Critical thinking and accuracy of nurses' diagnoses. Part II: application of cognitive skills and guidelines for self-development

Part I of this article, the author explained the difficulties of achieving accuracy of nurses' diagnoses, the relevance of critical thinking to the achievement of accuracy, and newer views of critical thinking. In Part II, the critical thinking dimensions identified as important for nursing practice are applied in the diagnostic process using a case study of a 16 year old girl with type 1 diabetes. Application of seven cognitive skills and ten habits of mind illustrate the importance of using critical thinking for accuracy of nurses' diagnoses. Ten strategies are proposed for self-development of critical thinking abilities.

Propranolol as an adjunct therapy for hyperthyroid tremor.

We evaluated the use of propranolol as an adjunct to carbimazole in the treatment of hyperthyroid tremor and tachycardia in a double-blind, cross-over and placebo-controlled study. Seven patients were given carbimazole plus either placebo or propranolol (40 mg) for 1 month and then switched to the alternative adjunct treatment for a further month. All patients showed significant improvements (p < 0.001) of heart rate and tremor amplitude after 1 or 2 months from baseline. One month after the baseline, the mean improvements of heart rate were 23% for the carbimazole + placebo group and 38% for carbimazole + propranolol group. Tremor also improved during the 1st month of the study by 31% in the carbimazole + placebo group versus 59% in the carbimazole + propranolol group. Whereas further improvements were observed in both variables in those receiving propranolol as the second adjunct treatment, this was not the case in those who received placebo during the same period. These findings confirm that the beta-blocker propranolol is a useful adjunct in the early treatment of both the tremor and tachycardia of hyperthyroidism.

Downregulation of cannabinoid receptor 1 from neuropeptide Y interneurons in the basal ganglia of patients with Huntington's disease and mouse models.

Cannabinoid receptor 1 (CB(1) receptor) controls several neuronal functions, including neurotransmitter release, synaptic plasticity, gene expression and neuronal viability. Downregulation of CB(1) expression in the basal ganglia of patients with Huntington's disease (HD) and animal models represents one of the earliest molecular events induced by mutant huntingtin (mHtt). This early disruption of neuronal CB(1) signaling is thought to contribute to HD symptoms and neurodegeneration. Here we determined whether CB(1) downregulation measured in patients with HD and mouse models was ubiquitous or restricted to specific striatal neuronal subpopulations. Using unbiased semi-quantitative immunohistochemistry, we confirmed previous studies showing that CB(1) expression is downregulated in medium spiny neurons of the indirect pathway, and found that CB(1) is also downregulated in neuropeptide Y (NPY)/neuronal nitric oxide synthase (nNOS)-expressing interneurons while remaining unchanged in parvalbumin- and calretinin-expressing interneurons. CB(1) downregulation in striatal NPY/nNOS-expressing interneurons occurs in R6/2 mice, Hdh(Q150/Q150) mice and the caudate nucleus of patients with HD. In R6/2 mice, CB(1) downregulation in NPY/nNOS-expressing interneurons correlates with diffuse expression of mHtt in the soma. This downregulation also occludes the ability of cannabinoid agonists to activate the pro-survival signaling molecule cAMP response element-binding protein in NPY/nNOS-expressing interneurons. Loss of CB(1) signaling in NPY/nNOS-expressing interneurons could contribute to the impairment of basal ganglia functions linked to HD.

Drug use and suicide attempts: the role of personality factors.

This study on suicide attempts is part of a large research project on dependent behavior in adolescents and young adults. 228 subjects aged 14-25 (107 "drug abusers," 121 controls) from the French speaking part of Switzerland were evaluated on the basis of a semi-structured interview (Mini International Neuropsychiatric Interview), enabling a DSM-IV diagnosis, and self-reports (SSS by Zuckermann, MMPI-2, IDI by Hirschfeld). 31.5% of "drug abuser" males and 41.2% of "drug abuser" females committed one or more suicide attempts. The results of a logistic regression show that the significant factor explaining suicide attempts in drug users is emotional reliance for males and experience-seeking for females.

