Selection of Top 10 Quality Indicators for Nutrition Therapy

Background: The identification of useful quality indicators for nutrition therapy (QINTs) is of great interest and a challenge. This study attempted to identify the 10 QINTs that best suit the practice of quality control in nutrition therapy (NT) by evaluating the opinion of experts in NT with the use of psychometric techniques and statistical tools. Methods: Thirty-six QINTs available for clinical application in Brazil were assessed in 2 distinct phases. In phase 1, 26 nutrition experts ranked QINTs by scoring 4 attributes (utility, simplicity, objectivity, low cost) to assess each QINT on a 5-point Likert scale. The top 10 QINTs were identified from the 10 best scores obtained, and the reliability of expert opinion for each indicator was assessed by Cronbach's alpha. In phase 2, experts provided feedback regarding the selected top 10 QINTs by answering 2 closed questions. Results: The top 10 QINTs, in descending order, are the frequency of nutrition screening of hospitalized patients, diarrhea, involuntary withdrawal of enteral feeding tubes, feeding tube obstruction, fasting longer than 24 hours, glycemic dysfunction, estimated energy expenditure and protein needs, central venous catheter infection, compliance of NT indication, and frequency of application of subjective global assessment. Opinions were consistent among the interviewed experts. During feedback, 96% of experts were satisfied with the top 10 QINTs, and 100% had considered them in accordance with their previous opinion. Conclusion: The top 10 QINTs were identified according to their usefulness in clinical practice by obtaining adequate agreement and representativeness of opinion of nutrition experts. (Nutr Clin Pract. 2012;27:261-267)

Spatial and temporal patterns in size and maturation of Loligo plei and Loligo sanpaulensis (Cephalopoda: Loliginidae) in southeastern Brazilian waters, between 23 degrees S and 27 degrees S

Patterns of population dynamics of Loligo plei and Loligo sanpaidensis in Southeastern Brazil were investigated with samples obtained from commercial catches and research cruises from 1999 to 2000 and from 2002 to 2003. Size and maturity Structure of the two species varied according to depth and season. Body size decreased with depth for L plei, whereas for L. sanpaidensis size increased with depth LIP to 100 m and decreased again in deeper areas. GSI and incidence of mature animals decreased with depth in both species. L. plei females matured at a larger size in summer, while size at maturity in L. sanpaulensis was greater in autumn. For L. plei, reproductive events Occurred in the late winter and spring, in depths up to 40 m, and during summer in inshore waters. L. sanpaidensis increased reproductive activity ill Summer, winter and spring between depths of 30 and 80 Ill. The presence of high proportions of immature Squid offshore Suggests that juveniles might develop in these areas and, upon maturation, migrate back to inshore waters to spawn, particularly in spring and Summer. However, differences found in aggregation patterns in different depth strata, as well as the seasonal differences found in the size structure of L. plei and L. sanpaidensis, Could ultimately be due to Changes in the water Column related to food availability. Considering that L. plei and L. sanpaidensis are both caught as by-catch by shrimp trawlers throughout file year, we also discuss hypotheses on the life cycle of the species and its implications for fishery management. We recommend measures to protect squid spawning grounds by creating spring and summer protected areas where trawling would be prohibited until 60 m depth, i.e. in the area and time of year when mature individuals concentrate.

Nuclear rainbow in the O-16+(27)AL system: The role of couplings at energies far above the barrier

High precision elastic and inelastic angular distributions have been measured for the O-16 + Al-27 system at a beam energy of 100 MeV. The data analysis confirms a rainbow formation as already predicted by parameter-free Coupled Channel calculations. It also helps to reveal the crucial role of inelastic couplings in the rainbow formation for heavier systems even at energies far above the Coulomb barrier. This feature, well known in atomic/molecular scattering, is experimentally studied for the first time in Nuclear Physics. (C) 2012 Elsevier B.V. All rights reserved.

Interannual variation in commercial oyster (Crassostrea gigas) farming in the sea (Florianopolis, Brazil, 27 degrees 44 ' S; 48 degrees 33 ' W) in relation to temperature, chlorophyll a and associated oceanographic conditions

