Conhecimento da doença renal crônica entre médicos conforme as diretrizes práticas

INTRODUCTION: Chronic kidney disease (CKD) is a global health problem, with increasing prevalence in its terminal stage and one of the factors that can contribute is the failure to recognize the disease and its risk factors. OBJECTIVE: To evaluate the knowledge of medical residents (MR) and medical preceptors (MP) in hospitals in the Federal University of Rio Grande do Norte in Natal-RN - Brazil, on the DRC, based on the policy of the Kidney Disease Improving Global Outcomes (KDIGO ). METHODS: Cross-sectional study where 64 MR (R1 = 32; R2 = 15; R3 = 17) and 63 MP answered a questionnaire divided into seven sessions that addressed aspects of the DRC since the setting up referral to a nephrologist. RESULTS: Only 20 participants (15.7%) reported using any guidelines for the management of CKD. The scores obtained by session were: Definition and classification (46.1 ± 47.8); Risk factors (70.5 ± 27.9); Laboratory evaluation (58.2 ± 8.8); Clinical action plan (57.6 ± 19.9); Reduction in proteinuria (68.3 ± 15.0); Complications (64.8 ± 19.9); Referral to a nephrologist (73.0 ± 44.6). There was a statistically significant difference between the knowledge of MR and MP in the sessions: Laboratory evaluation (MR 61.5 ± 8.4 vs 54.8 ± 7.9 MP; p <0.001); Reduction in proteinuria (73.1 ± 11.4 vs MR MP 63.5 ± 16.7; p <0.001) and Referral to a nephrologist (MR 81.2 ± 39.3 vs 64.5 ± 48.2 MP; p = 0.035). Among the MR, the R2 obtained the best score (63.9 ± 22.6 vs R1 R2 R3 71.9 ± 17.2 vs 63.5 ± 22.5, p = 0.445). It identified a low percentage of success of the doctors on the definition of CKD (MP = 46%; R1 = 40.6%; R2 = 60%; R3 = 52.9%; p = 0.623) and classification (MP = 34.9%; R1 = 53.1%, R2 = 60%; R3 = 52.9%; p = 0.158). CONCLUSION: The study showed that most doctors do not use any guidelines for clinical management of CKD and that there are gaps in knowledge on the subject, even among physicians who work in the university environment. In this sense, we propose the realization of mini-workshops for participants and students from boarding UFRN, using Case-Based Learning Strategy (CBL), with small group discussion, to strengthen the incorporation of CKD guidelines in undergraduate teaching and in clinical medical practice in general.

Implementación sobre FPGA de un algoritmo de compresión de imágenes hiperespectrales bajo el estándar CCSDS 123.0-B-1

A lo largo de la historia, nuestro planeta ha atravesado numerosas y diferentes etapas. Sin embargo, desde finales del cretácico no se vivía un cambio tan rápido como el actual. Y a la cabeza del cambio, nosotros, el ser humano. De igual manera que somos la causa, debemos ser también la solución, y el análisis a gran escala de la tierra está siendo un punto de interés para la comunidad científica en los últimos años. Prueba de ello es que, cada vez con más frecuencia, se lanzan gran cantidad de satélites cuya finalidad es el análisis, mediante fotografías, de la superficie terrestre. Una de las técnicas más versátiles para este análisis es la toma de imágenes hiperespectrales, donde no solo se captura el espectro visible, sino numerosas longitudes de onda. Suponen, eso sí un reto tecnológico, pues los sensores consumen más energía y las imágenes más memoria, ambos recursos escasos en el espacio. Dado que el análisis se hace en tierra firme, es importante una transmisión de datos eficaz y rápida. Por ello creemos que la compresión en tiempo real mediante FPGAs es la solución idónea, combinando un bajo consumo con una alta tasa de compresión, posibilitando el análisis ininterrumpido del astro en el que vivimos. En este trabajo de fin de grado se ha realizado una implementación sobre FPGA, utilizando VHDL, del estándar CCSDS 123. Este está diseñado para la compresión sin pérdida de imágenes hiperespectrales, y permite una amplia gama de configuraciones para adaptarse de manera óptima a cualquier tipo de imagen. Se ha comprobado exitosamente la validez de la implementación comparando los resultados obtenidos con otras implementaciones (software) existentes. Las principales ventajas que presentamos aquí es que se posibilita la compresión en tiempo real, obteniendo además un rendimiento energético muy prometedor. Estos resultados mejoran notablemente los de una implementación software del algoritmo, y permitirán la compresión de las imágenes a bordo de los satélites que las toman.

