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Background: There is ongoing uncertainty regarding transmission chains and the respective roles of healthcare workers (HCWs) and elderly patients in nosocomial outbreaks of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in geriatric settings. Methods: We performed a retrospective cohort study including patients with nosocomial coronavirus disease 2019 (COVID-19) in four outbreak-affected wards, and all SARS-CoV-2 RT-PCR positive HCWs from a Swiss university-affiliated geriatric acute-care hospital that admitted both Covid-19 and non-Covid-19 patients during the first pandemic wave in Spring 2020. We combined epidemiological and genetic sequencing data using a Bayesian modelling framework, and reconstructed transmission dynamics of SARS-CoV-2 involving patients and HCWs, to determine who infected whom. We evaluated general transmission patterns according to case type (HCWs working in dedicated Covid-19 cohorting wards: HCWcovid; HCWs working in non-Covid-19 wards where outbreaks occurred: HCWoutbreak; patients with nosocomial Covid-19: patientnoso) by deriving the proportion of infections attributed to each case type across all posterior trees and comparing them to random expectations. Results: During the study period (March 1 to May 7, 2020) we included 180 SARS-CoV-2 positive cases: 127 HCWs (91 HCWcovid, 36 HCWoutbreak) and 53 patients. The attack rates ranged from 10-19% for patients, and 21% for HCWs. We estimated that 16 importation events occurred with high confidence (four patients, 12 HCWs) that jointly led to up to 41 secondary cases; in six additional cases (five HCWs, one patient), importation was possible with a posterior between 10-50%. Most patient-to-patient transmission events involved patients having shared a ward (95.2%, 95% credible interval [CrI] 84.2-100%), in contrast to those having shared a room (19.7%, 95%CrI 6.7-33.3%). Transmission events tended to cluster by case type: patientnoso were almost twice as likely to be infected by other patientnoso than expected (observed:expected ratio 2.16, 95%CrI 1.17 – 4.20, p = 0.006); similarly, HCWoutbreak were more than twice as likely to be infected by other HCWoutbreak than expected (2.72, 95%CrI 0.87-9.00, p = 0.06). The proportion of infectors being HCWcovid was as expected as random. We found a trend toward a greater proportion of high transmitters (≥2 secondary cases) among HCWoutbreak than patientnoso in the late phases (28.6% vs. 11.8%) of the outbreak, although this was not statistically significant. Conclusions: Most importation events were linked to HCW. Unexpectedly, transmission between HCWcovid was more limited than transmission between patients and HCWoutbreak. This finding highlights gaps in infection control and suggests possible areas of improvements to limit the extent of nosocomial transmission. Funding: This work was supported by a grant from the Swiss National Science Foundation under the NRP78 funding scheme (Grant no. 4078P0_198363).

Actinobacillus pleuropneumoniae (APP) is the causative agent of porcine pleuropneumonia, resulting in high economic impact worldwide. There are currently 19 known serovars of APP, with different ones being predominant in specific geographic regions. Outbreaks of pleuropneumonia, characterized by sudden respiratory difficulties and high mortality, can occur when infected pigs are brought into naïve herds, or by those carrying different serovars. Good biosecurity measures include regular diagnostic testing for surveillance purposes. Current gold standard diagnostic techniques lack sensitivity (bacterial culture), require expensive thermocycling machinery (PCR) and are time consuming (culture and PCR). Here we describe the development of an isothermal point-of-care diagnostic test - utilizing recombinase polymerase amplification (RPA) for the detection of APP, targeting the species-specific apxIVA gene. Our APP-RPA diagnostic test achieved a sensitivity of 10 copies/µL using a strain of APP serovar 8, which is the most prevalent serovar in the UK. Additionally, our APP-RPA assay achieved a clinical sensitivity and specificity of 84.3% and 100%, respectively, across 61 extracted clinical samples obtained from farms located in England and Portugal. Using a small subset (n = 14) of the lung tissue samples, we achieved a clinical sensitivity and specificity of 76.9% and 100%, respectively) using lung imprints made on FTA cards tested directly in the APP- RPA reaction. Our results demonstrate that our APP-RPA assay enables a suitable rapid and sensitive screening tool for this important veterinary pathogen.