Aspectos oceanográficos durante los experimentos de calibraciones hidroacusticas con anchovetas vivas. Crucero BIC Humboldt 9711 de Huacho a Pacasmayo

El crucero se desarrolló del 7 al 19 de noviembre de 1997, dividiéndose en dos etapas: La etapa I de calibración de equipos tuvo lugar en dos puntos muy próximos frente a Huacho, entre el 8 y el 13 de noviembre. La etapa II, de rastreo de pesca, se efectuó del 13 al 19 del mismo mes. La temperatura superficial en los puntos de calibración fluctuó de 18,8° C a 19,9° C con mínimos valores en horas de la noche y madrugada y las máximas después de medio día. Las salinidades de origen subtropical variaron de 35,12 a 35,22%. Durante el rastreo y pesca entre Huacho y Pacasmayo los valores de temperatura, salinidad y oxígeno variaron de 19,1 a 24,4° C, 35,14 a 35,37% y 3,3 a 6,9 mL/L, respectivamente. Se registraron anomalías térmicas positivas de +2,6 a +6,4° C, valores ascendentes de sur a norte y presencia de aguas subtropicales superficiales en toda la columna de agua.

Las aves guaneras, la cadena alimentaria y la producción de guano

Desarrolla los temas de la cadena alimenticia de las aves guaneras, enfocándose en el Plancton existente en toda la corriente marina, nutriente de esta fauna y en especial de la Anchoveta, pez que posteriormente servirá de alimento a las aves guaneras.

Comparison of C-reactive protein and white blood cell count with differential in neonates at risk for septicaemia.

We prospectively compared the diagnostic value of C-reactive protein (CRP) and white blood cell counts for detection of neonatal septicaemia. Sensitivity and specifity in receiver operating characteristics, and positive and negative predictive value of CRP and white blood cell count were compared in 195 critically ill preterm and term newborns clinically suspected of infection. Blood cultures were positive in 33 cases. During the first 3 days after birth CRP elevation (sensitivity 75%, specifity 86%), leukopenia (67%/90%), neutropenia (78%/80%) and immature to total neutrophil count (I/T) ratio (78%/73%) were good diagnostic parameters, as opposed to band forms with absolute count (84%/66%) or percentage (79%/71%), thrombocytopenia (65%/57%) and toxic granulations (44%/94%). Beyond 3 days of age elevated CRP (88%/87%) was the best parameter. Increased total (84%/66%) or percentage band count (79%/71%) were also useful. Leukocytosis (74%/56%), increased neutrophils (67%/65%), I/T ratio (79%/47%), thrombocytopenia (65%/57%) and toxic granulations had a low specifity. The positive predictive value of CRP was 32% before and 37% after 3 days of age, that of leukopenia was 37% in the first 3 days. CONCLUSION: During the first 3 days of life CRP, leukopenia and neutropenia were comparably good tests while after 3 days of life CRP was the best single test in early detection of neonatal septicaemia. Serial CRP estimations confirm the diagnosis, monitor the course of infection and the efficacy of antibiotic treatment.

Filiação entre arenitos da formação Guará e sua cobertura pedológica no Rio Grande Do Sul

As regiões oeste e sudoeste do Rio Grande do Sul, RS, destacam-se pela ocorrência de extensas áreas com solos frágeis desenvolvidos sobre sedimentos arenosos continentais do Mesozoico da Bacia do Paraná. O uso inadequado das terras tem acelerado o processo de arenização sobre essas áreas. Nesse caso, o conhecimento dos solos é fundamental para a seleção de práticas adequadas de manejo visando a sua sustentabilidade. Os objetivos deste trabalho foram entender a evolução e estabelecer a relação, em termos de filiação, entre a rocha e sua respectiva cobertura pedológica por meio de perfis desenvolvidos sobre os arenitos da Formação Guará no RS. Foram realizadas análises químicas, físicas, mineralógicas e morfológicas em dois perfis de Cambissolos Háplicos e um perfil de Argissolo Vermelho. Verificaram-se indícios de adição externa de materiais aos perfis estudados, principalmente ilmenita, oriunda da alteração de áreas com rochas vulcânicas básicas circunvizinhas. O aporte de material alóctone nos perfis estudados é responsável pela pedogênese de horizontes B com incremento de argila, característicos de Argissolos e Cambissolos. Os dados sugerem a identificação e interpretação de um sexto componente pedogenético definido como contexto geológico do entorno.

Soil and phytosociological characterization of an area with predominance of arnica (Lychnophora pohlii sch. bip.)

