Hospital de Clínicas da Unicamp

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Americanae nace como un proyecto conjunto que surge dentro de la Red Europea de Información y Documentación sobre América Latina (REDIAL), y que ha afrontado la Biblioteca de la Agencia Española de Cooperación Internacional para el Desarrollo (AECID). Esta nueva biblioteca virtual hace más accesibles los libros digitales de tema americanista a los investigadores y usuarios interesados de cualquier parte del mundo.

PURPOSE: To assess which antiepileptic medications (AEDs) have the best evidence for long-term efficacy or effectiveness as initial monotherapy for patients with newly diagnosed or untreated epilepsy. METHODS: A 10-member subcommission of the Commission on Therapeutic Strategies of The International League Against Epilepsy (ILAE), including adult and pediatric epileptologists, clinical pharmacologists, clinical trialists, and a statistician evaluated available evidence found through a structured literature review including MEDLINE, Current Contents and the Cochrane Library for all applicable articles from 1940 until July 2005. Articles dealing with different seizure types (for different age groups) and two epilepsy syndromes were assessed for quality of evidence (four classes) based on predefined criteria. Criteria for class I classification were a double-blind randomized controlled trial (RCT) design, >or=48-week treatment duration without forced exit criteria, information on >or=24-week seizure freedom data (efficacy) or >or=48-week retention data (effectiveness), demonstration of superiority or 80% power to detect a <or=20% relative difference in efficacy/effectiveness versus an adequate comparator, and appropriate statistical analysis. Class II studies met all class I criteria except for having either treatment duration of 24 to 47 weeks or, for noninferiority analysis, a power to only exclude a 21-30% relative difference. Class III studies included other randomized double-blind and open-label trials, and class IV included other forms of evidence (e.g., expert opinion, case reports). Quality of clinical trial evidence was used to determine the strength of the level of recommendation. RESULTS: A total of 50 RCTs and seven meta-analyses contributed to the analysis. Only four RCTs had class I evidence, whereas two had class II evidence; the remainder were evaluated as class III evidence. Three seizure types had AEDs with level A or level B efficacy and effectiveness evidence as initial monotherapy: adults with partial-onset seizures (level A, carbamazepine and phenytoin; level B, valproic acid), children with partial-onset seizures (level A, oxcarbazepine; level B, None), and elderly adults with partial-onset seizures (level A, gabapentin and lamotrigine; level B, None). One adult seizure type [adults with generalized-onset tonic-clonic (GTC) seizures], two pediatric seizure types (GTC seizures and absence seizures), and two epilepsy syndromes (benign epilepsy with centrotemporal spikes and juvenile myoclonic epilepsy) had no AEDs with level A or level B efficacy and effectiveness evidence as initial monotherapy. CONCLUSIONS: This evidence-based guideline focused on AED efficacy or effectiveness as initial monotherapy for patients with newly diagnosed or untreated epilepsy. The absence of rigorous comprehensive adverse effects data makes it impossible to develop an evidence-based guideline aimed at identifying the overall optimal recommended initial-monotherapy AED. There is an especially alarming lack of well-designed, properly conducted RCTs for patients with generalized seizures/epilepsies and for children in general. The majority of relevant existing RCTs have significant methodologic problems that limit their applicability to this guideline's clinically relevant main question. Multicenter, multinational efforts are needed to design, conduct and analyze future clinically relevant RCTs that can answer the many outstanding questions identified in this guideline. The ultimate choice of an AED for any individual patient with newly diagnosed or untreated epilepsy should include consideration of the strength of the efficacy and effectiveness evidence for each AED along with other variables such as the AED safety and tolerability profile, pharmacokinetic properties, formulations, and expense. When selecting a patient's AED, physicians and patients should consider all relevant variables and not just efficacy and effectiveness.

