Autopsy: quality assurance in the ICU

Objective: To examine the correlation between the clinical diagnosis and autopsy findings in adult patients who died in an intensive care unit (ICU). To determine the rate of agreement of the basic and terminal causes of death and the types of errors in order to improve quality control of future care,Design, Retrospective study.Setting: Adult ICU in a university hospital.Patients: 30 adult patients who died in the ICU. with the exclusion of medicolegal cases.Methods and main results: Anatomo-clinical meetings were held to analyze the pre- and postmortem correlations in 30 consecutive autopsies at the ICU of the University Hospital, School of Medicine of Botucatu/ UNESP, from January 1994 to January 1997. The rate of correct clinical diagnoses of the basic cause was 66.7 %; in 23.3 % of cases, if the correct diagnosis was made, management would have been different, as would have been the evolution of the patient's course (Class I error): in 10 % of the cases the error would not have led to a change in management (Class II error). The rate of correct clinical diagnoses of terminal cause was 80 %.Conclusions: the rate of recognition of the basic cause was 66.7 %, which is consistent with the literature, but the Class I error rate was higher than that reported in the literature.

Management of Orbital Reconstruction

One of the concerns after a major trauma to the orbit is to be rebuilt. This can be achieved with care in management of orbital reconstruction, techniques, types of materials, and osseointegrated implants; it allows satisfactory aesthetic recuperation and well-being, whereas psychological therapy allows for patients' re-insertion in social and family environment to make them feel happier and safer.

Production of Nile tilapia Oreochromis niloticus and freshwater prawn Macrobrachium rosenbergii stocked at different densities in polyculture systems in Brazil

The effect of stocking prawns Macrobrachium rosenbergii at increasing densities in ponds with Nile tilapia Oreochromis niloticus reared at low density was evaluated. Twelve 0.01-ha earthen ponds were stocked with 1 tilapia/m2 and 0, 2, 4, or 6 post-larvae prawn/m2. Three replicates were randomly assigned to each prawn density. Postlarval prawns were stocked a week prior to tilapia juveniles and both were harvested 175 d after the beginning of the experiment. Tilapia final average weight, survival, production, and food conversion rates did not differ significantly among treatments (P > 0.05); the averages were 531 g. 67%, 3,673 kg/ha, and 1.91, respectively. Prawn survival rates did not differ for the three stocking densities (mean 90%). However, final weight and production were significantly different (P < 0.05) as follows: 34.0, 23.0, and 14.7 g and 639, 909, and 818 kg/ha, respectively for 2, 4, and 6 prawns/m2 densities. Stocking densities up to 6 prawn/m2 did not affect tilapia production and required neither additional feeding nor significant changes in management. The polyculture system allowed an increase in total production with the same amount of supplied feed, thus improving the system sustainability.

Effect of 6-months of physical exercise on the nitrate/nitrite levels in hypertensive postmenopausal women

Background: Evidences have showed that the incidence of arterial hypertension is greater in postmenopausal women as compared to premenopausal. Physical inactivity has been implicated as a major contributor to weight gain and abdominal obesity in postmenopausal women and the incidence of cardiovascular disease increases dramatically after menopause. Additionally, more women than men die each year of coronary heart disease and are twice as likely as men to die within the first year after a heart attack. A healthy lifestyle has been strongly associated with the regular physical activity and evidences have shown that physically active subjects have more longevity with reduction of morbidity and mortality. Nitric oxide (NO) produced by endothelial cells has been implicated in this beneficial effect with improvement of vascular relaxing and reduction in blood pressure in both laboratory animals and human. Although the effect of exercise training in the human cardiovascular system has been largely studied, the majority of these studies were predominantly conducted in men or young volunteers. Therefore, the aim of this work was to investigate the effects of 6 months of dynamic exercise training (ET) on blood pressure and plasma nitrate/nitrite concentration (NOx-) in hypertensive postmenopausal women. Methods: Eleven volunteers were submitted to the ET consisting in 3 days a week, each session of 60 minutes during 6 months at moderate intensity (50% of heart rate reserve). Anthropometric parameters, blood pressure, NOx- concentration were measured at initial time and after ET. Results: A significant reduction in both systolic and diastolic blood pressure values was seen after ET which was accompanied by markedly increase of NOx- levels (basal: 10 ± 0.9; ET: 16 ± 2 μM). Total cholesterol was significantly reduced (basal: 220 ± 38 and ET: 178 ± 22 mg/dl), whereas triglycerides levels were not modified after ET (basal: 141 ± 89 and ET: 147 ± 8 mg/dl). Conclusion: Our study shows that changing in lifestyle promotes reducftion of arterial pressure which was accompanied by increase in nitrite/nitrate concentration. Therefore, 6-months of exercise training are an important approach in management arterial hypertension and play a protective effect in postmenopausal women. © 2009 Zaros et al; licensee BioMed Central Ltd.

