23 resultados para Value-based pricing
em Scielo Saúde Pública - SP
Resumo:
The phyllochron is defined as the time required for the appearance of successive leaves on a plant; this characterises plant growth, development and adaptation to the environment. To check the growth and adaptation in cultivars of strawberry grown intercropped with fig trees, it was estimated the phyllochron in these production systems and in the monocrop. The experiment was conducted in greenhouses at the University of Passo Fundo (28º15'41'' S, 52º24'45'' W and 709 m) from June 8th to September 4th, 2009; this comprised the period of transplant until the 2nd flowering. The cultivars Aromas, Camino Real, Albion, Camarosa and Ventana, which seedlings were originated from the Agrícola LLahuen Nursery in Chile, as well as Festival, Camino Real and Earlibrite, originated from the Viansa S.A. Nursery in Argentina, were grown in white polyethylene bags filled with commercial substrate (Tecnomax®) and evaluated. The treatments were arranged in a randomised block design and four replicates were performed. A linear regression was realized between the leaf number (LN) in the main crown and the accumulated thermal time (ATT). The phyllochron (degree-day leaf-1) was estimated as the inverse of the angular coefficient of the linear regression. The data were submitted to ANOVA, and when significance was observed, the means were compared using the Tukey test (p < 0.05). The mean and standard deviation of phyllochrons of strawberry cultivars intercropped with fig trees varied from 149.35ºC day leaf-1 ± 31.29 in the Albion cultivar to 86.34ºC day leaf-1 ± 34.74 in the Ventana cultivar. Significant differences were observed among cultivars produced in a soilless environment with higher values recorded for Albion (199.96ºC day leaf-1 ± 29.7), which required more degree-days to produce a leaf, while cv. Ventana (85.76ºC day leaf-1 ± 11.51) exhibited a lower phyllochron mean value. Based on these results, Albion requires more degree-days to issue a leaf as compared to cv. Ventana. It was conclude that strawberry cultivars can be grown intercropped with fig trees (cv. Roxo de Valinhos).
Resumo:
The evaluation of filtration methods on the yield and oleochemicals characteristics on the crude fish oil from the soapstock of marine fish for purposes of nutrition has been conducted in this work. The analytical properties of the crude and the neutralized oil with three excesses of sodium hydroxide (NaOH, 20%, 40% and 60%) were carried out on two different ways with organza and the “glass wool”. The neutralization of the oil brought about a notable improvement in the analytical properties of the oil. Thus, it leads to a high quality fish oil in terms of taste, colour, odours, shelf life and market value. Based on the improved characteristics of the oil, it could be suitable for applications in pharmaceutical and food industries.
Resumo:
One major goal of research on Chagas disease is the development of effective chemotherapy to eliminate the infection from individuals who have not yet developed cardiac and/or digestive disease manifestations. Cure evaluation is the more complex aspect of its treatment, often leading to diverse and controversial results. The absence of reliable methods or a diagnostic gold standard to assess etiologic treatment efficacy still constitutes a major challenge. In an effort to develop more sensitive tools, polymerase chain reaction (PCR)-based assays were introduced to detect low amounts of Trypanosoma cruzi DNA in blood samples from chagasic patients, thus improving the diagnosis and follow-up evaluation after chemotherapy. In this article, I review the main problems concerning drug efficacy and criteria used for cure estimation in treated chagasic patients, and the work conducted by different groups on developing PCR methodologies to monitor treatment outcome of congenital infections as well as recent and late chronic T. cruzi infections.
Resumo:
The application of the Extreme Value Theory (EVT) to model the probability of occurrence of extreme low Standardized Precipitation Index (SPI) values leads to an increase of the knowledge related to the occurrence of extreme dry months. This sort of analysis can be carried out by means of two approaches: the block maxima (BM; associated with the General Extreme Value distribution) and the peaks-over-threshold (POT; associated with the Generalized Pareto distribution). Each of these procedures has its own advantages and drawbacks. Thus, the main goal of this study is to compare the performance of BM and POT in characterizing the probability of occurrence of extreme dry SPI values obtained from the weather station of Ribeirão Preto-SP (1937-2012). According to the goodness-of-fit tests, both BM and POT can be used to assess the probability of occurrence of the aforementioned extreme dry SPI monthly values. However, the scalar measures of accuracy and the return level plots indicate that POT provides the best fit distribution. The study also indicated that the uncertainties in the parameters estimates of a probabilistic model should be taken into account when the probability associated with a severe/extreme dry event is under analysis.
