No contexto da Nova Gestão Pública, encontram-se os servidores públicos como agentes centrais na consecução dos objetivos da organização pública e na oferta de bens e serviços à sociedade. Portanto, ...as entidades públicas se defrontam com o desafio de potencializar e gerenciar seus colaboradores de forma estratégica. A fim de explorar as competências que agregam valor, o gerenciamento do desempenho individual contribuirá para o desempenho organizacional. Considerando que a gestão de Recursos Humanos envolve, entre outras funções, o desenvolvimento de Sistemas para avaliar o desempenho dos servidores, fazer uso dos insights da área de Avaliação de Desempenho Organizacional pode contribuir para o sucesso dessa função. Assim, o presente artigo tem por objetivo investigar as pesquisas científicas, em língua inglesa, sobre Avaliação de Desempenho do Servidor Público, salientando as lacunas e oportunidades de pesquisa com base nos resultados das análises bibliométrica e sistêmica. Para alcançar tal objetivo, adotou-se o ProKnow-C como instrumento de intervenção. Com base nesse instrumento, selecionaram-se 23 artigos entre 2000 e 2017, os quais foram analisados pela afiliação teórica de Ensslin et al. (2010), focando exclusivamente nas Lentes da Abordagem, Singularidade e Identificação dos Objetivos. Constatou-se a necessidade de (i) explorar a área de gestão de pessoas no setor público; (ii) desenvolver modelos nas entidades públicas sob o viés Construtivista; e (iii) ampliar a rede de colaboração e estudos de caso que demonstrem a aplicação de modelos da Avaliação de Desempenho.
Originality / Relevance: In the current literature on distance training, there is a gap in the process to evaluate an evasion in these courses and, consequently, to aid the decision-making process of ...its managers and planners. Metodologia/Abordagem: Adotou-se a metodologia Multicriterio de Apoio a Decisao-Construtivista (MCDA-C) para subsidiar a construcao do modelo com base na perspectiva dos decisores (Diretora da Escola e Administrador da SEA). Para a selecao do aporte teorico, utilizou-se o Knowledge Development Process-Constructivist (ProKnow-C). Os pesquisadores adotaram uma abordagem epistemologica Construtivista. Metodologia / Enfoque: Se adopto la metodologia Multicriterio de Apoyo a la Decision-Constructivista (MCDA-C) para subsidiar la construccion del modelo con base en la perspectiva de los decisores (Directora de la Escuela y Administrador de la SEA). Para la seleccion del aporte teorico, se utilizo el Knowledge Development Process-Constructivist (ProKnow-C). Los investigadores adoptaron un enfoque epistemologico constructivista.
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CEKLJ, IZUM, KILJ, NUK, PILJ, SAZU, UL, UM, UPUK
Abstract
In order to develop appropriate combined immuno/chemotherapeutic interventions to treat Mtb infection, it is important to understand the interaction between the host immune response and ...antibiotic therapy of this pathogen. We and others have observed that CD4 T+ cell responses to Mtb decline after conventional chemotherapy. In an attempt to sustain CD4+ T cell responsiveness during antibiotic treatment, we repeatedly immunized mice with the immunodominant peptides (ESAT-64-17 or Ag85B280-294) from the major Mtb antigens ESAT-6 and Ag85B beginning at the start of drug treatment 28days post aerosol infection. When bacillary loads were assayed after 4 weeks of treatment, we found that peptide administration failed to enhance the bacterial clearance observed with chemotherapy alone. Similarly, weekly adoptive transfer of in vitro differentiated Th1 cells specific for ESAT-6 (C7) or Ag85B (P25) during antibiotic treatment failed to improve bacterial clearance despite the successful migration and proliferation of these cells in the lung parenchyma. These findings suggest that therapeutic vaccination by boosting CD4+ T cell responses during the initial phase of Mtb chemotherapy is unlikely to improve the efficacy of treatment. Nevertheless, additional experiments have suggested a major role for endogenous T lymphocytes in drug-mediated control of Mtb infection. Thus, we have observed that antibiotic treatment is ineffective in T cell deficient (TCRα−/−) mice that have received higher dose infections. We are currently evaluating the nature of this T cell requirement and whether it can be targeted to improve the outcome of Mtb therapy.
This work was supported by the intramural research program of the NIAID.
There is scarce information regarding clinical evolution of HBV infection in renal transplant patients.
To evaluate the prevalence of acute exacerbation in HBV-infected renal transplant patients and ...its association with the time after transplantation, presence of viral replication, clinical evolution, and use of antiviral prophylaxis.
HBV infected renal transplant patients who underwent regular follow-up visits at 6-month intervals were included in the study. The criteria adopted to characterize exacerbation were: ALT >5× ULN and/or >3× baseline level. Predictive factors of exacerbation evaluated were age, gender, time on dialysis, type of donor, post-transplant time, ALT, HBeAg, HBV-DNA, HCV-RNA, immunosuppressive therapy, and use of antiviral prophylaxis.
140 HBV-infected renal transplant patients were included (71% males; age 46±10 years; post-renal transplant time 8±5 years). During follow-up, 25% (35/140) of the patients presented exacerbation within 3.4±3 years after renal transplant. Viral replication was observed in all patients with exacerbation. Clinical and/or laboratory signs of hepatic insufficiency were present in 17% (6/35) of the patients. Three patients died as a consequence of liver failure. In univariate analysis variables associated with exacerbation were less frequent use of prophylactic/preemptive lamivudine and of mycophenolate mofetil. Lamivudine use was the only variable independently associated with exacerbation, with a protective effect.
