Comparative evaluation of underlying causes of death processed by the Automated Classification of Medical Entities and the Underlying Cause of Death Selection Systems

INTRODUCTION: The correct identification of the underlying cause of death and its precise assignment to a code from the International Classification of Diseases are important issues to achieve accurate and universally comparable mortality statistics These factors, among other ones, led to the development of computer software programs in order to automatically identify the underlying cause of death. OBJECTIVE: This work was conceived to compare the underlying causes of death processed respectively by the Automated Classification of Medical Entities (ACME) and the "Sistema de Seleção de Causa Básica de Morte" (SCB) programs. MATERIAL AND METHOD: The comparative evaluation of the underlying causes of death processed respectively by ACME and SCB systems was performed using the input data file for the ACME system that included deaths which occurred in the State of S. Paulo from June to December 1993, totalling 129,104 records of the corresponding death certificates. The differences between underlying causes selected by ACME and SCB systems verified in the month of June, when considered as SCB errors, were used to correct and improve SCB processing logic and its decision tables. RESULTS: The processing of the underlying causes of death by the ACME and SCB systems resulted in 3,278 differences, that were analysed and ascribed to lack of answer to dialogue boxes during processing, to deaths due to human immunodeficiency virus [HIV] disease for which there was no specific provision in any of the systems, to coding and/or keying errors and to actual problems. The detailed analysis of these latter disclosed that the majority of the underlying causes of death processed by the SCB system were correct and that different interpretations were given to the mortality coding rules by each system, that some particular problems could not be explained with the available documentation and that a smaller proportion of problems were identified as SCB errors. CONCLUSION: These results, disclosing a very low and insignificant number of actual problems, guarantees the use of the version of the SCB system for the Ninth Revision of the International Classification of Diseases and assures the continuity of the work which is being undertaken for the Tenth Revision version.

Intraventricular hemorrhage in very low birth weight infants: associated risk factors and outcome in the neonatal period

Intraventricular hemorrhage (IVH) is a severe complication in very low birth weight (VLBW) newborns (NB). With the purpose of studying the incidence of IVH, the associated risk factors, and the outcomes for these neonates, we studied all the VLBW infants born in our neonatal unit. Birth weight, gestational age, presence of perinatal asphyxia, mechanical ventilation, length of hospitalization, apnea crisis, hydrocephalus, and periventricular leukomalacia were analyzed. The diagnosis of IVH was based on ultrasound scan studies (Papile's classification) performed until the tenth day of life and repeated weekly in the presence of abnormalities. Sixty-seven/101 neonates were studied. The mortality rate was 30.6% (31/101) and the incidence of IVH was 29.8% (20/67) : 70% grade I, 20% grade III and 10% grade IV. The incidence of IVH in NB <1,000 g was 53.8% (p = 0.035) and for gestational age <30 weeks was 47.3% (p = 0.04), both considered risk factors for IVH. The length of hospitalization (p = 0.00015) and mechanical ventilation (p = 0.038) were longer in IHV NB. The IVH NB had a relative risk of 2.3 of developing apnea (p = 0.02), 3.7 of hydrocephalus (p = 0.0007), and 7.7 of periventricular leukomalacia (p < 0.00001). The authors emphasize the importance of knowing the risk factors related to IVH so as to introduce prevention schemes to reduce IVH and to improve outcomes of affected newborns.

Prevalence of Burnout syndrome in health professionals of an onco-hematological pediatric hospital

OBJECTIVE To identify the prevalence of Burnout Syndrome in medical professionals, nurses and nursing technicians working in an Onco-Hematological Pediatric Hospital in São Paulo. METHOD An exploratory, descriptive study with cross-sectional design and quantitative approach, with a sample of 188 health professionals. Data were collected using two self-report instruments: the Maslach Burnout Inventory (MBI-HSS) which is a biosocial data form, and a non-participant observation guide. RESULTS High depersonalization for nurses (29.8%), low job performance for physicians (27.8%), and of nursing technicians (25.5%). High scores were identified in at least two domains of Burnout in 19.2% of nurses, 16.8% of nursing technicians, and 16.6% of doctors. CONCLUSION Health professionals are highly vulnerable to each of the dimensions of Burnout syndrome - namely emotional exhaustion, alienation, and low job performance/satisfaction- in the hospital work.

