Intervention to reduce C-reactive protein determination requests for acute infections at an emergency department

Introduction C-reactive protein (CRP) levels rise during inflammatory processes and have been ordered for rheumatic disease follow-up since the 1950s. The number of tests ordered in the emergency setting has increased, but without evident improvement in medical care quality. Objective To determine the pattern of CRP determinations in the emergency department (ED) of a university hospital in Sao Paulo, Brazil, and to evaluate the effect of an intervention with staff and students about the best use of the test in the ED. Methods Data regarding CRP testing requests, related diagnoses and the number of monthly consultations in the hospital ED were analysed before and after the intervention. Because of an increase in CRP measurement requests from 2007 to 2009, the author started discussing the role of CRP determinations in the medical decision-making process in early 2010. Staff and faculty members openly discussed the pattern of requests in the hospital and related current medical literature. During 2010, the medical staff worked as multipliers to change the behaviour of new students and residents. The results of the first 4 months after the intervention were presented at another general meeting in July 2010. Results From 2007 to 2009, there were 11 786 CRP measurement requests with a clear exponential trend. After the intervention, during the calendar year 2010, there was a 48% reduction in adjusted annual CRP requests. Pneumonia, fever and urinary tract infections were the most common reasons for CRP requests. Discussion Inexpensive, well-directed, interactive educational interventions may affect professional behaviour and curb rates of laboratory tests.

Florística e fitossociologia em parcelas permanentes da Mata Atlântica do sudeste do Brasil ao longo de um gradiente altitudinal

