Analysis of variables that are not directly observable: influence on decision-making during the research process

The sample dimension, types of variables, format used for measurement, and construction of instruments to collect valid and reliable data must be considered during the research process. In the social and health sciences, and more specifically in nursing, data-collection instruments are usually composed of latent variables or variables that cannot be directly observed. Such facts emphasize the importance of deciding how to measure study variables (using an ordinal scale or a Likert or Likert-type scale). Psychometric scales are examples of instruments that are affected by the type of variables that comprise them, which could cause problems with measurement and statistical analysis (parametric tests versus non-parametric tests). Hence, investigators using these variables must rely on suppositions based on simulation studies or recommendations based on scientific evidence in order to make the best decisions.

The decision of an obese woman to have bariatric surgery: the social phenomenology

Objective To understand the process by which an obese woman decides to have bariatric surgery. Method A qualitative survey with a social phenomenology approach, carried out in 2012, with 12 women, using the phenomenological interview. Results A woman bases the decision to have the surgery on: the inappropriateness of her eating habits; a physical appearance that is incompatible with an appearance that is standardized by society; the social prejudice that she has to live with; the limitations imposed by obesity; and her lack of success with previous attempts to lose weight. Outcomes that she hopes for from the decision to have the surgery include: restoring her health; achieving social inclusion; and entering the labor market. Conclusion This study allows one to reflect that prescriptive actions do not give a satisfactory response to a complexity of the subjective questions involved in the decision to have surgery for obesity. For this, what is called for is a program of work based on an interdisciplinary approach, and training that gives value to the bio-psycho-social aspects involved in a decision in favor of surgical treatment.

Informatics competencies essential to decision making in nursing management

Abstract OBJECTIVE To identify informatics abilities essential to decision making in nursing management. METHOD Survey study with specialist nurses in health informatics and management. An electronic questionnaire was built based on the competencies Information Literacy (five categories; 40 abilities) and Information Management (nine categories; 69 abilities) of the TIGER - Technology Informatics Guiding Education Reform - initiative, with the guiding question: Which informatics abilities are essential to decision making in management? Answers were sorted in a Likert scale, ranging from 1 to 5. Rasch analysis was conducted with the software WINSTEPS ®. Results were presented in logits, with cutoff value zero. RESULTS Thirty-two specialists participated, coming from all regions of Brazil. In the information literacy competency, 18 abilities were considered essential and in Information Management, 38; these were sorted according to their degree of essentiality. CONCLUSION It is believed that the incorporation of these abilities in teaching can support the education of nurse managers and contribute to evidence-based practice, incorporation of information and communication technologies in health and information management.

Macronutrient uptake, accumulation and export by the irrigated 'vitória' pineapple plant

The nutritional state of the pineapple plant has a large effect on plant growth, on fruit production, and fruit quality. The aim of this study was to assess the uptake, accumulation, and export of nutrients by the irrigated 'Vitória' pineapple plant during and at the end of its development. A randomized block statistical design with four replications was used. The treatments were defined by different times of plant collection: at 270, 330, 390, 450, 510, 570, 690, 750, and 810 days after planting (DAP). The collected plants were separated into the following components: leaves, stem, roots, fruit, and slips for determination of fresh and dry matter weight at 65 ºC. After drying, the plant components were ground for characterization of the composition and content of nutrients taken up and exported by the pineapple plant. The results were subjected to analysis of variance, and non-linear regression models were fitted for the significant differences identified by the F test (p<0.01). The leaves and the stem were the plant components that showed the greatest accumulation of nutrients. For production of 72 t ha-1 of fruit, the macronutrient accumulation in the 'Vitória' pineapple exhibited the following decreasing order: K > N > S > Ca > Mg > P, which corresponded to 898, 452, 134, 129, 126, and 107 kg ha-1, respectively, of total accumulation. The export of macronutrients by the pineapple fruit was in the following decreasing order: K > N > S > Ca > P > Mg, which was equivalent to 18, 17, 11, 8, 8, and 5 %, respectively, of the total accumulated by the pineapple. The 'Vitória' pineapple plant exported 78 kg ha-1 of N, 8 kg ha-1 of P, 164 kg ha-1 of K, 14 kg ha-1 of S, 10 kg ha-1 of Ca, and 6 kg ha-1 of Mg by the fruit. The nutrient content exported by the fruits represent important components of nutrient extraction from the soil, which need to be restored, while the nutrients contained in the leaves, stems and roots can be incorporated in the soil within a program of recycling of crop residues.