Asthma inhaler adherence determinants in adults : systematic review of observational data

Copyright ©ERS 2014.

Asthma inhaler adherence determinants in adults : systematic review of observational data

Copyright ©ERS 2014.

Mapping the Asthma Care Process : Implications for Research and Practice

The authors would like to thank the participants to the Respiratory Effectiveness Group Adherence symposium for their comments on the model overview presented during this meeting, members of the ASTRO-LAB consortium for collaborative work on reviewing literature and performing qualitative interviews, and patients and clinicians that shared valuable insights into asthma management during the telephone interviews.

The geochemistry, mineralogy, and petrology of basalts at DSDP Leg 59 Holes

Legs 59 and 60 of the International Phase of Oceanic Drilling (IPOD) were designed to study the nature and history of volcanism of the active Mariana arc, its currently spreading inter-arc basin (the Mariana Trough), and the series of inactive basins and intervening ridges that lie to the west. The older basins and ridges were drilled during Leg 59 as the first part of a transect of single-bit holes drilled in each major basin and ridge. The eastern part of the transect - the technically active region - was drilled during Leg 60. The evolution of island-arc volcanos and magma genesis associated with lithospheric subduction remain some of the most complex petrologic problems confronting us. Many types of source material (mantle, oceanic crust, continental crust) and an unusually wide range of possible physical conditions at the time of magma genesis must be identified even before the roles of partial melting and subsequent magma fractionation, mixing, and contamination can be assessed.

LOTUS: A low cost, ultraviolet spectrograph

We describe the design, construction and commissioning of LOTUS; a simple, low-cost long-slit spectrograph for the Liverpool Telescope. The design is optimized for near-UV and visible wavelengths and uses all transmitting optics. It exploits the instrument focal plane field curvature to partially correct axial chromatic aberration. A stepped slit provides narrow (2.5x95 arcsec) and wide (5x25 arcsec) options that are optimized for spectral resolution and flux calibration respectively. On sky testing shows a wavelength range of 3200-6300 Angstroms with a peak system throughput (including detector quantum efficiency) of 15 per cent and wavelength dependant spectral resolution of R=225-430. By repeated observations of the symbiotic emission line star AG Peg we demonstrate the wavelength stability of the system is less than 2 Angstroms rms and is limited by the positioning of the object in the slit. The spectrograph is now in routine operation monitoring the activity of comet 67P/Churyumov-Gerasimenko during its current post-perihelion apparition.

Departure of high temperature iron lines from the equilibrium state in flaring solar plasmas

The aim of this study is to clarify if the assumption of ionization equilibrium and a Maxwellian electron energy distribution is valid in flaring solar plasmas. We analyze the 2014 December 20 X1.8 flare, in which the \ion{Fe}{xxi} 187~\AA, \ion{Fe}{xxii} 253~\AA, \ion{Fe}{xxiii} 263~\AA\ and \ion{Fe}{xxiv} 255~\AA\ emission lines were simultaneously observed by the EUV Imaging Spectrometer onboard the Hinode satellite. Intensity ratios among these high temperature Fe lines are compared and departures from isothermal conditions and ionization equilibrium examined. Temperatures derived from intensity ratios involving these four lines show significant discrepancies at the flare footpoints in the impulsive phase, and at the looptop in the gradual phase. Among these, the temperature derived from the \ion{Fe}{xxii}/\ion{Fe}{xxiv} intensity ratio is the lowest, which cannot be explained if we assume a Maxwellian electron distribution and ionization equilibrium, even in the case of a multi-thermal structure. This result suggests that the assumption of ionization equilibrium and/or a Maxwellian electron energy distribution can be violated in evaporating solar plasma around 10MK.