Resumo:
In order to evaluate the role of the determination of adenosine deaminase activity (ADA) in ascitic fluid for the diagnosis of tuberculosis, 44 patients were studied. Based on biochemical, cytological, histopathological and microbiological tests, the patients were divided into 5 groups: G1 - tuberculous ascites (n = 8); G2 - malignant ascites (n = 13); G3 - spontaneous bacterial peritonitis (n = 6); G4 - pancreatic ascites (n = 2); G5 - miscelaneous ascites (n = 15). ADA concentration were significantly higher in G1 (133.50 ± 24.74 U/l) compared to the other groups (G2 = 41.85 ± 52.07 U/l; G3 = 10.63 ± 5.87 U/l; G4 = 18.00 ± 7.07 U/l; G5 = 11.23 ± 7.66 U/l). At a cut-off value of >31 U/l, the sensitivity, specificity and positive and negative preditive values were 100%, 92%, 72% and 100%, respectively. ADA concentrations as high as in tuberculous ascites were only found in two malignant ascites caused by lymphoma. We conclude that ADA determination in ascitic fluid is a useful and reliable screening test for diagnosing tuberculous ascites. Values of ADA higher than 31 U/l indicate more invasive methods to confirm the diagnosis of tuberculosis.
Resumo:
A rapid test based on an immunochromatography assay - Determine Syphilis TP (Abbott Lab.) for detecting specific antibodies to Treponema pallidum was evaluated against serum samples from patients with clinical, epidemiological and serological diagnosis of syphilis, patients with sexually transmitted disease other than syphilis, and individuals with negative serology for syphilis. The Determine test presented the sensitivity of 93.6%, specificity of 92.5%, and positive predictive value and negative predictive value of 95.2% and 93.7%, respectively. One serum sample from patient with recent latent syphilis showed a prozone reaction. Determine is a rapid assay, highly specific and easy to perform. This technique obviates the need of equipment and its diagnostic features demonstrate that it may be applicable as an alternative assay for syphilis screening under some emergency conditions or for patients living in remote localities.
Resumo:
A ligase chain reaction DNA amplification method for direct detection of Mycobacterium tuberculosis (Abbott LCx MTB) in respiratory specimens was evaluated. Results from LCx MTB Assay were compared with those from acid fast bacilli smear, culture, and final clinical diagnosis for each patient. A total of 297 respiratory specimens (sputum and bronchial lavage) from 193 patients were tested. The sensitivity, specificity, positive predictive value and negative predictive value of LCx vs culture were 92.7%, 93%, 67.8% and 98.7%, respectively. When compared to the clinical final diagnosis, the sensitivity, specificity, PPV and NPV for LCx were 88.9%, 96.8%, 86.5% and 97.4%, respectively. The sensitivity of LCx MTB assay was 75% for smear-negative, culture positive samples. The results indicate that LCx MTB assay is a rapid, simple and valuable technique as a complementary tool for the diagnosis of tuberculosis.
Resumo:
PURPOSE: The Internet expands the range and flexibility of teaching options and enhances the ability to process the ever-increasing volume of medical knowledge. The aim of this study is to describe and discuss our experience with transforming a traditional medical training course into an Internet-based course. METHOD: Sixty-nine students were enrolled for a one-month course. They answered pre- and post-course questionnaires and took a multiple-choice test to evaluate the acquired knowledge. RESULTS: Students reported that the primary value for them of this Internet-based course was that they could choose the time of their class attendance (67%). The vast majority (94%) had a private computer and were used to visiting the Internet (75%) before the course. During the course, visits were mainly during the weekends (35%) and on the last week before the test (29%). Thirty-one percent reported that they could learn by reading only from the computer screen, without the necessity of printed material. Students were satisfied with this teaching method as evidenced by the 89% who reported enjoying the experience and the 88% who said they would enroll for another course via the Internet. The most positive aspect was freedom of scheduling, and the most negative was the lack of personal contact with the teacher. From the 80 multiple-choice questions, the mean of correct answers was 45.5, and of incorrect, 34.5. CONCLUSIONS: This study demonstrates that students can successfully learn with distance learning. It provides useful information for developing other Internet-based courses. The importance of this new tool for education in a large country like Brazil seems clear.