Effect of potassium sources and rates on arabica coffee yield, nutrition, and macronutrient export

The use of potassium (K) rock powder can be an alternative for K supply of crops. Thus, to reduce K fertilizer imports from abroad, possibilities of extracting this nutrient from Brazilian rocks are being studied. The objective was to evaluate the effect of phonolite rock powder (F2) as K source (Ekosil®) on the air-dried fruit yield, nutrition and macronutrient export of Arabica coffee. The experiment was carried out on a dystroferric Red Latosol (Typic Haplorthox), in Piraju, São Paulo State, Brazil, in the 2008/09 and 2009/10 growing seasons. The experimental design was a randomized complete block, in a factorial 2 × 3 + 1 arrangement, with four replications. The treatments consisted of two K sources (KCl - 58 % of K2O and F2 - 8.42 % K2O) and three rates ½-, 1-, and 2-fold the K2O rate recommended for coffee, i.e., 75, 150, and 300 kg ha-1 of K2O), plus a control (without K application). Potassium supply increased coffee yield, regardless of the source. Application of source F2 increased coffee yield similarly to KCl at the recommended K rate for coffee (150 kg ha-1 K2O), proving efficient as K supply for coffee. Potassium application increased macronutrient export in coffee, especially in the growing season with higher yield.

Sustainability of Wood Productivity of Pinus TaedaBased on Nutrient Export and Stocks in the Biomass and in the Soil

ABSTRACT The impact of intensive management practices on the sustainability of forest production depends on maintenance of soil fertility. The contribution of forest residues and nutrient cycling in this process is critical. A 16-year-old stand of Pinus taeda in a Cambissolo Húmico Alumínico léptico (Humic Endo-lithic Dystrudept) in the south of Brazil was studied. A total of 10 trees were sampled distributed in five diameter classes according to diameter at breast height. The biomass of the needles, twigs, bark, wood, and roots was measured for each tree. In addition to plant biomass, accumulated plant litter was sampled, and soil samples were taken at three increments based on sampling depth: 0.00-0.20, 0.20-0.40, 0.40-0.60, 0.60-1.00, 1.00-1.40, 1.40-1.80, and 1.80-1.90 m. The quantity and concentration of nutrients, as well as mineralogical characteristics, were determined for each soil sample. Three scenarios of harvesting intensities were simulated: wood removal (A), wood and bark removal (B), and wood + bark + canopy removal (C). The sum of all biomass components was 313 Mg ha-1.The stocks of nutrients in the trees decreased in the order N>Ca>K>S>Mg>P. The mineralogy of the Cambissolo Húmico Alumínico léptico showed the predominance of quartz sand and small traces of vermiculite in the silt fraction. Clay is the main fraction that contributes to soil weathering, due to the transformation of illite-vermiculite, releasing K. The depletion of nutrients from the soil biomass was in the order: P>S>N>K>Mg>Ca. Phosphorus and S were the most limiting in scenario A due to their low stock in the soil. In scenario B, the number of forest rotations was limited by N, K, and S. Scenario C showed the greatest reduction in productivity, allowing only two rotations before P limitation. It is therefore apparent that there may be a difference of up to 30 years in the capacity of the soil to support a scenario such as A, with a low nutrient removal, compared to scenario C, with a high nutrient removal. Hence, the effect of different harvesting intensities on nutrient availability may jeopardize the sustainability of P. taeda in the short-term.