The purpose of this report was to update the 2006 International League Against Epilepsy (ILAE) report and identify the level of evidence for long-term efficacy or effectiveness for antiepileptic drugs (AEDs) as initial monotherapy for patients with newly diagnosed or untreated epilepsy. All applicable articles from July 2005 until March 2012 were identified, evaluated, and combined with the previous analysis (Glauser et al., 2006) to provide a comprehensive update. The prior analysis methodology was utilized with three modifications: (1) the detectable noninferiority boundary approach was dropped and both failed superiority studies and prespecified noninferiority studies were analyzed using a noninferiority approach, (2) the definition of an adequate comparator was clarified and now includes an absolute minimum point estimate for efficacy/effectiveness, and (3) the relationship table between clinical trial ratings, level of evidence, and conclusions no longer includes a recommendation column to reinforce that this review of efficacy/evidence for specific seizure types does not imply treatment recommendations. This evidence review contains one clarification: The commission has determined that class I superiority studies can be designed to detect up to a 20% absolute (rather than relative) difference in the point estimate of efficacy/effectiveness between study treatment and comparator using an intent-to-treat analysis. Since July, 2005, three class I randomized controlled trials (RCT) and 11 class III RCTs have been published. The combined analysis (1940-2012) now includes a total of 64 RCTs (7 with class I evidence, 2 with class II evidence) and 11 meta-analyses. New efficacy/effectiveness findings include the following: levetiracetam and zonisamide have level A evidence in adults with partial onset seizures and both ethosuximide and valproic acid have level A evidence in children with childhood absence epilepsy. There are no major changes in the level of evidence for any other subgroup. Levetiracetam and zonisamide join carbamazepine and phenytoin with level A efficacy/effectiveness evidence as initial monotherapy for adults with partial onset seizures. Although ethosuximide and valproic acid now have level A efficacy/effectiveness evidence as initial monotherapy for children with absence seizures, there continues to be an alarming lack of well designed, properly conducted epilepsy RCTs for patients with generalized seizures/epilepsies and in children in general. These findings reinforce the need for multicenter, multinational efforts to design, conduct, and analyze future clinically relevant adequately designed RCTs. When selecting a patient's AED, all relevant variables and not just efficacy and effectiveness should be considered.

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Dengue is a vector-borne disease transmitted by the mosquito Aedes aegypti. The incidence of dengue disease shows a clear dependence on seasonal variation. How does the temperature affect the incidence? We addressed this question indirectly by estimating the size of the A. aegypti population for different temperatures applying population dynamics theory. In order to achieve this objective we designed temperature-controlled experiments to assess the entomological parameters regarding the mosquito's life-cycle at different temperatures. By obtaining the mortality, transition and oviposition rates for different stages of the life-cycle of the mosquito we were able to calculate the basic offspring number Q(0), which is the capacity of vector reproduction and ultimately gives the size of the vector population.

O método de análise de conteúdo constitui-se em um conjunto de técnicas utilizadas na análise de dados qualitativos. Percebe-se, porém, que existe por parte do pesquisador iniciante ou do não familiarizado com estas técnicas, dificuldades em relação ao entendimento e aplicação do método. Assim sendo, objetivou-se neste trabalho, apresentar de maneira clara, conceitos e aspectos importantes constantes do método de análise de conteúdo e discutir alguns de seus pontos centrais. O método de análise de conteúdo foi sistematizado na primeira metade do século XX e a princípio foi importante ferramenta na busca dos sentidos dos artigos e propagandas da imprensa escrita nos Estados Unidos, sendo hoje um método amplamente utilizado em pesquisas científicas no campo da saúde.

O texto analisa a relação entre tecnologia e aprendizagem. Inicia pela compreensão de que o uso das tecnologias disponíveis, em cada época da história da humanidade, transforma radicalmente a forma de organização social, comunicação, cultura e a aprendizagem. No atual estágio da civilização, as tecnologias digitais de comunicação e informação possibilitam novas formas de acesso à informação, novas possibilidades de interação e de comunicação e formas diferenciadas de se alcançar a aprendizagem. Essas tecnologias, no entanto, requerem um amplo conhecimento de suas especificidades para que possam ser utilizadas adequadamente em projetos sistemáticos de educação. Exigem também metodologias de ensino diferenciadas, uma nova pedagogia e a utilização ampla das capacidades humanas (muito além da cognição) em processos diferenciados de aprendizagem. Além disso, essas novas tecnologias possibilitam que a aprendizagem possa acontecer de forma coletiva, integrada, articulando informações e pessoas que estão em locais diferentes e que são de idade, sexo, condições físicas, áreas e níveis diferenciados de formação. O texto conclui que as atuais tecnologias digitais de comunicação e informação possibilitam o alcance de novas aprendizagens, que encaminham as pessoas para novos avanços, socialmente válidos, no atual estágio de desenvolvimento da humanidade.

