Variability of starch-based thickened drinks for patients with dysphagia in the hospital setting

Starch-based thickening agents may be prescribed for patients with dysphagia. Thickened fluids alter variables of the swallow reflex, allowing more time for bolus manipulation without compromising airway closure. This investigation explored the variation in viscosity and physical characteristics of thickened drinks prepared in different media under laboratory conditions and compared the results with those of thickened drinks presented to dysphagic patients in one hospital. The rheological characteristics were tested on a simple plastometer and a Bohlin CVOR rheometer (Malvern Instruments, Worcestershire, UK). Samples prepared to “syrup” consistency both in the laboratory and in the hospitalwere significantly different from each other (P < 0.0001). This was also the case for samples prepared to “custard” consistency. Differences existed not only in viscosity, but drinks prepared in different media produced different rheological matrices. This signifies different viscoelastic behaviors that may effect manipulation in the mouth. From this study, preparation of thickened drinks using starch-based instant thickening powders appears to be a highly variable practice.

Planning autonomous vehicles in the absence of speed lanes using an elastic strip

Planning of autonomous vehicles in the absence of speed lanes is a less-researched problem. However, it is an important step toward extending the possibility of autonomous vehicles to countries where speed lanes are not followed. The advantages of having nonlane-oriented traffic include larger traffic bandwidth and more overtaking, which are features that are highlighted when vehicles vary in terms of speed and size. In the most general case, the road would be filled with a complex grid of static obstacles and vehicles of varying speeds. The optimal travel plan consists of a set of maneuvers that enables a vehicle to avoid obstacles and to overtake vehicles in an optimal manner and, in turn, enable other vehicles to overtake. The desired characteristics of this planning scenario include near completeness and near optimality in real time with an unstructured environment, with vehicles essentially displaying a high degree of cooperation and enabling every possible(safe) overtaking procedure to be completed as soon as possible. Challenges addressed in this paper include a (fast) method for initial path generation using an elastic strip, (re-)defining the notion of completeness specific to the problem, and inducing the notion of cooperation in the elastic strip. Using this approach, vehicular behaviors of overtaking, cooperation, vehicle following,obstacle avoidance, etc., are demonstrated.

Bio-inspired autonomous visual vertical control of a quadrotor UAV

Near ground maneuvers, such as hover, approach and landing, are key elements of autonomy in unmanned aerial vehicles. Such maneuvers have been tackled conventionally by measuring or estimating the velocity and the height above the ground often using ultrasonic or laser range finders. Near ground maneuvers are naturally mastered by flying birds and insects as objects below may be of interest for food or shelter. These animals perform such maneuvers efficiently using only the available vision and vestibular sensory information. In this paper, the time-to-contact (Tau) theory, which conceptualizes the visual strategy with which many species are believed to approach objects, is presented as a solution for Unmanned Aerial Vehicles (UAV) relative ground distance control. The paper shows how such an approach can be visually guided without knowledge of height and velocity relative to the ground. A control scheme that implements the Tau strategy is developed employing only visual information from a monocular camera and an inertial measurement unit. To achieve reliable visual information at a high rate, a novel filtering system is proposed to complement the control system. The proposed system is implemented on-board an experimental quadrotor UAV and shown not only to successfully land and approach ground, but also to enable the user to choose the dynamic characteristics of the approach. The methods presented in this paper are applicable to both aerial and space autonomous vehicles.

Bioinspired autonomous visual vertical control of a quadrotor unmanned aerial vehicle

Near-ground maneuvers, such as hover, approach, and landing, are key elements of autonomy in unmanned aerial vehicles. Such maneuvers have been tackled conventionally by measuring or estimating the velocity and the height above the ground, often using ultrasonic or laser range finders. Near-ground maneuvers are naturally mastered by flying birds and insects because objects below may be of interest for food or shelter. These animals perform such maneuvers efficiently using only the available vision and vestibular sensory information. In this paper, the time-tocontact (tau) theory, which conceptualizes the visual strategy with which many species are believed to approach objects, is presented as a solution for relative ground distance control for unmanned aerial vehicles. The paper shows how such an approach can be visually guided without knowledge of height and velocity relative to the ground. A control scheme that implements the tau strategy is developed employing only visual information from a monocular camera and an inertial measurement unit. To achieve reliable visual information at a high rate, a novel filtering system is proposed to complement the control system. The proposed system is implemented onboard an experimental quadrotor unmannedaerial vehicle and is shown to not only successfully land and approach ground, but also to enable the user to choose the dynamic characteristics of the approach. The methods presented in this paper are applicable to both aerial and space autonomous vehicles.

