NURSES AND THE ASSESSMENT IN HEALTH SYSTEM MANAGEMENT

The objective of this study was to undertake a critical reflection regarding assessment as a managerial tool that promotes the inclusion of nurses in the health system management process. Nurses, because of their education and training, which encompasses knowledge in both the clinical and managerial fields and is centered on care, have the potential to assume a differentiated attitude in management, making decisions and proposing health policies. Nevertheless, it is necessary to first create and consolidate an expressive inclusion in decisive levels of management. Assessment is a component of management, the results of which may contribute to making decisions that are more objective and allow for improving healthcare interventions and reorganizing health practice within a political, economic, social and professional context; it is also an area for the application of knowledge that has the potential to change the current panorama of including nurses in management.

Maize and soybeans production in integrated system under no-tillage with different pasture combinations and animal categories

The adoption of no-till system (NTS) combined with crop-livestock integration (CLI) has been a strategy promoted in Brazil, aiming to maximize areas yield and increase agribusiness profitability. This study aimed to evaluate grains yield and phytotechnical attributes from maize and soybean culture by CLI system under NTS after winter annual pure and diversified pastures with the absence or presence of grazing animals. The experiment was installed in Castro (Parana State, Brazil) on in a dystrophic Humic Rhodic Hapludox with a clay texture, using experimental design of randomized complete blocks in 4 x 2 factorial scheme with three replications. Treatments included four pasture combinations (diversified or pure) and animal categories (light and heavy) subjected or not to grazing animals during the winter. During 2008/09 and 2009/10 summers, the area was cultivated with soybeans and maize, respectively, with yield assessment of grains and phytotechnical attributes. Treatments did not alter the yield and weight of a thousand seeds (WTS) of soybeans. In maize culture, the grazing animal during the winter increased the plant population and grains yield, but gave slight decrease in WTS. Pasture combinations (diversified or pure) and animal categories (light and heavy) did not interfere in soybean culture, but benefited the maize crop.

Robust and optimal adjustment of Power System Stabilizers through Linear Matrix Inequalities

This work presents the application of Linear Matrix Inequalities to the robust and optimal adjustment of Power System Stabilizers with pre-defined structure. Results of some tests show that gain and zeros adjustments are sufficient to guarantee robust stability and performance with respect to various operating points. Making use of the flexible structure of LMI's, we propose an algorithm that minimizes the norm of the controllers gain matrix while it guarantees the damping factor specified for the closed loop system, always using a controller with flexible structure. The technique used here is the pole placement, whose objective is to place the poles of the closed loop system in a specific region of the complex plane. Results of tests with a nine-machine system are presented and discussed, in order to validate the algorithm proposed. (C) 2012 Elsevier Ltd. All rights reserved.

Soil-mediated effects on potential Euterpe edulis (Arecaceae) fruit and palm heart sustainable management in the Brazilian Atlantic Forest

Euterpe edulis is an endangered species due to palm heart overharvesting, the most important non-timber forest product of the Brazilian Atlantic Forest, and fruit exploitation has been introduced as a low impacting alternative. However, E. edulis is a keystone species for frugivores birds, and even the impact of fruit exploitation needs to be better investigated. Since this species occurs over contrasting habitats, the establishment of site-specific standards and limits for exploitation may also be essential to achieve truly sustainable management. In this context, we sought to investigate how soil chemical composition would potentially affect E. edulis (Arecaceae) palm heart and fruit exploitation considering current standards of management. We studied natural populations found in Restinga Forest and Atlantic Rainforest remnants established within Natural Reserves of Sao Paulo State, SE Brazil, where 10.24 ha permanent plots, composed of a grid of 256 subplots (20 m x 20 m), were located. In each of these subplots, we evaluated soil chemical composition and diameter at breast height of E. edulis individuals. Additionally, we evaluated fruit yield in 2008 and 2009 in 20 individuals per year. The Atlantic Rainforest population had a much higher proportion of larger diameter individuals than the population from the Restinga Forest, as a result of habitat-mediated effects, especially those related to soil. Sodium and potassium concentration in Restinga Forest soils, which have strong negative and positive effect on palm growth, respectively, played a key role in determining those differences. Overall, the number of fruits that could be exploited in the Atlantic Rainforest was four times higher than in Restinga Forest. If current rules for palm heart and fruit harvesting were followed without any restriction to different habitats, Restinga Forest populations are under severe threat, as this study shows that they are not suitable for sustainable management of both fruits and palm heart. Hence, a habitat-specific approach of sustainable management is needed for this species in order to respect the demographic and ecological dynamics of each population to be managed. These findings suggest that any effort to create general management standards of low impacting harvesting may be unsuccessful if the species of interest occur over a wide range of ecosystems. (C) 2012 Elsevier B.V. All rights reserved.

Determination of dynamical and physical parameters of the system CoRoT 3

The two main tools to determine the dynamical and physical parameters of exoplanet systems are the radial velocity (RV) measurements and, when available, transit timings. The two techniques are complementary: The RV's allow us to know some of the orbital elements while the transit timings allow us to obtain the orbital inclination and planetary radius, impossible of obtain from the RV, and to resolve the indetermination in the determination of the planet mass from the RV's. The space observation of transiting planets is however not limited to transit times. They extend to long periods of time and are precise enough to provide information on variations along the orbit. Besides the effects of stellar rotation, deserve mention the Doppler shift in the radiation flux, as consequence of stellar movement around the center of mass, or Beaming Effect (BE); the Ellipsoidal Variability (EV) due to the tidal deformation of the star due to the gravitation of its close companion; and the Reflection (ER) of the stellar radiation incident on the planet and re-emitted to the observer. In the case of large hot Jupiters, these effects are enhanced by the strong gravitational interaction and the analysis of the light variation allows us independent estimates of the mass and radius of planet. The planetary system CoRoT 3 is favorable for such analysis. In this case, the secondary is a brown dwarf whose mass is of the order of 22Mj. We show results obtained from the analysis of 35 RV measurements, 236999 photometric observations and 11 additional RV observations made during a transit to determine the star rotation via the Rossiter-McLaughlin effect. The results obtained from this determination are presented in this communication. The results are compared to those resulting from other determinations.

