. Em cada experimento os animais receberam injeção de uma das seguintes formulações: mepivacaína 2% associada à epinefrina 1:100.000 (Mepi-Epi), mepivacaína 3% lipossomal unilamelar (Mepi-LUV) e mepivacaína 3% lipossomal multilamelar (Mepi-MLV) e os respectivos controles: solução de NaCl 0,9%, suspensão lipossomal unilamelar e suspensão lipossomal multilamelar sem anestésico. Para o BNIO (30 ratos) e BNAI (51 ratos) os animais foram divididos em 3 grupos, e receberam uma das formulações contendo mepivacaína no lado direito e a respectiva formulação controle no lado esquerdo, sendo respectivamente 0,1 mL no BNIO e 0,2 mL no BNAI. A s o N oram avaliados dura ão e sucesso da anestesia no l bio su erior, por pinçamento. Após o NA oram avaliados latência, dura ão e sucesso da anestesia ul ar or estímulo el trico. Para a ISFC, 48 ratos foram divididos em 6 grupos, sendo submetidos a estímulo inflamatório na pata traseira direita (incisão e sutura). Após 24h os animais que apresentaram hipernocicepção (diminuição de pelo menos 20% na sensibilidade à pressão - analgesímetro de von Frey) receberam injeção de 0,1 mL de uma das formulações, contendo mepivacaína ou controle, ao lado da ferida cirúrgica. A anestesia local foi avaliada com analgesímetro de von Frey a cada 10 minutos. Os resultados foram submetidos aos testes Log-Rank, Tukey, Kruskal-Wallis, Student-Newman-Keuls (alfa=5%). Nos três modelos estudados, a solu ão de Me i-Epi promoveu maior sucesso e duração da anestesia (p0,05). Para o experimento do BNAI, não foram observadas diferenças entre as formulações (p>0,05) para latência da anestesia. Conclui-se que a encapsulação em lipossomas uni ou multilamelares foi menos eficaz do que a epinefrina em aumentar a eficácia anestésica da mepivacaína em todos os modelos estudadosAbstract: The aim of this study was to evaluate the anesthetic efficacy of two liposomal (unilamelar and multilamelar, 8mM lipid concentration) mepivacaine formulations compared to mepivacaine with epinephrine in three models: infraorbital nerve block (IONB), inferior alveolar nerve block (IANB) and subcutaneous infiltration in surgical wound (SISW) in rats. In each model animals received one of the following formulations: 2% mepivacaine with 1:100,000 epinephrine, (Mepi-Epi), liposomal unilamelar 3% mepivacaína (Mepi-LUV), liposomal multilamelar 3% mepivacaína (Mepi-MLV), and the respective controls: 0.9% NaCl solution, and liposomal unilamelar and liposomal multilamelar suspensions without the local anesthetic. For IONB (n= 30) and IANB (n= 51) the animals were divided into 3 groups, which received one of the formulations containing mepivacaine in the right side and the respective control formulation in the left side; 0.1 mL and 0.2mL were respectively injected for IONB and IANB. After IONB the success and duration of anesthesia was evaluated by upper lip pinching.After IANB the onset, duration and success of pulpal anesthesia were evaluated by electric stimulus. For SISW experiment the 48 rats were divided into 6 groups and submitted to an inflammatory stimulus in the right hind paw (incision and suture). After 24 h the animals that presented hypernociception (at least 20% decrease in the baseline response to force - von Frey anesthesiometer) received a 0.1mL injection of one of mepivacaíne or control formulations at the side of the surgical wound. Local anesthesia was evaluated each 10 min with von Frey anesthesiometer. Data were submitted to Log-Rank, Tukey, Kruskal-Wallis and Student-Newman-Keuls tests (alpha=5%). Mepi-Epi provided higher success and duration of anesthesia (p0.05). No differences in the anesthesia onset were observed among formulations for IANB (p>0.05). It is concluded that the encapsulation in unilamelar and multilamelar liposomes was less effective than epinephrine to improve mepivacaine anesthetic efficacy in all studied modelsMestradoFarmacologia, Anestesiologia e TerapeuticaMestre em Odontologi

