The morbidity of Guillain-Barré syndrome admitted to the intensive care unit

Patients with severe forms of Guillain-Barré syndrome (GBS) require intensive care. Specific treatment, catheterization, and devices may increase morbidity in the intensive care unit (ICU). To understand the spectrum of morbidity associated with ICU care, the authors studied 114 patients with GBS. Major morbidity occurred in 60% of patients. Complications were uncommon if ICU stay was less than 3 weeks. Respiratory complications such as pneumonia and tracheobronchitis occurred in half of the patients and were linked to mechanical ventilation. Systemic infection occurred in one-fifth of patients and was more frequent with increasing duration of ICU admission. Direct complications of treatment and invasive procedures occurred infrequently. Life-threatening complications such as gastrointestinal bleeding and pulmonary embolism were very uncommon. Pulmonary morbidity predominates in patients with severe GBS admitted to the ICU. Attention to management of mechanical ventilation and weaning is important to minimize this complication of GBS. Other causes of morbidity in a tertiary center ICU are uncommon.

A unit cell waveguide model of a reflectarray formed by microstrip patches and slots

An equivalent unit cell waveguide approach (WGA) is described to obtain reflection coefficient phase curves for designing a microstrip patch reflectarray supported by a ground plane with periodic apertures or slots. Based on the presented theory, a computer algorithm for determining the reflection coefficient of a plane wave normally incident on a multi-layer structure of patches and apertures is developed. The validity of the developed algorithm is verified by comparing the obtained results with those published in the literature and the ones generated by Agilent High Frequency Structure Simulator (HFSS). A good agreement in all the presented examples is obtained, proving that the developed theory and computer algorithm can be an effective tool for designing multi-layer microstrip reflectarrays with a periodically perforated ground plane. (C) 2003 Wiley Periodicals, Inc.

Diagnostic and management protocols for equine Cushing's syndrome

Equine Cushing's syndrome is a common problem in aged horses and ponies. It presents with a variable combination of clinical signs; hirsutism is characteristic of the disease, with laminitis frequently being the most devastating consequence. This article describes the diagnostic protocols available and, in view of the fact that complete resolution of the disease is not achievable, discusses how the condition might be managed appropriately to improve the quality of life of affected animals.

Use of an accelerated chest pain assessment protocol in patients at intermediate risk of adverse cardiac events

Objective: To determine the feasibility, safety and effectiveness of a structured clinical pathway for stratification and management of patients presenting with chest pain and classified as having intermediate risk of adverse cardiac outcomes in the subsequent six months. Design: Prospective clinical audit. Participants and setting: 630 consecutive patients who presented to the emergency department of a metropolitan tertiary care hospital between January 2000 and June 2001 with chest pain and intermediate-risk features. Intervention: Use of the Accelerated Chest Pain Assessment Protocol (ACPAP), as advocated by the Management of unstable angina guidelines - 2000 from the National Heart Foundation and the Cardiac Society of Australia and New Zealand. Main outcome measure: Adverse cardiac events during six-month follow-up. Results: 409 patients (65%) were reclassified as low risk and discharged at a mean of 14 hours after assessment in the chest pain unit. None had missed myocardial infarctions, while three (1%) had cardiac events at six months (all elective revascularisation procedures, with no readmissions with acute coronary syndromes). Another 110 patients (17%) were reclassified as high risk, and 21 (19%) of these had cardiac events (mainly revascularisations) by six months. Patients who were unable to exercise or had non-diagnostic exercise stress test results (equivocal risk) had an intermediate cardiac event rate (8%). Conclusions: This study validates use of ACPAP. The protocol eliminated missed myocardial infarction; allowed early, safe discharge of low-risk patients; and led to early identification and management of high-risk patients.

Use of web-based formative assessment to support student learning in metabolism/nutrition unit

In 2002, an integrated basic science course was introduced into the Bachelor of Dental Sciences programme at the University of Queensland, Australia. Learning activities for the Metabolism and Nutrition unit within this integrated course included lectures, problem-based learning tutorials, computer-based self-directed learning exercises and practicals. To support student learning and assist students to develop the skills necessary to become lifelong learners, an extensive bank of formative assessment questions was set up using the commercially available package, WebCT®. Questions included short-answer, multiple-choice and extended matching questions. As significant staff time was involved in setting up the question database, the extent to which students used the formative assessment and their perceptions of its usefulness to their learning were evaluated to determine whether formative assessment should be extended to other units within the course. More than 90% of the class completed formative assessment tasks associated with learning activities scheduled in the first two weeks of the block, but this declined to less than 50% by the fourth and final week of the block. Patterns of usage of the formative assessment were also compared in students who scored in the top 10% for all assessment for the semester with those who scored in the lowest 10%. High-performing students accessed the Web-based formative assessment about twice as often as those who scored in the lowest band. However, marks for the formative assessment tests did not differ significantly between the two groups. In a questionnaire that was administered at the completion of the block, students rated the formative assessment highly, with 80% regarding it as being helpful for their learning. In conclusion, although substantial staff time was required to set up the question database, this appeared to be justified by the positive responses of the students.