The perihelion activity of comet 67P/Churyumov-Gerasimenko as seen by robotic telescopes

Around the time of its perihelion passage the observability of 67P/Churyumov-Gerasimenko from Earth was limited to very short windows each morning from any given site, due to the low solar elongation of the comet. The peak in the comet's activity was therefore difficult to observe with conventionally scheduled telescopes, but was possible where service/queue scheduled mode was possible, and with robotic telescopes. We describe the robotic observations that allowed us to measure the total activity of the comet around perihelion, via photometry (dust) and spectroscopy (gas), and compare these results with the measurements at this time by Rosetta's instruments. The peak of activity occurred approximately two weeks after perihelion. The total brightness (dust) largely followed the predictions from Snodgrass et al. 2013, with no significant change in total activity levels from previous apparitions. The CN gas production rate matched previous orbits near perihelion, but appeared to be relatively low later in the year.

Gaining by Giving? Peer Research into Service User and Carer Perceptions of Inclusivity in Higher Education

Service users and carers (SUAC) have made significant contributions to professional training in social work courses in Higher Education (HE) over the past decade in the UK. Such participation has been championed by government, academics and SUAC groups from a range of theoretical and political perspectives. Most research into the effectiveness of SUAC involvement at HE has come from the perspectives of academics and very little SUAC-led research exists. This qualitative peer research was led by two members of the University of Worcester’s SUAC group. Findings were that SUAC perceived their involvement brought benefits to students, staff, the University and the local community. Significant personal benefits such as finding a new support network, increased self-development and greater confidence to manage their own care were identified in ways that suggested that the benefits that can flow from SUAC involvement at HE are perhaps more far-reaching than previously recognised. Barriers to inclusion were less than previously reported in the literature and the humanising effects of SUAC involvement are presented as a partial antidote to an increasingly marketised HE culture.

Metodología para la implementación de un servicio de asesoría sobre formalización de predios en la Alcaldía de Itagüí

Siguiendo la metodología de Marco Lógico, durante el proceso de formulación del proyecto, se pudo identificar como un problema central la poca voluntad que existe en amplios sectores de la población en materia de legalización de predios, convirtiéndose este un problema central, tanto para las administraciones territoriales, como para la población. Para las administraciones territoriales y entidades encargadas de llevar el registro de predios y sus mutaciones, esto es un asunto importante, ya que es con base en los registros de predios legalizados que se establecen buena parte de los ingresos tributarios y se orientan varios de los programas sociales, incluidos los de vivienda. Mientras que para los sectores de la población que se han abstenido de iniciar procesos, la no legalización de predios redunda en pérdida de beneficios o en la dificultad para acceder a ellos. La metodología de Marco Lógico, permitió evidenciar que las principales causas del problema son la desconfianza y el desconocimiento en la población, por lo cual en el presente trabajo se definió como alternativa de solución la del diseño de un servicio de asesoría personalizado que contribuya en la solución del problema, sensibilizando e informando a la población simultáneamente.

A proposal for self-correcting stabilizer quantum memories in 3 dimensions (or slightly less)

We propose a family of local CSS stabilizer codes as possible candidates for self-correcting quantum memories in 3D. The construction is inspired by the classical Ising model on a Sierpinski carpet fractal, which acts as a classical self-correcting memory. Our models are naturally defined on fractal subsets of a 4D hypercubic lattice with Hausdorff dimension less than 3. Though this does not imply that these models can be realized with local interactions in R3, we also discuss this possibility. The X and Z sectors of the code are dual to one another, and we show that there exists a finite temperature phase transition associated with each of these sectors, providing evidence that the system may robustly store quantum information at finite temperature.

