La Rabida Children's Hospital

Brazil is in fact a powerhouse in the manufacture of beers, producing around 15 billion liters per year, a number only surpassed by China and the United States. In addition to the giants in the sector, more than six hundred breweries are registered in Brazil. In 2017 alone, 91 new brewing establishment registrations were granted. With regard to the Rio de Janeiro economy, the phenomenon is similar, with a 900% growth in the number of brewers in the state of Rio de Janeiro. Thus, in recent years, we have seen significant changes in beer production and consumption in the Brazilian and Rio de Janeiro realities. The creation of AmBev has created a giant international company, as well as the significant growth of small artisinal breweries dedicated to the manufacture of a more sophisticated beer for a specific public. In this scenario, the Rota Turística e Cervejeira do Rio de Janeiro (Touristic and Beer Route of Rio de Janeiro) is formed, located in the Serrana Fluminense region and which brings together large and small producers of the drink, more than 60 styles of beer and offers packages that include attractions such as "beer experiences" in the large and microbreweries, visits to tourist attractions in the cities, harmonized tastings in local restaurants. The central objective of this chapter is to understand the productive, urban and touristic changes of this emerging economic-spatial structure from the analysis of the Touristic and Beer Route of Rio de Janeiro, from the Economic Geography and with the scope to analyze the central contents of this new phenomenon economic-tourism.

In the past 20 years, many advances (e.g., maternal steroids and surfactant) have changed the course of neonatal medicine. As a result, extremely preterm infants survive medical complications that were previously fatal. Once they are discharged from the neonatal intensive care unit, preterm infants may continue to experience a spectrum of medical and developmental challenges, and their families are faced with the potentially daunting task of nurturing a vulnerable child. Families may be referred to multiple systems of care, including primary care physicians, pediatric subspecialists, and early intervention services. The ultimate goal for preterm infants is to optimize their motor, communicative, social-emotional, and adaptive development as well as to promote their learning at home, at school, and in the community. As children transition to school, key indicators of their functional status include the amount of developmental, educational, habilitative, and behavioral supports they require to participate in learning activities with their peers. Success may be measured by whether preterm infants are ready for large-group learning with peers and the extent of supports required to make this important transition. The purpose of this review is to describe what is known about certain indicators of school readiness in preterm infants, including neurodevelopmental impairments, social-emotional skills, and social factors. We conclude with guidelines for using this transition as an important indicator of developmental trajectories that may help us to better understand risk and resilience in this vulnerable population of children.

In this communication we discuss preliminary evidence suggesting a very strong synergism between tumour necrosis factor (TNF) and lipopolysaccharide (LPS) or between TNF and other bacteria in causing haemorrhagic necrosis and lethal shock. We found that TNF by itself does not cause haemorrhagic necrosis when injected into normal skin. TNF also had a rather low systemic toxicity when injected into disease-free, germfree-derived, defined-flora animals. On the other hand the addition of small amounts of LPS markedly raised the lethality of intravenous TNF treatments, and LPS injected into normal skin 'prepared' the site of injection for subsequent induction of haemorrhagic necrosis by locally injected TNF. Similar synergism was observed between TNF and mycoplasma. We suggest that the synergism between TNF and bacterial endotoxin (or other bacteria or bacterial products) may be part of an important defence mechanism against infections which is independent of specific immunity mediated by B and T cells. This synergism may be useful in increasing the therapeutic effects of TNF on tumours if the development of systemic toxicity in this treatment can be prevented.

This paper describes the development of a video-based evaluation tool for use in Rett syndrome (RTT). Components include a parent-report checklist, and video filming and coding protocols that contain items on eating, drinking, communication, hand function and movements, personal care and mobility. Ninety-seven of the 169 families who initially agreed to participate returned a videotape within 8 months of the first request. Subjects whose videos were returned had a similar age profile to those who did not provide a video but were more likely to have classical than atypical RTT. Evidence of the content and social validity and inter-rater reliability on 11 videos is provided. Video may provide detailed, objective assessment of function and behaviour in RTT.

The purpose of this article is to explain the use of technology as a tool to aid the school nurse’s decision-making process. This article demonstrates how decision support tools improve school nurses’ decision making regarding client care and nursing practice. Various decision support systems are discussed, examples provided, and the underlying technology explained. A listing of decision support systems and specific applications for school nurses are reviewed.

To evaluate the characteristics of vaso-occlusive episodes, home management of pain and its impact on the daily activities, and a diary as a method of data collection. Forty-six adolescents and 75 children were asked to complete daily diaries during the intervention period of a larger study. Mild pain was recorded 95% of the time; moderate pain, 3%; and severe pain, 1%. The pattern and location of pain varied greatly. Adolescents used more interventions than did children. When pain intensity was mild, 80% of the children/adolescents maintained school, social, and home activities, but decreased play/sport activities. When pain intensity was high, they decreased their participation in all activities. Sickle cell pain episodes are unpredictable and highly variable. Diaries can enhance children's and adolescents' documentation and communication about their pain experiences.