Este trabalho resume os dados de florística e fitossociologia de 11, das 14 parcelas de 1 ha, alocadas ao longo do gradiente altitudinal da Serra do Mar, São Paulo, Brasil. As parcelas começam na cota 10 m (Floresta de Restinga da Praia da Fazenda, município de Ubatuba) e estão distribuídas até a cota 1100 m (Floresta Ombrófila Densa Montana da Trilha do rio Itamambuca, município de São Luis do Paraitinga) abrangendo os Núcleos Picinguaba e Santa Virgínia do Parque Estadual da Serra do Mar. Na Restinga o solo é Neossolo Quartzarênico francamente arenoso, enquanto que na encosta o solo é um Cambisolo Háplico Distrófico argilo-arenoso, sendo que todas as parcelas apresentaram solo ácido (pH 3 – 4) com alta diluição de nutrientes e alta saturação de alumínio. Na Restinga e no sopé da encosta o clima é Tropical/Subtropical Úmido (Af/Cfa), sem estação seca, com precipitação média anual superior a 2.200 mm e temperatura média anual de 22 °C. Subindo a encosta mantêm-se a média de precipitação, mas há um gradativo resfriamento, de forma que a 1.100 m o clima é Subtropical Úmido (Cfa/Cfb), sem estação seca, com temperatura média anual de 17 °C. Destaca-se ainda que, quase diariamente, a parte superior da encosta, geralmente acima de 400 m, é coberta por uma densa neblina. Nas 14 parcelas foram marcados, medidos e amostrados 21.733 indivíduos com DAP ≥ 4,8 cm, incluindo árvores, palmeiras e fetos arborescentes. O número médio de indivíduos amostrados nas 14 parcelas foi de 1.264 ind.ha–1 (± 218 EP de 95%). Dentro dos parâmetros considerados predominaram as árvores (71% FOD Montana a 90% na Restinga), seguidas de palmeiras (10% na Restinga a 25% na FOD Montana) e fetos arborescentes (0% na Restinga a 4% na FOD Montana). Neste aspecto destaca-se a FOD Terras Baixas Exploradas com apenas 1,8% de palmeiras e surpreendentes 10% de fetos arborescentes. O dossel é irregular, com altura variando de 7 a 9 m, raramente as árvores emergentes chegam a 18 m, e a irregularidade do dossel permite a entrada de luz suficiente para o desenvolvimento de centenas de espécies epífitas. Com exceção da FOD Montana, onde o número de mortos foi superior a 5% dos indivíduos amostrados, nas demais fitofisionomias este valor ficou abaixo de 2,5%. Nas 11 parcelas onde foi realizado o estudo florístico foram encontradas 562 espécies distribuídas em 195 gêneros e 68 famílias. Apenas sete espécies – Euterpe edulis Mart. (Arecaceae), Calyptranthes lucida Mart. ex DC. e Marlierea tomentosa Cambess (ambas Myrtaceae), Guapira opposita (Vell.) Reitz (Nyctaginaceae), Cupania oblongifolia Mart. (Sapindaceae) e as Urticaceae Cecropia glaziovii Snethl. e Coussapoa microcarpa (Schott) Rizzini – ocorreram da Floresta de Restinga à FOD Montana, enquanto outras 12 espécies só não ocorreram na Floresta de Restinga. As famílias com o maior número de espécies são Myrtaceae (133 spp), Fabaceae (47 spp), 125 Fitossociologia em parcelas permanentes de Mata Atlântica http://www.biotaneotropica.org.br/v12n1/pt/abstract?article+bn01812012012 http://www.biotaneotropica.org.br Biota Neotrop., vol. 12, no. 1 Introdução A Mata Atlântica sensu lato (Joly et al. 1999) é a segunda maior floresta tropical do continente americano (Tabarelli et al. 2005). A maior parte dos Sistemas de Classificação da vegetação brasileira reconhece que no Domínio Atlântico (sensu Ab’Saber 1977) esse bioma pode ser dividido em dois grandes grupos: a Floresta Ombrófila Densa, típica da região costeira e das escarpas serranas com alta pluviosidade (Mata Atlântica – MA – sensu stricto), e a Floresta Estacional Semidecidual, que ocorre no interior, onde a pluviosidade, além de menor, é sazonal. Na região costeira podem ocorrer também Manguezais (Schaeffer-Novelli 2000), ao longo da foz de rios de médio e grande porte, e as Restingas (Scarano 2009), crescendo sobre a planície costeira do quaternário. No topo das montanhas, geralmente acima de 1500 m, estão os Campos de Altitude (Ribeiro & Freitas 2010). Em 2002, a Fundação SOS Mata Atlântica em parceria com o INPE (Instituto..., 2002) realizaram um levantamento que indica que há apenas 7,6% da cobertura original da Mata Atlântica (s.l.). Mais recentemente Ribeiro et al. (2009) refinaram a estimativa incluindo fragmentos menores, que não haviam sido contabilizados, e concluíram que resta algo entre 11,4 e 16% da área original. Mesmo com esta fragmentação, o mosaico da Floresta Atlântica brasileira possui um dos maiores níveis de endemismos do mundo (Myers et al. 2000) e cerca da metade desses remanescentes de grande extensão estão protegidos na forma de Unidades de Conservação (Galindo & Câmara 2005). Entre os dois centros de endemismo reconhecidos para a MA (Fiaschi & Pirani 2009), o bloco das regiões sudeste/sul é o que conserva elementos da porção sul de Gondwana (Sanmartin & Ronquist 2004), tido como a formação florestal mais antiga do Brasil (Colombo & Joly 2010). Segundo Hirota (2003), parte dos remanescentes de MA está no estado de São Paulo, onde cerca de 80% de sua área era coberta por florestas (Victor 1977) genericamente enquadradas como Mata Atlântica “sensu lato” (Joly et al. 1999). Dados de Kronka et al. (2005) mostram que no estado restam apenas 12% de área de mata e menos do que 5% são efetivamente florestas nativas pouco antropizadas. Nos 500 anos de fragmentação e degradação das formações naturais, foram poupadas apenas as regiões serranas, principalmente a fachada da Serra do Mar, por serem impróprias para práticas agrícolas. Usando o sistema fisionômico-ecológico de classificação da vegetação brasileira adotado pelo IBGE (Veloso et al. 1991), a Floresta Ombrófila Densa, na área de domínio da Mata Atlântica, foi subdividida em quatro faciações ordenadas segundo a hierarquia topográfica, que refletem fisionomias de acordo com as variações das faixas altimétricas e latitudinais. No estado de São Paulo, na latitude entre 16 e 24 °S temos: 1) Floresta Ombrófila Densa das Terras Baixas - 5 a 50 m de altitude; 2) Floresta Ombrófila Densa Submontana – no sopé da Serra do Mar, com cotas de altitude variando entre 50 e 500 m; 3) Floresta Ombrófila Densa Montana – recobrindo a encosta da Serra do Mar propriamente dita, em altitudes que variam de 500 a 1.200 m; 4) Floresta Ombrófila Densa Altimontana – ocorrendo no topo da Serra do Mar, acima dos limites estabelecidos para a formação montana, onde a vegetação praticamente deixa de ser arbórea, pois predominam os campos de altitude. Nas últimas três décadas muita informação vem sendo acumulada sobre a composição florística e a estrutura do estrato arbóreo dos remanescentes florestais do estado, conforme mostram as revisões de Oliveira-Filho & Fontes (2000) e Scudeller et al. (2001). Em florestas tropicais este tipo de informação, assim como dados sobre a riqueza de espécies, reflete não só fatores evolutivos e biogeográficos, como também o histórico de perturbação, natural ou antrópica, das respectivas áreas (Gentry 1992, Hubbell & Foster 1986). A síntese dessas informações tem permitido a definição de unidades fitogeográficas com diferentes padrões de riqueza de espécies e apontam para uma diferenciação, entre as florestas paulistas, no sentido leste/oeste (Salis et al. 1995, Torres et al. 1997, Santos et al. 1998). Segundo Bakker et al. (1996) um método adequado para acompanhar e avaliar as mudanças na composição das espécies e dinâmica da floresta ao longo do tempo é por meio de parcelas permanentes (em inglês Permanent Sample Plots –PSPs). Essa metodologia tem sido amplamente utilizada em estudos de longa duração em florestas tropicais, pois permite avaliar a composição e a estrutura florestal e monitorar sua mudança no tempo (Dallmeier 1992, Condit 1995, Sheil 1995, Malhi et al. 2002, Lewis et al. 2004). Permite avaliar também as consequências para a floresta de problemas como o aquecimento global e a poluição atmosférica (Bakker et al. 1996). No Brasil os projetos/programas que utilizam a metodologia de Parcelas Permanentes tiveram origem, praticamente, com o Projeto Rubiaceae (49) e Lauraceae (49) ao longo de todo gradiente da FOD e Monimiaceae (21) especificamente nas parcelas da FOD Montana. Em termos de número de indivíduos as famílias mais importantes foram Arecaceae, Rubiaceae, Myrtaceae, Sapotaceae, Lauraceae e na FOD Montana, Monimiaceae. Somente na parcela F, onde ocorreu exploração de madeira entre 1960 e 1985, a abundância de palmeiras foi substituída pelas Cyatheaceae. O gradiente estudado apresenta um pico da diversidade e riqueza nas altitudes intermediárias (300 a 400 m) ao longo da encosta (índice de Shannon-Weiner - H’ - variando de 3,96 a 4,48 nats.indivíduo–1). Diversas explicações para este resultado são apresentadas neste trabalho, incluindo o fato dessas altitudes estarem nos limites das expansões e retrações das diferentes fitofisionomias da FOD Atlântica durante as flutuações climáticas do Pleistoceno. Os dados aqui apresentados demonstram a extraordinária riqueza de espécies arbóreas da Floresta Ombrófila Densa Atlântica dos Núcleos Picinguaba e Santa Virgínia do Parque Estadual da Serra do Mar, reforçando a importância de sua conservação ao longo de todo o gradiente altitudinal. A diversidade desta floresta justifica também o investimento de longo prazo, através de parcelas permanentes, para compreender sua dinâmica e funcionamento, bem como monitorar o impacto das mudanças climáticas nessa vegetação.

