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A urgência e emergência, por sua vez, se faz como ocorrência imprevista com ou sem risco potencial à vida, onde o indivíduo necessita de assistência e pressupõem atendimento rápido, proporcional a sua gravidade. O presente trabalho tem o objetivo de promover reflexões acerca dos desafios que surgem diante do atendimento a múltiplas vítimas nos serviços médicos de urgência e emergência. Trata-se de uma revisão integrativa da literatura. Realizou-se uma análise de materiais já publicados na literatura e artigos científicos divulgados em bases de dados: Scientific Eletronic Library Online, Medical Literature Analysis and Retrieval System Online e Localizador de informação em Saúde. Foram encontradas nas bases de dados, 25 estudos completos, após a leitura dos resumos, 21 artigos foram selecionados para análise na íntegra, sendo 17 eleitos para integrar a revisão integrativa. Diante dos resultados obtidos, observou que as equipes de atendimento pré-hospitalar vivenciam desafios para atender múltiplas vítimas, e dentro desse paradigma existem várias etapas que devem ser seguidas, que envolvem comunicação desde um protocolo de atendimento inicial ao transporte final. Portanto, observa-se a necessidade de maiores estudos e desenvolvimento de novas tecnologias que auxiliam na assistência a múltiplas vítimas, como também o prepara e atualização dos profissionais.

Introduction: The majority of products subject to health surveillance can be easily classified into medicines, medical devices, cosmetics, sanitizers or food, for purposes of regularization at the Brazilian Health Regulatory Agency (Anvisa). However, there are products, called “borderline products”, that share characteristics of several of these categories simultaneously, making it difficult to comply with the current health legislation. Objective: To describe Anvisa’s role in the regulatory framework for borderline products for marketing purposes in Brazil. Method: Documentary research of a descriptive nature and qualitative and quantitative approach carried out based on documents produced by Anvisa, such as normative acts, reports and technical opinions and minutes of meetings. The elaboration of the narrative was based on a selective, judicious and iterative process. The numerical values were expressed in absolute and relative frequencies, the median being used as a measure of central tendency. Results: Twenty-seven documents were analyzed. Anvisa instituted a technical committee in October 2015, with the task of subsidizing decisions of its Collegiate Board (Dicol) on the framing of borderline products. It is formed by representatives from the marketing authorization areas, post-market monitoring, inspection and improvement of regulatory quality. The committee adopted five borderline demarcation criteria, based on the experience of other international regulatory agencies. Between 2017 and 2019, the committee issued ten opinions that had Dicol’s deliberations. In five cases, the border demarcation involved two types of product categories, namely: drug products and medical devices. Sixty-two citations were identified in the eight borderline product framing opinions, most of which were classified as gray literature (n = 53; 85.5%). Conclusions: Anvisa has recently taken a more systematic and integrated approach to the issue of framing borderline products, with the creation of a technical committee formed by representatives of the areas responsible for product marketing authorization, inspection, monitoring and regulation. The current conformation of the committee produced, in 2019, a greater number of opinions in relation to the previous years studied.

A síndrome de Prune Belly (SPB) é uma doença congênita rara (1:40.000 nascidos vivos) caracterizada por uma tríade de anomalias: ausência, deficiência ou hipoplasia da parede abdominal, criptorquidia bilateral e anormalidades do trato urinário. O diagnóstico pode ser realizado ainda no pré-natal, todavia, apresenta alta taxa de mortalidade perinatal. Assim, o presente estudo objetivou descrever um relato de caso sobre SPB em paciente escolar. VSSB, sexo masculino, diagnosticado com SPB. USG de 2º trimestre evidenciou feto polidrâmnio com alterações morfológicas. Com 38 semanas de gestação foi realizado parto cesáreo por evidência de oligoâmnio severo e má formação fetal. Ao nascimento, foi observado abdome em ameixa e criptorquidia bilateral, sugerindo SPB; a suspeita diagnóstica foi confirmada no 13º dia de vida. O paciente seguiu acompanhamento por equipe multiprofissional. Pelo quadro clínico, necessitou de várias internações ao longo da vida, falecendo na última, com 7 anos e 11 meses. Por conseguinte, é indubitável relatar a importância do pré-natal de qualidade no diagnóstico precoce das doenças congênitas e do acompanhamento multiprofissional. Ademais, a longitudinalidade e integralidade do cuidado se mostram como cruciais no aumento da sobrevida do paciente com qualidade. Palavras-chave: Síndrome. Prune Belly. Relatos de casos.