Integration in new product development: Case study in a large Brazilian high-technology company

Proficiency in management activities undertaken in product development processes is regarded as a key competitive advantage for companies, particularly for high-tech industrial firms, which benefit from the important competitiveness factor of launching products with a differentiated technological content. This paper's objective was to identify, through case study, practices for integration between the roles of R & D with others involved in product development in a large Brazilian company of industrial automation. The results suggest some management practices to improve the integration in new products development, such as the use of employees from marketing with knowledge and experience previously gained from R & D activities and uses the heavyweight product manager to solve synchronization problems between product and technology development. © Universidad Alberto Hurtado, Facultad de Economía y Negocios.

The lauraceae collected in brazil by ludwig riedel - I

The species of Lauraceae collected by Ludwig Riedel, excluding Ocotea, are commented and contex-tualized according to the different itineraries he travelled in Brazil, from 1821 to 1836, indicating the localities and dates of collections, whenever possible. To complete this work, two diaries of Riedel have been consulted and the information from them cross-checked with the annotations found on specimen labels. An annotated list of 48 entries provides information on the status of species names and their types, currently accepted names, and collections found in different herbaria. Lectotypes for five names, Aydendron verrucosum var. attenuata, Aydendron parviflorum, Mespilodaphne parviflora, Nectandra spicata, and Oreodaphne fasciculata, are designated. The species of Ocotea collected by Riedel will be treated in part II of this series. © President and Fellows of Harvard College, 2012.

The lauraceae collected in brazil by ludwig riedel - II. Ocotea

The species of Ocotea (Lauraceae) collected by Ludwig Riedel are commented and contextualized according to the different itineraries he travelled in Brazil, from 1821 to 1836, indicating the localities and dates of collections, whenever possible. To complete this work, two diaries of Riedel have been consulted and the information from them crossed-checked with the annotations found on specimen labels. An annotated list of 44 entries provides information on the status of species names and their types, currently accepted names, and collections found in different herbaria. Lectotypes for 19 names are designated, two new synonyms are proposed, as well as the new combination Ocotea estrellensis (Meisn.) P.L.R. Moraes, based on Oreodaphne estrellensis Meisn. © President and Fellows of Harvard College, 2012.

New approaches by highway agencies in dealing with road users

The context in which society develops has changed. The principles of democracy and human rights, in addition to the explosive development of communications, have encouraged citizens' desire for involvement in many areas which formerly had been the preserve of the State. This is also reflected in the attitudes of public utility customers, who are no longer prepared to accept mediocre service from the bodies responsible; on the contrary, they are increasingly putting pressure on those bodies, demanding better service in return for the charges they pay. Road agencies are no exception. They can no longer maintain their traditional isolation from the public and from users in areas such as decision-making or accountability for results achieved. Furthermore, it is no longer enough to provide road networks; these must be managed in such a way as to ensure improved levels of service, acceptable to users who are more and more demanding. This is why conventional styles of highway management have become unsatisfactory and new approaches are developing. There is a gradual increase in openness to the interests and views of users, who are increasingly considered as partners and participants in management. There are numerous examples in various countries, including those of Latin America, of this significant change; it is likely to cause a major transformation in the way in which public highways are managed. The innovations are recent, many of them still at the embryonic stage. A wide variety of concrete measures have been proposed or tried out. It is not yet possible to predict the size or scope of these changes, or which of them will ultimately become normal practice, but the changes have begun. The purpose of this article is to outline the principal changes which are being observed and the new outlook for road users.