Two versions of the threshold contact model in two dimensions

Two versions of the threshold contact process ordinary and conservative - are studied on a square lattice. In the first, particles are created on active sites, those having at least two nearest neighbor sites occupied, and are annihilated spontaneously. In the conservative version, a particle jumps from its site to an active site. Mean-field analysis suggests the existence of a first-order phase transition, which is confirmed by Monte Carlo simulations. In the thermodynamic limit, the two versions are found to give the same results. (C) 2012 Elsevier B.V. All rights reserved.

TUNGSTEN ISOTOPIC COMPOSITIONS IN STARDUST SiC GRAINS FROM THE MURCHISON METEORITE: CONSTRAINTS ON THE s-PROCESS IN THE Hf-Ta-W-Re-Os REGION

We report the first tungsten isotopic measurements in stardust silicon carbide (SiC) grains recovered from the Murchison carbonaceous chondrite. The isotopes (182,183,184,186)Wand (179,180)Hf were measured on both an aggregate (KJB fraction) and single stardust SiC grains (LS+ LU fraction) believed to have condensed in the outflows of low-mass carbon-rich asymptotic giant branch (AGB) stars with close-to-solar metallicity. The SiC aggregate shows small deviations from terrestrial (= solar) composition in the (182)W/(184)Wand (183)W/(184)Wratios, with deficits in (182)W and (183)W with respect to (184)W. The (186)W/(184)W ratio, however, shows no apparent deviation from the solar value. Tungsten isotopic measurements in single mainstream stardust SiC grains revealed lower than solar (182)W/(184)W, (183)W/(184)W, and (186)W/(184)W ratios. We have compared the SiC data with theoretical predictions of the evolution of W isotopic ratios in the envelopes of AGB stars. These ratios are affected by the slow neutron-capture process and match the SiC data regarding their (182)W/(184)W, (183)W/(184)W, and (179)Hf/(180)Hf isotopic compositions, although a small adjustment in the s-process production of (183)W is needed in order to have a better agreement between the SiC data and model predictions. The models cannot explain the (186)W/(184)W ratios observed in the SiC grains, even when the current (185)W neutron-capture cross section is increased by a factor of two. Further study is required to better assess how model uncertainties (e. g., the formation of the (13)C neutron source, the mass-loss law, the modeling of the third dredge-up, and the efficiency of the (22)Ne neutron source) may affect current s-process predictions.

Adding value to the Brazilian sisal: acid hydrolysis of its pulp seeking production of sugars and materials

The present work is inserted into the broad context of the upgrading of lignocellulosic fibers. Sisal was chosen in the present study because more than 50% of the world's sisal is cultivated in Brazil, it has a short life cycle and its fiber has a high cellulose content. Specifically, in the present study, the subject addressed was the hydrolysis of the sisal pulp, using sulfuric acid as the catalyst. To assess the influence of parameters such as the concentration of the sulfuric acid and the temperature during this process, the pulp was hydrolyzed with various concentrations of sulfuric acid (30-50%) at 70 A degrees C and with 30% acid (v/v) at various temperatures (60-100 A degrees C). During hydrolysis, aliquots were withdrawn from the reaction media, and the solid (non-hydrolyzed pulp) was separated from the liquid (liquor) by filtering each aliquot. The sugar composition of the liquor was analyzed by HPLC, and the non-hydrolyzed pulps were characterized by viscometry (average molar mass), and X-ray diffraction (crystallinity). The results support the following conclusions: acid hydrolysis using 30% H2SO4 at 100 A degrees C can produce sisal microcrystalline cellulose and the conditions that led to the largest glucose yield and lowest decomposition rate were 50% H2SO4 at 70 A degrees C. In summary, the study of sisal pulp hydrolysis using concentrated acid showed that certain conditions are suitable for high recovery of xylose and good yield of glucose. Moreover, the unreacted cellulose can be targeted for different applications in bio-based materials. A kinetic study based on the glucose yield was performed for all reaction conditions using the kinetic model proposed by Saeman. The results showed that the model adjusted to all 30-35% H2SO4 reactions but not to greater concentrations of sulfuric acid. The present study is part of an ongoing research program, and the results reported here will be used as a comparison against the results obtained when using treated sisal pulp as the starting material.

Detection of glucose and triglycerides using information visualization methods to process impedance spectroscopy data

In this paper we discuss the detection of glucose and triglycerides using information visualization methods to process impedance spectroscopy data. The sensing units contained either lipase or glucose oxidase immobilized in layer-by-layer (LbL) films deposited onto interdigitated electrodes. The optimization consisted in identifying which part of the electrical response and combination of sensing units yielded the best distinguishing ability. It is shown that complete separation can be obtained for a range of concentrations of glucose and triglyceride when the interactive document map (IDMAP) technique is used to project the data into a two-dimensional plot. Most importantly, the optimization procedure can be extended to other types of biosensors, thus increasing the versatility of analysis provided by tailored molecular architectures exploited with various detection principles. (C) 2012 Elsevier B.V. All rights reserved.