Direita religiosa e partidos políticos no Brasil: os casos do PRB e do PSC

Este artigo pretende analisar dois dos principais partidos políticos brasileiros associados as denominações evangélicas: o  Partido Republicano Brasileiro (PRB) e o Partido Social Cristão (PSC). Procura-se identificar a composição religiosa de seus respectivos comandos partidários e de seus principais líderes políticos, além de interpretar o uso que fazem do discurso religioso e de símbolos religiosos. Por fim, também busca-se analisar as estratégias políticas adotadas frente aos governos e os blocos políticos nacionais, relacionando-as com as diferentes formas de apropriação de aspectos religiosos. A análise identificou o PSC como um partido com políticos de várias denominações religiosas, e que busca se afirmar publicamente como religioso. Em termos de programa e imagem políticas, o PSC mescla a defesa de pautas morais com a defesa do liberalismo econômico. Já o PRB se mostrou ligado a uma única denominação - A Igreja Universal do Reino de Deus -, no entanto, sua imagem e programa políticos procuram ignorar o seu caráter religioso. Seu caráter ideológico não é delimitado, o que facilita fazer alianças em torno de todo o espectro político

Optimization of brewers’ spent grain drying process / Otimização do processo de secagem do bagaço de malte

In order to reduce the water activity of brewers’ spent grains (BSG), drying processes are a viable alternative to this demand, since this residue has a high moisture content, which can contribute to deterioration processes to occur with more easiness. Thus, the objective of this work was to study the drying kinetics for BSG and optimize its dehydration process through mathematical models and statistical analysis. A 22 factorial design was used, where the factors of drying temperature and layer thickness were varied, in order to optimize the drying time at the lowest possible value. In addition, five drying kinetic models were used to determine model parameters. The kinetic model of Page was the one that best fit most of the data obtained in this study and through statistical analysis it was possible to conclude that the drying process occurs more efficiently when the process temperatures are higher, not depending on the thickness of the layer of material

Desequilíbrio muscular dos flexores e extensores do joelho associado ao surgimento de lesão musculoesquelética relacionada à corrida: um estudo de coorte prospectivo

ResumoO objetivo deste estudo foi verificar se o desequilíbrio dos músculos do joelho pode estar associado com o surgimento de lesões em corredores. Vinte corredores fizeram uma avaliação isocinética nas velocidades de 60, 180 e 300o/s e foram acompanhados por três meses para verificar a ocorrência de lesões. Quatro atletas (21%) apresentaram lesões que envolveram a região do joelho e o desequilíbrio muscular encontrado foi associado ao surgimento de lesões, nas três velocidades testadas (p<0,05).AbstractThe aim of this study was to determine whether a muscle imbalance of the knee is associated with running injuries. Twenty runners were evaluated by an isokinetic dynamometer at 60, 180 and 300 degrees/second. Runners were followed for three months to determine the incidence of injuries. We used the chi‐square test to verify the association between muscular imbalance and the appearance of injury. Four athletes experienced injuries (21%), all registered in the knee. Muscle imbalance was associated with running‐related injuries for the three tested velocities (p<0.05). To conclude, a muscle imbalance may be associated with running injuries

A moda pode ser uma ferramenta política? / Can fashion be a political tool?

Este artigo relaciona a moda atual com o advento da urbanização, e busca explorar as relações da cidade para pensar a moda apresentando um duplo aspecto: individualizante e aglutinador. A possibilidade da moda se transformar em uma ferramenta política envolve a sua construção dentro do seu aspecto aglutinador e cultural, superando seu caráter de mercadoria e sua dimensão individualizante

Malignant paratesticular mesothelioma

Mesothelioma of the tunica vaginalis testis (MTVT) is a rare tumor that usually affects patients after the sixth decade of life. Exposure to asbestos is a known risk factor. Enlargement of the scrotal volume is the most common initial clinical manifestation, and about 15% of cases present metastasis at diagnosis. The treatment relies on surgical resection while the role of adjuvant chemotherapy and radiotherapy remains unclear. The prognosis for patients is generally poor, with a lethal outcome in 30% over a 24-month period. The authors report a case of a 62-year-old patient with the diagnosis of MTVT without a history of asbestos exposure. After surgical treatment, metastatic disease ensued. Chemotherapy was initiated, but could not be continued due to marked and fast clinical deterioration. The authors call attention to the difficulty of early diagnosis of MTVT due to a nonspecific clinical picture, the lack of action by the patient when the scrotal enlargement was first noticed, and the lack of tumor markers. Delayed diagnosis is definitely related to unfavorable prognosis