Escravidão negra em Belém: mercado, trabalho e liberdade (1810-1850)

Entre os anos de 1810 e 1850, a presença de trabalhadores escravos em Belém era significativa. Em termos demográficos, essa população representava quase metade da população da cidade, formada pelas freguesias urbanas da Sé e Campina. A presente dissertação analisa a escravidão em Belém, a partir de diversos aspectos como o tráfico, a procedência e/ou origem geográfica e étnica dos cativos, a demografia e as cores, mercado e a mobilidade cativa, o controle social e a liberdade escrava, permeados por acontecimentos sociais, políticos e econômicos ocorridos no Brasil e no Grão-Pará, no período em questão, tais como a chegada da família real e a abertura dos portos, a independência, a Cabanagem e a promulgação das leis anti-tráfico de 1815, 1831 e 1850. Narrativas de viajantes estrangeiros, jornais, inventários post-mortem, relatórios de governo, códigos de posturas e ações de liberdade são algumas das fontes utilizadas para construção do cenário: a Belém da primeira metade do século XIX, e para conhecimento da atuação de nossos atores: os trabalhadores escravos.

Genomic analysis for managing small and endangered populations: a case study in Tyrol Grey cattle

Analysis of genomic data is increasingly becoming part of the livestock industry. Therefore, the routine collection of genomic information would be an invaluable resource for effective management of breeding programs in small, endangered populations. The objective of the paper was to demonstrate how genomic data could be used to analyse (1) linkage disequlibrium (LD), LD decay and the effective population size (NeLD); (2) Inbreeding level and effective population size (NeROH) based on runs of homozygosity (ROH); (3) Prediction of genomic breeding values (GEBV) using small within-breed and genomic information from other breeds. The Tyrol Grey population was used as an example, with the goal to highlight the potential of genomic analyses for small breeds. In addition to our own results we discuss additional use of genomics to assess relatedness, admixture proportions, and inheritance of harmful variants. The example data set consisted of 218 Tyrol Grey bull genotypes, which were all available AI bulls in the population. After standard quality control restrictions 34,581 SNPs remained for the analysis. A separate quality control was applied to determine ROH levels based on Illumina GenCall and Illumina GenTrain scores, resulting into 211 bulls and 33,604 SNPs. LD was computed as the squared correlation coefficient between SNPs within a 10 mega base pair (Mb) region. ROHs were derived based on regions covering at least 4, 8, and 16 Mb, suggesting that animals had common ancestors approximately 12, 6, and 3 generations ago, respectively. The corresponding mean inbreeding coefficients (F ROH) were 4.0% for 4 Mb, 2.9% for 8 Mb and 1.6% for 16 Mb runs. With an average generation interval of 5.66 years, estimated NeROH was 125 (NeROH>16 Mb), 186 (NeROH>8 Mb) and 370 (NeROH>4 Mb) indicating strict avoidance of close inbreeding in the population. The LD was used as an alternative method to infer the population history and the Ne. The results show a continuous decrease in NeLD, to 780, 120, and 80 for 100, 10, and 5 generations ago, respectively. Genomic selection was developed for and is working well in large breeds. The same methodology was applied in Tyrol Grey cattle, using different reference populations. Contrary to the expectations, the accuracy of GEBVs with very small within breed reference populations were very high, between 0.13-0.91 and 0.12-0.63, when estimated breeding values and deregressed breeding values were used as pseudo-phenotypes, respectively. Subsequent analyses confirmed the high accuracies being a consequence of low reliabilities of pseudo-phenotypes in the validation set, thus being heavily influenced by parent averages. Multi-breed and across breed reference sets gave inconsistent and lower accuracies. Genomic information may have a crucial role in management of small breeds, even if its primary usage differs from that of large breeds. It allows to assess relatedness between individuals, trends in inbreeding and to take decisions accordingly. These decisions would be based on the real genome architecture, rather than conventional pedigree information, which can be missing or incomplete. We strongly suggest the routine genotyping of all individuals that belong to a small breed in order to facilitate the effective management of endangered livestock populations.