Decision criteria for optimizing postemergence johnsongrass control in soybean crops in Argentina

Field studies were established in Zavalla and Oliveros, Argentina, during four years in order to optimize Johnsongrass (Sorghum halepense (L.) Pers.) chemical control by means of the thermal calendar model in comparison with other criteria (weed height or days after sowing). The effect of three application dates of postemergence herbicides was determined by visual control, density of tillers originated from rhizome bud regrowth, and from crown and shoot bud regrowth, and soybean yield. Following the thermal calendar model criterion, applications during the second date afforded the best control. Weed height for the first date showed little variability between experiments but was highly variable in the second and third application dates, achieving in some cases values greater than 120 cm. For all years, no significant differences were detected for crop yield between the first and second application dates, and yields were always lower for the third date. The greatest rhizome bud regrowth was observed for the earliest application date and the highest crown and shoot bud regrowth was determined for the last application date. Parameters associated with control efficiency showed the best behaviour for the second date. However, plant height at this moment may interfere with herbicide application and the variability exhibited by this parameter highlights the risk of determining control timing using only one decision criterion.

An ABC for decision making

The present study was aimed at proposing a systematic evaluation of cranial computed tomography, identifying the main aspects to be analyzed in order to facilitate the decision making process regarding diagnosis and management in emergency settings. The present descriptive study comprised a literature review at the following databases: Access Medicine and Access Emergency Medicine (McGraw- Hill Education); British Medical Journal Evidence Center; UptoDate; Bireme; PubMed; Lilacs; SciELO; ProQuest; Micromedex (Thomson Reuters); Embase. Once the literature review was completed, the authors identified the main diseases with tomographic repercussions and proposed the present system to evaluate cranial computed tomography images. An easy-to-memorize ABC system will facilitate the decision making in emergency settings, as it covers the main diseases encountered by intensivists and emergency physicians, and provides a sequential guidance about anatomical structures to be investigated as well as their respective alterations.

Magnetic resonance imaging of the vagina: an overview for radiologists with emphasis on clinical decision making

AbstractMagnetic resonance imaging is a method with high contrast resolution widely used in the assessment of pelvic gynecological diseases. However, the potential of such method to diagnose vaginal lesions is still underestimated, probably due to the scarce literature approaching the theme, the poor familiarity of radiologists with vaginal diseases, some of them relatively rare, and to the many peculiarities involved in the assessment of the vagina. Thus, the authors illustrate the role of magnetic resonance imaging in the evaluation of vaginal diseases and the main relevant findings to be considered in the clinical decision making process.

Medical students' knowledge about end-of-life decision-making

The influence of medical students' knowledge concerning end-of-life care, considering ethical theories and clinical practice, remains controversial. We aimed to investigate medical students' knowledge of bioethical concepts related to moral kinds of death (euthanasia, disthanasia, and orthothanasia) and to analyze the influence of their clinical experience on practicing such approaches in a tertiary hospital in the state of São Paulo, Brazil. We interviewed 180 medical students [distributed in Group 1 (G1) - first to third- year students, and Group 2 (G2) - fourth to sixth-year students] to evaluate the influence of the course on "medical ethics" on ethical theories and clinical practice, using a closed questionnaire. The course on "medical ethics" did not distinguish the groups (P=0.704) in relation to bioethical concepts. Neologisms such as "cacothanasia" and "idiothanasia" were incorrectly viewed as bioethical concepts by 28% of the interviewees. Moreover, 45.3% of the sample considered health care professionals incapable of managing terminally ill patients, especially G2 (29%) as compared to G1 (16.5%, P=0.031). The concept of euthanasia was accepted by 41% of sample, as compared to 98.2% for orthothanasia. Among medical students that accepted ways to abbreviate life (22.9%), 30.1% belonged to G1, and only 16.1% to G2 (P=0.049). These medical students were unfamiliar with common bioethical concepts. Moreover, they considered healthcare professionals incapable of managing terminally ill patients. The ethical ideal of the "good death" reflects better acceptance of orthothanasia by medical students, suggesting a tendency to apply it in their future clinical practice.