This study aimed to demonstrate the potential use of the problem analysis and definition, one of the Regulatory Impact Analysis (RIA) phases, as an alternative in directing critical, rational and logical thinking for the formulation of regulatory policies and actions to face COVID-19. The theoretical basis involved an overview of regulation, RIA and problem analysis and definition. A descriptive study with qualitative approach was used to report the results of the virtual workshop, with didactic-pedagogical characteristics, on the main problem analysis and definition in the COVID-19 context. Seven employees and one trainee, who works in the regulatory quality improvement unit at Anvisa, participated in the virtual workshop. The main problem was defined as “Dissemination of the little-known SARS-COV-2 coronavirus, untreated and with a high rate of contagion”. Ten consequences related to the problem were identified, with worsening mental health problems being one of them. As an illustration, the study highlighted five of the 20 causes listed by the participants. The low population adherence to the prevention and control measures was considered one of the problem causes. The risk group population, such as the elderly and people with comorbidities, was one of the 30 agents affected by the problem identified in the workshop. This study is a contribution to coping with COVID-19, as well as to other future public health emergencies.

We propose a non-Hermitian deformation of the Mathieu equation that preserves $\mathcal{PT}$ symmetry and study its spectrum and the transition from $\mathcal{PT}$-unbroken to $\mathcal{PT}$-broken phases. We show that our model not only reproduces behaviors expected by the literature but also indicates the existence of a richer structure for the spectrum. We also discuss the influence of the boundary condition and the model parameters in the exceptional line that marks the $\mathcal{PT}$ breaking.

Objetivo: avaliar a qualidade de vida dos profissionais da saúde, durante a pandemia da COVID-19 no Brasil, e verificar possíveis associações entre a qualidade de vida e as características sociodemográficas e profissionais. Método: estudo transversal, com amostragem não probabilística, por conveniência. Os questionários foram administrados na modalidade on-line o questionário de caracterização e o World Health Organization Quality of Life instrument–Abbreviated Version (WHOQOL-BREF). Resultado: entre 196 profissionais de saúde, 78,2% eram do sexo feminino, 49,7% da raça branca, 41,1% atuavam na atenção primária. Os profissionais apresentaram média dos escores do WHOQOL variando de 57,14 a 66,19, com menor média no domínio meio ambiente com o valor de 58,94 (DP = 14,20). Conclusão: os profissionais de saúde apresentaram uma qualidade de vida mediana com alterações de acordo com o local de trabalho e profissão nesse período de pandemia no Brasil.ABSTRACTObjective: to assess the quality of life of health personnel during the COVID-19 pandemic in Brazil, and to ascertain possible associations between quality of life and sociodemographic and professional characteristics. Method: this was a cross-sectional study of a non-probabilistic, convenience sample. The characteristics questionnaire and the World Health Organization Quality of Life instrument–Abbreviated Version (WHOQOL-BREF) were administered online. Result: of the 196 health personnel, 78.2% were female, 49.7% white, and 41.1% worked in primary care. Average scores in the WHOQOL ranged from 57.14 to 66.19, with the lowest average of 58.94 (SD = 14.20) in the environment domain. Conclusion: during this pandemic period in Brazil, health personnel’s quality of life was median, and changed with place of work and profession.RESUMENObjetivo: evaluar la calidad de vida de los profesionales de la salud durante la pandemia de COVID-19 en Brasil y verificar posibles asociaciones entre la calidad de vida y las características sociodemográficas y profesionales. Método: estudio transversal, con muestra no probabilística, por conveniencia. Se administraron los cuestionarios en línea de caracterización y el World Health Organization Quality of Life instrument–Abbreviated Version (WHOQOL-BREF). Resultado: entre 196 profesionales de la salud, el 78,2% era de mujeres, el 49,7% blanco, el 41,1% trabajaba en la atención primaria. Los profesionales tuvieron un promedio de los escores del WHOQOL que varía de 57,14 a 66,19, con el promedio más bajo en el dominio medioambiental, con un valor de 58,94 (DE = 14,20). Conclusión: los profesionales de la salud presentaron una calidad de vida mediana con alteraciones según el lugar de trabajo y la profesión en este período de pandemia en Brasil.

COVID-19 pandemic following the outbreak in China and Western Europe, where it finally lost the momentum, is now devastating North and South America. It has not been identified the reason and the molecular mechanisms of the two different patterns of the pulmonary host responses to the virus from a minimal disease in young subjects to a severe distress syndrome (ARDS) in older subjects, particularly those with previous chronic diseases (including diabetes) and cancer. The Management of the Istituto Nazionale Tumori - IRCCS “Fondazione Pascale” in Naples (INT-Pascale), along with all Health professionals decided not to interrupt the treatment of those hospitalized and to continue, even if after a careful triage in order not to allow SARS-CoV-2 positive subjects to access, to take care of cancer patients with serious conditions. Although very few (n = 3) patients developed a symptomatic COVID-19 and required the transfer to a COVID-19 area of the Institute, no patients died during the hospitalization and completed their oncology treatment. Besides monitoring of the patients, all employees of the Institute (physicians, nurses, researchers, lawyers, accountants, gatekeepers, guardians, janitors) have been tested for a possible exposure. Personnel identified as positive, has been promptly subjected to home quarantine and subdued to health surveillance. One severe case of respiratory distress has been reported in a positive employees and one death of a family member. Further steps to home monitoring of COVID-19 clinical course have been taken with the development of remote Wi-Fi connected digital devices for the detection of early signs of respiratory distress, including heart rate and oxygen saturation.In conclusion cancer care has been performed and continued safely also during COVID-19 pandemic and further remote home strategies are in progress to ensure the appropriate monitoring of cancer patients.