Charcoal production has often been neglected in national or regional plans/studies dealing with the management of forest biomass residuesin Portugal. However, charcoal is one of the oldest biofuels produced in Europe, especially used in metallurgy activities and as cooking fuel, with production sites and methods known for millennia. Likewise, some Portuguese villagesare well known for their historical link with charcoal production, although the current situation of this activity at the national level is poorly known. To promote more efficient charcoal production, basic data regarding the widely used feedstocks, technologies, infrastructure,and main products/by-products were collected through an extensive field monitoring program combined with the analysis of satellite imagery. Our results show that charcoal production in Portugal mainly relies on rudimentary technologies and traditional methods, with rather scarce development in the last decades. The results also show that charcoal production is an important economic activity in the southern part of the country, as evidenced by the number and size of active production sites reported in this work, thus playing a relevant role in the management of certain woody residues and producing considerable amounts of valuable products for well-established markets in Portugal and Europe., Proceedings of the 30th European Biomass Conference and Exhibition, 9-12 May 2022, Online, pp. 980-985

We report the first search for the $K_L \to \pi^0 \gamma$ decay, which is forbidden by Lorentz invariance, using the data from 2016 to 2018 at the J-PARC KOTO experiment. With a single event sensitivity of $(7.1\pm 0.3_{\rm stat.} \pm 1.6_{\rm syst.})\times 10^{-8}$, no candidate event was observed in the signal region. The upper limit on the branching fraction was set to be $1.7\times 10^{-7}$ at the 90\% confidence level.

The rare decay $K_L \!\to\! ��^0 ��\overline��$ was studied with the dataset taken at the J-PARC KOTO experiment in 2016, 2017, and 2018. With a single event sensitivity of $( 7.20 \pm 0.05_{\rm stat} \pm 0.66_{\rm syst} ) \times 10^{-10}$, three candidate events were observed in the signal region. After unveiling them, contaminations from $K^{\pm}$ and scattered $K_L$ decays were studied, and the total number of background events was estimated to be $1.22 \pm 0.26$. We conclude that the number of observed events is statistically consistent with the background expectation. For this dataset, we set an upper limit of $4.9 \times 10^{-9}$ on the branching fraction of $K_L \!\to\! ��^0 ��\overline��$ at the 90% confidence level., 6 pages, 5 figures; published version, no change in the results. Fig. 2 and Fig. 4 were revised. In Fig. 5, the plot of the $P_{t}$ versus ${Z_{\mathrm{vtx}}}$ of the beam-halo $K_L\!\to\!2\gamma$ background events was added as Fig. 5 (b)

We report the first search for the $K_L \to ��^0 ��$ decay, which is forbidden by Lorentz invariance, using the data from 2016 to 2018 at the J-PARC KOTO experiment. With a single event sensitivity of $(7.1\pm 0.3_{\rm stat.} \pm 1.6_{\rm syst.})\times 10^{-8}$, no candidate event was observed in the signal region. The upper limit on the branching fraction was set to be $1.7\times 10^{-7}$ at the 90\% confidence level.

Financial auditing focuses on obtaining and assessing evidence, based on certain assertions. It is based on the scrutiny of companies' data, with the objective of obtaining appropriate and sufficient evidence that provides a reasonable degree of certainty that the financial statements are free from fraud and / or material errors, subsequently communicating the results to the stakeholders. However, the growing dimension and complexity of organizations, well represented by the volume of data they currently generate and store, have greatly increased the requirements for the auditor's work, which must be effective and efficient. Classic audit procedures, which are highly dependent on sampling and manual procedures, have proved to be insufficient. Due to the massive amount of data, the emergence of new technologies and computer tools at a frenetic level, auditing is now being rethought, with the debate extending from professional organizations to academics. This article brings together the gaps and shortcomings recently revealed in the thought of the so-called traditional audit, and the challenges it faces today. It presents the new technologies, specifically Robotic Process Automation and Artificial Intelligence, as already having expression in today's audit, and which, in a future vision, are enhanced by their combination in Intelligent Process Automation. info:eu-repo/semantics/acceptedVersion

