Evaluation of a multimedia online tool for teaching bronchial hygiene to physical therapy students

Background: Advances in information technology have been widely used in teaching health care professionals. The use of multimedia resources may be important for clinical learning and we are not aware of previous reports using such technology in respiratory physical therapy education. Objectives: Our approach was to evaluate a conventional bronchial hygiene techniques (BHTs) course with an interactive online environment, including multimedia resources. Methods: Previous developed audiovisual support material comprised: physiology, physiopathology and BHTs, accessible to students through the Internet in conjunction with BHTs classes. Two groups of students were compared and both attended regular classes: the on-line group (n=8) received access to online resources, while the control group (n=8) received conventional written material. Student's performance was evaluated before and after the course. Results: A preliminary test (score 0 to 10) was applied before the beginning of the course, showing that the initial knowledge of both groups was comparable [online, 6.75 (SD=0.88) vs. control, 6.125 (SD=1.35); p>0.05]. Two weeks after the end of the course, a second test showed that the online group performed significantly better than the control group [respectively, 7.75 (SD=1.28) vs. 5.93 (SD=0.72); p>0.05]. Conclusions: The use of a multimedia online resource had a positive impact on student's learning in respiratory therapy field in which instrumental and manual resources are often used and can be explored using this technology.

Perception of social support by individuals with diabetes mellitus and foot ulcers

OBJECTIVE: To evaluate the perception of social support and the relationship of sociodemographic, clinical and metabolic control variables in individuals with diabetes mellitus and foot ulcers in an outpatient unit. METHODS: A quantitative cross-sectional approach was carried out using a social support network inventory. RESULTS: Participants had a high perception of social support; family and health professionals were identified as the main support sources. Fasting plasma glucose values were directly related with social support. CONCLUSION: Family members were identified as the main support source, which emphasizes their importance in the health care process.

Matrix Support in Mental Health: Achievements and Limits in Primary Health Care

Changes in mental health care in the city of Fortaleza (Northeastern Brazil) have a recent historical and political process. Compared to other municipalities of the State of Ceara, which in the early 1990s were already pioneers in the process, Fortaleza has not implemented the changes due to the interests of psychiatric hospitals, of psychiatric outpatient clinics of the public network, and because of the difficulty in managing the new mental health devices and equipment present in Primary Care. In the municipality, the reorganization of mental health actions and services has required that the Primary Care Network faces the challenge of assisting mental health problems with the implementation of Matrix Support. In light of this context, we aimed to evaluate Matrix Support in mental health in Primary Care Units and to identify achievements and limitations in the Primary Care Units with Matrix Support. This study used a qualitative approach and was carried out by means of a case study. We interviewed twelve professionals from the Family Health Teams of four Units with implemented Matrix Support. The analysis of the information reveals that access, decision making, participation and the challenges of implementing Matrix Support are elements that are, in a dialectic way, weak and strong in the reorganization of services and practices. The presence of Matrix Support in Primary Care highlights the proposal of dealing with mental health within the network in the municipality. The process has not ended. Mobilization, awareness-raising and qualification of Primary Care have to be enhanced constantly, but implementation has enabled, to the service and professionals, greater acceptance of mental health in Primary Care.

A Randomized Trial of Noninvasive Positive End Expiratory Pressure in Patients With Acquired Immune Deficiency Syndrome and Hypoxemic Respiratory Failure