Black carbon (BC) inventories for cities are scarce, especially in developing countries, despite their importance to tackle climate change and local air pollution. Here, we draw on results from a case study in a Brazilian city to discuss the challenges of compiling a BC inventory for different activity sectors. We included traditionally inventoried sectors, such as industries and on-road transportation, other less reported sectors (food establishments and aviation), and open burning of household solid waste (HSW), typically found in developing countries. We present a machine-learning technique (Random Forest) as a novel approach to obtain HSW burning activity using a set of spatial predictors. The BC inventory was based on PM

Objetivo: Identificar os estudos publicados na literatura nacional e internacional sobre a avaliação da qualidade de vida dos profissionais durante a pandemia da COVID-19. Métodos: Revisão integrativa da literatura. A busca dos estudos foi realizada na base de dados e MEDLINE/PubMed, EMBASE e Literatura Latino-Americana e do Caribe em Ciências da Saúde-LILACS. Os dados extraídos dos artigos selecionados foram analisados e apresentados em tabelas. Resultados: Foram selecionados 12 artigos de uma amostral total com 14.215 participantes, sendo a maioria dos participantes dos estudos eram mulheres profissionais da área da enfermagem. Os profissionais de saúde que trabalham na linha frente do COVID-19 apresentaram baixos escores na qualidade de vida, além de alterações significativas na saúde mental e sintomas de distúrbios do sono. Os enfermeiros e médicos relataram piora na qualidade de vida. A depressão também foi identificada nos estudos como consequência nesse período de pandemia, independente se o profissional trabalhava diretamente com paciente com diagnóstico ou suspeita de COVID-19. O sexo feminino apresentou pior qualidade de vida. Profissionais com idade maior que 40 anos apresentaram menor escore para qualidade de vida. Conclusão: Os profissionais de saúde apresentaram uma qualidade de vida prejudicada no período de pandemia da COVID-19 no Brasil, principalmente os profissionais que trabalham na linha de frente.

O movimento da Reforma Psiquiátrica foi um grande marco na história do Brasil que teve como objetivo modificar o sistema de tratamento das pessoas com transtornos mentais. No entanto, ainda verifica-se um aumento na ocupação dos leitos psiquiátricos no Brasil. O objetivo deste estudo foi avaliar o perfil de internações psiquiátricas no Estado de São Paulo entre os anos de 2009 a 2020. Estudo descritivo e retrospectivo com abordagem quantitativa. A busca foi realizada no Sistema de Informações Hospitalares do Sistema Único de Saúde do DATASUS. Foram consideradas as internações psiquiátricas no Estado de São Paulo entre os anos de 2009 a 2020. Foi realizada a análise descritiva dos dados. A amostra total foi composta por 746.403 internações por transtornos mentais e comportamentais no período de janeiro de 2009 a julho de 2020 no Estado de São Paulo. 61,5% das internações foram de pessoas do sexo masculino, 25,41% eram da faixa etária de 30 a 39 anos e 53,0% da raça branca. 37,9% das internações foram no regime privado. O ano de 2011 apresentou a maior taxa de internações, 10,2%. A região da grande São Paulo foi a que apresentou maior taxa de internação totalizando 40,70% das internações. Embora o movimento da Reforma Psiquiátrica tenha contribuído para a desinstitucionalização psiquiátrica, os resultados deste estudo demonstram um elevado número de internações por transtornos mentais e comportamentais no Estado de São Paulo.

This study analyses four Brazilian laws against domestic violence. It used the conceptual bibliographic method. It had as units of analysis, the laws Maria da Penha, Feminicide, the Statute of the Elderly, and Child and Adolescent Statute. We collected and organised the data around the presentation of the causes of violence. It includes the law intends to curb, forms of prevention, and treatments given to those who commit the transgression, interpreted with semantic analysis and the results presented in a synthesiser table. The results showed that the Maria da Penha Law presents the types, forms of prevention, and treatment of the violence suffered; the Femicide Law only provided treatment; the Statutes of the Elderly and Children and Adolescents did not present the causes on rights to indicate prevention and treatment. The conclusion shows that the structure of Brazilian laws does not allow full comprehension by ordinary citizens.