Genomovar diversity amongst Burkholderia cepacia complex isolates from an Australian adult cystic fibrosis unit

In this study, a combination of recA-based PCR assays and 16S rDNA restriction fragment length polymorphism (RFLP) analysis was used to determine the genomovar diversity of clinical Burkholderia cepacia complex isolates. Twenty-eight isolates were prospectively collected from patients attending a large Australian adult cystic fibrosis (CF) unit, 22 isolates were referred from other Australian CF units and a further eight isolates originated from patients without CF. The 28 prospectively collected isolates were distributed amongst the following genomovars: Burkholderia cepacia genomovar I (28.6%), Burkholderia multivorans (21.4%), Burkholderia cepacia genomovar III (39.3%), Burkholderia vietnamiensis (3.6%) and Burkholderia ambifaria (7.1%). The results of this study highlight the usefulness of 16S rDNA RFLP typing for the identification of other Burkholderia spp. and non-fermenting gram-negative bacteria.

Injury related risk behavior - a study of Australian skydivers

Risk taking behaviour has been identified as an important host-related determinant of injury in young adults. The aim of this study is to clarify the relationship between the two key elements of risk taking behaviour - ie, risk assessment and risk acceptance - in participants of a high risk sporting activity. Skydivers registered with the Australian Parachute Federation were sampled at several jump meetings held at three 'drop-zones' in North Eastern Australia. A cross sectional survey of 215 skydivers ascertained each subject's risk assessment of each of nine hypothetical sky diving scenes and whether or not they would jump in the described conditions. Variables which independently predicted an individual's risk assessment were age group (p < 0.05), gender (p < 0.05) and scene details (p < 0.001). Risk assessment was found to be a statistically significant predictor of the decision to jump, with a 22% decrease in the odds of jumping with every unit increase in risk assessment (OR = 0.78: 95% Cl; 0.76, 0.80). Gender was also found to be a statistically significant predictor of the decision to jump, with males being 19% more likely to jump than females, after controlling for age, experience, currency and risk assessment (OR = 1.19: 95% CI; 1.04, 1.38). The importance of these results is that, by quantifying the relationship between two key elements of risk taking behaviour and several important host factor determinants, they facilitate more informed discussion about the possible role of risk taking behaviour in the causation of injury.

Estudo do efeito da face sobre o equilíbrio de estruturas de contenção de solo reforçado sob condições de trabalho

Os métodos de análise de estruturas de contenção de solo reforçado sob condições de trabalho, em geral, desconsideram a contribuição da face para o equilíbrio da estrutura. Visando estudar a influência do peso específico da face e das propriedades relacionadas à rigidez da mesma sobre o desempenho das estruturas de solo reforçado, são realizadas simulações numéricas de diversas estruturas, utilizando a versão de dupla precisão do programa CRISP92-SC. Avalia-se, também, o emprego de diferentes tipos de elementos para a representação da face. Verifica-se que a face rígida impõe redução significativa das solicitações máximas de tração nos reforços e dos deslocamentos das estruturas de solo reforçado. A influência do peso específico da face sobre a estabilidade interna dos maciços reforçados mostrase desprezível e constata-se que a rigidez à flexão e a rigidez axial da face, função da sua geometria e do seu módulo de Young, são parâmetros influentes no comportamento das estruturas de contenção de solo reforçado. As variações da tração no reforço e da resultante de força cortante na face, em decorrência do enrijecimento da face, são analisadas e propõe-se uma relação entre elas. Quanto à forma de representação de uma face com rigidez expressiva, na simulação de uma estrutura de solo reforçado com o CRISP92-SC, é observado que a representação da face, seja por elementos de viga, seja por elementos quadriláteros, não altera os resultados da análise.