End-of-life practices in seven Brazilian pediatric intensive care units

Objective: To evaluate the incidence of life support limitation and medical practices in the last 48 hrs of life of children in seven Brazilian pediatric intensive care units (PICUs). Design. Cross-sectional multicenter retrospective study based on medical chart review. Setting: Seven PICUs belonging to university and tertiary hospitals located in three Brazilian regions: two in Porto Alegre (southern region), two in Sao Paulo (southeastern region), and three in Salvador (northeastern region). Patients. Medical records of all children who died in seven PICUs from January 2003 to December 2004. Deaths in the first 24 hrs of admission to the PICU and brain death were excluded. Interventions: Two pediatric intensive care residents from each PICU were trained to fill out a standard protocol (K = 0.9) to record demographic data and all medical management provided in the last 48 hrs of life (inotropes, sedatives, mechanical ventilation, full resuscitation maneuvers or not). Student`s t-test, analysis of variance, chi-square test, and relative risk were used for comparison of data. Measurements and Main Results. Five hundred and sixty-one deaths were identified; 97 records were excluded (61 because of brain death and 36 due to <24 hrs in the PICU). Thirty-six medical charts could not be found. Cardiopulmonary resuscitation was performed in 242 children (57%) with a significant difference between the southeastern and northeastern regions (p =.0003). Older age (p = .025) and longer PICU stay (p = .001) were associated with do-not-resuscitate orders. In just 52.5% of the patients with life support limitation, the decision was clearly recorded in the medical chart. No ventilatory support was provided in 14 cases. Inotropic drug infusions were maintained or increased in 66% of patients with do-not-resuscitate orders. Conclusions. The incidence of life support limitation has increased among Brazilian PICUs but with significant regional differences. Do-not-resuscitate orders are still the most common practice, with scarce initiatives for withdrawing or withholding life support measures.

Entrance surface dose measurements in pediatric radiological examinations

A survey of pediatric radiological examinations was carried out in a reference pediatric hospital of the city of Sao Paulo. in order to investigate the doses to children undergoing conventional X-ray examinations. The results showed that the majority of pediatric patients are below 4 years, and that about 80% of the examinations correspond to chest projections. Doses to typical radiological examinations were measured in vivo with thermoluminescent dosimeters (LiF: Mg, Ti and LiF: Mg, Cu, P) attached to the skin of the children to determine entrance surface dose (ESD). Also homogeneous phantoms were used to obtain ESD to younger children, because the technique uses a so small kVp that the dosimeters would produce an artifact image in the patient radiograph. Four kinds of pediatric examinations were investigated: three conventional examinations (chest, skull and abdomen) and a fluoroscopic procedure (barium swallow). Relevant information about kVp and mAs values used in the examinations was collected, and we discuss how these parameters can affect the ESD. The ESD values measured in this work are compared to reference levels published by the European Commission for pediatric patients. The results obtained (third-quartile of the ESD distribution) for chest AP examinations in three age groups were: 0.056 mGy (2-4 years old); 0,068 mGy (5-9 years old)-. 0.069 mGy (10-15 years old). All of them are below the European reference level (0.100mGy). ESD values measured to the older age group in skull and abdomen AP radiographs (mean values 3.44 and 1.20mGy, respectively) are above the European reference levels (1.5mGy to skull and 1.0 mGy to abdomen). ESD values measured in the barium swallow examination reached 10 mGy in skin regions corresponding to thyroid and esophagus. It was noticed during this survey that some technicians use, improperly, X-ray fluoroscopy in conventional examinations to help them in positioning the patient. The results presented here are a preliminary survey of doses in pediatric radiological examinations and they show that it is necessary to investigate the technical parameters to perform the radiographs. to introduce practices to control pediatric patient`s doses and to improve the personnel training to perform a pediatric examination. (c) 2007 Elsevier Ltd. All rights reserved.