Background: Malignant pleural mesothelioma (MPM) is a rare tumor with a challenging diagnosis. Its histological diagnosis is gradual and should be based on morphological assessment, supported by clinical and radiological evidence and immunohistochemistry (IHC). There are many immunohistochemical markers known to distinguish between a malignant mesothelioma and a carcinoma, but, none of the potential antibodies exhibit absolute specificity or sensitivity for both tumors. Case presentation: We report a case of diffuse mesothelioma of the peritoneum with a misleading diagnosis of colon carcinoma, opened to different possibilities of differential diagnosis among the advanced stages of neoplasms with peritoneal dissemination. We highlighted a very weak sporadic nuclear positive for thyroid transcription factor-1 (TTF-1) expression in malignant mesothelioma. Conclusion: The aim of the present study is to demonstrate the important role of TTF-1 in the diagnosis of mesothelioma. A positive tissue expression of TTF-1 may not exclude a malignant mesothelioma and could help the clinicians to improve its diagnosis and treatment.

A disponibilidade hídrica tem sido afetada pela crescente demanda de água, pelas mudanças climáticas, bem como pela variabilidade espaço temporal das precipitações. A geoestatística é uma metodologia capaz de incorporar a correlação espacial entre as medições em seus procedimentos, sendo, portanto, relevante em estudos hidrológicos e de dinâmica da precipitação. O presente estudo investigou a distribuição espacial dos padrões temporais da precipitação na Bacia Hidrográfica do Rio Brígida, no semiárido de Pernambuco, aplicando técnicas geoestatísticas. Foram utilizados registros de 41 estações pluviométricas, com série temporal anual de 55 anos (1963 a 2017), disponibilizados pela Agência Pernambucana de Águas e Clima, e complementados por Tropical Rainfall Measuring Mission, formando uma malha dinâmica no tempo, devido às falhas existentes. Os dados pluviométricos totais anuais diretos (manuais e automáticos) e indiretos (por satélite) foram sistematizados, e os anos classificados em secos, normais e chuvosos através da Técnica dos Quantis. Todos os registros pluviométricos apresentaram alta a média dependência espacial, com alcances variando de 20 a 45 km. Os valores de CV (>20%) indicam média variabilidade espacial da precipitação na bacia, o que reforça a necessidade de uma estratégia de monitoramento baseada em malha intensamente distribuída. Constatou-se que a rede pluviométrica existente permitiu adequada estimativa da precipitação e classificação da condição de aridez, para todos os períodos estudados, com média incerteza, nas principais regiões da bacia. Precipitation spatialization in the Brígida River Basin in Pernambuco semi-arid A B S T R A C TWater availability has been affected by increasing water demand, climate change, as well as the spatio temporal variability of rainfall. Geostatistics is a methodology able to incorporate the spatial correlation between measurements in its procedures and being relevant for hydrological and precipitation dynamics studies. The present study analysed the spatial distribution of temporal patterns of rainfall at the Brígida River Basin in the semi-arid region of Pernambuco, applying geostatistical techniques. It was used records from 41 rain gauges, with a 55-year annual time series (1963 to 2017), available from the Pernambuco's Water and Climate Agency and complemented by the Tropical Rainfall Measuring Mission, forming a dynamic mesh in time due to existing gaps. Direct annual rainfall data (manual and automatic) and indirect (satellite) data were systematized and classified in dry, normal and rainy years, using the Quantile technique. All rainfall records showed high to medium spatial dependence, with ranges varying from 20 to 45 km. CV values (> 20%) indicate mean spatial variability of rainfall in the basin, requiring a monitoring strategy on an intensely distributed network. It was observed that the existing rainfall network allowed an adequate estimation of precipitation, for all periods studied, with intermediate uncertainty, at the main regions of the basin.Keywords: spatial dependence, precipitation, geostatistics, Quantiles.

Among the numerous environmental problems that plague the world today, the water crisis is scaring because it involves an indispensable resource for the maintenance not only of life, but of human life, but of the entire planet. Conflicts between state interests, between seeing water as a public good or as an economic good, and the discrepancy between the natural distribution of water and its political and geographical distribution permeate the scenario of the crisis and establish a complicated task for International Law: formulation of a comprehensive water management policy capable of preventing and suppressing conflicts. From the accomplishment of a qualitative research combined with the method of bibliographical research. The present article has as main objective to expose the ideological conflicts and obstacles that permeate the current world water crisis, highlighting the negative implications of the absence of a strong and comprehensive international legislation on the subject. The methodology used was the descriptive study of the literature.