The effect of environment on development and survival of pupae of the necrophagous fly Ophyra albuquerquei Lopes (Diptera, Muscidae)

The effect of environment on development and survival of pupae of the necrophagous fly Ophyra albuquerquei Lopes (Diptera, Muscidae). Species of Ophyra Robineau-Desvoidy, 1830 are found in decomposing bodies, usually in fresh, bloated and decay stages. Ophyra albuquerquei Lopes, for example, can be found in animal carcasses. The influence of environmental factors has not been evaluated in puparia of O. albuquerquei. Thus, the focus of this work was motivated by the need for models to predict the development of a necrophagous insect as a function of abiotic factors. Colonies of O. albuquerquei were maintained in the laboratory to obtain pupae. On the tenth day of each month 200 pupae, divided equally into 10 glass jars, were exposed to the environment and checked daily for adult emergence of each sample. We concluded that the high survival rate observed suggested that the diets used for rearing the larvae and maintaining the adults were appropriate. Also, the data adjusted to robust generalized linear models and there were no interruptions of O. albuquerquei pupae development within the limits of temperatures studied in southern Rio Grande do Sul, given the high survival presented.

Phenology of Spalangia endius Walker (Hymenoptera, Pteromalidae) in pupae of Musca domestica Linnaeus (Diptera, Muscidae) under laboratory conditions

This work describes the phenology of Spalangia endius Walker in pupae of Musca domestica Linnaeus under laboratory conditions. In order to understand the developmental cycle of Spalangia endius under laboratory conditions, 360 Musca domestica pupae aged from 24 to 48 hours were exposed to 15 S. endius pairs for a period of 24 hours at 26 ± 2ºC. These pupae were kept in a BOD incubator at the same temperature, with a relative humidity of <70%, and 12 hours photophase. Fifteen hymenopteran specimens were dissected daily to evaluate their stage and development time. The phenology concluded that S. endius had a development cycle of 19 days with an incubation period of 24 hours. The development of the larvae of S. endius occurred in the subsequent eight days, during which a series of morphological alterations were observed. The pre-pupal stage occurred on the tenth day, where the movement ceased and elimination of the meconium started. The pupal stage occurred from the 11th to the 19th day, with emergence of males first, followed by female emergence approximately 24 hours later. These results allowed the evaluation of aspects of the detailed bionomics of the development of S. endius in order to record and program production of this parasitoid, thus optimizing its utilization as a biological control agent.

Short and long-term effects of tillage systems and nutrient sources on soil physical properties of a Southern Brazilian Hapludox

Soil tillage promotes changes in soil structure. The magnitude of the changes varies with the nature of the soil, tillage system and soil water content and decreases over time after tillage. The objective of this study was to evaluate short-term (one year period) and long-term (nine year period) effects of soil tillage and nutrient sources on some physical properties of a very clayey Hapludox. Five tillage systems were evaluated: no-till (NT), chisel plow + one secondary disking (CP), primary + two (secondary) diskings (CT), CT with burning of crop residues (CTb), and CT with removal of crop residues from the field (CTr), in combination with five nutrient sources: control without nutrient application (C); mineral fertilizers, according to technical recommendations for each crop (MF); 5 Mg ha-1 yr-1 of poultry litter (wetmatter) (PL); 60 m³ ha-1 yr-1 of cattle slurry (CS) and; 40 m³ ha-1 yr-1 of swine slurry (SS). Bulk density (BD), total porosity (TP), and parameters related to the water retention curve (macroporosity, mesoporosity and microporosity) were determined after nine years and at five sampling dates during the tenth year of the experiment. Soil physical properties were tillage and time-dependent. Tilled treatments increased total porosity and macroporosity, and reduced bulk density in the surface layer (0.00-0.05 m), but this effect decreased over time after tillage operations due to natural soil reconsolidation, since no external stress was applied in this period. Changes in pore size distribution were more pronounced in larger and medium pore diameter classes. The bulk density was greatest in intermediate layers in all tillage treatments (0.05-0.10 and 0.12-0.17 m) and decreased down to the deepest layer (0.27-0.32 m), indicating a more compacted layer around 0.05-0.20 m. Nutrient sources did not significantly affect soil physical and hydraulic properties studied.