As Mudanças Organizacionais e seus Gestores nas Empresas na Era da Informação

In the past, the changes made in organizations were from decisions made by senior administrators and were implemented through authority and power. This sort of change doesn¿t work today because at a time when knowledge is one of the main tools for development, senior administrators need the participation of employees who directly handle strategic information for the company, having the necessary data for the conception, planning and execution of changes. Companies have begun to realize that the use of their own competent staff is the way to implement faster and more efficient strategic maneuvers. Which means, for a successful change, the whole process has to involve their employees. They have to develop efficient methods, such as, techniques for analysis, problem solution, team work, system modeling, change in attitudes and behavior, and management of the organizations culture. These methods define the professional profile of those responsible for the change. Today, each administrator must have the necessary qualifications, knowledge, and competence to identify the need for an organizational change and its introduction. In truth, each administrator is responsible for the structural change in his area and the standardization of his services.

Administrador escolar: especialista ou educador?: uma análise a partir do caso sergipano

A administração da educação pública sergipana se tem submetido as determinações do contexto histórico-estrutural do estado, as quais têm reduzido as escolas públicas a meros espaços de manobras político-partidárias. As direções das instituições escolares são ocupadas, via de regra, por pessoas arbitrariamente indicadas pelo Estado, que estão deixando fluir até a clientela a ideologia da classe dominante. Na hegemonia em curso, seu papel tem sido o de reforço à evasão e seletividade da escola pública e o de controlador da distribuição do saber elaborado junto as crianças oriundas das camadas populares. E nesse sentido não se verifica qualquer diferença a partir da habilitação desses administradores. Considerada a escola pública numa perspectiva progressista e dada a insatisfação geral registrada, sobretudo nas escolas estaduais da capital e municipais do interior do estado, sugere-se dentre outras medidas, que todo o processo de formação do educador enfatize sua possibilidade como organizador de propostas pedagógicas coletivas, vinculadas ao movimento de democratização da sociedade. Isto desde as licenciaturas, às escolas normais e programas especiais de preparação do professor leigo, portanto extrapolando o âmbito das discussões sobre uma habilitação do Curso de Pedagogia. Também se propõe a união de forças da sociedade civil e a deflagração de um amplo processo de discussão na sociedade, a ser desenvolvido por etapas (municipal, micro-regional e estadual) tendo em vista a definição de diretrizes para uma política educacional em Sergipe. A mediação que se espera do organizador da escola é o exercício de uma administração de um direito civil básico de todo e cada cidadão sergipano: o domínio competente do saber social acumulado; essa prática ensejará ao diretor de escolas evoluir da postura de intelectual tradicional para a de intelectual progressista.

Need and opportunity: what are the main security threats to the pharmaceuticals industry in Latin America?

Os preços altos de produtos farmacêuticos patenteados sempre têm sido uma polêmica na América Latina. Considerando as disparidades económicas na região e a falta histórica do desenvolvimento, muitas vezes os preços altos servem como barreiras contra o acesso aos medicamentos essenciais. Por um lado, as companhias farmacêuticas dizem que os preços elevados são necessários para financiar os processos de pesquisa e desenvolvimento e para gerar um retorno do investimento lucrativo. Por outro lado, os consumidores, tanto privados como públicos, dizem que os preços altos têm resultado em uma falta histórica de medicamentos baratos. Neste debate, ambos lados têm realizado uma série de manobras e contramanobras que têm exposto algumas das vulnerabilidades do setor. Utilizando vários métodos de análise e entrevistas com profissionais no setor, este projeto analisa as vulnerabilidades do setor para determinar o risco, ao mesmo tempo tentando a responder à pergunta: Quais são as ameaças principais na segurança da indústria farmacêutica na América Latina? Justificação deste projeto é o aumento dos crimes relacionados aos produtos farmacêuticos na última década, que têm exposto os pacientes a um número de riscos mais alto. Uma compreensão das ameaças principais é necessária para melhor mitigar o risco, garantir a integridade de produtos e preservar a saúde pública.

Physiological and morphological responses to feeding in broad-nosed caiman (Caiman latirostris)

Broad nosed caiman are ectotherm sauropsids that naturally experience long fasting intervals. We have studied the postprandial responses by measuring oxygen consumption using respirometry, the size changes of the duodenum, the distal small intestine, and the liver, using repeated non-invasive ultrasonography, and by investigating structural changes on the level of tissues and cells by using light- and electron microscopy. The caimans showed the same rapid and reversible changes of organ size and identical histological features, down to the ultrastructure level, as previously described for other ectothermic sauropsids. We found a configuration change of the mucosa epithelium from pseudostratified during fasting to single layered during digestion, in association with hypertrophy of enterocytes by loading them with lipid droplets. Similar patterns were also found for the hepatocytes of the liver. By placing the results of our study in comparative relationship and by utilizing the phylogenetic bracket of crocodiles, birds and squamates, we suggest that the observed features are plesiomorphic characters of sauropsids. By extending the comparison to anurans, we suggest that morphological and physiological adjustments to feeding and fasting described here may have been a character of early tetrapods. In conclusion, we suggest that the ability to tolerate long fasting intervals and then swallow a single large meal as described for many sit-an-wait foraging sauropsids is a functional feature that was already present in ancestral tetrapods.