Oak toxicity in cattle results from ingestion of acorns, buds, leaves, sprouts, and saplings from several species of trees in the genus Quercus, all of which contain high concentrations of tannins. Consumption of acorns by ruminants, principally between late summer and early winter, is common in the south of Portugal, where there is a high prevalence of Quercus suber. Oak poisoning can lead to progressive damage to the kidneys and may result in renal failure and death. This study involved 17 beef cows that died of chronic oak poisoning related to ingestion of Quercus suber. The most relevant findings from necropsy examinations were abdominal fluid accumulation, atrophic/fibrotic kidneys, mesenteric and sub-mandibular edema, absence of body fat reserves and muscle atrophy, and weight loss. The most significant histopathologic finding was chronic interstitial nephritis. Elevated blood urea nitrogen, creatinine, and K+ values and reduced albumin values were found in 4 cows examined ante-mortem. Straight-bred Mertolengo cows appeared to be highly resistant to oak toxicity., The Bovine Practitioner, Vol. 53, No. 2 (2019 Summer)

Made available in DSpace on 2019-05-30T02:06:37Z (GMT). No. of bitstreams: 1 tese_12246_Thaís de Souza Nunes.pdf: 869852 bytes, checksum: 38763e6edc780cafda0c1a800f595697 (MD5) Previous issue date: 2019-02-28 Este trabalho teve como objetivo avaliar o desempenho produtivo e a qualidade dos ovos de codornas japonesas em postura, em função de diferentes níveis de extrato pirolenhoso (EPL) e de diferentes aditivos não nutrientes. Dois experimentos com duração de 84 dias, foram conduzidos no setor de avicultura da Universidade Federal do Espírito Santo. No primeiro experimento, foram utilizadas 405 codornas japonesas fêmeas, distribuída em delineamento inteiramente ao acaso em 5 tratamentos (0,0; 0,4; 0,8; 1,2 e 1,6% de EPL), 9 repetições e 9 aves por unidade experimental. No segundo experimento, foram utilizadas 486 codornas japonesas fêmeas, distribuída em delineamento inteiramente ao acaso em 6 tratamentos (ração basal, ração basal + antibiótico (enramicina 8% - 125 g/ tonelada), ração basal + probiótico (protexin -50g/tonelada, composição: Lactobacillus plantarium, Lactobacillus bulgaricus, Lactobacillus acidophilus, Lactobacillus rhamnosus, Bifidobacterium bifidum, Streptococcus thermophilus, Enterococcus faecium), ração basal + prebiótico (Yes golf - 2 Kg/ tonelada, composição: 1,3 e 1,6 β glucanos fosforilados MOS mananoligossacarídeos),FOS(frutooligossacarídeo),GOS(galactooligossacarídeos), ração basal + 1,2% de EPL, ração basal + óleos essências (Essentials - 1,5 Kg/tonelada), composição: óleo de caju, óleo de mamona e veículo), 9 repetições e 9 aves por unidade experimental. As características avaliadas foram consumo de ração, taxa de postura, peso médio do ovo, massa dos ovos, conversão alimentar por massa do ovo e por dúzia de ovos, peso relativo e absoluto da gema, do albúmen e da casca, além da unidade Haugh. Pelos resultados obtidos pode se concluir que o nível de extrato pirolenhoso a 0,833% foi suficiente para melhorar o desempenho e características de qualidade de ovos de codornas japonesas. Os aditivos antibiótico, probiótico, prebiótico e óleos essenciais podem ser substituídos por extrato pirolenhoso ao nível de 1,2%.

WOS: 000481590200024, PubMed ID: 31427717, Rett syndrome (RTT) is a severe neurological disorder usually caused by mutations in the MECP2 gene. Since the MECP2 gene is located on the X chromosome, X chromosome inactivation (XCI) could play a role in the wide range of phenotypic variation of RTT patients; however, classical methylation-based protocols to evaluate XCI could not determine whether the preferentially inactivated X chromosome carried the mutant or the wild-type allele. Therefore, we developed an allele-specific methylation-based assay to evaluate methylation at the loci of several recurrent MECP2 mutations. We analyzed the XCI patterns in the blood of 174 RTT patients, but we did not find a clear correlation between XCI and the clinical presentation. We also compared XCI in blood and brain cortex samples of two patients and found differences between XCI patterns in these tissues. However, RTT mainly being a neurological disease complicates the establishment of a correlation between the XCI in blood and the clinical presentation of the patients. Furthermore, we analyzed MECP2 transcript levels and found differences from the expected levels according to XCI. Many factors other than XCI could affect the RTT phenotype, which in combination could influence the clinical presentation of RTT patients to a greater extent than slight variations in the XCI pattern., Spanish Ministry of Health (Instituto de Salud Carlos III/FEDER) [PI15/01159]; Crowdfunding program PRECIPITA, from the Spanish Ministry of Health (Fundacion Espanola para la Ciencia y la Tecnologia); Catalan Association for Rett Syndrome; Fondobiorett; Mi Princesa Rett, We thank all patients and their families who contributed to this study. The work was supported by grants from the Spanish Ministry of Health (Instituto de Salud Carlos III/FEDER, PI15/01159); Crowdfunding program PRECIPITA, from the Spanish Ministry of Health (Fundacion Espanola para la Ciencia y la Tecnologia); the Catalan Association for Rett Syndrome; Fondobiorett and Mi Princesa Rett.