Microminerais orgânicos para codornas japonesas

Este trabalho teve como objetivo avaliar o desempenho produtivo e a qualidade dos ovos de codornas japonesas em postura, em função da redução e da substituição parcial ou total de microminerais (manganês, zinco, ferro, cobre, iodo e selênio) orgânicos em substituição ao micromineral inorgânico. Foram conduzidos dois experimentos no setor de avicultura do Instituto Federal do Espírito Santo, com duração de 84 dias, distribuídos em quatro períodos de 21 dias. Em cada experimento, foram utilizadas 480 codornas japonesas fêmeas, com 79 dias de idade. As aves foram distribuídas em delineamento inteiramente ao acaso em 6 tratamentos, 10 repetições e 8 aves por unidade experimental. Foi utilizada uma mesma ração basal em ambos experimentos, variando apenas os níveis e a fonte dos microminerais utilizados. No primeiro experimento foi adicionado à essa ração cinco diferentes níveis de microminerais orgânicos 25; 50; 75; 100 e 125% da recomendação do complexo mineral orgânico e um nível com microminerais inorgânicos (100% da recomendação) sendo utilizado 1 kg/ton de ração. No segundo experimento, foram adicionados quatro diferentes níveis de mistura de microminerais orgânicos e inorgânicos (20% orgânico + 80% inorgânico, 40% orgânico + 60% inorgânico, 60% orgânico + 40% inorgânico e 80% orgânico + 20% inorgânico), um inorgânico (100%) e um orgânico (100%) na ração. As características avaliadas foram consumo de ração, taxa de postura, peso médio do ovo, massa dos ovos, conversão alimentar por massa do ovo e por dúzia de ovos, peso relativo e absoluto da gema, do albúmen e da casca, além da unidade Haugh. Os parâmetros avaliados não foram afetados de forma significativa pelas diferentes relações de uso de minerais orgânicos e inorgânicos. Observou-se que é possível reduzir para 25% da recomendação de microminerais, quando utiliza-se microminerais orgânicos e que, é possível a substituição em até 100% dos microminerais inorgânicos por orgânicos sem efeito sobre desempenho o produtivo e a qualidade de ovos de codornas japonesas.

Práticas pedagógicas inclusivas no cotidiano da educação infantil : considerações sobre a infância e a criança com deficiência e transtornos globais do desenvolvimento

Esta dissertação tem como objetivo investigar as práticas pedagógicas inclusivas instituídas no cotidiano da educação infantil a partir de um olhar para a infância e para a criança com deficiência e transtornos globais do desenvolvimento. Apontamos como objetivos específicos: definir o que está sendo reconhecido como práticas educacionais inclusivas a partir de indicadores estabelecidos para identificá- las no contexto de uma escola de educação infantil; investigar como a escola reflete, dialoga sobre as questões da inclusão das crianças na primeira infância na unidade de educação infantil e como se configuram as propostas de formação dos professores neste espaço, a fim de constituir práticas pedagógicas inclusivas na unidade escolar; escutar as crianças com deficiência e transtornos globais do desenvolvimento e as demais crianças sobre como estão compreendendo o acontecimento das práticas pedagógicas em geral e as práticas pedagógicas inclusivas da unidade de ensino de educação infantil. Para tanto, desenvolvemos um estudo de natureza qualitativa, tendo como base a metodologia do estudo de caso etnográfico numa perspectiva colaborativa, no qual realizamos análise documental, entrevistas semiestruturadas, observações participantes, ciclos de formação com os professores e roda de conversa com as crianças, que foram registrados por meio de fotografias, áudio e videogravações. O estudo foi desenvolvido no contexto de uma escola pública de educação infantil do município de Cachoeiro de Itapemirim – ES. Os participantes foram oito crianças público-alvo da educação especial, com idade entre dois a seis anos de idade, dez professores, três pedagogas, uma diretora, uma coordenadora e duas auxiliares de turma que se envolveram direta ou indiretamente com o estudo. O estudo foi realizado durante quatorze meses, no período de 28 de outubro de 2011 a 10 de dezembro de 2012, em uma Escola Municipal de Educação Básica do município de Cachoeiro do Itapemirim/ES, que atende exclusivamente aos alunos da educação infantil, em duas turmas de creche e três de pré-escola. Os aportes teóricos fundamentam-se na abordagem histórico-cultural e nos estudos de Phelippe Meirieu. Os dados foram organizados em temáticas e “episódios interativos” e analisados por meio da abordagem microgenética e das análises das narrativas. A análise dos resultados evidenciou a importância do investimento na formação dos professores, a constituição de relações de colaboração entre professores regentes e de Educação Especial e a assunção de que toda criança tem capacidade de aprender, pois esses elementos influenciam as práticas pedagógicas constituídas nos espaços-tempos da Educação Infantil mediante o desafio de inclusão escolar de crianças com deficiência e com transtornos globais do desenvolvimento.

