O Ginecologista obstetra e a internet

OBJETIVOS: identificar a influência do uso da internet na prática e ambiente de trabalho médico e verificar como estas mudanças vêm acorrendo entre médicos ginecologistas e obstetras. MÉTODO: foram enviados 1.120 questionários para médicos ginecologistas e obstetras da cidade de São Paulo, dos quais retornaram 152, o correspondente a 13,6 por cento da amostra ou 6,1 por cento do total dos médicos cadastrados na SOGESP. A análise quantitativa do comportamento do médico quanto ao uso da internet foi realizada por meio de proporções, médias, cálculos de desvios-padrão e do teste de associação de qui-quadrado. Através da técnica de Cluster Analysis, foram determinados 4 grupos segundo o perfil dos profissionais relacionado ao uso desta ferramenta. RESULTADOS: não se observou relação de idade, sexo, locais de trabalho e desenvolvimento de apenas uma das especialidades Ginecologia ou Obstetrícia quanto à utilização da internet na prática médica. Observou-se uma tendência de uso mais freqüente entre médicos com doutorado. Quanto aos serviços médicos prestados por e-mail, receber e devolver exames foram as atividades mais realizadas pelos sujeitos da pesquisa. CONCLUSÃO: os ginecologistas obstetras pesquisados utilizam a internet na prática médica para própria atualização, para comunicação com pacientes ou para oferecer serviços às mesmas com diferentes assiduidades. Entretanto, este uso é ainda parcial, talvez relacionado ao receio de interferências negativas na relação com o paciente, além de preocupações quanto à implicações legais, éticas e principalmente econômicas relacionadas à prática profissional

New simple and efficient heuristics for the uncapacitated single allocation hub location problem

Hub-and-spoke networks are widely studied in the area of location theory. They arise in several contexts, including passenger airlines, postal and parcel delivery, and computer and telecommunication networks. Hub location problems usually involve three simultaneous decisions to be made: the optimal number of hub nodes, their locations and the allocation of the non-hub nodes to the hubs. In the uncapacitated single allocation hub location problem (USAHLP) hub nodes have no capacity constraints and non-hub nodes must be assigned to only one hub. In this paper, we propose three variants of a simple and efficient multi-start tabu search heuristic as well as a two-stage integrated tabu search heuristic to solve this problem. With multi-start heuristics, several different initial solutions are constructed and then improved by tabu search, while in the two-stage integrated heuristic tabu search is applied to improve both the locational and allocational part of the problem. Computational experiments using typical benchmark problems (Civil Aeronautics Board (CAB) and Australian Post (AP) data sets) as well as new and modified instances show that our approaches consistently return the optimal or best-known results in very short CPU times, thus allowing the possibility of efficiently solving larger instances of the USAHLP than those found in the literature. We also report the integer optimal solutions for all 80 CAB data set instances and the 12 AP instances up to 100 nodes, as well as for the corresponding new generated AP instances with reduced fixed costs. Published by Elsevier Ltd.

Morpho-anatomical variations during stem development in some epiphytic Cactaceae

LEMOS, R. C. C. AND G. F. A. MELO-DE-PINNA (Departamento de Botanica, Instituto de Biociencias, Universidade de Sao Paulo, Rua do Matao 277, Travessa 14, Cidade Universitaria, Butanta, Caixa Postal 11461, 05422-970, Sao Paulo, SP, Brasil). Morpho-anatomical variations during stem development in some epiphytic Cactaceae. J. Torrey Bot. Soc. 138: 16-25. 2011. In this study, the morpho-anatomical features of Hatiora salicornioides (Harworth) Britton & Rose, Rhipsalis floccosa Salm-Dyck Pfeiffer, Rhipsalis elliptica G. Lindb. ex K. Schum. and Epiphyllum phyllanthus (L.) Haworth. were studied during different phases of stem development. Primary (more developed) and terminal (less developed) segments showed variations of anatomical features as exhibited by the epidermal cells in surface view and transverse section. Features of the vascular system, e.g., the occurrence of non-lignified parenchyma in bands (H. salicornioides) or in small groups (R. floccosa and R. elliptica), as well as pericycle fibers and lignified cells in the medullar region, were only observed on the primary segments. Nevertheless, based on our anatomical analysis of stem segments in different developmental phases, we conclude that some characters described and used in systematic interpretations should be revised, mainly in the vascular (secondary xylem; non-xylematic vascular fibers) and dermal systems (epidermis in surface view and transverse section).