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No abstract available.

International audience

In a longitudinal study, we looked at the link between children's understanding of a morphemically-based orthographic rule and their awareness of morphemic distinctions. The orthographic rule in question was the use of the apostrophe to denote possession in English. Early on in the study, we gave the children phonological, semantic/syntactic and morpho-syntactic awareness tasks, and later we gave them a spelling task in which they had to write words which were either genitives (e.g., 'boy's') or nominative or accusative plurals (e.g., 'boys'). Eight- to 10-year-old children found this task difficult, but their performance improved to some extent with age. The morpho-syntactic, but not the phonological or semantic/syntactic, awareness tasks predicted how well the children placed apostrophes in genitive words and omitted them from plural words. We conclude that different forms of linguistic awareness affect different aspects of reading and spelling. Learning about spelling patterns based on morphemes is heavily influenced by children's morpho-syntactic awareness but not, apparently, by other forms of linguistic awareness. © 2000 Kluwer Academic Publishers.

This study assessed the effects of contextual factors embedded in stories on children's conception of the fair allocation of resources. Previous studies on children's concept of distributive justice led to the conclusion that preschool children use only the equality rule to allocate resources among recipients and are unable to use the equity rule to reward effort or task performance. We hypothesised that children's allocation decisions can include an equity rule, depending on the context of resource allocation. Five-year-olds' allocation decisions varied with contextual factors, supporting the view that cognitive development takes place in context. They used the equity rule more in the family context and preferred the equality rule in the school context. Implications for classroom practice are discussed.

In the previous chapter, we saw that teaching children about morphemes has a strong and positive effect on their ability to analyze words into morphemes and to spell their suffixes. This seems to apply not only when children are taught on a one-to-one basis or in small groups but also when the teaching is delivered to the whole class. However, in the studies we have discussed so far, the teaching was always delivered by researchers, unaffected by the daily pressures of school life, or by teachers working in close connection with researchers. In this and in the following chapter we will describe a project that assessed how our ideas work when used by teachers in real-life classroom settings and as part of their normal teaching. This chapter concentrates on the effects that the teaching program had on the children's ability to spell.

We all know that words have meanings, but not everyone understands that the meaning of any word depends on its underlying structure. Words consist of morphemes, which are units of meaning. These morphemes, in our view, are of immense importance in children's learning of the meaning of new words and also in their learning how to read and write familiar and novel words. The aim of our book is to show how important morphemes can be in children's education and how easy it is to enhance their knowledge about morphemes and thus to increase the richness of their vocabulary and the fluency of their reading and writing.

With reports from several studies showing the benefits of teaching young children about morphemes, this book is essential reading for anyone concerned with helping children to read and write. By breaking words down into chunks of meaning that can be analyzed as complete units rather than as strings of individual letters, children are better able to make sense of the often contradictory spelling and reading rules of English. As a result, their enjoyment of learning about words increases, and their literacy skills improve. Written by leading researchers for trainee teachers, practising teachers and interested parents, this highly accessible and innovative book provides sound, evidence-based advice and materials that can be used to help teach children about morphemes, and highlights the beneficial effects of this approach.