Lychnophora pohlii Sch. Bip. (Asteraceae), known as "Arnica mineira", is widely used in folk medicine and very abundant in the altitude vegetation of rocky grassland. The aim of this work was to study the density of this species and its relationship with soil parameters in rocky grassland in Diamantina, in the Upper Jequitinhonha region, Minas Gerais. Ten contiguous 20 x 50 m plots were marked (total sampled area 10,000 m²) on the campus Juscelino Kubitschek of the Federal University of Jequitinhonha and Mucuri Valleys (UFVJM). The plants in these plots were evaluated for frequency, dominance and density. The relationship between the density of this species with nine soil physical and chemical properties was analyzed by means of canonical correspondence analysis (CCA). The highest plant abundance (I) of the species Lychnophora pohlii Sch. Bip. was found in the vegetation sampling areas: plot 6 with 255 plants, plot 7 with 173, plot 8 with 189, plot 9 with 159, and plot 1 with 151 plants. In these areas, the floristic soil characteristics were similar, resulting in spatial proximity in the ACC diagrams. The density of Lychnophora pohlii was higher in plots with higher pH, P-rem and base saturation, the variables most strongly correlated with the first axis of canonical correspondence analysis.

Relationships between microbial activity and soil physical and chemical properties in native and reforested Araucaria angustifolia forests in the state of São Paulo, Brazil

Araucaria angustifolia (Bert.) O. Kuntze is the main component of the Mixed Ombrophilous forest and, in the State of São Paulo, it is associated with a high diversity of soil organisms, essential for the maintenance of soil quality, making the conservation of this ecosystem a major and pressing challenge. The objective of this study was to identify the physical and chemical properties that are most closely correlated with dehydrogenase enzyme activity, basal respiration and microbial biomass under native (NF) and replanted (RF) Araucaria angustifolia forests in three regions of the state of São Paulo, in winter and summer. The main differentiating factors between the areas were also determined. Each forest was represented by three true replications; at each site, from around the araucaria trees, 15 soil samples (0-20 cm) were collected to evaluate the soil physical, chemical and microbiological properties. At the same points, forest litter was sampled to assess mass and chemical properties. The following microbiological properties were evaluated: microbial biomass carbon (MBC), basal respiration (CO2-C), metabolic quotient (Q: CO2), dehydrogenase enzyme activity (DHA) as well as the physical properties (moisture, bulk density, macroporosity and total porosity), soil chemical properties [pH, organic carbon (org-C), P, Ca, K, Mg, Al, H+Al], litter dry mass, and C, N and S contents. The data were subjected to analysis of variance (TWO-WAY: ANOVA). A Canonical Discriminant Analysis (CDA) and a Canonical Correlation Analysis (CCA) were also performed. In the soil under NF, the values of K, P, soil macroporosity, and litter dry mass were higher and Q: CO2 and DHA lower, regardless of the sampling period, and DHA was lower in winter. In the RF areas, the levels of moisture, porosity and Q: CO2 were higher in both sampling periods, and DHA was higher in winter. The MBC was only higher under NF in the summer, while the litter contents of C, N and S were greater in winter. In winter, CCA showed a high correlation of DHA with CO2-C, pH and H+Al, while in the summer org-C, moisture, Mg, pH and litter C were more associated with DHA and CO2-C. The CDA indicated H+Al, available P, total porosity, litter S content, and soil moisture as the most discriminating variables between NF and RF, but moisture was the most relevant, in both seasons and CO2-C only in winter. The combined analysis of CCA and CDA showed that the contribution of the microbiological variables to a differentiation of the areas was small at both samplings, which may indicate that the period after reforestation was long enough to allow an almost complete recovery of the microbial activity.

Fauna edáfica em área periodicamente inundável na restinga da Marambaia, RJ

No compartimento serapilheira-solo, a fauna do solo exerce importante papel na disponibilização de nutrientes, uma vez que é responsável pela regulação da comunidade de microrganismos decompositores da matéria orgânica e pela fragmentação desse material. Este trabalho objetivou avaliar a riqueza e abundância da fauna edáfica, bem como sua distribuição vertical, em área de restinga periodicamente inundada na Ilha da Marambaia, RJ, em duas épocas distintas, verão (chuvosa) e inverno (seca). Foram coletadas 10 amostras de serapilheira e de solo na profundidade de 0-5 cm, em que foram feitas extrações da fauna por meio de extratores do tipo Berlese-Tüllgren. Observou-se aumento da abundância da fauna edáfica do período seco para o chuvoso, enquanto a riqueza de grupos taxonômicos não foi modificada. Em ambas as épocas, os grupos de maior ocorrência foram Formicidae e Collembola. Quanto à distribuição vertical, verificou-se a preferência dos organismos pelo compartimento serapilheira, no período chuvoso, e pelo solo, no período seco. A microfagia e a saprofagia representaram as principais formas de utilização dos recursos alimentares, seguidos da predação, sugerindo melhor estruturação do habitat no ecossistema. Além disso, a ocorrência de grupos que só são percebidos em ambientes não perturbados indica que o ecossistema de restinga da Ilha da Marambaia, no momento em que foi avaliado, ano de 2002, encontrava-se pouco ou nada degradado e em bom estado de conservação.