Americanae nace como un proyecto conjunto que surge dentro de la Red Europea de Información y Documentación sobre América Latina (REDIAL), y que ha afrontado la Biblioteca de la Agencia Española de Cooperación Internacional para el Desarrollo (AECID). Esta nueva biblioteca virtual hace más accesibles los libros digitales de tema americanista a los investigadores y usuarios interesados de cualquier parte del mundo.

This paper presents a hierarchical decomposition approach for optimal transmission network expansion planning. A major difficulty in obtaining global optimal solutions for complex, real-life networks is due to the nonconvexity of the problem. Hierarchical decomposition has proved to be an efficient heuristic for coping with nonconvexity, as illustrated in the test results section of the paper. Significant reductions in investment costs have been obtained in some practical cases for which results are available in the literature. The current implementation of the hierarchical decomposition approach utilizes three different levels of network modeling: transportation models, hybrid models, and linearized power flow models. An initial solution is obtained for the simplest model (transportation model) and as one moves towards the final solution the algorithm successively switches to more accurate models.< <ETX xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">&gt;</ETX>

This paper proposes a fading model that leads to a formal, but simple method to obtain the exact formula of the Nakagami-m published in 1960 distribution for m=n/2, with n a nonzero integer number. Based on such a model, the joint distribution of the envelope and its time derivative are accomplished, and exact formulas for the level crossing rate (closed-form formula) and for the average fade duration are derived. Simulation curves and exact formulas are checked against each other and a very good agreement between them is attained. Although derived for discrete values of m (m being an integer multiple of 1/2), there are no mathematical constraints for these expressions to be used for any real value of m/spl ges/1/2.

Breast cancer remains the most prevalent cause of cancer mortality in woman worldwide due to the metastatic process and therapy resistance. Resistance against cancer therapy is partially attributed to cancer stem cells (CSCs). These cells arise from epithelial cells undergoing epithelial-to-mesenchymal transition (EMT) and might be responsible for tumor recurrence. In this study, we reported the relevance of miR-155 upregulation in chemoresistant cells associated with EMT. Notably, we found miR-155 induction in exosomes isolated from CSCs and resistant cells, followed by resistant cells' exosome transfer to the recipient sensitive cells. Functionally, miR-155 mimic assay showed an enrichment in miR-155 from exosome concomitant with miR-155 exosome transfer to breast cancer cells. In parallel to these effects, we also observed EMT change in miR-155 transfected cells. The chemoresistance phenotype transfer to sensitive cells and the migration capability was analyzed by MTT and scratch assays and our results suggest that exosomes may intermediate resistance and migration capacity to sensitive cells partly through exosome transfer of miR-155. Taken together, our findings establish the significance of exosome-mediate miR-155 chemoresistance in breast cancer cells, with implications for targeting miR-155 signaling as a possible therapeutic strategy.

Microbial pathogenicity in Staphylococcus aureus is a complex process involving a number of virulence genes that are regulated by global regulatory systems including sar and agr. To evaluate the roles of these two loci in virulence, we constructed sar-/agr- mutants of strains RN6390 and RN450 and compared their phenotypic profiles to the corresponding single sar- and agr- mutants and parents. The secretion of all hemolysins was absent in the sar-/agr- mutants while residual beta-hemolysin activity remained in single agr- mutants. The fibronectin binding capacity was significantly diminished in both single sar- mutants and double mutants when compared with parents while the reduction in fibrinogen binding capacity in the double mutants was modest. In the rabbit endocarditis model, there was a significant decrease in both infectivity rates and intravegetation bacterial densities with the double mutant as compared to the parent (RN6390) at 10(3)-10(6) CFU inocula despite comparable levels of early bacteremia among various challenge groups. Notably, fewer bacteria in the double mutant group adhered to valvular vegetations at 30 min after challenge (10(6) CFU) than the parent group. These studies suggest that both the sar and agr loci are involved in initial valvular adherence, intravegetation persistence and multiplication of S. aureus in endocarditis.

Para melhor compreensão e avaliação das políticas públicas sociais implementadas por um governo, é fundamental a compreensão da concepção de Estado e de política social que sustentam tais ações e programas de intervenção. Visões diferentes de sociedade, Estado, política educacional geram projetos diferentes de intervenção nesta área. Este texto objetiva trazer elementos que contribuam para a compreensão desta relação, enfocando autores que se aproximam da abordagem marxista e da neoliberal sobre o tema.