Aquaculture of filter-feeding bivalve mollusks involves the fruitful conversion of marine particulate organic matter into premium protein of high nutritive value. Culture performance of bivalves is largely dependent on hydrological conditions and directly affected by e. g. temperature and chlorophyll levels. Accordingly, these parameters may be related with seasonality but also with oceanographic features combined with climate events. Yields of Pacific cupped oyster (Crassostrea gigas) reared at commercial procedures in suspended structures (long-lines) in a sheltered bay in Southern Brazil (Santa Catarina State, 27S 43'; 48 W 30') were evaluated in relation to local environmental conditions: sea surface temperature, chlorophyll a concentration, and associate effects of cold fronts events and El Nino and La Nina periods. Outputs from four consecutive commercial crop years were analyzed (2005/06, 2006/07, 2007/08, 2008/09) in terms of oyster survival and development time during the following grow-out phases of the culture cycle: seed to juvenile, juvenile to adult, adult to marketable. Since culture management and genetics were standardized significant differences verified among crop performance could be mostly related to environmental effects. Time series of temperature and chlorophyll a (remote sensing data) from crop periods displayed significant seasonal and interannual variation. As expected, performance during initial grow-out stages (seed to juvenile) was critical for final crop yield. Temperature was the main factor affecting survival in these initial stages with a trend of negative correlation, though not statistically significant. On the other hand, oyster development rate was significantly and positively affected by chlorophyll a concentration. Chlorophyll a values could be increased by upwelled cold nutrient-rich South Atlantic Central Water (SACW, related to predominant Northern winds) though further dependent on occurrence of Southern winds (cold fronts) to assist seawater penetration into the sheltered farming area. Lower salinity nutrient-rich northward drifted waters from La Plata River discharge may also result in chlorophyll a rise in the farming area. The El Nino period (July 2006 to February 2007) coincided with lower chlorophyll a levels in the farming site that may be related to both decreased number of cold fronts as well as predominance of Northern winds that retain northward spreading of La Plata River discharge waters. In contrast, the La Nina period (August 2007 to June 2008) corresponded to higher chlorophyll a values in the farming area by both upwelling of SACW and penetration of La Plata River discharge water assisted by increased occurrence of Southern winds and cold fronts. The recognition of the potentially changing climate and effects upon the environment will be an important step in planning future development of bivalve aquaculture.

Inspiratory Muscle Training Reduces Sympathetic Nervous Activity and Improves Inspiratory Muscle Weakness and Quality of Life in Patients With Chronic Heart Failure A CLINICAL TRIAL

PURPOSE: To evaluate the effect of inspiratory muscle training (IMT) on cardiac autonomic modulation and on peripheral nerve sympathetic activity in patients with chronic heart failure (CHF). METHODS: Functional capacity, low-frequency (LF) and high-frequency (HF) components of heart rate variability, muscle sympathetic nerve activity inferred by microneurography, and quality of life were determined in 27 patients with CHF who had been sequentially allocated to 1 of 2 groups: (1) control group (with no intervention) and (2) IMT group. Inspiratory muscle training consisted of respiratory exercises, with inspiratory threshold loading of seven 30-minute sessions per week for a period of 12 weeks, with a monthly increase of 30% in maximal inspiratory pressure (PImax) at rest. Multivariate analysis was applied to detect differences between baseline and followup period. RESULTS: Inspiratory muscle training significantly increased PImax (59.2 +/- 4.9 vs 87.5 +/- 6.5 cmH(2)O, P = .001) and peak oxygen uptake (14.4 +/- 0.7 vs 18.9 +/- 0.8 mL.kg(-1).min(-1), P = .002); decreased the peak ventilation (V. E) +/- carbon dioxide production (V-CO2) ratio (35.8 +/- 0.8 vs 32.5 +/- 0.4, P = .001) and the (V) over dotE +/-(V) over dotCO(2) slope (37.3 +/- 1.1 vs 31.3 +/- 1.1, P = .004); increased the HF component (49.3 +/- 4.1 vs 58.4 +/- 4.2 normalized units, P = .004) and decreased the LF component (50.7 +/- 4.1 vs 41.6 +/- 4.2 normalized units, P = .001) of heart rate variability; decreased muscle sympathetic nerve activity (37.1 +/- 3 vs 29.5 +/- 2.3 bursts per minute, P = .001); and improved quality of life. No significant changes were observed in the control group. CONCLUSION: Home-based IMT represents an important strategy to improve cardiac and peripheral autonomic controls, functional capacity, and quality of life in patients with CHF.

Intervenções psicoeducacionais para cuidadores de idosos com demência: uma revisão sistemática

OBJETIVO: Identificar modelos de intervenções psicoeducacionais e os seus efeitos em cuidadores de idosos com demência. MÉTODOS: Levantamento de estudos publicados entre janeiro de 2000 e abril de 2012 nas bases de dados PubMed, Web of Knowledge, Lilacs e SciELO, utilizando as seguintes palavras-chave "psychoeducational and caregiver", "cuidador e demência e psicoeducação" e "cuidador e intervenção". Apenas os artigos que denominavam a intervenção estudada como psicoeducação fazem parte do presente estudo. RESULTADOS: Foram encontrados 27 artigos com relatos acerca do impacto de intervenções psicoeducacionais em cuidadores de idosos com demência. Os resultados mais prevalentes desses estudos são: melhora do bem-estar dos cuidadores (37% dos estudos); aumento do uso de estratégias de enfrentamento (30%); diminuição de pensamentos disfuncionais (30%); aumento do conhecimento sobre os serviços disponíveis (19%); melhora da autoeficácia (15%); e aumento de habilidades para o cuidado (11%). A abordagem psicoeducacional descrita nos estudos é do âmbito informativo, cognitivo-comportamental, com técnicas de gerenciamento de estresse e de emoções; técnicas de resolução de problemas e apoio emocional. CONCLUSÃO: A intervenção psicoeducacional contribui significativamente para a melhora do bem-estar do cuidador, contudo ainda é necessária uma padronização dessa abordagem, em termos de estrutura, duração e conteúdos ministrados, para que haja evidências mais precisas do efeito desse tipo de intervenção.