Captores del fósforo: preferencias de los pacientes en hemodiálisis y su repercusión sobre el cumplimiento del tratamiento y el control del fósforo

Introducción: En la actualidad disponemos de un amplio abanico de captores del fósforo (CF), pero sabemos poco acerca de las preferencias de los pacientes y de su repercusión sobre el cumplimiento del tratamiento y el control de los niveles de fósforo. Objetivo: Estudiar las preferencias y creencias de los pacientes respecto a los CF, y su influencia sobre el cumplimiento del tratamiento y el control de los niveles de fósforo. Pacientes y métodos: Estudio observacional transversal. Se incluyeron 121 pacientes que respondieron un cuestionario genérico de cumplimiento del tratamiento (SMAQ) y a un cuestionario específico sobre cumplimiento del tratamiento con CF, tipo de CF preferido y razones de dicha preferencia. Todos los pacientes entrevistados habían probado dos o tres CF. Las consecuencias de la falta de cumplimiento del tratamiento con CF se estimaron indirectamente analizando los valores promedio de fósforo sérico. Resultados: El 40% de los pacientes era incumplidor según el cuestionario SMAQ; se encontró una asociación estadísticamente significativa entre la falta de cumplimiento en general y no alcanzar el objetivo de fósforo sérico promedio <5,5 mg/dl (OR = 4,8; IC 95%, 1,0-6,6; p = 0,02). El 21,4% de los pacientes reconocía un incumplimiento específico para los CF; estos pacientes presentaban una mayor probabilidad de tener cifras medias de fósforo >5,5 mg/dl (OR = 4,7; IC 95%, 1,1-6,5; p = 0,03). Un 43,8% de los pacientes no refirió tener preferencias entre los diferentes tipos de CF; para el resto de pacientes, el CF preferido fue Royen®, seguido de Fosrenol®, Renagel® y Pepsamar®. Las razones expresadas para el desagrado con el Renagel® fueron las siguientes: incomodidad en la toma por su gran tamaño (28,8%), necesidad de tomar muchos comprimidos y gran consumo de agua (57,7%) e intolerancia gástrica (13,3%). En el caso del Fosrenol®: incómodo de tomar (72,7%) e intolerancia gástrica (27,2%); para el Pepsamar®: mal sabor (54,5%) e intolerancia gástrica (45,4%). Sólo al 9,4% no le gustaba el Royen®. Al analizar los conocimientos de los pacientes respecto a la utilidad de los CF, un 42% sabía que servían para controlar el fósforo; un 52% no lo sabía y un 6% tenía ideas equivocadas. En cuanto a su importancia: un 47% no conocía por qué son importantes; un 2% tenía ideas erróneas; un 9% creía que era beneficioso para la salud; un 11% creía que era bueno «porque lo dice el medico»; un 26% porque controla el fósforo y un 5% lo relacionaba con el hueso. Ningún paciente relacionó los CF con la enfermedad cardiovascular. Un 24,4% no se llevaba los CF cuando salía fuera de casa o estaba con los amigos; eran pacientes más jóvenes a quienes se les habían prescrito un mayor número de comprimidos de CF y que presentaban un mayor riesgo de no cumplir el objetivo de fósforo (OR = 10,5; IC 95%, —1,8 a —16,4; p <0,001). El porcentaje de pacientes a quienes no les gustaba el CF prescrito fue del 54,5%; dichos pacientes presentaban un mayor riesgo de tener niveles séricos de fósforo >5,5 mg/dl (OR = 13.3; IC 95%, 1,1-1,5; p = 0,0001). Paradójicamente, los pacientes que no cumplían con el tratamiento demostraban un mejor conocimiento de su uso (OR = 17,3; IC 95%, 2,2-10,1; p <0.0001) e importancia (OR = 10,4; IC 95%, 1,5-6,6; p = 0,001). Conclusión: Los pacientes a los que se les habían prescrito CF que no les gustaban tenían un peor control de los niveles de fósforo sérico y se les habían recomendado dosis más altas de los fármacos. El conocimiento de las preferencias de los pacientes acerca de las medicaciones que se les prescriben puede ser un factor esencial para conseguir un mayor cumplimiento del tratamiento y, por ende, lograr mejores resultados en la consecución de los objetivos terapéuticos.

Experiences on using Arduino for laboratory experiments of Automatic Control and Robotics

The free hardware platforms have become very important in engineering education in recent years. Among these platforms, Arduino highlights, characterized by its versatility, popularity and low price. This paper describes the implementation of four laboratory experiments for Automatic Control and Robotics courses at the University of Alicante, which have been developed based on Arduino and other existing equipment. Results were evaluated taking into account the views of students, concluding that the proposed experiments have been attractive to them, and they have acquired the knowledge about hardware configuration and programming that was intended.

