Early nephrology consultation can have an impact on outcome of acute kidney injury patients

Background. Patients who develop acute kidney injury (AKI) in the intensive care unit (ICU) have extremely high rates of mortality and morbidity. The objectives of this study were to compare clinical and laboratory characteristics of AKI patients evaluated and not evaluated by nephrologists in ICU and generate the hypothesis of the relationship between timing of nephrology consultation and outcome.Methods. We explored associations among presence and timing of nephrology consultation with ICU stay and in-ICU mortality in 148 ICU patients with AKI at a Brazilian teaching hospital from July 2008 to May 2010. Multivariable logistic regression was used to adjust confounding and selection bias.Results. AKI incidence was 30% and 52% of these AKI patients were evaluated by nephrologists. At multivariable analysis, AKI patients evaluated by nephrologists showed higher Acute Tubular Necrosis-Index Specific Score and creatinine level, more dialysis indications, lower urine output and longer ICU stay. The mortality rate was similar to AKI patients who were not evaluated. Nephrology consultation was delayed (>= 48 h) in 62.3% (median time to consultation, 4.7 days). Lower serum creatinine levels (P - 0.009) and higher urine output (P = 0.002) were associated with delayed consultation. Delayed consultation was associated with increased ICU mortality (65.4 versus 88.2%, P < 0.001).Conclusions. In AKI, patients evaluated by nephrologists seem to be more seriously ill than those not evaluated and present similar mortality rate. The delayed nephrology consultation can be associated with increased ICU mortality.

Modelling an expert GIS system based on knowledge to evaluate oil spill environmental sensitivity

Oil spills cause great damage to coastal habitats, especially when rapid and suitable response measures are not taken. Establishing high priority areas is fundamental for the operation of response teams. Under this context and considering the need for keeping all geographical information up-to-date for emergencial use, the present study proposes employing a decision tree coupled with a knowledge-based approach using GIS to assign oil sensitivity indices to Brazilian coastal habitats. The modelled system works based on rules set by the official standards of Brazilian Federal Environment Organ. We tested it on one of the littoral regions of Brazil where transportation of petroleum is most intense: the coast of the municipalities of Sao Sebastiao and Caraguatatuba in the northern littoral of São Paulo state, Brazil. The system automatically ranked the littoral sensitivity index of the study area habitats according to geographical conditions during summer and winter; since index ranks of some habitats varied between these seasons because of sediment alterations. The obtained results illustrate the great potential of the proposed system in generating ESI maps and in aiding response teams during emergency operations. (C) 2009 Elsevier Ltd. All rights reserved.

Nursing consultation applied to hypertensive clients: application of orem's self-care theory

O objetivo foi implantar a Consulta de Enfermagem para indivíduos hipertensos, utilizando-se a teoria do autocuidado de Orem e sistematizar a assistência de enfermagem. Foram entrevistados 56 pacientes, sendo 58,9% mulheres, 75% na faixa etária de 50 a 80 anos, 76,4% casados, 42,9% donas de casa, 47,2% aposentados e 67,3% com ensino fundamental completo. Utilizou-se instrumento estruturado abordando os requisitos de autocuidado universal, de desenvolvimento e de desvios de saúde. A análise dos dados possibilitou avaliar os requisitos de autocuidado alterados. No planejamento da assistência, as ações de apoio-educação foram prioridades. A teoria do autocuidado possibilitou identificar aspectos importantes para serem trabalhados pelo enfermeiro.

An extended query-the-user tool for expert systems

An extended version of HIER, a query-the-user facility for expert systems is presented. HIER was developed to run over Prolog programs, and has been incorporated to systems that support the design of large and complex applications. The framework of the extended version is described,; as well as the major features of the implementation. An example is included to illustrate the use of the tool, involving the design of a specific database application.

Expert system for hot forging design

Planning hot forging processes is a time-consuming activity with high costs involved because of the trial-and-error iterative methods used to design dies and to choose equipment and process conditions. Some processes demand many months to produce forged parts with controlled shapes, dimensions and microstructure. This paper shows how expert systems can help engineers to reduce the time needed to design precision forged parts and dies from machined parts. The software ADHFD interfacing MS Visual Basic v.5.0 and SolidEdge v.3.0 was used to design flashless hot forged gears, chosen from families of gears. © 1998 Elsevier Science S.A. All rights reserved.