Hidden charm mesons continue playing an essential role as relevant probes to understand the evolution of partonic matter. It is expected that the charmonia that survived the quark-gluon plasma phase suffer collisions with other particles composing the hadronic matter. In this work, we intend to contribute on this subject by presenting an updated study about the interactions of $J/��$ with surrounding hadronic medium. The meson-meson interactions are described with a $SU(4)$ effective Lagrangian, and within the framework of unitarized coupled channel amplitudes projected onto s-wave. The symmetry is explicitly broken to $SU(3)$ by suppression of the interactions driven by charmed mesons. We calculate the cross sections for $J/��$ scattering by light pseudoscalar mesons ($��, K, ��$) and vector mesons ($��, K^\ast, ��$), as well as their inverse processes. Keeping the validity of this present approach in the low CM energy range, the most relevant channels are evaluated and a comparison of the findings with existing literature is performed., 21 pages, 11 figures

This article illustrates the importance of water as an essential element for life of living beings, as well as its role as the object of disputes among the people, the state and utilities companies responsible for collection, treatment and subsequent distribution. The focus of the research was Manaus, a city that despite being intersected by streams and be located on the banks of the River Negro, has much of its population, specifically the Eastern and Northern areas, do not have regular water supply. We note that those responsible for this task, including the municipal government, are ineffective in fulfilling this mission. This difficulty does not happen only by operational difficulties, becoming apparent the occurrence of urban dispossession, the non-recognition of the needs of the lower classes to a right to the city. Sought through hierarchical selectivity of social policies theory, try to explain the model and why the incipient actions that are taken in municipal water management. Thus, it is not prudent to move away from the state management in the distribution network of water, especially in the poorest areas. The methodology used was the qualitative research is to identify and interpret the necessary information on the matter and establish descriptively investigated the phenomena in order to promote an analysis of its object, and the literature search, using doctrine and legal text.

The authors conducted a flow cytometry immunophenotyping study in patients with acute lymphoblastic leukemia (ALL) from Natal, Rio Grande do Norte, Brazil. The patients (n = 126) were newly diagnosed using a panel of monoclonal antibodies: CD1a, CD2, CD3, CD4, CD7, CD8, CD10, CD13, CD33, CD14, CD19, CD22, CD79a, CD117, CD34, anti-IgM, anti-TdT, anti-HLA-Dr, and anti-human kappa and lambda light chains. Additional data, such as patients' age and gender, clinical and laboratory findings such as presence of tumor masses, lymphadenopathy, hepatomegaly, splenomegaly, leukemic infiltration in the central nervous system (CNS) were also investigated. Results showed that 56.7% of the cases were B-lineage ALL and 55% were T-cell ALL. Also, we found that males were more affected by the disease, regardless of immunological classification. The correlation between age and immunological subtypes showed that the B-lineage ALL occurred more frequently in patients aged under 15 while the T-cell ALL subtype was more frequent in adults. Immunophenotypic profiles and morphological subtypes showed a direct correlation between L3 subtype and B-lineage ALL, while L1 and L2 subtypes correlated more often with B-cell lineage and T-cell ALL, respectively. Correlation analysis between immunophenotypic and clinical profiles showed that T-cell ALL was more associated with a higher incidence of lymphadenopathy, hepatomegaly, splenomegaly and CNS leukemic infiltration, also showing a greater blast cell count in peripheral blood than the other subgroups. The presented data suggest that immunophenotyping is an important method in the diagnosis, monitoring and prognostic assessment in determining the pathological mechanisms of evolution of ALL.

A atual realidade das universidades públicas brasileiras é a escassez. O objetivo da pesquisa foi verificar a necessidade de se reinterpretar a garantia da gratuidade do ensino público nos estabelecimentos oficiais de ensino superior. Concluiu-se que o princípio da vedação da proteção deficiente determina essa reinterpretação, pois há valores e objetivos constitucionais que estão sendo protegidos de maneira não razoável, através de uma interpretação desproporcional que universaliza essa gratuidade, ignorando a dimensão objetiva dos direitos fundamentais. Os resultados evidenciaram que cobranças de mensalidades em Universidades Públicas, inclusive na graduação, não ferem a Constituição, mas, ao contrário, viabilizam promoção de valores e objetivos tutelados por ela. A metodologia utilizada foi a pesquisa qualitativa, consistente em identificar e interpretar as informações necessárias sobre o assunto e estabelecer descritivamente os fenômenos a fim de promover análise do objeto, bem como a pesquisa bibliográfica, com uso de doutrina, legislação e jurisprudência.