This book offers a theory for the analysis of how children learn and are taught about whole numbers. Two meanings of numbers are distinguished – the analytical meaning, defined by the number system, and the representational meaning, identified by the use of numbers as conventional signs that stand for quantities. This framework makes it possible to compare different approaches to making numbers meaningful in the classroom and contrast the outcomes of these diverse aspects of teaching. The book identifies themes and trends in empirical research on the teaching and learning of whole numbers since the launch of the major journals in mathematics education research in the 1970s. It documents a shift in focus in the teaching of arithmetic from research about teaching written algorithms to teaching arithmetic in ways that result in flexible approaches to calculation. The analysis of studies on quantitative reasoning reveals classifications of problem types that are related to different cognitive demands and rates of success in both additive and multiplicative reasoning. Three different approaches to quantitative reasoning education illustrate current thinking on teaching problem solving: teaching reasoning before arithmetic, schema-based instruction, and the use of pre-designed diagrams. The book also includes a summary of contemporary approaches to the description of the knowledge of numbers and arithmetic that teachers need to be effective teachers of these aspects of mathematics in primary school. The concluding section includes a brief summary of the major themes addressed and the challenges for the future. The new theoretical framework presented offers researchers in mathematics education novel insights into the differences between empirical studies in this domain. At the same time the description of the two meanings of numbers helps teachers distinguish between the different aims of teaching about numbers supported by diverse methods used in primary school. The framework is a valuable tool for comparing the different methods and identifying the various assumptions about teaching and learning.

Assessment is essential for designing individualized educational plans (IEPs) for children. In order to contribute effectively to this process, assessments must be appropriate for the group, show neither floor nor ceiling effects, and help teachers formulate specific aims. Different attempts to develop such assessments for the writing of deaf primary school children have shown floor effects. This paper reports the validation of an analytic instrument aimed at assessing deaf primary school children's writing and at contributing to the design of IEPs. Participants (N = 167) were deaf children in the age range 6y6m to 13y11m, who were attending special schools or mainstream schools with units for the deaf; orally educated deaf children fully integrated in mainstream schools were not included. The writing samples were elicited by means of a story picture sequence. The dimensions of analysis included 16 items related to aspects of grammar and story development. A single and reliable scale was formed by these items, generating one score with a normal distribution. High inter-judge reliability, high test-retest correlation and a high correlation with reading comprehension were observed. We conclude that the assessment is a useful, reliable and valid instrument for analysis of deaf children's writing. Copyright © 2008 John Wiley and Sons, Ltd.

Archaea are widespread and abundant in many terrestrial and aquatic environments, and are thus outside extreme environments, accounting for up to ~10% of the prokaryotes. Compared to bacteria and other microorganisms, however, very little is known about the abundance, diversity, and dispersal of archaea in the atmosphere. By means of DNA analysis and Sanger sequencing targeting the 16S rRNA (435 sequences) and amoA genes in samples of air particulate matter collected over 1 year at a continental sampling site in Germany, we obtained first insights into the seasonal dynamics of airborne archaea. The detected archaea were identified as Thaumarchaeota or Euryarchaeota, with soil Thaumarchaeota (group I.1b) being present in all samples. The normalized species richness of Thaumarchaeota correlated positively with relative humidity and negatively with temperature. This together with an increase in bare agricultural soil surfaces may explain the diversity peaks observed in fall and winter. The detected Euryarchaeota were mainly predicted methanogens with a low relative frequency of occurrence. A slight increase in their frequency during spring may be linked to fertilization processes in the surrounding agricultural fields. Comparison with samples from the Cape Verde islands (72 sequences) and from other coastal and continental sites indicates that the proportions of Euryarchaeota are enhanced in coastal air, which is consistent with their suggested abundance in marine surface waters. We conclude that air transport may play an important role in the dispersal of archaea, including assumed ammonia-oxidizing Thaumarchaeota and methanogens.

Interest in renewable energies has increased in recent years due to environmental concerns about global warming and air pollution, reduced costs and improved efficiency of technologies. Under the EU energy directive, biomass is an eligible source of renewable energy. Among others, the technology of fluidized bed combustion represents an important asset in many industrial processes because it presents several advantages. The aim of this study was to experimentally quantify and characterize the emissions of particulate matter (PM2.5) resulting from combustion in a pilot-scale bubbling fluidized bed combustor with variations in fuel (pine and eucalyptus chips), and operational conditions. The variables evaluated were the stoichiometry used and, in the case of the eucalyptus, the leaching of the fuel. The CO and PM2.5 emission factors were lower when the stoichiometry used in the experiment was higher. The treatment of the fuel before its combustion has showed to be an effective way to reduce the CO emissions. However, the PM2.5 emissions were higher when the leachate eucalyptus was used. The particulate mass was composed mainly of inorganic matter. Organic and elemental carbon represented 3.7 to 29.8% (w/w) and the carbonate (CO32-) represented between 2.3 and 8.5% (w/w) of the particles mass., Proceedings of the 22nd European Biomass Conference and Exhibition, 23-26 June 2014, Hamburg, Germany, pp. 765-776