Does gender affect visiting a world heritage site?

The city of Guimarães in Portugal is a place of strong symbolic and cultural significance, and the nomination of its historical center as a World Heritage Site in 2001 enhanced its tourism potential. This study presents the results of a survey conducted in 2010 and 2011 to capture the profile and motivations of tourists visiting Guimarães as a cultural tourism destination. The study addressed two main issues: whether males and females have similar or different preferences in choosing the city as their destination, and whether there are gender differences in the perception of the attributes of Guimarães. A better understanding of the gendered nature of the destination is a valuable cue for shaping products and services according to visitors’ preferences. The results suggest that both men and women are aware of the main elements responsible for the city’s World Heritage status. That the destination is a Heritage Site that also offers the opportunity to tour the region has a significant positive effect on male tourists’ choice of Guimarães. Regarding the perceived attributes of the city, results indicate minor gender differences with one exception: Women expressed more apprehension than men regarding the perceived security of the destination.

A model for the evaluation of data quality in health unit website

This article presents a research work, the goal of which was to achieve a model for the evaluation of data quality in institutional websites of health units in a broad and balanced way. We have carried out a literature review of the available approaches for the evaluation of website content quality, in order to identify the most recurrent dimensions and the attributes, and we have also carried out a Delphi method process with experts in order to reach an adequate set of attributes and their respective weights for the measurement of content quality. The results obtained revealed a high level of consensus among the experts who participated in the Delphi process. On the other hand, the different statistical analysis and techniques implemented are robust and attach confidence to our results and consequent model obtained.

Diagnostic leaf to evaluate the nutritional status of Jatropha

ABSTRACT The analytical determination of nutrient levels in recently mature leaves in order to diagnose nutritional status is based on the fact that leaves are metabolically active and more sensitive to variation in nutrients of the soil. In most of cases, there is a direct well known between foliar content and the development and yield of the plant. However, for a more accurate interpretation, it is essential to establish the index leaf. There are few published studies about Jatropha with contrasting results. In order to establish the index leaf, in adult plants, the macronutrient levels were evaluated in samples collected in experimental plots, in which doses of nitrogen and phosphorus were applied, in two parts of the floral branches (in the top and in the middle thirds); and in three positions of leaves of the floral branch (between the 1st and 3rd, 6th and 8th, and 13th and 15th leaves below the inflorescence). The location of the leaf on the plant significantly affects nutrient contents. Nitrogen, phosphorus, potassium and sulfur tend to have higher concentration in young tissues. Calcium and magnesium showed higher levels in the basal leaves of floral branches. Samples collected in the top third of plants (between the 6th and 15th leaves of the floral branch) are more sensitive to variations of nitrogen and phosphorus fertilization. Therefore, we indicate the 6th to 15th leaves of the top third plants as index leaves estimate nutritional status of Jatropha.

Diagnostic performance of visual screening tests in the elderly

This study aimed to determine and evaluate the diagnostic accuracy of visual screening tests for detecting vision loss in elderly. This study is defined as study of diagnostic performance. The diagnostic accuracy of 5 visual tests -near convergence point, near accommodation point, stereopsis, contrast sensibility and amsler grid—was evaluated by means of the ROC method (receiver operating characteristics curves), sensitivity, specificity, positive and negative likelihood ratios (LR+/LR−). Visual acuity was used as the reference standard. A sample of 44 elderly aged 76.7 years (±9.32), who were institutionalized, was collected. The curves of contrast sensitivity and stereopsis are the most accurate (area under the curves were 0.814−p = 0.001, C.I.95%[0.653;0.975]— and 0.713−p = 0.027, C.I.95%[0,540;0,887], respectively). The scores with the best diagnostic validity for the stereopsis test were 0.605 (sensitivity 0.87, specificity 0.54; LR+ 1.89, LR−0.24) and 0.610 (sensitivity 0.81, specificity 0.54; LR+1.75, LR−0.36). The scores with higher diagnostic validity for the contrast sensibility test were 0.530 (sensitivity 0.94, specificity 0.69; LR+ 3.04, LR−0.09). The contrast sensitivity and stereopsis test's proved to be clinically useful in detecting vision loss in the elderly.