Psychiatric disorders and psychiatric consultation in a general hospital: A case- control study

Introduction: Psychiatric consultation (PC) has been considered an efficient tool to develop research, to track and to give assistance benefiting patients, health professionals and the institution. However, it has not been much used in Brazil. Although 30 to 50% of general hospital (GH) inpatients may present a psychiatric disorder, only 1 to 12% of them are referred to assessment. The aims of this study were: to assess mental disorders in a GH; to identify which of these patients are sent to psychiatric care; to verify alleged reasons for referral to psychiatric consultation, and to examine the relationship between PC and psychiatric learning (during medical school and residence). Methods: A case-control patient study was conducted (47 cases and 94 controls) to analyze in detail the following variables: socio-demographic; clinical; degree of information (about the disease and diagnostic/therapeutic procedures), and relationship between patient and health team. Psychiatric diagnoses were made according to the ICD- 10 criteria. The Self Report Questionnaire (SRQ), the CAGE and Brief Psychiatric Rating Scale (BPRS) were used as well as a specifically designed questionnaire to collect clinical and demographic data. Results: Behavioral alterations, either of elation or of depression, were the main for requesting a PC; 95.8% of the cases and 27.7% of the controls had a mental disorder. Organic mental disorders and alcohol-related disorders were the most frequent diagnoses in group I (cases), while anxiety, depressive and alcohol-related disorders were predominant in group II (controls). Control group patients were better informed and more able to establish an appropriate relationship with the health team than case patients. The logistic regression showed CAGE-positive patients having 12.85 times greater risk of being referred to PC, followed by unemployed patients (2.44 times more PC referrals). Discussion: The SRQ and CAGE were quite useful in the screening of possible patients and might be important for medical students to learn and use as generalists. Further research is needed to verify if and how the newly-established service will improve the diagnostic and treatment skills of our students.

Elaboração e avaliação de um ambiente virtual para o ensino/aprendizagem de embriologia

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

Cogeneration design problem Computational complexity analysis and solution through an expert system

Purpose - The purpose of this paper is twofold: to analyze the computational complexity of the cogeneration design problem; to present an expert system to solve the proposed problem, comparing such an approach with the traditional searching methods available.Design/methodology/approach - The complexity of the cogeneration problem is analyzed through the transformation of the well-known knapsack problem. Both problems are formulated as decision problems and it is proven that the cogeneration problem is np-complete. Thus, several searching approaches, such as population heuristics and dynamic programming, could be used to solve the problem. Alternatively, a knowledge-based approach is proposed by presenting an expert system and its knowledge representation scheme.Findings - The expert system is executed considering two case-studies. First, a cogeneration plant should meet power, steam, chilled water and hot water demands. The expert system presented two different solutions based on high complexity thermodynamic cycles. In the second case-study the plant should meet just power and steam demands. The system presents three different solutions, and one of them was never considered before by our consultant expert.Originality/value - The expert system approach is not a "blind" method, i.e. it generates solutions based on actual engineering knowledge instead of the searching strategies from traditional methods. It means that the system is able to explain its choices, making available the design rationale for each solution. This is the main advantage of the expert system approach over the traditional search methods. On the other hand, the expert system quite likely does not provide an actual optimal solution. All it can provide is one or more acceptable solutions.

Novel expert system for defining power quality compensators

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

Ditregra - An auxiliary program for structural determination of diterpenes

This work describes the creation of heuristics rules based on 13C-NMR spectroscopy that characterize several skeletal types of diterpenes. Using a collection of 2745 spectra we built a database linked to the expert system SISTEMAT. Several programs were applied to the database in order to discover characteristic signals that identify with a good performance, a large diversity of skeletal types. The heuristic approach used was able to differentiate groups of skeletons based firstly on the number of primary, secondary, tertiary and quaternary carbons, and secondly the program searches, for each group, if there are ranges of chemical shifts that identifies specific skeletal type. The program was checked with 100 new structures recently published and was able to identify the correct skeleton in 65 of the studied cases. When the skeleton has several hundreds of compounds, for example, the labdanes, the program employs the concept of subskeletal, and does not classify in the same group labdanes with double bounds at different positions. The chemical shift ranges for each subskeletal types and the structures of all skeletal types are given. The consultation program can be obtained from the authors. © 1997 - IOS Press. All rights reserved.

Paricipation in Bauru marter plans, Brazil: analysis of the historical evolution of the consultation process

In Brazil, a policy on citizen participation and consultation in urban intervention programs, in particular in the development of master plans, was first introduced into the Federal Constitution in 1988. This article presents an historical reconstitution of Master Plans in Bauru – State of São Paulo – Brazil. The 1968, 1988 and 2005/2006 consultation methods are analyzed using established criteria. The degree of community participation in the processes is estimated by drawing on a typology based on the level of involvement by residents. The effects of participation caused by changes in political regime, technical planning vision, legal support to consultation, recognition of community importance and knowledge acquired during the process are highlighted and discussed.

Expert system to detect incipient fauts in rotating machines using fuzzy logic and virtual instrumentation

This paper refers to the design of an expert system that captures a waveform through the use of an accelerometer, processes the signal and converts it to the frequency domain using a Fast Fourier Transformer to then, using artificial intelligence techniques, specifically Fuzzy Reasoning, it determines if there is any failure present in the underlying mode of the equipment, such as imbalance, misalignment or bearing defects.

Validação de conteúdo das intervenções de enfermagem “Ensino: Pré-operatório” e “Ensino: Procedimento/Tratamento” da Classificação das Intervenções de Enfermagem, para procedimento percutâneo em hemodinâmica

Pós-graduação em Enfermagem (mestrado profissional) - FMB