How to progress from discourse to practice? a new agenda for change in medical schools into the next decade

In the context of medical school instruction, the segmented approach of a focus on specialties and excessive use of technology seem to hamper the development of the professional-patient relationship and an understanding of the ethics of this relationship. The real world presents complexities that require multiple approaches. Engagement in the community where health competence is developed allows extending the usefulness of what is learned. Health services are spaces where the relationship between theory and practice in health care are real and where the social role of the university can be revealed. Yet some competencies are still lacking and may require an explicit agenda to enact. Ten topics are presented for focus here: environmental awareness, involvement of students in medical school, social networks, interprofessional learning, new technologies for the management of care, virtual reality, working with errors, training in management for results, concept of leadership, and internationalization of schools. Potential barriers to this agenda are an underinvestment in ambulatory care infrastructure and community-based health care facilities, as well as in information technology offered at these facilities; an inflexible departmental culture; and an environment centered on a discipline-based medical curriculum.

Determining spatial and temporal scales for management: lessons from whaling

Selection of the appropriate management unit is critical to the conservation of animal populations. Defining such units depends upon knowledge of population structure and upon the timescale being considered. Here, we examine the trajectory of eleven subpopulations of five species of baleen whales to investigate temporal and spatial scales in management. These subpopulations were all extirpated by commercial whaling, and no recovery or repopulation has occurred since. In these cases, time elapsed since commercial extinction ranges from four decades to almost four centuries. We propose that these subpopulations did not recover either because cultural memory of the habitat has been lost, because widespread whaling among adjacent stocks eliminated these as sources for repopulation, and/or because segregation following exploitation produced the abandonment of certain areas. Spatial scales associated with the extirpated subpopulations are frequently smaller than those typically employed in management. Overall, the evidence indicates that: (1) the time frame for management should be at most decadal in scope (i.e., <100 yr) and based on both genetic and nongenetic evidence of population substructure, and (2) at least some stocks should be defined on a smaller spatial scale than they currently are.

Effect of 6-months of physical exercise on the nitrate/nitrite levels in hypertensive postmenopausal women

Abstract Background Evidences have showed that the incidence of arterial hypertension is greater in postmenopausal women as compared to premenopausal. Physical inactivity has been implicated as a major contributor to weight gain and abdominal obesity in postmenopausal women and the incidence of cardiovascular disease increases dramatically after menopause. Additionally, more women than men die each year of coronary heart disease and are twice as likely as men to die within the first year after a heart attack. A healthy lifestyle has been strongly associated with the regular physical activity and evidences have shown that physically active subjects have more longevity with reduction of morbidity and mortality. Nitric oxide (NO) produced by endothelial cells has been implicated in this beneficial effect with improvement of vascular relaxing and reduction in blood pressure in both laboratory animals and human. Although the effect of exercise training in the human cardiovascular system has been largely studied, the majority of these studies were predominantly conducted in men or young volunteers. Therefore, the aim of this work was to investigate the effects of 6 months of dynamic exercise training (ET) on blood pressure and plasma nitrate/nitrite concentration (NOx-) in hypertensive postmenopausal women. Methods Eleven volunteers were submitted to the ET consisting in 3 days a week, each session of 60 minutes during 6 months at moderate intensity (50% of heart rate reserve). Anthropometric parameters, blood pressure, NOx- concentration were measured at initial time and after ET. Results A significant reduction in both systolic and diastolic blood pressure values was seen after ET which was accompanied by markedly increase of NOx- levels (basal: 10 ± 0.9; ET: 16 ± 2 μM). Total cholesterol was significantly reduced (basal: 220 ± 38 and ET: 178 ± 22 mg/dl), whereas triglycerides levels were not modified after ET (basal: 141 ± 89 and ET: 147 ± 8 mg/dl). Conclusion Our study shows that changing in lifestyle promotes reduction of arterial pressure which was accompanied by increase in nitrite/nitrate concentration. Therefore, 6-months of exercise training are an important approach in management arterial hypertension and play a protective effect in postmenopausal women.