Resumo:
Abstract Background: Pulmonary hypertension is associated with poor prognosis in heart failure. However, non-invasive diagnosis is still challenging in clinical practice. Objective: We sought to assess the prognostic utility of non-invasive estimation of pulmonary vascular resistances (PVR) by cardiovascular magnetic resonance to predict adverse cardiovascular outcomes in heart failure with reduced ejection fraction (HFrEF). Methods: Prospective registry of patients with left ventricular ejection fraction (LVEF) < 40% and recently admitted for decompensated heart failure during three years. PVRwere calculated based on right ventricular ejection fraction and average velocity of the pulmonary artery estimated during cardiac magnetic resonance. Readmission for heart failure and all-cause mortality were considered as adverse events at follow-up. Results: 105 patients (average LVEF 26.0 ±7.7%, ischemic etiology 43%) were included. Patients with adverse events at long-term follow-up had higher values of PVR (6.93 ± 1.9 vs. 4.6 ± 1.7estimated Wood Units (eWu), p < 0.001). In multivariate Cox regression analysis, PVR ≥ 5 eWu(cutoff value according to ROC curve) was independently associated with increased risk of adverse events at 9 months follow-up (HR2.98; 95% CI 1.12-7.88; p < 0.03). Conclusions: In patients with HFrEF, the presence of PVR ≥ 5.0 Wu is associated with significantly worse clinical outcome at follow-up. Non-invasive estimation of PVR by cardiac magnetic resonance might be useful for risk stratification in HFrEF, irrespective of etiology, presence of late gadolinium enhancement or LVEF.
Resumo:
The objective of this population-based study was to estimate the liver morbidity attributable to Schistosoma mansoni infection by ultrasonography adopting the proposed standard protocols of the Cairo Meeting on Ultrasonography, 1991. We examined 2384 individuals representing 20 of the households of the rural population of the Ismailia Governorate, East of Delta, Egypt. Prevalence of S. mansoni and S. haematobium infections were 40.3 and 1.7 respectively. Portal tract thickening (PTT) grade 1, 2 and 3 considered diagnostic of schistosomal liver morbidity was detected in 35.1, 1.3 and 0.2 individuals respectively. Generally, ultrasonographically-detected pathological changes increased with age, but correlated with intensity of infection only in age group 20-59 years. Comparing individuals with and without S. mansoni infections in an endemic and a non-endemic community indicated no significant difference between the former and the latter in either case. In conclusion: ultrasonography had a limited value in estimating schistosomal liver morbidity in our population-based study where early grades of liver morbidly were prevalent. The criteria of diagnosing grade I portal fibrosis need to be revised as well as the staging system proposed by the Cairo Meeting on ultrasonography in schistosomiasis.
Resumo:
Macroporosity is often used in the determination of soil compaction. Reduced macroporosity can lead to poor drainage, low root aeration and soil degradation. The aim of this study was to develop and test different models to estimate macro and microporosity efficiently, using multiple regression. Ten soils were selected within a large range of textures: sand (Sa) 0.07-0.84; silt 0.03-0.24; clay 0.13-0.78 kg kg-1 and subjected to three compaction levels (three bulk densities, BD). Two models with similar accuracy were selected, with a mean error of about 0.02 m³ m-3 (2 %). The model y = a + b.BD + c.Sa, named model 2, was selected for its simplicity to estimate Macro (Ma), Micro (Mi) or total porosity (TP): Ma = 0.693 - 0.465 BD + 0.212 Sa; Mi = 0.337 + 0.120 BD - 0.294 Sa; TP = 1.030 - 0.345 BD 0.082 Sa; porosity values were expressed in m³ m-3; BD in kg dm-3; and Sa in kg kg-1. The model was tested with 76 datum set of several other authors. An error of about 0.04 m³ m-3 (4 %) was observed. Simulations of variations in BD as a function of Sa are presented for Ma = 0 and Ma = 0.10 (10 %). The macroporosity equation was remodeled to obtain other compaction indexes: a) to simulate maximum bulk density (MBD) as a function of Sa (Equation 11), in agreement with literature data; b) to simulate relative bulk density (RBD) as a function of BD and Sa (Equation 13); c) another model to simulate RBD as a function of Ma and Sa (Equation 16), confirming the independence of this variable in relation to Sa for a fixed value of macroporosity and, also, proving the hypothesis of Hakansson & Lipiec that RBD = 0.87 corresponds approximately to 10 % macroporosity (Ma = 0.10 m³ m-3).