Modelling and control of refrigeration systems: an account of a pedagogic experiment in a post-secondary technical course

Comunicação apresentada no CYTEF 2016/VIII Congresso Ibérico | VI Congresso Ibero-Americano de Ciências e Técnicas do Frio, 3-6 maio 2016, Coimbra, Portugal

Quo vadis Aethina tumida? Biology and control of small hive beetles

Small hive beetles (SHBs) are generalists native to sub-Saharan Africa and reproduce in association with honeybees, bumblebees, stingless bees, fruits and meat. The SHB has recently become an invasive species, and introductions have been recorded from America, Australia, Europe and Asia since 1996. hile SHBs are usually considered a minor pest in Africa, they can cause significant damage to social bee colonies in their new ranges. Potential reasons for differential impact include differences in bee behaviour, climate and release from natural enemies. Here, we provide an overview on biology, distribution, pest status, diagnosis, control and prevention to foster adequate mitigation and stimulate future research. SHBs have become a global threat to both apiculture and wild bee populations, but our knowledge of this pest is still limited, reating demand for more research in all areas of its biology.

Family Influence and Psychological Ownership: The Mediating Effects of Control

The concept of psychological ownership (PO) has been increasingly researched in the last years. However, knowledge about the emergence of PO is still scarce. So far, no study has investigated the development of PO in the context of family firms. We aim to investigate the emergence of PO in that context by drawing on the family´s influence on the business as a decisive factor. We thereby elaborate on the effect of family influence on PO, mediated by non-family managers´ perceived control over the company.

Public understanding of traffic control devices in Texas. Final report.

Texas State Department of Highways and Public Transportation, Transportation Planning Division, Austin

Urea based osmoregulation and endocrine control in elasmobranch fish with special reference to euryhalinity

Since the landmark contributions of Homer Smith and co-workers in the 1930s there has been a considerable advance in our knowledge regarding the osmoregulatory strategy of elasmobranch fish. Smith recognised that urea was retained in the body fluids as part of the 'osmoregulatory ballast' of elasmobranch fish so that body fluid osmolality is raised to a level that is iso- or slightly hyper-osmotic to that of the surrounding medium. From studies at that time he also postulated that many marine dwelling elasmobranchs were not capable of adaptation to dilute environments. However, more recent investigations have demonstrated that, at least in some species, this may not be the case. Gradual acclimation of marine dwelling elasmobranchs to varying environmental salinities under laboratory conditions has demonstrated that these fish do have the capacity to acclimate to changes in salinity through independent regulation of Na+, Cl- and urea levels. This suggests that many of the presumed stenohaline marine elasmobranchs could in fact be described as partially euryhaline. The contributions of Thomas Thorson in the 1970s demonstrated the osmoregulatory strategy of a fully euryhaline elasmobranch, the bull shark, Carcharhinus leucas, and more recent investigations have examined the mechanisms behind this strategy in the euryhaline elasmobranch, Dasyatis sabina. Both partially euryhaline and fully euryhaline species utilise the same physiological processes to control urea, Na+ and Cl- levels within the body fluids. The role of the gills, kidney, liver, rectal gland and drinking process is discussed in relation to the endocrine control of urea, Na+ and Cl- levels as elasmobranchs acclimate to different environmental salinities. (C) 2003 Elsevier Inc. All rights reserved.

Knowledge beliefs and attitudes of squash venue operators relating to use of protective eyewear

Sports venues are in a position to potentially influence the safety practices of their patrons. This study examined the knowledge, beliefs and attitudes of venue operators that could influence the use of protective eyewear by squash players. A 50% random sample of all private and public squash venues affiliated with the Victorian Squash Federation in metropolitan Melbourne was selected. Face-to-face interviews were conducted with 15 squash venue operators during August 2001. Interviews were transcribed and content and thematic analyses were performed. The content of the interviews covered five topics: (1) overall injury risk perception, (2) eye injury occurrence, (3) knowledge, behaviors, attitudes and beliefs associated with protective eyewear, (4) compulsory protective eyewear and (5) availability of protective eyewear at venues. Venue operators were mainly concerned with the severe nature of eye injuries, rather than the relatively low incidence of these injuries. Some venue operators believed that players should wear any eyewear, rather than none at all, and believed that more players should use protective eyewear. Generally, they did not believe that players with higher levels of experience and expertise needed to wear protective eyewear when playing. Only six venues had at least one type of eyewear available for players to hire or borrow or to purchase. Operators expressed a desire to be informed about correct protective eyewear. Appropriate protective eyewear is not readily available at squash venues. Better-informed venue operators may be more likely to provide suitable protective eyewear.

