Coronariografia via transradial: curva de aprendizagem, avaliada por estudo multicêntrico

INTRODUÇÃO: A via de acesso femoral tem sido a preferida para os procedimentos diagnósticos e terapêuticos coronarianos, mas apresenta limitações, principalmente relacionadas a complicações vasculares e hemorrágicas. O aces-so transradial é uma técnica mais recentemente empregada com o objetivo principal de diminuir essas complicações, além de produzir maior conforto e redução dos custos de hospitalização, embora com maior curva de aprendizagem. O objetivo deste estudo foi avaliar a realização de coronariografia transradial, executada por operadores sem experiência na técnica, e comparar com a abordagem clássica (Sones e femoral) em termos de sucesso do procedimento e complicações, analisando a influência da curva de aprendizagem. MÉTODO: Estudo multicêntrico realizado em 14 hospitais do interior de São Paulo, no período de um ano. Foram randomizados mil pacientes de maneira equivalente para as técnicas transradial ou clássica. RESULTADOS: A taxa de sucesso em ambos os grupos foi similar (97,8% vs. 98,5%; P = 0,47). No grupo clássico, 95,2% dos procedimentos foram realizados pela técnica de Sones. O número de cateteres utilizados, a duração do procedimento e o tempo de exposição aos raios X foram maiores no grupo transradial (P < 0,001). Não houve diferença quanto às complicações maiores (morte, infarto e acidente vascular cerebral) e quanto às complicações vasculares e hemorrágicas. Os grupos que realizaram mais de 100 procedimentos pela artéria radial (3 centros/5 operadores) obtiveram menor taxa de insucesso (1,6% vs. 3,6%; P = 0,04). CONCLUSÃO: Um período de aprendizagem para a realização de procedimentos pela via transradial mostra-se necessário, porém não se acompanha de menor índice de sucesso, nem tampouco de maior taxa de complicações para os pacientes.

Economic design of (X)over-bar and R charts under Weibull shock models

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Joint conomic design of (x)over-bar and R charts under Weibull shock models

This paper deals with the joint economic design of (x) over bar and R charts when the occurrence times of assignable causes follow Weibull distributions with increasing failure rates. The variable quality characteristic is assumed to be normally distributed and the process is subject to two independent assignable causes (such as tool wear-out, overheating, or vibration). One cause changes the process mean and the other changes the process variance. However, the occurrence of one kind of assignable cause does not preclude the occurrence of the other. A cost model is developed and a non-uniform sampling interval scheme is adopted. A two-step search procedure is employed to determine the optimum design parameters. Finally, a sensitivity analysis of the model is conducted, and the cost savings associated with the use of non-uniform sampling intervals instead of constant sampling intervals are evaluated.

Assessment of brachial plexus blockade in chickens by an axillary approach

Objective To assess the brachial plexus block in chickens by an axillary approach and using a peripheral nerve stimulator.Study design Prospective, randomized, double-blinded study.Animals Six, 84-week old, female chickens.Methods Midazolam (1 mg kg(-1)) and butorphanol (1 mg kg(-1)) were administered into the pectoralis muscle. Fifteen minutes later, the birds were positioned in lateral recumbency and following palpation of the anatomic landmarks, a catheter was inserted using an axillary approach to the brachial plexus. Lidocaine or bupivacaine (1 mL kg(-1)) was injected after plexus localization by the nerve stimulator. Sensory function was tested before and after blockade (carpus, radius/ulna, humerus and pectoralis muscle) in the blocked and unblocked wings. The latency to onset of motor and sensory block and the duration of sensory block were recorded. A Friedman nonparametric one-way repeated-measures ANOVA was used to compare scores from baseline values over time and to compare the differences between wings at each time point.Results A total of 18 blocks were performed with a success rate of 66.6% (12/18). The latency for motor block was 2.8 +/- 1.1 and 3.2 +/- 0.4 minutes for lidocaine and bupivacaine, respectively. The latencies for and durations of the sensory block were 6.0 +/- 2.5 and 64.0 +/- 18.0 and 7.8 +/- 5.8 and 91.6 +/- 61.7 minutes for lidocaine and bupivacaine, respectively. There was no statistical difference between these times for lidocaine or bupivacaine. Sensory function was not abolished in nonblocked wings.Conclusions and clinical relevance The brachial plexus block was an easy technique to perform but had a high failure rate. It might be useful for providing anesthesia or postoperative analgesia of the wing in chickens and exotic avian species that have similar wing anatomy.