A partir da leitura dos cadernos 53 e 55, ambos dedicados à composição do romance A prisioneira, elencamos um conjunto de notas que ressuscitam uma antiga discussão da crítica com relação ao “je” proustiano, muitas vezes confundido como portador de traços autobiográficos. O objetivo deste artigo é percorrer a elaboração dessa primeira pessoa na carreira literária do escritor para demonstrar que o uso do “je” não se operou de forma espontânea na obra proustiana.

Introduction In Brazil, Erythrina velutina (Fabaceae) is widely used as a tranquilizer and/or sedative, and its extract exerts an anxiolytic-like effect profile in animal models, although these results may be caused by its sedative or amnesic effects. Aims, materials and methods Thus, this study evaluated the effect of acute and chronic (23–26 days) administrations of the hydroalcoholic extract of the stem bark of Erythrina velutina (orally) in mice submitted to the following tests: elevated plus-maze, forced swim, spontaneous locomotor activity, and habituation to active chamber. Chlordiazepoxide and imipramine were used as standard drugs. Results In the elevated plus-maze test, chronic, but not acute, Erythrina velutina (100 mg/kg) administration increased the percentage of open arm entries, an effect also seen in both acute and chronic treatments with chlordiazepoxide (7.5 mg/kg). In the forced swim test, only imipramine (25 mg/kg) decreased immobility time. Impairment of habituation was seen only with acute imipramine administration and with the lowest doses of Erythrina velutina extract tested in acute (10 mg/kg) and chronic (50 mg/kg) administrations. Conclusions These results suggest that chronic administration of the hydroalcoholic extract of the stem bark of Erythrina velutina exerts an anxiolytic-like effect on mice, and it could serve as a new approach for the treatment anxiety, although it may have an amnesic effect at low doses.

Objective: To describe the epidemiological profile of women with HPV who treated in a Basic Health Unit. Method: A survey of quantitative trait was performed in a district in the municipality of Santa Cruz/RN through the individual records of 205 users of the Unit. Results: The epidemiological profile was characterized by women with age between 19-30 years; married; white; schooling until the incomplete high school; income up to a wage minimum; first intercourse among 15-17 years; with a partner. Conclusion: The same are in the risk group for the involvement of HPV because they present themselves as young, married, low education and income, and sexual initiation before age 18 years.

A água é imprescindível para todas as formas de vida, sendo fundamental recurso para sobrevivência humana e desenvolvimento sócio-econômico. Este trabalho faz uma discussão sobre os usos múltiplos e sistema de gerenciamento do rio Taquari, recurso natural tão importante para a cidade de Araguatins, busca contribuir com informações para subsidiar o planejamento e orientar a implementação de ações nesta bacia, contribuindo para o seu manejo. Os resultados apontam para ausência de política de gerenciamento, desta forma um programa de gestão de água deve ser implantado buscando prevenir a poluição e práticas de degradação ambiental, preservando o recurso de abastecimento da cidade.

Embora o romance Em busca do tempo perdido seja incontestavelmente uma obra inacabada, não se trata, entretanto, de uma obra incompleta. Seu fechamento circular, promovido pelo diálogo entre o primeiro e último volumes, foi tema de grande parte da crítica proustiana. Com relação à sua composição, seu processo escritural passou por diversas mudanças e a construção, equiparada à execução de uma catedral, poderia igualmente ser caracterizada pela colagem, montagem ou costura dos fragmentos textuais esboçados nos setenta e cinco cadernos de rascunho. A busca pela unidade em meio a essa profusão de textos levou o escritor à atividade incessante de releitura e reescritura e, consequentemente, ao inacabamento da obra. O trabalho que ora apresentamos tem por objetivo o estudo dessa composição, a partir da leitura e análise dos cadernos 53 e 55, ambos consagrados à elaboração da história de Albertine. Although the novel In Search of Lost Time is certainly unfinished, it is not an incomplete work. Its round ending, promoted by the dialogue between the first and last volumes, was the subject of much Proustian criticism. With respect to its composition, its writing process has gone through many changes and the construction, equivalent to the execution of a cathedral, could also be characterized by the process of montage or the stitching of textual fragments contained in Prousts seventy-five exercise books. The search for unity amongst this profusion of texts has led the writer to the ceaseless activity of rereading and rewriting and thus to the incompleteness of the work. The analysis presented here is aimed at studying this composition, having the reading and the analysis of exercise books 53 and 55, both related to the elaboration of the story of Albertine, as a starting point.

Suicide is a serious public health problem worldwide in which they act influences multifactorial. We seek to clarify how social networks act on suicidal behavior. In this context, we conclude that the way in social networks interact with the risk factors determining how it can intervene in individual.

The Electroconvulsive Therapy (ECT) is a safe and effective treatment of depression in the elderly. With a high rate of remission may be t he treatment of choice in cases of psychotic depression or when antidepressant treatment fails. Although its mechanism of action is unknown the therapeutic effects of ECT may be related to changes in cerebral blood flw. Studies confim differences in the effects of ECT according to patient age. There are side effects related to cognitive function. ECT is as safe for elderly patients and for young patients.