Origins and early development of human body knowledge

As a knowable object, the human body is highly complex. Evidence from several converging lines of research, including psychological studies, neuroimaging and clinical neuropsychology, indicates that human body knowledge is widely distributed in the adult brain, and is instantiated in at least three partially independent levels of representation. Sensori-motor body knowledge is responsible for on-line control and movement of one's own body and may also contribute to the perception of others' moving bodies; visuo-spatial body knowledge specifies detailed structural descriptions of the spatial attributes of the human body; and lexical-semantic body knowledge contains language-based knowledge about the human body. In the first chapter of this Monograph, we outline the evidence for these three hypothesized levels of human body knowledge, then review relevant literature on infants' and young children's human body knowledge in terms of the three-level framework. In Chapters II and III, we report two complimentary series of studies that specifically investigate the emergence of visuospatial body knowledge in infancy. Our technique is to compare infants' responses to typical and scrambled human bodies, in order to evaluate when and how infants acquire knowledge about the canonical spatial layout of the human body. Data from a series of visual habituation studies indicate that infants first discriminate scrambled from typical human body pictures at 15 to 18 months of age. Data from object examination studies similarly indicate that infants are sensitive to violations of three-dimensional human body stimuli starting at 15-18 months of age. The overall pattern of data supports several conclusions about the early development of human body knowledge: (a) detailed visuo-spatial knowledge about the human body is first evident in the second year of life, (b) visuo-spatial knowledge of human faces and human bodies are at least partially independent in infancy and (c) infants' initial visuo-spatial human body representations appear to be highly schematic, becoming more detailed and specific with development. In the final chapter, we explore these conclusions and discuss how levels of body knowledge may interact in early development.

Impact of an intensive nursing education course on nurses' knowledge, confidence, attitudes, and perceived skills in the care of patients with cancer

Purpose/Objectives: To evaluate the impact of a cancer nursing education course on RNs. Design: Quasi-experimental, longitudinal, pretest/post-test design, with a follow-up assessment six weeks after the completion of the nursing education course. Setting: Urban, nongovernment, cancer control agency in Australia. Sample: 53 RNs, of whom 93% were female, with a mean age of 44.6 years and a mean of 16.8 years of experience in nursing; 86% of the nurses resided and worked in regional areas outside of the state capital. Methods: Scales included the Intervention With Psychosocial Needs: Perceived Importance and Skill Level Scale, Palliative Care Quiz for Nurses, Breast Cancer Knowledge, Preparedness for Cancer Nursing, and Satisfaction With Learning. Data were analyzed using multiple analysis of variance and paired t tests. Main Research Variables: Cancer nursing-related knowledge, preparedness for cancer nursing, and attitudes toward and perceived skills in the psychosocial care of patients with cancer and their families. Findings: Compared to nurses in the control group, nurses who attended the nursing education course improved in their cancer nursing-related knowledge, preparedness for cancer nursing, and attitudes toward and perceived skills in the psychosocial care of patients with cancer and their families. Improvements were evident at course completion and were maintained at the six-week follow-up assessment. Conclusions: The nursing education course was effective in improving nurses' scores on all outcome variables. Implications for Nursing: Continuing nursing education courses that use intensive mode timetabling, small group learning, and a mix of teaching methods, including didactic and interactive approaches and clinical placements, are effective and have the potential to improve nursing practice in oncology.

Improving learning in undergraduate control engineering courses using context-based learning models

Control Engineering is an essential part of university electrical engineering education. Normally, a control course requires considerable mathematical as well as engineering knowledge and is consequently regarded as a difficult course by many undergraduate students. From the academic point of view, how to help the students to improve their learning of the control engineering knowledge is therefore an important task which requires careful planning and innovative teaching methods. Traditionally, the didactic teaching approach has been used to teach the students the concepts needed to solve control problems. This approach is commonly adopted in many mathematics intensive courses; however it generally lacks reflection from the students to improve their learning. This paper addresses the practice of action learning and context-based learning models in teaching university control courses. This context-based approach has been practised in teaching several control engineering courses in a university with promising results, particularly in view of student learning performances.

A novel approach to modelling and exploiting uncertainty in stochastic control systems

We consider an inversion-based neurocontroller for solving control problems of uncertain nonlinear systems. Classical approaches do not use uncertainty information in the neural network models. In this paper we show how we can exploit knowledge of this uncertainty to our advantage by developing a novel robust inverse control method. Simulations on a nonlinear uncertain second order system illustrate the approach.