This study aims at analyzing the comprehension of additive composition of number by deaf children. This article describes two studies that use the Purchasing Task from Nunes and Schliemann (1990) to investigate the perception of additive composition by children in the context of counting money. In the first study, we compared the comprehension of the concept by deaf children and hearing children of the same age. In the second study, we carried out a brief intervention to evaluate the possibility of enhancing deaf children's apprehension of the concept. We concluded that the interventions, even brief ones, but theoretically meaningful and clearly directed, can be used to improve the performance of deaf children in tasks that evaluate additive composition.

IBD is a chronic and relapsing inflammatory disorder of the gut that demands long-lasting treatment targeting both flare-up periods and maintenance of remission. Oral systemic steroids have been used to induce remission in patients with active IBD for over 50 years due to their potent anti-inflammatory effects. The efficacy of systemic steroids in this setting has been largely demonstrated. However, the wide range of adverse events associated with these drugs has prompted the development of equally effective but less toxic steroid compounds. Currently, topically acting oral steroids are an important therapeutic option for Crohn's disease, ulcerative colitis and microscopic colitis, being oral budesonide and oral beclomethasone established elements of the IBD armamentarium. At present, oral budesonide is the first-line therapy to induce remission in microscopic colitis and mild to moderate ileocaecal CD patients and oral beclomethasone is effective treating mild to moderate UC patients with left-sided or extensive disease. This review aims at evaluating the current role of these compounds in IBD clinical practice.

Background. Two distinct abilities, mathematical reasoning and arithmetic skill, might make separate and specific contributions to mathematical achievement. However, there is little evidence to inform theory and educational practice on this matter. Aims. The aims of this study were (1) to assess whether mathematical reasoning and arithmetic make independent contributions to the longitudinal prediction of mathematical achievement over 5 years and (2) to test the specificity of this prediction. Sample. Data from Avon Longitudinal Study of Parents and Children (ALSPAC) were available on 2,579 participants for analyses of KS2 achievement and on 1,680 for the analyses of KS3 achievement. Method. Hierarchical regression analyses were used to assess the independence and specificity of the contribution of mathematical reasoning and arithmetic skill to the prediction of achievement in KS2 and KS3 mathematics, science, and English. Age, intelligence, and working memory (WM) were controls in these analyses. Results. Mathematical reasoning and arithmetic did make independent contributions to the prediction of mathematical achievement; mathematical reasoning was by far the stronger predictor of the two. These predictions were specific in so far as these measures were more strongly related to mathematics than to science or English. Intelligence and WM were non-specific predictors; intelligence contributed more to the prediction of science than of maths, and WM predicted maths and English equally well. Conclusions. There is clear justification for making a distinction between mathematical reasoning and arithmetic skills. The implication is that schools must plan explicitly to improve mathematical reasoning as well as arithmetic skills. © 2011 The British Psychological Society.

No abstract available.