A decision support system for cost determination in grain storage facility operations

Many research works have being carried out on analyzing grain storage facility costs; however a few of them had taken into account the analysis of factors associated to all pre-processing and storage steps. The objective of this work was to develop a decision support system for determining the grain storage facility costs and utilization fees in grain storage facilities. The data of a CONAB storage facility located in Ponta Grossa - PR, Brazil, was used as input of the system developed to analyze its specific characteristics, such as amount of product received and stored throughout the year, hourly capacity of drying, cleaning, and receiving, and dispatch. By applying the decision support system, it was observed that the reception and expedition costs were exponentially reduced as the turnover rate of the storage increased. The cleaning and drying costs increased linearly with grain initial moisture. The storage cost increased exponentially as the occupancy rate of the storage facility decreased.

Decision support system for the diagnosis of schizophrenia disorders

Clinical decision support systems are useful tools for assisting physicians to diagnose complex illnesses. Schizophrenia is a complex, heterogeneous and incapacitating mental disorder that should be detected as early as possible to avoid a most serious outcome. These artificial intelligence systems might be useful in the early detection of schizophrenia disorder. The objective of the present study was to describe the development of such a clinical decision support system for the diagnosis of schizophrenia spectrum disorders (SADDESQ). The development of this system is described in four stages: knowledge acquisition, knowledge organization, the development of a computer-assisted model, and the evaluation of the system's performance. The knowledge was extracted from an expert through open interviews. These interviews aimed to explore the expert's diagnostic decision-making process for the diagnosis of schizophrenia. A graph methodology was employed to identify the elements involved in the reasoning process. Knowledge was first organized and modeled by means of algorithms and then transferred to a computational model created by the covering approach. The performance assessment involved the comparison of the diagnoses of 38 clinical vignettes between an expert and the SADDESQ. The results showed a relatively low rate of misclassification (18-34%) and a good performance by SADDESQ in the diagnosis of schizophrenia, with an accuracy of 66-82%. The accuracy was higher when schizophreniform disorder was considered as the presence of schizophrenia disorder. Although these results are preliminary, the SADDESQ has exhibited a satisfactory performance, which needs to be further evaluated within a clinical setting.

A mechanistic view of mitochondrial death decision pores

Mitochondria increase their outer and inner membrane permeability to solutes, protons and metabolites in response to a variety of extrinsic and intrinsic signaling events. The maintenance of cellular and intraorganelle ionic homeostasis, particularly for Ca2+, can determine cell survival or death. Mitochondrial death decision is centered on two processes: inner membrane permeabilization, such as that promoted by the mitochondrial permeability transition pore, formed across inner membranes when Ca2+ reaches a critical threshold, and mitochondrial outer membrane permeabilization, in which the pro-apoptotic proteins BID, BAX, and BAK play active roles. Membrane permeabilization leads to the release of apoptogenic proteins: cytochrome c, apoptosis-inducing factor, Smac/Diablo, HtrA2/Omi, and endonuclease G. Cytochrome c initiates the proteolytic activation of caspases, which in turn cleave hundreds of proteins to produce the morphological and biochemical changes of apoptosis. Voltage-dependent anion channel, cyclophilin D, adenine nucleotide translocase, and the pro-apoptotic proteins BID, BAX, and BAK may be part of the molecular composition of membrane pores leading to mitochondrial permeabilization, but this remains a central question to be resolved. Other transporting pores and channels, including the ceramide channel, the mitochondrial apoptosis-induced channel, as well as a non-specific outer membrane rupture may also be potential release pathways for these apoptogenic factors. In this review, we discuss the mechanistic models by which reactive oxygen species and caspases, via structural and conformational changes of membrane lipids and proteins, promote conditions for inner/outer membrane permeabilization, which may be followed by either opening of pores or a rupture of the outer mitochondrial membrane.