Diffusion-controlled growth of aggregates in layer-by-layer films of poly(o-methoxyaniline)

The adsorption process in layer-by-layer (LBL) films of poly(o-methoxyaniline) alternated with poly(vinyl sulfonic acid) is explained using the Avrami equation. This equation was used due to its mathematical simplicity and adequate description of experimental data in real polymer systems. The Avrami parameters are a convenient means to represent empirical data of crystallization, and if microscopic knowledge is available these parameters can also be associated with adsorption mechanisms. The growth of spherulites in the LBL films was studied as a function of time using atomic force microscopy and the data were used to estimate the number and radii of aggregates, from which the Avrami parameters were determined. We find that the adsorption mechanism may correspond to a tri dimensional, diffusion-controlled growth, with increasing nucleation rate, consistent with results from kinetics of adsorption.

Pore size evolution during sintering of ceramic oxides

This paper reviews the influence of particle size distribution, agglomerates, rearrangement, sintering atmospheres and impurities on the pore evolution of some commonly studied oxides. These factors largely affect sintering mechanisms due to modifications of diffusion coefficients or evaporation-condensation. Very broad particle size distribution leads to grain growth and agglomerates densify first. Rearrangement of particles due to neck asymmetry mainly in the early stage of sintering is responsible for a high rate of densification in the first minutes of sintering by collapse of large pores. Sintering atmospheres play an important role in both densification and pore evolution. The chemical interaction of water molecules with several oxides like MgO, ZnO and SnO2 largely affects surface diffusion. As a consequence, there is an increase in the rates of pore growth and densification for MgO and ZnO and in the rate of pore growth for SnO2. Carbon dioxide does not affect the rate of sintering of MgO but greatly affects both rates of pore growth and densification of ZnO. Oxygen concentration in the atmosphere can especially affect semiconductor oxides but significantly affects the rate of pore growth of SnO2. Impurities like chlorine ions increase the rate of pore growth in MgO due to evaporation of HCl and Mg(OH)Cl, increasing the rate of densification and particle cuboidization. CuO promotes densification in SnO2, and is more effective in dry air. The rate of densification decrease and pore widening are promoted in argon. An inert atmosphere favors SnO2 evaporation due to reduction of CuO. © 1990.

Analytical chemistry in a liquid film/droplet

The measurement of nitrogen dioxide at the parts-perbillion level is described. The experimental arrangement consists of two optical fibers placed on opposite sides of and in contact with a liquid film (14-57 μL in volume) supported on a U-shaped wire guide and two tubular conduits (one of which constitutes the means for the delivery of the liquid), light from a green (555 nm) light-emitting diode enters the liquid film, composed of Griess-Saltzman reagent. The transmitted light is measured by a referenced photodetection arrangement. Sample gas flows past the droplet at a low flow rate (typically 0.10-0.25 L/min). The response is proportional to the sampling period and the analyte concentration. The limit of detection for this nonoptimized arrangement is estimated to be <10 ppb by volume for a 5 min sample. Some unusual characteristics are observed. The initial absorbance, when most of the analyte/reaction product is still near the surface, is higher than that when the content of the droplet is fully mixed. The signal depends on the sample flow rate in a nonmonotonic fashion, first increasing and then decreasing with increasing sampling rate; the specific chemistry involved in the collection and determination of NO2 may be responsible.

Joint conomic design of x̄ and R charts under Weibull shock models

This paper deals with the joint economic design of x̄ and R charts when the occurrence times of assignable causes follow Weibull distributions with increasing failure rates. The variable quality characteristic is assumed to be normally distributed and the process is subject to two independent assignable causes (such as tool wear-out, overheating, or vibration). One cause changes the process mean and the other changes the process variance. However, the occurrence of one kind of assignable cause does not preclude the occurrence of the other. A cost model is developed and a non-uniform sampling interval scheme is adopted. A two-step search procedure is employed to determine the optimum design parameters. Finally, a sensitivity analysis of the model is conducted, and the cost savings associated with the use of non-uniform sampling intervals instead of constant sampling intervals are evaluated.