Morphological abnormalities and apoptosis in lamellar tissue of equines after intestinal obstruction and treatment with hydrocortisone

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

Associação entre midazolam e detomidina na medicação pré-anestésica para indução da anestesia geral com cetamina em potros

Empregou-se a associação midazolam e detomidina para indução de anestesia com cetamina em 16 potros, machos e fêmeas, entre três e seis meses de idade, distribuídos aleatória e equitativamente em dois grupos (GI e GII). A todos os animais foram administrados midazolam, via intramuscular, na dose de 0,2mg/kg, e após 15 minutos, detomidina, via intravenosa, na dose de 0,02mg/kg. Os animais do GII receberam cetamina pela via intravenosa, dose 2,0mg/kg, três minutos após a administração de detomidina. Quinze minutos após o midazolam, ocorreram sedação e ligeira ataxia, e dois minutos após a administração da detomidina, decúbito lateral em todos os potros, com miorrelaxamento e presença dos reflexos de deglutição e miorrelaxamento, anal e oculo-palpebral. A associação midazolam/detomidina e cetamina provocou ausência dos reflexos de deglutição. Para todos os animais, o tempo de recuperação foi de 45-60 minutos, e temperatura retal e frequência respiratória permaneceram estáveis. Ocorreram bradicardia, bloqueio atrioventricular de segundo grau e aumento das pressões arteriais sistólica, diastólica e média após dois minutos da administração da detomidina. A associação midazolam/detomidina e cetamina demonstrou ser um método eficiente e seguro para a anestesia de potros hígidos.

Um algoritmo para estimação de estado em alimentadores de distribuição de energia elétrica com base no método da soma de potências

Most algorithms for state estimation based on the classical model are just adequate for use in transmission networks. Few algorithms were developed specifically for distribution systems, probably because of the little amount of data available in real time. Most overhead feeders possess just current and voltage measurements at the middle voltage bus-bar at the substation. In this way, classical algorithms are of difficult implementation, even considering off-line acquired data as pseudo-measurements. However, the necessity of automating the operation of distribution networks, mainly in regard to the selectivity of protection systems, as well to implement possibilities of load transfer maneuvers, is changing the network planning policy. In this way, some equipments incorporating telemetry and command modules have been installed in order to improve operational features, and so increasing the amount of measurement data available in real-time in the System Operation Center (SOC). This encourages the development of a state estimator model, involving real-time information and pseudo-measurements of loads, that are built from typical power factors and utilization factors (demand factors) of distribution transformers. This work reports about the development of a new state estimation method, specific for radial distribution systems. The main algorithm of the method is based on the power summation load flow. The estimation is carried out piecewise, section by section of the feeder, going from the substation to the terminal nodes. For each section, a measurement model is built, resulting in a nonlinear overdetermined equations set, whose solution is achieved by the Gaussian normal equation. The estimated variables of a section are used as pseudo-measurements for the next section. In general, a measurement set for a generic section consists of pseudo-measurements of power flows and nodal voltages obtained from the previous section or measurements in real-time, if they exist -, besides pseudomeasurements of injected powers for the power summations, whose functions are the load flow equations, assuming that the network can be represented by its single-phase equivalent. The great advantage of the algorithm is its simplicity and low computational effort. Moreover, the algorithm is very efficient, in regard to the accuracy of the estimated values. Besides the power summation state estimator, this work shows how other algorithms could be adapted to provide state estimation of middle voltage substations and networks, namely Schweppes method and an algorithm based on current proportionality, that is usually adopted for network planning tasks. Both estimators were implemented not only as alternatives for the proposed method, but also looking for getting results that give support for its validation. Once in most cases no power measurement is performed at beginning of the feeder and this is required for implementing the power summation estimations method, a new algorithm for estimating the network variables at the middle voltage bus-bar was also developed

DNA extraction from hair shafts of wild Brazilian felids and canids

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