Knowledge management applied to enterprise risk management

Risk and knowledge are two concepts and components of business management which have so far been studied almost independently. This is especially true where risk management (RM) is conceived mainly in financial terms, as for example, in the financial institutions sector. Financial institutions are affected by internal and external changes with the consequent accommodation to new business models, new regulations and new global competition that includes new big players. These changes induce financial institutions to develop different methodologies for managing risk, such as the enterprise risk management (ERM) approach, in order to adopt a holistic view of risk management and, consequently, to deal with different types of risk, levels of risk appetite, and policies in risk management. However, the methodologies for analysing risk do not explicitly include knowledge management (KM). This research examines the potential relationships between KM and two RM concepts: perceived quality of risk control and perceived value of ERM. To fulfill the objective of identifying how KM concepts can have a positive influence on some RM concepts, a literature review of KM and its processes and RM and its processes was performed. From this literature review eight hypotheses were analysed using a classification into people, process and technology variables. The data for this research was gathered from a survey applied to risk management employees in financial institutions and 121 answers were analysed. The analysis of the data was based on multivariate techniques, more specifically stepwise regression analysis. The results showed that the perceived quality of risk control is significantly associated with the variables: perceived quality of risk knowledge sharing, perceived quality of communication among people, web channel functionality, and risk management information system functionality. However, the relationships of the KM variables to the perceived value of ERM are not identified because of the low performance of the models describing these relationships. The analysis reveals important insights into the potential KM support to RM such as: the better adoption of KM people and technology actions, the better the perceived quality of risk control. Equally, the results suggest that the quality of risk control and the benefits of ERM follow different patterns given that there is no correlation between both concepts and the distinct influence of the KM variables in each concept. The ERM scenario is different from that of risk control because ERM, as an answer to RM failures and adaptation to new regulation in financial institutions, has led organizations to adopt new processes, technologies, and governance models. Thus, the search for factors influencing the perceived value of ERM implementation needs additional analysis because what is improved in RM processes individually is not having the same effect on the perceived value of ERM. Based on these model results and the literature review the basis of the ERKMAS (Enterprise Risk Knowledge Management System) is presented.

Knowledge management in a New Zealand tree farming company:Ambiguity and resistance to the "technology solution"

Purpose - Managers at the company attempt to implement a knowledge management information system in an attempt to avoid loss of expertise while improving control and efficiency. The paper seeks to explore the implications of the technological solution to employees within the company. Design/methodology/approach - The paper reports qualitative research conducted in a single organization. Evidence is presented in the form of interview extracts. Findings - The case section of the paper presents the accounts of organizational participants. The accounts reveal the workers' reactions to the technology-based system and something of their strategies of resistance to the system. These accounts also provide glimpses of the identity construction engaged in by these knowledge workers. The setting for the research is in a knowledge-intensive primary industry. Research was conducted through observation and interviews. Research limitations/implications - The issues identified are explored in a single case-study setting. Future research could look at the relevance of the findings to other settings. Practical implications - The case evidence presented indicates some of the complexity of implementation of information systems in organizations. This could certainly be seen as more evidence of the uncertainty associated with organizational change and of the need for managers not to expect an easy adoption of intrusive IT solutions. Originality/value - This paper adds empirical insight to a largely conceptual literature. © Emerald Group Publishing Limited.

People, technology, processes and risk knowledge sharing

The present global economic crisis creates doubts about the good use of accumulated experience and knowledge in managing risk in financial services. Typically, risk management practice does not use knowledge management (KM) to improve and to develop new answers to the threats. A key reason is that it is not clear how to break down the “organizational silos” view of risk management (RM) that is commonly taken. As a result, there has been relatively little work on finding the relationships between RM and KM. We have been doing research for the last couple of years on the identification of relationships between these two disciplines. At ECKM 2007 we presented a general review of the literature(s) and some hypotheses for starting research on KM and its relationship to the perceived value of enterprise risk management. This article presents findings based on our preliminary analyses, concentrating on those factors affecting the perceived quality of risk knowledge sharing. These come from a questionnaire survey of RM employees in organisations in the financial services sector, which yielded 121 responses. We have included five explanatory variables for the perceived quality of risk knowledge sharing. These comprised two variables relating to people (organizational capacity for work coordination and perceived quality of communication among groups), one relating to process (perceived quality of risk control) and two related to technology (web channel functionality and RM information system functionality). Our findings so far are that four of these five variables have a significant positive association with the perceived quality of risk knowledge sharing: contrary to expectations, web channel functionality did not have a significant association. Indeed, in some of our exploratory regression studies its coefficient (although not significant) was negative. In stepwise regression, the variable organizational capacity for work coordination accounted for by far the largest part of the variation in the dependent variable perceived quality of risk knowledge sharing. The “people” variables thus appear to have the greatest influence on the perceived quality of risk knowledge sharing, even in a sector that relies heavily on technology and on quantitative approaches to decision making. We have also found similar results with the dependent variable perceived value of Enterprise Risk Management (ERM) implementation.