The authors conducted a flow cytometry immunophenotyping study in patients with acute lymphoblastic leukemia (ALL) from Natal, Rio Grande do Norte, Brazil. The patients (n = 126) were newly diagnosed using a panel of monoclonal antibodies: CD1a, CD2, CD3, CD4, CD7, CD8, CD10, CD13, CD33, CD14, CD19, CD22, CD79a, CD117, CD34, anti-IgM, anti-TdT, anti-HLA-Dr, and anti-human kappa and lambda light chains. Additional data, such as patients' age and gender, clinical and laboratory findings such as presence of tumor masses, lymphadenopathy, hepatomegaly, splenomegaly, leukemic infiltration in the central nervous system (CNS) were also investigated. Results showed that 56.7% of the cases were B-lineage ALL and 55% were T-cell ALL. Also, we found that males were more affected by the disease, regardless of immunological classification. The correlation between age and immunological subtypes showed that the B-lineage ALL occurred more frequently in patients aged under 15 while the T-cell ALL subtype was more frequent in adults. Immunophenotypic profiles and morphological subtypes showed a direct correlation between L3 subtype and B-lineage ALL, while L1 and L2 subtypes correlated more often with B-cell lineage and T-cell ALL, respectively. Correlation analysis between immunophenotypic and clinical profiles showed that T-cell ALL was more associated with a higher incidence of lymphadenopathy, hepatomegaly, splenomegaly and CNS leukemic infiltration, also showing a greater blast cell count in peripheral blood than the other subgroups. The presented data suggest that immunophenotyping is an important method in the diagnosis, monitoring and prognostic assessment in determining the pathological mechanisms of evolution of ALL.

PURPOSE: CD5 is a T cell marker, aberrantly express in B cell chronic lymphocytic leukemia (B-CLL) and mantle cell lymphoma (MCL). Other chronic B cell malignancies including hairy cell leukemia (HCL) and B cell prolymphocytic leukemia (B-PLL) are CD5 negative or express this antigen in a weak way. In this study, CD5 expression was investigated in leukemic cells from 42 patients with chronic B cell lymphoproliferative disease. METHODS: We studied the CD5 expression in leukemic cells from 42 patients with chronic B-cell malignancies by flow cytometry. Demographic features such as age, sex and clinical date were also analyzed. RESULTS: There were 22 males and 20 females. The immunophenotyping showed that 35 cases were B-CLL, 3 B-PLL and HCL and one patient was MCL. CD5 expression was present in all B-CLL and MCL. Low expression of CD5 was observed in one patient with B-PLL and negative in all cases of HCL. CONCLUSION: Our date demonstrated that CD5 expression can help distinguish among B-CLL from HCL and B-PLL, but is similar expressed in MCL. OBJETIVOS: CD5 é um marcador normalmente expresso nas células T e de forma aberrante nas células B da leucemia linfocítica crônica (LLC) e no linfoma de células do manto (LCM). Outras doenças linfoproliferativas crônicas como a hairy cell leukemia (HCL) e leukemia prolinfocítica de células B (LPL-B), são geralmente CD5 negativas ou expressam fracamente este antígeno. Neste trabalho investigou-se o padrão de expressão do CD5 em 42 pacientes com doenças linfoproliferativas crônicas de células B (DLC-B). METODOS: Investigamos a expressão de CD5 em células leucêmicas de 42 pacientes com DLC-B através da citometria de fluxo. Dados demográficos, tais como idade e sexo, bem como dados clínicos e laboratoriais também foram analisados. RESULTADOS: A imunofenotipagem mostrou que 35 casos foram LLC, 3 LPL-B, 3 HCL e um caso de LMC. O CD5 mostrou-se fortemente expresso em todos os casos de LLC e LMC. Baixa expressão desse antígeno foi observada em um caso de LPL-B, mostrando-se negativamente expresso em todos os casos de HCL. CONCLUSÃO: Nossos resultados demonstram que o padrão de expressão do CD5 pode auxiliar na distinção entre LLC da HCL e LPL-B, sendo no entanto similares na HCL e LCM.