BACKGROUND: Acquired immunodeficiency syndrome (AIDS) is a pandemic disease commonly associated with respiratory infections, hypoxemia, and death. Noninvasive PEEP has been shown to improve hypoxemia. In this study, we evaluated the physiologic effects of different levels of noninvasive PEEP in hypoxemic AIDS patients. METHODS: Thirty AIDS patients with acute hypoxemic respiratory failure received a randomized sequence of noninvasive PEEP (5, 10, or 15 cm H2O) for 20 min. PEEP was provided through a facial mask with pressure-support ventilation (PSV) of 5 cm H2O and an F-IO2, of 1. Patients were allowed to breathe spontaneously for a 20-min washout period in between each PEEP trial. Arterial blood gases and clinical variables were recorded after each PEEP treatment. RESULTS: The results indicate that oxygenation improves linearly with increasing levels of PEEP. However, oxygenation levels were similar regardless of the first PEEP level administered (5, 10, or 15 cm H2O), and only the subgroup that received an initial treatment of the lowest level of PEEP (ie, 5 cm H2O) showed further improvements in oxygenation when higher PEEP levels were subsequently applied. The P-aCO2, also increased in response to PEEP elevation, especially with the highest level of PEEP (ie, 15 cm H2O). PSV of 5 cm H2O use was associated with significant and consistent improvements in the subjective sensations of dyspnea and respiratory rate reported by patients treated with any level of PEEP (from 0 to 15 cm H2O). CONCLUSIONS: AIDS patients with hypoxemic respiratory failure improve oxygenation in response to a progressive sequential elevation of PEEP (up to 15 cm H2O). However, corresponding elevations in P-aCO2, limit the recommended level of PEEP to 10 cm H2O. At a level of 5 cm H2O, PSV promotes an improvement in the subjective sensation of dyspnea regardless of the PEEP level employed.

Ethanol steam reforming over rhodium and cobalt-based catalysts: Effect of the support

The effect of support on the properties of rhodium and cobalt-based catalysts for ethanol steam reforming was studied in this work, by comparing the use of magnesia, alumina and Mg-Al oxide (obtained from hydrotalcite) as supports. It was found that metallic rhodium particles with around 2.4-2.6 nm were formed on all supports, but Mg-Al oxide led to the narrowest particles size distribution; cobalt was supposed to be located on the support, affecting its acidity. Rhodium interacts strongly with the support in the order: alumina> Mg-Al oxide > magnesia. The magnesium-containing catalysts showed low ethene selectivity and high hydrogen selectivity while the alumina-based ones showed high ethene selectivity, assigned to the Lewis sites of alumina. The Mg-Al oxide-supported rhodium and cobalt catalyst was the most promising sample to produce hydrogen by ethanol reforming, showing the highest hydrogen yield, low ethene selectivity and high specific surface area during reaction. Copyright (C) 2011, Hydrogen Energy Publications, LLC. Published by Elsevier Ltd. All rights reserved.

The subplacenta of the red-rumped agouti (Dasyprocta leporina L)

Background: Hystricognath rodents have a lobed placenta, comprising labyrinthine exchange areas and interlobular trophoblast. These correspond to the labyrinthine and spongy zones of other rodent placentae. Beneath them, however, is a structure unique to hystricognath rodents called the subplacenta. We here describe the subplacenta of the red-rumped agouti and examine the possible functional correlates of this structure. Methods: Placentae were collected from early in midgestation to near term of pregnancy and examined by standard histological techniques, immunohistochemistry and transmission electron microscopy. In addition, to study the microvasculature of the subplacenta, vessel casts were inspected by scanning electron microscopy. Results: In the subplacenta, lamellae of connective tissue support a layer of mononuclear cytotrophoblast cells. Beneath this is found syncytiotrophoblast. Clusters of multinuclear giant cells occur in the transition zone between the subplacenta and decidua. There are prominent intercellular spaces between the cytotrophoblast cells. The basal membrane of these cells is often close to fetal blood vessels. The syncytiotrophoblast surrounds an extensive system of lacunae. Microvilli project into these lacunae from the plasma membrane of the syncytiotrophoblast. The syncytial cytoplasm contains electron-dense granules. This is probably the amylase-resistant PAS-positive material identified by histochemistry. The subplacenta is supplied entirely from the fetal circulation. Within it the vessels pursue a tortuous course with sinusoidal dilatations and constrictions. Conclusion: The functions that have been attributed to the subplacenta include hormone production. Our findings are consistent with this interpretation, but suggest that hormone secretion is directed towards the fetal circulation rather than the maternal tissues.