Tillage systems and nutrient sources affecting soil cover, temperature and moisture in a clayey oxisol under corn

Tillage affects soil physical properties, e.g., porosity, and leads to different amounts of mulch on the soil surface. Consequently, tillage is related to the soil temperature and moisture regime. Soil cover, temperature and moisture were measured under corn (Zea mays) in the tenth year of five tillage systems (NT = no-tillage; CP = chisel plow and single secondary disking; CT = primary and double secondary disking; CTb = CT with crop residues burned; and CTr = CT with crop residues removed). The tillage systems were combined with five nutrient sources (C = control; MF = mineral fertilizer; PL = poultry litter; CS = cattle slurry; and SS = swine slurry). Soil cover after sowing was greatest in NT (88 %), medium in CP (38 %) and lowest in CT treatments (< 10 %), but differences decreased after corn emergence. Soil temperature was related with soil cover, and significant differences among tillage were observed at the beginning of the growing season and at corn maturity. Differences in soil temperature and moisture in the surface layer of the tilled treatments were greater during the corn cycle than in untilled treatments, due to differences in intensity of soil mobilization and mulch remaining after soil management. Nutrient sources affected soil temperature and moisture in the most intense part of the corn growth period, and were related to the variation of the corn leaf area index among treatments

An improved method for measuring soil microbial activity by gas phase flow injection analysis

The rate of carbon dioxide production is commonly used as a measure of microbial activity in the soil. The traditional method of CO2 determination involves trapping CO2 in an alkali solution and then determining CO2 concentration indirectly by titration of the remaining alkali in the solution. This method is still commonly employed in laboratories throughout the world due to its relative simplicity and the fact that it does not require expensive, specific equipment. However, there are several drawbacks: the method is time-consuming, requires large amounts of chemicals and the consistency of results depends on the operator's skills. With this in mind, an improved method was developed to analyze CO2 captured in alkali traps, which is cheap and relatively simple, with a substantially shorter sample handling time and reproducibility equivalent to the traditional titration method. A comparison of the concentration values determined by gas phase flow injection analysis (GPFIA) and titration showed no significant difference (p > 0.05), but GPFIA has the advantage that only a tenth of the sample volume of the titration method is required. The GPFIA system does not require the purchase of new, costly equipment but the device was constructed from items commonly found in laboratories, with suggestions for alternative configurations for other detection units. Furthermore, GPFIA for CO2 analysis can be equally applied to samples obtained from either the headspace of microcosms or from a sampling chamber that allows CO2 to be released from alkali trapping solutions. The optimised GPFIA method was applied to analyse CO2 released from degrading hydrocarbons from a site contaminated by diesel spillage.

Assessment of growth and yield performance of rubber tree clones of the IAC 500 series

The objective of this work was to evaluate the performance of 15 clones of the IAC 500 series of Hevea brasiliensis, developed at Instituto Agronômico (IAC), over a 12-year period, in the northwest region of São Paulo State, Brazil. The 15 new clones evaluated are primary clones obtained from selected ortets within half-sib progenies. The clone RRIM 600, of Malaysian origin, was used as the control. Dry rubber yield performance over a four-year period, mean girth at the tenth year, girth increment before and during tapping, thermal properties of the natural rubber produced and other characters of the laticiferous system were evaluated. Forty percent of the clones were superior in comparison to the control for yield. Clone IAC 500 recorded the highest yield (66.81 g per tree per tapping) over four years of tapping, followed by IAC 502 (62.37 g per tree per tapping), whereas the control recorded 48.71 g per tree per tapping. All selected clones were vigorous in growth. The natural rubber from this IAC clones showed thermal stability up to 300ºC. No differences were observed in the thermal behavior of rubber among the IAC series and the RRIM 600 clones. The clones IAC 500, IAC 501, IAC 502, IAC 503 and IAC 506 are the more promising for small-scale plantations, due to growth and yield potential.

Monitoring the viability of citrus rootstocks seeds stored under refrigeration

The citrus nursery tree is produced through the bud grafting process, in which rootstock is usually grown from seed germination. The objective of this research was to evaluate, in two dissimilar environmental conditions, the viability and polyembryony expression of five citrus rootstocks seeds stored in different periods under refrigeration. The rootstock varieties evaluated were: Rangpur lime (Citrus limonia Osb. cv. Limeira), Trifoliate orange (Poncirus trifoliata Raf. cv. Limeira), Citrumelo (P. trifoliata x C. paradisi Macf. cv. Swingle), Sunki mandarin (C. sunki Hort. ex Tanaka) and Volkamer lemon (C. volkameriana Ten. & Pasq. cv. Catania 2). The experimental design was the randomized blocks in a 11 x 5 x 2 factorial scheme, evaluating from time zero to the tenth month of storage, the five varieties of rootstock in two environments: germination and growth B.O.D type chamber (Biological Oxygen Demand - Eletrolab Brand Model FC 122) at 25 °C; and greenhouse seedbed with partial temperature control (22 °C to 36 °C) and humidity control (75-85%). The plot had 24 seeds in four replicates, using trays with substrate in greenhouse and Petri dishes with filter paper in B.O.D. chamber. The seed germination rate and polyembryony expression were evaluated monthly. It was concluded that Trifoliate and Citrumelo Swingle seeds can be stored for up to seven months, while Volkamer lemon, Rangpur lime and Sunki seeds can be stored for up to ten months. The polyembryony expression rate was slightly higher when measured in greenhouse than in B.O.D. chamber and remained stable in both environments until the seventh month, from which dropped sharply. Citrumelo Swingle seeds expressed the highest polyembryony rate (18.8%), followed by Rangpur lime and Volkamer lemon (average value of 13.7%), Sunki (9.4%) and Trifoliate (3.2%). Despite some differences among varieties, the viability of rootstock stored seeds can be monitored either in the greenhouse or in B.O.D. germination chamber, the latter being the faster and more suitable method.