Masking environmental feedback : Misfits between institutions and ecosystems in Belize and Thailand

The thesis analyses relationships between ecological and social systems in the context of coastal ecosystems. It examines human impacts from resource extraction and addresses management and governance behind resource exploitation. The main premises are that a lack of ecological knowledge leads to poor ecosystem management and that the dichotomy between social and natural systems is an artificial one. The thesis illustrates the importance of basing resource management on the ecological conditions of the resource and its ecosystem. It also demonstrates the necessity of accounting for the human dimension in ecosystem management and the challenges of organising human actions for sustainable use of ecosystem services in the face of economic incentives that push users towards short-term extraction. Many Caribbean coral reefs have undergone a shift from coral to macroalgal domination. An experiment on Glovers Reef Atoll in Belize manually cleared patch reefs in a no-take zone and a fished zone (Papers I and II). The study hypothesised that overfishing has reduced herbivorous fish populations that control macroalgae growth. Overall, management had no significant effect on fish abundance and the impacts of the algal reduction were short-lived. This illustrated that the benefits of setting aside marine reserves in impacted environments should not be taken for granted. Papers III and IV studied the development of the lobster and conch fisheries in Belize, and the shrimp farming industry in Thailand respectively. These studies found that environmental feedback can be masked to give the impression of resource abundance through sequential exploitation. In both cases inadequate property rights contributed to this unsustainable resource use. The final paper (V) compared the responses to changes in the resource by the lobster fisheries in Belize and Maine in terms of institutions, organisations and their role in management. In contrast to Maine’s, the Belize system seems to lack social mechanisms for responding effectively to environmental feedback. The results illustrate the importance of organisational and institutional diversity that incorporate ecological knowledge, respond to ecosystem feedback and provide a social context for learning from and adapting to change.

The Road to Poverty Reduction: Corporate Governance and Female Participation in MFIs

1.Microfinance Industry – Context of Analysis. This paper is an introduction to the microfinance industry. It serves as a context of analysis, for the empirical settings and basis for building the theoretical argument for the thesis. 2.Women in Microfinance Institutions: The Road to Poverty Reduction and Gender Equality? One of the unique aspects of microfinance institutions is their focus on outreach, i.e. their ability to reach the poor. This paper explores whether the presence of women in microfinance institutions is associated with improved outreach. Building on prior research that shows that women tend to improve financial performance and social responsibility, we examine an original dataset of 226 microfinance institutions. The empirical results suggest that the presence of a female CEO, female managers and female loan officers is directly related to improved outreach, while the presence of women board members is not. 3. Women in Microfinance Institutions: Is There a Trade-Off Between Outreach and Sustainability? Abstract This paper’s contribution to the understanding of microfinance is two-fold. First, while it has been shown that female CEOs in MFIs increase financial performance, it will be argued that female managers, female loan officers and female board members will do the same. Secondly, having previously shown that having a female presence in management in MFIs improves social performance the outreach, it will be argued that having females in the MFIs’ management will not lead to a trade-off between outreach and sustainability. These findings are based on an original data set of 226 MFIs. Statistical analysis demonstrates that a weak relationship between female managers and female loan officers vis-à-vis financial performance, but female board members do not. The trade-off between outreach and sustainability can be avoided with the appointment of females to the MFIs’ management positions, but the same cannot be concluded for female board members.