Wide-band tracheids (WBTs) of photosynthetic and non-photosynthetic stems in species of Cactaceae

ARRUDA, E. AND G. F. A. MELO-DE-PINNA (Departamento de Botanica, Instituto de Biociencias. Universidade de Sao Paulo, Rua do Matao, travessa 14, Cidade Universitaria, Butanta, Caixa Postal 11461, 05422-970. Sao Paulo, SP, Brasil). Wide-band tracheids (WBTs) of the photosynthetic and non-photosynthetic stems in species of Cactaceae. J. Torrey Bat. Soc. 137: 16-29. 2010.-The absence of WBTs and wood polymorphisms in some species of the Caryophyllales may be related to the particular area of plant analyzed. The present research has the objective of studying the photosynthetic and non-photosynthetic stems of different species and stages of differentiation to register wood polymorphisms and to understand the distribution and occurrence of WBTs. Wood polymorphism was observed in the non-photosynthetic stern of young and adult plants of Opuntioideae and Cactoideae and is also found in the photosynthetic stem of young plants of some species of Cactoideae. Cactoideae present WBT/fibrous dimorphic wood that can be related to cambial variation associated with growth habits and plant development. As expected, in the photosynthetic stem of the adult columnar cacti the wood is monomorphic fibrous in which WBTs were not found. This wood contains a great amount of fibers due to necessity of the mechanical support. In contrast, the globular species do not possess fibers in this area of the stem in either adult or young plants. Opuntia monacantha Haw. had non-fibrous wood in which WBTs were observed in the axial system and in the inner parts of the rays. Fiber clusters were present in the axial system. This wood represents a variation in the wood types described for Opuntioideae. Also, in O. monacantha, cells similar to the WBTs were observed in the pith, which can be interpreted as variation in the morphogenic processes during the ontogeny of the plant, probably a case of homeosis. Monomorphic fibrous wood without WBTs was found along the entire stem of Pereskia bahiensis Gurke. This feature has been observed in other pereskias, and in addition to the others, indicates its proximity to the ancestral cacti.

Diagnostic reference levels for the most frequent radiological examinations carried out in Brazil

Objectives. A large-scale survey of doses to patients undergoing the most frequent radiological examinations was carried out in health services in Sao Paulo (347 radiological examinations per 1 000 inhabitants), the most populous Brazilian state. Methods. A postal dosimetric kit with thermoluminescence dosimeters was used to evaluate the entrance surface dose (ESD) to patients. A stratified sampling technique applied to the national health database furnished important data on the distribution of equipment and the annual number of examinations. Chest, head (skull and sinus), and spine (cervical, thoracic, and lumbar) examinations were included in the trial. A total of 83 rooms and 868 patients were included, and 1 415 values of ESD were measured. Results. The data show large coefficients of variation in tube charge, giving rise to large variations in ESD values. Also, a series of high ESD values associated with unnecessary localizing fluoroscopy were detected. Diagnostic reference levels were determined, based on the 75th percentile (third quartile) of the ESD distributions. For adult patients, the diagnostic reference levels achieved are very similar to those obtained in international surveys. However, the situation is different for pediatric patients: the ESD values found in this survey are twice as large as the international recommendations for chest radiographs of children. Conclusions. Despite the reduced number of ESD values and rooms for the pediatric patient group, it is recommended that practices in chest examinations be revised and that specific national reference doses and image quality be established after a broader survey is carried out.