Traumatismo cardíaco com retenção de corpo estranho em criança de sete anos

This is a case report about a seven year-old child who arrived at Emergency Department of Hospital da Restauração with gunshot wound on precordial area and clinical signs of cardiac tamponade. The roentgenogram showed 27 retained pellets in cardiac area. Thoracotomy was performed and repaired a cardiac wound in right ventricule. The patient developed conduction disturbance and valvar defect, but was discharged on the tenth postoperative day. Diagnosis, treatment and complications of retained projectiles are discussed.

Hemorragia digestiva baixa devido a melanoma maligno metastático

A case of lower gastrointestinal bleeding due to metastatic malignant melanoma in a man, in which the final diagnosis was made only on surgery, is reported. The patient underwent a segmentary enterectomy with primary anastomosis and he was discharged on tenth postoperative day.

Effect of thyroparathyroidectomy on urinary acidification in diabetic rats

In previous studies we have shown stimulation of renal acid excretion in the proximal tubules of rats with diabetes of short duration, with no important alterations in glomerular hemodynamics; on the other hand, in thyroparathyroidectomized rats (TPTX model), a significant decrease in renal acid excretion, glomerular filtration rate (GFR) and renal plasma flow (RPF) was detected. Since important changes in the parathyroid hormone-vitamin D-Ca axis are observed in the diabetic state, the present study was undertaken to investigate the renal repercussions of thyroparathyroidectomy in rats previously made diabetic by streptozotocin (45 mg/kg). Four to 6 days after the induction of diabetes (DM), a group of rats were thyroparathyroidectomized (DM + TPTX). Renal functional parameters were evaluated by measuring the inulin and sodium para-aminohippurate clearance on the tenth day. The decrease in the GFR and RPF observed in TPTX was not reversed by diabetes since the same alterations were observed in DM + TPTX. Net acid (NA) excretion was unchanged in DM (6.19 ± 0.54), decreased in TPTX (3.76 ± 0.25) and returned to normal levels in DM + TPTX (5.54 ± 0.72) when compared to the control group (6.34 ± 0.14 µmol min-1 kg-1). The results suggest that PTH plays an important vasodilator role regarding glomerular hemodynamics, since in its absence the impairment in GFR and RPF was not reversed by the diabetic state. However, with respect to acid excretion, the presence of diabetes was able to overcome the negative stimulus represented by TPTX.

Physicochemical and sensory characteristics of pan bread samples available in the Brazilian market

Pan bread samples available in the Brazilian market were evaluated for their physicochemical and sensory characteristics. Twelve pan breads, seven white and five whole grain breads, were evaluated. Moisture, water activity (Aw), firmness, and color (L*, a*, b*) of the crumb were evaluated on the first, fourth, seventh, and tenth days after purchasing the breads. Specific volume was evaluated on the first day of analysis with averages of 4.72 and 4.70 mL/g for the white and whole grain breads, respectively. The average results on the first day of analysis were: 37.03% and 41.23% moisture, 0.954 and 0.966 Aw, 276.27 and 267.83 gf firmness, 74.73 and 64.45 L* values, 0.37 and 3.85 a* values, and 15.51 and 18.98 b* values for the white and whole grain breads, respectively. The samples showed an increase in firmness, reduction in moisture and Aw, and no color changes over time. A survey conducted prior to the acceptance test showed that the three most important factors influencing purchase were taste (19.6%), tenderness (16.8%), and expiration date of the product (14.3%). The results showed that 37.2% of the panelists preferred white bread, 62.8% preferred bread with fibers, and 82.6% would probably or definitely buy white bread with fibers.