Acute exacerbation was a frequent and severe event in HBV-infected renal transplant patients. Prophylactic/preemptive therapy with antiviral drugs should be indicated for all HBsAg-positive renal transplant patients.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
The aim of the present study was to perform a systematic review of the literature on the effects of low-level laser therapy in the treatment of TMD, and to analyze the use of different assessment ...tools. Subjects and Methods Searches were carried out of the BIREME, MEDLINE, PubMed and SciELO electronic databases by two independent researchers for papers published in English and Portuguese using the terms: “temporomandibular joint laser therapy” and “TMJ laser treatment”. Results Following the application of the eligibility criteria, 11 papers were selected for in-depth analysis. The papers analyzed exhibited considerable methodological differences, especially with regard to the number of sessions, anatomic site and duration of low-level laser therapy irradiation, as well as irradiation parameters, diagnostic criteria and assessment tools. Conclusion Further studies are needed, especially randomized clinical trials, to establish the exact dose and ideal parameters for low-level laser therapy and define the best assessment tools in this promising field of research that may benefit individuals with signs and symptoms of TMD.
Abstract
Aims
Chest pain is a major cause of medical evaluation at emergency department (ED) and demands observation to exclude the diagnosis of acute myocardial infarction (AMI). High-sensitivity ...cardiac troponin assays used as isolated measure and by 0- and 1-h algorithms are accepted as a rule-in/rule-out strategy, but there is a lack of validation in specific populations.
Methods and results
The IN-HOspital Program to systematizE Chest Pain Protocol (IN-HOPE study) is a multicentre study that prospectively included patients admitted to the ED due to suspected symptoms of AMI at 16 sites in Brazil. Medical decisions of all patients followed the standard approach of 0 h/3 h protocol, but, in addition, blood samples were also collected at 0 and 1 h and sent to a central laboratory (core lab) to measure high-sensitivity cardiac troponin T (hs-cTnT). To assess the theoretical performance of 0 h/1 h algorithm, troponin < 12 ng/L with a delta < 3 was considered rule-out while a value ≥ 52 or a delta ≥ 5 was considered a rule-in criterion (the remaining were considered as observation group). The main objective of the study was to assess, in a population managed by the 0 h/3 h protocol, the accuracy of 0 h/1 h algorithm overall and in groups with a higher probability of AMI. All patients were followed up for 30 days, and potential events were adjudicated. In addition to the prospective cohort, a retrospective analysis was performed assessing all patients with hs-cTnT measured during the year of 2021 but not included in the prospective cohort, regardless of the indication of the test. A total of 5.497 patients were included (583 in the prospective and 4.914 in the retrospective analysis). The prospective cohort had a mean age of 57.3 (± 14.8) and 45.6% of females with a mean HEART score of 4.0 ± 2.2. By the core lab analysis, 74.4% would be eligible for a rule-out approach (45.3% of them with a HEART score > 3) while 7.3% would fit the rule-in criteria. In this rule-out group, the negative predictive value for index AMI was 100% (99.1–100) overall and regardless of clinical scores. At 30 days, no death or AMI occurred in the rule-out group of both 0/1 and 0/3 h algorithms while 52.4% of the patients in the rule-in group (0 h/1 h) were considered as AMI by adjudication. In the observation group (grey zone) of 0 h/1 h algorithm, GRACE discriminated the risk of these patients better than HEART score. In the retrospective analysis, 1.091 patients had a troponin value of <5 ng/L and there were no cardiovascular deaths at 30 days in this group. Among all 4.914 patients, the 30-day risk of AMI or cardiovascular death increased according to the level of troponin: 0% in the group < 5 ng/L, 0.6% between 5 and 14 ng/L, 2.2% between 14 and 42 ng/L, 6.3% between 42 and 90 ng/L, and 7.7% in the level ≥ 90 ng/L.
Conclusion
In this large multicentre study, a 0 h/1 h algorithm had the potential to classify as rule-in or rule-out in almost 80% of the patients. The rule-out protocol had high negative predictive value regardless of clinical risk scores. Categories of levels of hs-cTn T also showed good accuracy in discriminating risk of the patients with a very favourable prognosis for cardiovascular death in the group with value < 5 ng/L.
ClinicalTrials.gov
NCT04756362
Graphical Abstract
Graphical Abstract
Objective: The objective of this review article is to analyze the efficacy and safety of non-surgical electromagnetic and thermal therapies in managing chronic lower back pain. The review will ...focus on modalities such as short-wave therapy, therapeutic ultrasound, and diathermy, assessing their clinical outcomes and practical implications in treating this prevalent condition. Theoretical Framework: Electromagnetic and thermal therapies represent non-invasive alternatives for treating chronic lower back pain. Diathermy, using electric currents, generates heat that improves circulation and reduces muscle stiffness. Therapeutic ultrasound and short-wave therapy penetrate deep tissues, increasing blood flow and stimulating healing. These modalities are promising options for patients who avoid surgery, reducing pain and enhancing functionality without significant risks. Method: A systematic review was conducted by consulting major scientific databases to identify studies on non-surgical electromagnetic and thermal therapies applied to the treatment of chronic lower back pain. Using specific keywords, recent articles exploring these techniques were collected. This analysis allowed for the consolidation of information on the efficacy of these therapies and highlighted areas needing further investigation, reinforcing evidence-based clinical practice. Results and Discussion: The systematic review shows that non-surgical electromagnetic and thermal therapies are effective in relieving chronic lower back pain, with studies highlighting improvements in pain and functionality. However, variability in treatment protocols underscores the need for standardization to enhance comparability and replicability of results. Further research is essential to elucidate underlying mechanisms and improve clinical practices.
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CEKLJ, NUK, ODKLJ, UL, UM, UPUK
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