Resumo:
Data available in the literature were used to develop a warning system for bean angular leaf spot and anthracnose, caused by Phaeoisariopsis griseola and Colletotrichum lindemuthianum, respectively. The model is based on favorable environmental conditions for the infectious process such as continuous leaf wetness duration and mean air temperature during this subphase of the pathogen-host relationship cycle. Equations published by DALLA PRIA (1977) showing the interactions of those two factors on the disease severity were used. Excell spreadsheet was used to calculate the leaf wetness period needed to cause different infection probabilities at different temperature ranges. These data were employed to elaborate critical period tables used to program a computerized electronic device that records leaf wetness duration and mean temperature and automatically shows the daily disease severity value (DDSV) for each disease. The model should be validated in field experiments under natural infection for which the daily disease severity sum (DDSS) should be identified as a criterion to indicate the beginning and the interval of fungicide applications to control both diseases.
Resumo:
ABSTRACT In the present study, onion plants were tested under controlled conditions for the development of a climate model based on the influence of temperature (10, 15, 20 and 25°C) and leaf wetness duration (6, 12, 24 and 48 hours) on the severity of Botrytis leaf blight of onion caused by Botrytis squamosa. The relative lesion density was influenced by temperature and leaf wetness duration (P <0.05). The disease was most severe at 20°C. Data were subjected to nonlinear regression analysis. Beta generalized function was used to adjust severity and temperature data, while a logistic function was chosen to represent the effect of leaf wetness on the severity of Botrytis leaf blight. The response surface obtained by the product of two functions was expressed as ES = 0.008192 * (((x-5)1.01089) * ((30-x)1.19052)) * (0.33859/(1+3.77989 * exp (-0.10923*y))), where ES represents the estimated severity value (0.1); x, the temperature (°C); and y, the leaf wetness (in hours). This climate model should be validated under field conditions to verify its use as a computational system for the forecasting of Botrytis leaf blight in onion.
Resumo:
Genotyping techniques are valuable tools for the epidemiologic study of Staphylococcus aureus infections in the hospital setting. Pulsed-field gel electrophoresis (PFGE) is the current method of choice for S. aureus strain typing. However, the method is laborious and requires expensive equipment. In the present study, we evaluated the natural polymorphism of the genomic 16S-23S rRNA region for genotyping purpose, by PCR-based ribotyping. Three primer pairs were tested to determine the size of amplicons produced and to obtain better discrimination with agar gel electrophoresis and ethidium bromide staining. The resolution of the typing system was determined using sets of bacteria obtained from clinical specimens from a large tertiary care hospital. These included DNA from three samples obtained from a bacteremic patient, six strains with known and diverse PGFE patterns, and 88 strains collected over a 3-month period in the same hospital. Amplification patterns obtained from samples from the same patient were identical, and PFGE from samples known to be different produced three genotypes. Amplification of DNA from 61 methicillin-resistant isolates produced only one pattern. Methicillin-sensitive strains yielded a diversity of patterns, pointing to a true polyclonal distribution throughout the hospital (22 unique patterns from 27 strains). Computer-based software can be used to differentiate among identifiable strains, given the low number of bands and good characterization of PCR products. PCR-based ribotyping can be a useful technique for genotyping methicillin-sensitive S. aureus strains, but is of limited value for methicillin-resistant strains.
Resumo:
The objective of the present study was to explore the factors related to the prognosis of colorectal cancer (CRC) and to establish a prognostic model for the selection of patients who might benefit from hepatic resection for metastatic CRC. A total of 293 patients undergoing liver resection for metastatic CRC (172 males and 80 females ranging in age from 26 to 80 years) were selected and clinical, pathological and outcome data were examined in this retrospective study. The prognostic index (PI) of the patients was calculated on the basis of results of multivariate analysis. Patients were stratified into different groups, with survival curves projected according to PI. The 1-, 3-, and 5-year overall survival rates were 58.3, 26.4, and 11.3%, respectively. Univariate analysis indicated that degree of primary tumor differentiation, resection margin, preoperative carcinoembryonic antigen (CEA) level, number of liver metastases, and resection of liver metastases were associated with prognosis (P < 0.05). In multivariate analysis, the last three factors were found to be independent prognostic factors. The resection of liver metastases was a favorable factor. Patients were classified into three groups according to PI, which differed significantly in survival rate (P < 0.05). The individual survival rate was evaluated based on PI. Resection of hepatic colorectal metastases may produce long-term survival and cure. The proposed PI was easy to use, was highly predictive of patient outcome, and permitted categorization of patients into treatment groups.