Power system state estimation derives a real-time network model by extracting information from a redundant data set consisting of telemetered, predicted and static data items. This paper describes a generalized, fully developed, estimation approach that fundamentally improves the information extraction process. Its main contribution is the successful inclusion of topology and parameters in the estimation and bad data analysis processes. This is valuable both in the initial commissioning of a state estimator, and in its routine real-time and study mode application. The approach involves a variety of novel concepts and methods. It is usable in weighted least squares (WLS) and other estimation approaches.

This study presents a novel procedure for switched affine systems control design specially developed to deal with switched converters where the main goal is to attain a set of equilibrium points. The main contribution is on the determination of a switching function, which assures global stability and minimises a guaranteed quadratic cost. The implementation of the switching function taking into account only partial information is analysed and discussed with particular interest. The theoretical results are applied to buck, boost and buck–boost converters control design. Several simulations show the usefulness of the methodology and its favourable impact in a class of real-world control design problems.

ResumoEste artigo tem o objetivo de contribuir para as reflexões sobre os processos de saúde-adoecimento que impactam o mundo do trabalho no capitalismo contemporâneo. Parte de uma análise que articula as alterações ocorridas no interior dos locais de trabalho para um processo de maior amplitude, de reorganização do padrão de acumulação capitalista e do redesenho da divisão internacional do trabalho, fenômenos marcantes da sociabilidade capitalista na transição do século XX para o XXI.

Abstract Sugarcane is currently the main renewable energy source in Brazil. Due to the importance of the cane industry and its contribution to a wide range of biobased energy and other products, LCA studies regarding cane‐derived products are needed to assess their environmental benefits. The main objective of this work was the assessment of life cycle energy use and greenhouse gas (GHG) emissions related to cane sugar and ethanol, considering bagasse and electricity surpluses as coproducts. We performed an overall balance for the Brazilian Center‐South Region, adopting different methods to evaluate sugar and ethanol production separately. The GREET 1.8c.0 model was used for the ‘well‐to‐wheels’ calculations but adapted to the comprehensive set of Brazilian parameters that best represent the Center‐South Region. For the reference case, fossil energy use and GHG emissions related to sugar production were evaluated as 721 kJ/kg and 234 g CO 2 eq/kg, respectively. For the ethanol life cycle, these values were 80 kJ/MJ and 21.3 g CO 2 eq/MJ. Special attention was paid to the variation of some parameters among producing units based on data collected by industry. The consequent uncertainties in ethanol life cycle emissions were assessed through a Monte Carlo analysis based on assigned distribution of probability curves for eleven selected parameters and informed by partial statistical data available from industry for distribution generation. Projections were also made for 2020 scenario parameters based on the best in current class technologies and technological improvements deemed commercially possible today. Published in 2011 by John Wiley &amp; Sons, Ltd

Background: Acute appendicitis (AA) is the most common surgical disease, and appendectomy is the treatment of choice in the majority of cases. A correct diagnosis is key for decreasing the negative appendectomy rate. The management can become difficult in case of complicated appendicitis. The aim of this study is to describe the worldwide clinical and diagnostic work-up and management of AA in surgical departments. Methods: This prospective multicenter observational study was performed in 116 worldwide surgical departments from 44 countries over a 6-month period (April 1, 2016-September 30, 2016). All consecutive patients admitted to surgical departments with a clinical diagnosis of AA were included in the study. Results: A total of 4282 patients were enrolled in the POSAW study, 1928 (45%) women and 2354 (55%) men, with a median age of 29 years. Nine hundred and seven (21.2%) patients underwent an abdominal CT scan, 1856 (43.3%) patients an US, and 285 (6.7%) patients both CT scan and US. A total of 4097 (95.7%) patients underwent surgery; 1809 (42.2%) underwent open appendectomy and 2215 (51.7%) had laparoscopic appendectomy. One hundred eighty-five (4.3%) patients were managed conservatively. Major complications occurred in 199 patients (4.6%). The overall mortality rate was 0.28%. Conclusions: The results of the present study confirm the clinical value of imaging techniques and prognostic scores. Appendectomy remains the most effective treatment of acute appendicitis. Mortality rate is low.