Leucine and HMB differentially modulate proteasome system in skeletal muscle under different sarcopenic conditions

In the present study we have compared the effects of leucine supplementation and its metabolite β-hydroxy-β-methyl butyrate (HMB) on the ubiquitin-proteasome system and the PI3K/Akt pathway during two distinct atrophic conditions, hindlimb immobilization and dexamethasone treatment. Leucine supplementation was able to minimize the reduction in rat soleus mass driven by immobilization. On the other hand, leucine supplementation was unable to provide protection against soleus mass loss in dexamethasone treated rats. Interestingly, HMB supplementation was unable to provide protection against mass loss in all treatments. While solely fiber type I cross sectional area (CSA) was protected in immobilized soleus of leucine-supplemented rats, none of the fiber types were protected by leucine supplementation in rats under dexamethasone treatment. In addition and in line with muscle mass results, HMB treatment did not attenuate CSA decrease in all fiber types against either immobilization or dexamethasone treatment. While leucine supplementation was able to minimize increased expression of both Mafbx/Atrogin and MuRF1 in immobilized rats, leucine was only able to minimize Mafbx/Atrogin in dexamethasone treated rats. In contrast, HMB was unable to restrain the increase in those atrogenes in immobilized rats, but in dexamethasone treated rats, HMB minimized increased expression of Mafbx/Atrogin. The amount of ubiquitinated proteins, as expected, was increased in immobilized and dexamethasone treated rats and only leucine was able to block this increase in immobilized rats but not in dexamethasone treated rats. Leucine supplementation maintained soleus tetanic peak force in immobilized rats at normal level. On the other hand, HMB treatment failed to maintain tetanic peak force regardless of treatment. The present data suggested that the anti-atrophic effects of leucine are not mediated by its metabolite HMB.

Variations in Management of Mild Prenatal Hydronephrosis Among Maternal-Fetal Medicine Obstetricians, and Pediatric Urologists and Radiologists

Purpose: There are no current guidelines for diagnosing and managing mild prenatal hydronephrosis. Variations in physician approach make it difficult to analyze outcomes and establish optimal management. We determined the variability of diagnostic approach and management regarding prenatal hydronephrosis among maternal-fetal medicine obstetricians, pediatric urologists and pediatric radiologists. Materials and Methods: Online surveys were sent to mailing lists for national societies for each specialty. Participants were surveyed regarding criteria for diagnosing mild prenatal hydronephrosis and recommendations for postnatal management, including use of antibiotic prophylaxis, followup scheduling and type of followup imaging. Results: A total of 308 maternal-fetal medicine obstetricians, 126 pediatric urologists and 112 pediatric radiologists responded. Pediatric urologists and radiologists were divided between Society for Fetal Urology criteria and use of anteroposterior pelvic diameter for diagnosis, while maternal-fetal medicine obstetricians preferred using the latter. For postnatal evaluation radiologists preferred using personal criteria, while urologists preferred using anteroposterior pelvic diameter or Society for Fetal Urology grading system. There was wide variation in the use of antibiotic prophylaxis among pediatric urologists. Regarding the use of voiding cystourethrography/radionuclide cystography in patients with prenatal hydronephrosis, neither urologists nor radiologists were consistent in their recommendations. Finally, there was no agreement on length of followup for mild prenatal hydronephrosis. Conclusions: We observed a lack of uniformity regarding grading criteria in diagnosing hydronephrosis prenatally and postnatally among maternal-fetal medicine obstetricians, pediatric urologists and pediatric radiologists. There was also a lack of agreement on the management of mild intermittent prenatal hydronephrosis, resulting in these cases being managed inconsistently. A unified set of guidelines for diagnosis, evaluation and management of mild intermittent prenatal hydronephrosis would allow more effective evaluation of outcomes.

A rigorous approach to facilitate and guarantee the correctness of the genetic testing management in human genome information systems

Abstract Background Recent medical and biological technology advances have stimulated the development of new testing systems that have been providing huge, varied amounts of molecular and clinical data. Growing data volumes pose significant challenges for information processing systems in research centers. Additionally, the routines of genomics laboratory are typically characterized by high parallelism in testing and constant procedure changes. Results This paper describes a formal approach to address this challenge through the implementation of a genetic testing management system applied to human genome laboratory. We introduced the Human Genome Research Center Information System (CEGH) in Brazil, a system that is able to support constant changes in human genome testing and can provide patients updated results based on the most recent and validated genetic knowledge. Our approach uses a common repository for process planning to ensure reusability, specification, instantiation, monitoring, and execution of processes, which are defined using a relational database and rigorous control flow specifications based on process algebra (ACP). The main difference between our approach and related works is that we were able to join two important aspects: 1) process scalability achieved through relational database implementation, and 2) correctness of processes using process algebra. Furthermore, the software allows end users to define genetic testing without requiring any knowledge about business process notation or process algebra. Conclusions This paper presents the CEGH information system that is a Laboratory Information Management System (LIMS) based on a formal framework to support genetic testing management for Mendelian disorder studies. We have proved the feasibility and showed usability benefits of a rigorous approach that is able to specify, validate, and perform genetic testing using easy end user interfaces.