Internal mammary artery smooth muscle cells resist migration and possess high antioxidant capacity

Objective- This study investigated whether differences exist in atherogen-induced migratory behaviors and basal antioxidant enzyme capacity of vascular smooth muscle cells (VSMC) from human coronary (CA) and internal mammary (IMA) arteries. Methods- Migration experiments were performed using the Dunn chemotaxis chamber. The prooxidant [NAD(P)H oxidase] and antioxidant [NOS, superoxide dismutase, catalase and glutathione peroxidase] enzyme activities were determined by specific assays. Results- Chemotaxis experiments revealed that while both sets of VSMC migrated towards platelet-derived growth factor-BB (1-50 ng/ml) and angiotensin II (1-50 nM), neither oxidized-LDL (ox-LDL, 25-100 �g/ml) nor native LDL (100 �g/ml) affected chemotaxis in IMA VSMC. However, high dose ox-LDL produced significant chemotaxis in CA VSMC that was inhibited by pravastatin (100 nM), mevastatin (10 nM), losartan (10 nM), enalapril (1 �M), and MnTBAP (a free radical scavenger, 50��M). Microinjection experiments with isoprenoids i.e. geranylgeranylpyrophosphate (GGPP) and farnesylpyrophosphate (FPP) showed distinct involvement of small GTPases in atherogen-induced VSMC migration. Significant increases in antioxidant enzyme activities and nitrite production along with marked decreases in NAD(P)H oxidase activity and O2 .- levels were determined in IMA versus CA VSMC. Conclusions- Enhanced intrinsic antioxidant capacity may confer on IMA VSMC resistance to migration against atherogenic agents. Drugs that regulate ox-LDL or angiotensin II levels also exert antimigratory effects.

Síntese regioespecífica de novas N-acil trialometil pirazolinas graxas

Nesse trabalho é descrita a síntese de três hidrazidas graxas monosubstituídas [R1C(O)NHNH2, onde R1 =C15H31, C17H35, C17H33] derivadas dos ácidos graxos palmítico, esteárico e oléico, respectivamente, utilizando duas novas metodologias, primeiramente a partir de monocloridrato de hidrazina em presença de hidróxido de sódio e, em um segundo momento, usando dicloridrato de hidrazina e metóxido de sódio. Ambas as metodologias foram realizadas em metanol como solvente, sendo investigadas as proporções estequiométricas específicas para cada método utilizado. A síntese das hidrazidas graxas com as 4-alcóxi-1,1,1-trialometil-3-alquen-2-onas substituídas [R3C(O)C= C(R2 )(OR), onde R3 = CF3, CCl3; R2 = Me, 4-Me-C6H4, 4- OMe-C6H4, 4-Br-C6H4, 4-Cl-C6H4, 4-F-C6H4], através da reação de ciclocondensação do tipo [3+2] catalisada por BF3.MeOH, favoreceu a síntese regioespecífica de duas novas séries de N-acil trialometil pirazolinas graxas, com rendimentos de bons a excelentes (80 a 90%) e alto grau de pureza, tendo suas estruturas caracterizadas através de dados de Espectroscopia de Infravermelho, Cromatografia Gasosa Acoplada a Espectrometria de Massas e Ressonância Magnética Nuclear de 1H e 13C.

Cónicas en geometría proyectiva

La geometría proyectiva es una rama de la geometría que estudia los objetos lineales (puntos, líneas, planos, hiperplanos, etc.) y como se interceptan. Estos objetos son estudiados en espacios que tienen más puntos que los espacios usuales, es decir, que el plano R2 y el espacio tridimencional R3, estos espacios son llamados "proyectivos". Investigación documental que propone recabar información bibliográfica para su aplicación en la carrera de Licenciatura en Matemática, enfocado principalmente, en cónicas y sus construcciones en el área de geometría proyectiva. Analiza las diferencias que existen entre la geometría proyectiva, la euclidiana y la analítica.