A neural approach to evaluate the effect of lightning in power transformers

This paper proposes the application of computational intelligence techniques to assist complex problems concerning lightning in transformers. In order to estimate the currents related to lightning in a transformer, a neural tool is presented. ATP has generated the training vectors. The input variables used in Artificial Neural Networks (ANN) were the wave front time, the wave tail time, the voltage variation rate and the output variable is the maximum current in the secondary of the transformer. These parameters can define the behavior and severity of lightning. Based on these concepts and from the results obtained, it can be verified that the overvoltages at the secondary of transformer are also affected by the discharge waveform in a similar way to the primary side. By using the tool developed, the high voltage process in the distribution transformers can be mapped and estimated with more precision aiding the transformer project process, minimizing empirics and evaluation errors, and contributing to minimize the failure rate of transformers. © 2009 The Berkeley Electronic Press. All rights reserved.

A bayesian analysis for the parameters of the exponential-logarithmic distribution

The exponential-logarithmic is a new lifetime distribution with decreasing failure rate and interesting applications in the biological and engineering sciences. Thus, a Bayesian analysis of the parameters would be desirable. Bayesian estimation requires the selection of prior distributions for all parameters of the model. In this case, researchers usually seek to choose a prior that has little information on the parameters, allowing the data to be very informative relative to the prior information. Assuming some noninformative prior distributions, we present a Bayesian analysis using Markov Chain Monte Carlo (MCMC) methods. Jeffreys prior is derived for the parameters of exponential-logarithmic distribution and compared with other common priors such as beta, gamma, and uniform distributions. In this article, we show through a simulation study that the maximum likelihood estimate may not exist except under restrictive conditions. In addition, the posterior density is sometimes bimodal when an improper prior density is used. © 2013 Copyright Taylor and Francis Group, LLC.

Growth regulators for in vitro propagation of Tillandsia gardneri (Bromeliaceae)

Tillandsia gardneri Lindi, is a herbaceous perennial with ornamental value. However, in Brazil there is no report about this species' cultivation on a commercial scale. The low multiplication rate of T. gardneri (in average one offshoot/plant/year) leads to illegal over-collection in the wild to meet commercial demands. The development of protocols for in vitro propagation of T. gardneri may be useful for increasing multiplication rate, producing enough plants to supply the ornamental market and also to reduce the pressure over plants collection in the wild. The present study evaluated the effect of growth regulators (6-benzylaminopurine-BA alone or in combinations with naphthaleneacetic acid-NAA) on shoots development from seedlings pre-established in vitro, from seed germination on 1/4 MS medium without growth regulators. Seedlings (with about 1.0 cm long) were re-cultured to solid 1/2 MS media supplemented with growth regulators. After 30 days on the induction medium seedlings were re-cultured to MS basal medium. The experiment was conducted in a complete randomized design with four replications and ten treatments: control (free of growth regulators), BA (0.5, 1.0 and 2.0 mg/L), BA (0.5 mg/L) + ANA (0.1 mg/L), BA (1.0 mg/L) + ANA (0.1 mg/L), BA (1.0 mg/L) + ANA (0.5 mg/L), BA (2.0 mg/L) + ANA (0.1 mg/L), BA (2.0 mg/L) + ANA (0.5 mg/L), and BA (2.0 mg/L) + ANA (1.0 mg/L). The outgrowth of shoots did not occur on medium devoid of growth regulators (control). Regression analysis for some evaluated parameters, such as percentage of seedlings responsive to shoot formation and number of shoots/seedling, and regulators concentrations (BA or ANA) were significant, allowing the establishment of the growth regulators concentration for obtaining the best multiplication rate. Some seedlings maintained in media with ANA (0.5 or 1.0 mg/L) were completely converted into callus masses that turned dark brown leading to seedlings death.

Modelo de programação matemática para controle do crescimento da vegetação sob redes de distribuição de energia elétrica

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Estudo de uma ferramenta computacional inteligente para auxiliar a análise de ensaios de impulsos atmosféricos em transformadores de distribuição

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Análise Bayesiana para a distribuição Exponencial-Logarítmica

Pós-graduação em Matematica Aplicada e Computacional - FCT

Pressões inspiratórias como preditores de sucesso na extubação em prematuros de muito peso

Pós-graduação em Pediatria - FMB