As atividades comerciais têm contribuído com a geração de riquezas e progresso social na sociedade moderna, entretanto, podem-se observar problemas ambientais no setor, como a depleção de recursos naturais, geração de resíduos sólidos, esgoto, poluição sonora e atmosférica. Em Açailândia-MA, a atividade comercial apresentou expansão nos últimos anos, assim como os desafios ambientais supra-citados, que podem ser mitigados através de ações de gestão ambiental. Assim, o presente estudo objetivou avaliar o perfil ambiental de empresários no centro deste município. Para tanto, desenvolveu-se um estudo exploratório do tipo Survey com aplicação de questionários a 46 empresários locais, com predominância de atividades comerciais de calçados e vestuários (17 empresas). O sistema de gestão ambiental só ocorreu de forma incipiente em 04 organizações, sendo desconhecido por 80,43% dos entrevistados. Portanto, ações educativas e administrativas sobre a importância da gestão ambiental devem ser desenvolvidas para se mudar esta realidade, oportunizando ganhos econômicos, ambientais e sociais na cidade de Açailândia. Palavras-chave: Atividade Comercial, Açailândia-MA, Gestão Ambiental. Abstract Commercial activities have contributed to the generation of wealth and social progress in modern society. However, environmental problems in the sector can be observed, such as depletion of natural resources, solid waste, sewer, noise and air pollution. In Açailândia / MA, the commercial activity has expanded in recent years, as well as the above-mentioned environmental challenges, which can be mitigated through environmental management actions. Thus, this study aimed at evaluating the environmental profile of entrepreneurs in the downtown area of this city. To do so, a survey was developed and applied to 46 local entrepreneurs. There was a predominance in the footwear and clothing (17 companies). The environmental management system has only occurred incidentally in 04 organizations, and unknown to 80.43% of respondents. Therefore, educational and administrative actions on the importance of environmental management must be developed to change this reality, providing opportunities for economic, environmental and social gains in the town of Açailândia. Keywords:Commercial Activity, Açailândia-MA, Environmental Management

I apply some of the lessons from quantum theory, in particular from Bell's theorem, to a debate on the foundations of decision theory and causation. By tracing a formal analogy between the basic assumptions of Causal Decision Theory (CDT)--which was developed partly in response to Newcomb's problem-- and those of a Local Hidden Variable (LHV) theory in the context of quantum mechanics, I show that an agent who acts according to CDT and gives any nonzero credence to some possible causal interpretations underlying quantum phenomena should bet against quantum mechanics in some feasible game scenarios involving entangled systems, no matter what evidence they acquire. As a consequence, either the most accepted version of decision theory is wrong, or it provides a practical distinction, in terms of the prescribed behaviour of rational agents, between some metaphysical hypotheses regarding the causal structure underlying quantum mechanics., Cross-posted in http://philsci-archive.pitt.edu/archive/00004872/

Background/aim: Mixed Cryoglobulinemia (MC) represents the most frequent extrahepatic manifestation of chronic Hepatitis C Virus (HCV) infection. Its pathogenic mechanisms involve HCV-induced chronic stimulation of B-lymphocytes. We aimed to investigate the relationship between serum levels of vitamin D (a regulator of immune response) and the presence of serum cryoglobulins in the setting of HCV infection. Patients and methods: We evaluated the serum concentration of 25(OH)vitamin D and cryoglobulins in 106 patients with chronic HCV infection. Results: Thirty patients (28.3%) showed the presence of serum cryoglobulins. For the cohort overall, the median serum 25(OH)vitamin D level was 10.95 ng/ml. Patients with serum cryoglobulins had significantly lower levels of 25(OH)vitamin D (5.61 ng/ml) than those without (13.65 ng/ml, p=0.029). At multivariate analysis, severe hypovitaminosis [i.e. 25(OH)vitamin D

Neonatal colonization of the gastrointestinal tract depends on mother microbiome, thus mother microbiota dysbiosis is transmitted to the offspring during the delivery and shaped by breastmilk characteristics. Here we used a murine model of UC predisposition (Winnie-/-) to evaluate the effects of maternal diet during pregnancy and lactation. Using heterozygous breeders, we obtained both Winnie-/- and C57BL/6 littermates from the same mother and compared their microbiota at weaning and adult age, using a diet enriched with 1% tomato fruit of a line – named Bronze – highly enriched in bioactive polyphenols, or Control tomato. Females received enriched diets two weeks before the beginning of the breeding and never stopped for the following six months. No significant effect was observed in regard to the percentage of Winnie-/- offspring, as with both diets the percentage was about 25% as expected. Winnie littermates from breeders fed with the Bronze-enriched diet showed reduced dysbiosis at 4 weeks of age if compared with Winnie under the Control tomato diet. This effect was then reduced when mice reached adult age. Conversely, the microbiota of C57BL/6 does not change significantly, indicating that fortified mothers-diet significantly contribute to preventing dysbiosis in genetically predisposed offspring, but has mild effects on healthy littermates and adult mice. An overall tendency towards reduced inflammation was underlined by the colon weight and the percentage of Foxp3+ cells reduction in Winnie mice fed with Bronze diet. Control diet did not show similar tendency.