Environmental assessment of residues generated after consecutive acid-base pretreatment of sugarcane bagasse by advanced oxidative process

Abstract Background Biofuels produced from sugarcane bagasse (SB) have shown promising results as a suitable alternative of gasoline. Biofuels provide unique, strategic, environmental and socio-economic benefits. However, production of biofuels from SB has negative impact on environment due to the use of harsh chemicals during pretreatment. Consecutive sulfuric acid-sodium hydroxide pretreatment of SB is an effective process which eventually ameliorates the accessibility of cellulase towards cellulose for the sugars production. Alkaline hydrolysate of SB is black liquor containing high amount of dissolved lignin. Results This work evaluates the environmental impact of residues generated during the consecutive acid-base pretreatment of SB. Advanced oxidative process (AOP) was used based on photo-Fenton reaction mechanism (Fenton Reagent/UV). Experiments were performed in batch mode following factorial design L9 (Taguchi orthogonal array design of experiments), considering the three operation variables: temperature (°C), pH, Fenton Reagent (Fe2+/H2O2) + ultraviolet. Reduction of total phenolics (TP) and total organic carbon (TOC) were responsive variables. Among the tested conditions, experiment 7 (temperature, 35°C; pH, 2.5; Fenton reagent, 144 ml H2O2+153 ml Fe2+; UV, 16W) revealed the maximum reduction in TP (98.65%) and TOC (95.73%). Parameters such as chemical oxygen demand (COD), biochemical oxygen demand (BOD), BOD/COD ratio, color intensity and turbidity also showed a significant change in AOP mediated lignin solution than the native alkaline hydrolysate. Conclusion AOP based on Fenton Reagent/UV reaction mechanism showed efficient removal of TP and TOC from sugarcane bagasse alkaline hydrolysate (lignin solution). To the best of our knowledge, this is the first report on statistical optimization of the removal of TP and TOC from sugarcane bagasse alkaline hydrolysate employing Fenton reagent mediated AOP process.

Ileal amino acid digestibility in canola meals from yellow- and black-seeded Brassica napus and Brassica juncea fed to growing pigs

Twelve ileal cannulated pigs (30.9 ± 2.7 kg) were used to determine the apparent (AID) and standardized (SID) ileal digestibility of protein and AA in canola meals (CM) derived from black- (BNB) and yellow-seeded (BNY) Brassica napus canola and yellow-seeded Brassica juncea (BJY). The meals were produced using either the conventional pre-press solvent extraction process (regular meal) or a new, vacuum-assisted cold process of meal de-solventization (white flakes) to provide 6 different meals. Six cornstarch-based diets containing 35% canola meal as the sole source of protein in a 3 (variety) × 2 (processing) factorial arrangement were randomly allotted to pigs in a 6 × 7 incomplete Latin square design to have 6 replicates per diet. A 5% casein diet was fed to estimate endogenous AA losses. Canola variety and processing method interacted for the AID of DM (P = 0.048), N (P = 0.010), and all AA (P < 0.05), except for Arg, Lys, Phe, Asp, Glu, and Pro. Canola variety affected or tended to affect the AID of most AA but had no effect on the AID of Lys, Met, Val, Cys, and Pro, whereas processing method had an effect on only Lys and Asp and tended to affect the AID of Thr, Gly and Ser. The effects of canola variety, processing method, and their interaction on the SID values for N and AA followed a similar pattern as for AID values. For the white flakes, SID of N in BJY (74.2%) was lower than in BNY and BNB, whose values averaged 78.5%; however, among the regular meals, BJY had a greater SID value for N than BNY and BNB (variety × processing, P = 0.015). For the white flakes, the SID of Ile (86.4%), Leu (87.6%), Lys (88.9%), Thr (87.6%) and Val (84.2%) in BNB were greater than BNY and BJY. Opposite results were observed for the regular processing, with SID of Lys (84.1%), Met (89.5%), Thr (84.1%), and Val (83.6%) being greater in BJY, followed by BNB and BNY(variety × processing, P < 0.057). The SID of Met was greatest for the white flakes (90.2%) but least for the regular processing (83.0%) in BNY (variety × processing, P < 0.057). It was concluded that the AID and SID of N and AA of the CM tested varied according to canola variety and the processing method used. Overall, the SID values for Ile, Leu, Lys, Met, Thr, and Val averaged across CM types and processing methods were 81.8, 82.6, 83.4, 85.9, 80.8, and 78.4%, respectively.