Made available in DSpace on 2016-08-29T14:10:10Z (GMT). No. of bitstreams: 1 tese_3552_.pdf: 812077 bytes, checksum: 65ce72f3fc0ae86bd7990f7cc11cc0a3 (MD5) Previous issue date: 2010-08-27 O presente trabalho teve como objetivo descrever comportamentos profissionais e habilidades sociais dos agentes de saúde em cenas da prática cultural do Programa Municipal de Combate ao Dengue do município de Governador Valadares/MG (PMCD/GV). O método utilizado foi de pesquisa descritiva, documental, com abordagem quantitativa e qualitativa. Três fontes de dados foram examinadas: (1) documentos gerados pela ação do PMCD/GV; (2) respostas de 112 agentes de saúde aos instrumentos Questionário Profissional (QP) e Inventário de Habilidades Sociais (IHS); (3) observação do comportamento profissional de 20 agentes de saúde em campo. A primeira fonte de dados possibilitou descrever os aspectos históricos e comportamentais da prática cultural de controle ao dengue em GV durante os anos de 2000 a 2009. Embora várias estratégias tenham sido estabelecidas para o controle, prevenção e tentativa de erradicação do vetor Aedes aegypti na cidade, verificou-se, ao longo do período investigado, significativa variabilidade nos índices de infestação do mosquito e, conseqüentemente, a ocorrência de três epidemias da doença. Logo, observou-se que as metacontingências estabelecidas na prática cultural denominada PMCD/GV não alteraram o produto agregado gerado pela macrocontingência. Já a segunda fonte de dados permitiu avaliar o repertório de habilidades sociais, pessoal e profissional dos agentes de saúde. Os resultados levantados mostraram que a maioria dos participantes é do sexo masculino, jovens, possuem nível de instrução escolar médio, são inseridos no PMCD por indicação política e possuem níveis de habilidades sociais com resultados dentro da média e acima da média. Por fim, a terceira fonte de dados registrou a freqüência dos indicadores de habilidades técnicas e sociais no repertório profissional dos agentes de saúde emitidos durante a visita de inspeção residencial. Observou-se que os participantes emitem com maior freqüência comportamentos que demandam competências técnicas, como por exemplo, a verificação da existência de criadouros do Aedes aegypti, do que competências sociais, como por exemplo, a realização de uma instrução educativa ao residente. Conclui-se que, para que haja uma funcionalidade nos trabalhos dos agentes de saúde atuantes no controle do dengue e um melhor resultado da prática cultural da PMCD/GV, faz-se necessário o estabelecimento de modificações nas políticas de Saúde Coletiva, com um planejamento antecipado baseado nas práticas anteriores que deram certo e errado para que a partir delas possa ser feito um mapeamento do que será efetivo ou não no futuro. Enfatiza-se a importância da educação em saúde ser mais operacionalizada nos termos da Análise do Comportamento, especificamente no como se pode fazer a modificação do comportamento de uma coletividade, pois ela a educação em saúde é um dos objetivos de qualquer metacontingência que define uma política pública em Saúde Coletiva. Isto implicará numa alteração em dois momentos da prática cultural aqui focalizada o PMCD/GV-MG. O primeiro momento é o da capacitação deste profissional para um trabalho eficaz de educação em saúde, quando se arranjará contingências para a aquisição de competências interpessoais (necessárias a sua interação com a população residente) e de modificação do comportamento (que deverão ser parte essencial da necessária competência técnica enfatizada pela política atual). O segundo momento é o produto do primeiro: a interação eficaz do agente de saúde com os residentes na comunidade. Palavras-chaves: Metacontingência. Macrocontingência.