Estimation of soil moisture in the root-zone from remote sensing data

Field-based soil moisture measurements are cumbersome. Thus, remote sensing techniques are needed because allows field and landscape-scale mapping of soil moisture depth-averaged through the root zone of existing vegetation. The objective of the study was to evaluate the accuracy of an empirical relationship to calculate soil moisture from remote sensing data of irrigated soils of the Apodi Plateau, in the Brazilian semiarid region. The empirical relationship had previously been tested for irrigated soils in Mexico, Egypt, and Pakistan, with promising results. In this study, the relationship was evaluated from experimental data collected from a cotton field. The experiment was carried out in an area of 5 ha with irrigated cotton. The energy balance and evaporative fraction (Λ) were measured by the Bowen ratio method. Soil moisture (θ) data were collected using a PR2 - Profile Probe (Delta-T Devices Ltd). The empirical relationship was tested using experimentally collected Λ and θ values and was applied using the Λ values obtained from the Surface Energy Balance Algorithm for Land (SEBAL) and three TM - Landsat 5 images. There was a close correlation between measured and estimated θ values (p<0.05, R² = 0.84) and there were no significant differences according to the Student t-test (p<0.01). The statistical analyses showed that the empirical relationship can be applied to estimate the root-zone soil moisture of irrigated soils, i.e. when the evaporative fraction is greater than 0.45.

Qualidade estrutural de um latossolo vermelho submetido à compactação

A modificação estrutural do solo provocada pela sua compactação é fator limitante ao crescimento e desenvolvimento das plantas. O objetivo desta pesquisa foi avaliar, em um Latossolo Vermelho eutroférrico no município de Jaboticabal, SP, os parâmetros físicos do solo como a estabilidade de agregados, a condutividade hidráulica e o índice "S". O delineamento experimental foi o inteiramente casualizado com parcelas subdivididas (quatro níveis de compactação e duas profundidades), com quatro repetições e uma área de mata nativa (MN) como testemunha. Os tratamentos de compactação foram: C0= 0; C1= 2; C2= 4; e C3= 6 passadas de um trator de 11 Mg. Verificou-se que a MN apresentou elevada relação aos índices diâmetro médio geométrico (DMG) e diâmetro médio ponderado (DMP), que constaram agregados maiores e mais estáveis em comparação aos demais tratamentos estudados. Foi obtido o valor de "S" de 0,036 e redução nos níveis mais compactados para 0,026, visto que a compactação reduziu o valor de "S", que atingiu o valor limitante (< 0,035), apesar da mineralogia oxídica do solo analisado.

Influência das frações de areia na retenção e disponibilidade de água em solos das formações Caiuá e Paranavaí

Tem sido verificado que a adoção das técnicas de uso e manejo para solos derivados do arenito Caiuá no noroeste do Paraná nem sempre corresponde às expectativas de produção das culturas. Nessa região ocorrem duas Formações desse arenito: a Caiuá e a Paranavaí, com diferenças na granulometria dos solos. A hipótese é de que os solos da Formação Caiuá tenham menor retenção e disponibilidade de água para a produção agrícola, em razão da maior proporção da fração de areia grossa do que solos da Formação Paranavaí. O objetivo deste trabalho foi caracterizar a retenção e disponibilidade de água do solo em integração lavoura-pecuária e cultivado com abacaxi em solos do arenito das Formações Caiuá e Paranavaí, no noroeste do Paraná. Em 2010, foram realizadas duas amostragens de solo em quatro áreas agrícolas comerciais de integração lavoura-pecuária e produção de abacaxi, que apresentaram textura arenosa na camada de 0-40 cm; nessas havia evidências de que, mesmo com a utilização das melhores técnicas agronômicas de manejo de solo, as produtividades de soja, pastagem e de abacaxi eram muito baixas nos solos da Formação Caiuá. Coletas de amostras de solo deformadas e indeformadas nas camadas de 0-10, 11-20 e 21-40 cm foram realizadas para caracterizar a granulometria (argila, silte, areia fina e areia grossa), o carbono orgânico e a retenção de água no solo. Os solos da Formação Caiuá têm granulometria mais grosseira, poros de maior diâmetro e menor disponibilidade de água do que os da Paranavaí. Os riscos de deficiência hídrica são maiores em solos da Formação Caiuá do que os da Paranavaí.