Introducción: Los ACV, son considerados un suceso raro en la infancia, con fisiopatología, evolución y tratamiento aún discutidos. Pueden ser hemorrágicos o isquémicos. El brusco comienzo de una hemiplejía aguda, frecuentemente acompañado de convulsiones y alteración de la conciencia, en un niño previamente sano es orientador de ACV. La incidencia es de 2,5 a 4,5/100000 al año. Objetivo: Presentar las características de los ACV en la población infantil del HC-IPS de julio 2004 a julio 2006. Materiales y Métodos: Es un estudio retrospectivo con revisión de historias clínicas de pacientes con diagnóstico de ACV ingresados a sala de neuropediatría en el periodo de estudio. Se analizaron 13 eventos de ACV. Resultados: se registraron 10 pacientes con diagnóstico de ACV, y un total de 13 episodios, en 3 pacientes se presentaron 2 eventos tras un periodo de silencio. La distribución por grupo etario: preescolares 20% (2), escolares 50% (5), adolescentes 30%(3), según sexo: femenino 5(50%), y masculino 5(50%). Síntomas: cefalea 92% (12/13), paresias/plejia 69% (9/13), afasia de expresión 23% (3/13), pérdida de conocimiento 30% (4/13) convulsión 7% (1/13), la presentación brusca del cuadro se presentó en el 53% y el 47% fue insidioso, requirieron ingreso a UTIP 53% (7/13) de los eventos; 4/7 por hipertensión endocraneana y 3/7 por otras complicaciones. Tipo de ACV: hemorrágico 77% e isquémico 23%; de las 3 recidivas, 2 fueron hemorrágicos, y 1 isquémico. Territorio comprometido: carotídeo en el 100%; subcorticales 69%, subcorticales y corticales 23% y 1 hemorragia intraventricular. Evolución: sin secuela 38%, secuela de distinto grado 38% y fallecidos 23%, de este grupo 2 fueron ACV recidivante y 1 muy grave por la extensión del sangrado. Causas: malformaciones arteriovenosa (MAV) 23%, vasculitis 23%, Moya Moya 7%, afribinogenemia 7%, disección carotídea 7% y etiología no identificada 31%. Tratamiento: en todos los casos se aplicaron medidas generales según protocolo de ACV, se agregaron anticoagulantes en 2 casos y embolectomía en 1 caso (MAV). Conclusión: Los ACV hemorrágicos fueron las formas más frecuentes en esta casuística. El territorio vascular comprometido en todos los casos correspondió al carotídeo. Se registró una paridad entre los pacientes con secuelas y sin secuelas al alta, y la muerte se correlacionó con ACV muy graves y recidivantes. Introduction: CVA are considered to be rare in children, and their pathophysiology, progression, and treatment is still being analyzed. CVA can be hemorrhagic or ischemic. The sudden onset of acute hemiplegia, frequently accompanied by seizures and altered level of consciousness in a previously healthy child are indicative of CVA. The incidence is from 2.5 to 4.5 per 100,000 annually. Objective: To present the characteristics of CVA in the population of children at the central IPS hospital from July 2004 to July 2006. Materials and Methods: We conducted a retrospective study using review of patient records diagnosed with CVA and admitted to the pediatric neurology section during the study period. We analyzed 13 CVA events. Results: A total of 10 patients who experienced 13 episodes of CVA were recorded; in 3 patients 2 events occurred after a latent period. By age group, distribution was preschool age children 20% (n: 2), school-age children 50% (n: 5), adolescents 30% (n: 3). By gender, distribution was female 5 (50%), and male 5 (50%). Symptoms: headache 92% (12/13), paresis/-plegias 69% (9/13), Broca’s aphasia 23% (3/13), unconsciousness 30% (4/13), seizures 7% (1/13). Sudden onset of symptoms occurred in 53%, while presentation was insidious in 47%. Hospitalization in the pediatric ICU was required in 53% (7/13) of events, in 4/7 for intracranial hypertension and 3/7 due to other complications. Type of CVA: hemorrhagic 77%, ischemic 23%. Of the 3 recurrent cases, 2 were hemorrhagic and 1 ischemic. Areas affected: carotid in 100%; subcortical in 69%; subcortical and cortical in 23%; and 1 intraventricular hemorrhage. Progression: no sequelae were reported in 38%, various degrees of sequelae in 38%, and death in 23%: of the deaths, 2 were from recurrent CVA and one was critical due to extensive bleeding. Causes: arteriovenous malformation (AVM) 23%, vasculitis 23%, Moyamoya disease 7%, afibrinogenemia 7%, carotid dissection 7%, and unidentified etiology 31%. Treatment: general measures in accord with CVA protocols were applied in all cases, while anticoagulants were used in 2 cases and embolectomy was done in 1 case of AVM. Conclusion: Hemorrhagic CVA was the most common form in our study. The vascular area involved in all cases was the carotid. There were equal numbers of patients with and without sequelae at discharge, and the deaths were associated with cases of CVA that were very serious and recurrent.

We have now described, in Chapters 3 and 4, how our ideas about teaching morphemes fared when we took the path to the classroom and asked schoolteachers to use our methods with whole classes of children. In this chapter we shall describe what happened when we took the same path with our idea that teaching children about morphemes should help them to learn new words as well. We had three reasons for investigating whether teaching children about morphemes has a positive effect on their vocabulary growth. The first is that various theories (see Chapter 1) suggest that growth in vocabulary is a possible outcome of enhancing children's awareness of morphemes. Morphemes are units of meaning, and most of the words that children learn from the middle of primary school on are polymorphemic words. So, if children have a way of analyzing these words, they might find them easier to learn. The second reason is that vocabulary is an important part of literacy learning: Children's text comprehension is highly related to the size of their vocabulary. The third reason is also important: Research on how to teach children about vocabulary has dealt predominantly with the question of how to teach specific new words. This research focuses mainly on how many repetitions are required and whether it is best to get the children to encounter new words in a text or in isolation, to provide them with definitions or with different sentences in which the meaning and use of the word is illustrated. Our own idea is different to this. We argue that teaching children word-attack strategies based on morphemes should help them to analyze new words in order to understand their meaning. We carried out the next study to test this idea.