Care to terminal patients. Perception of nurses from the intensive care unit of a hospital

Objective. To identify the perception of nurses with regard to the process of providing care to patients in the context of hospice care. Method. Qualitative study using the methodological framework Collective Subject Discourse. A total of 18 nursing professionals of the adult intensive care unit of a public hospital in São Paulo, Brazil were interviewed between June and August 2012. Results. The process of providing care to terminal patients is permeated by negative, conflictive and mixed feelings. As regards communication, while the participants acknowledge its importance as a therapeutic resource, they also admit a lack of professional qualification. Conclusion. The interviewees have difficulties to deal with care provided to terminal patients. The qualification of these professionals needs to be improved, starting in the undergraduate program.

Perception of the informed consent form by participants in clinical trials

To understand the perception of the participants in controlled clinical trials (CCTs) about the informed consent and describe the meaning of their participation in the research. Qualitative study using the focus group technique. The sample was composed of 19 patients who participated in clinical trials about hypertension and coronary disease in a specialized cardiologic hospital located in the city of Sao Paulo. The methodological framework used was the content analysis. Some of the participants were aware of the real objective of these studies while others had misperceptions. The reading of the informed consent is not always done and, when it is done, the patient does not understand it. The lack of understanding about the term ''placebo'' was mentioned by some participants. The motivation to participate was the personal benefit. This study shows that obtaining the informed consent in CCTs is complex and that there is the need to adapt the structure and application of this document, in order to protect the participants and improve the quality of clinical trials performed in the country.

Medicinal plants in pregnancy and lactation: perception of the health risk and practical educational group in Araraquara, São Paulo State, Brazil

The use of medicinal plants among pregnant women and lactating is a common practice in diverse countries. However, many medicinal plants are contraindicated during pregnancy and lactating, due to various adverse effects, such as teratogenic, embryotoxic and abortive effects, exposing these women, their fetus and babies to health unknown risks. Thus, the purpose of this commentary, was to analyze the perception about the use of medicinal plants by pregnant women and lactating registered in the "baby on board" NGO, Araraquara, São Paulo state, Brazil, between 2010 at 2013. The group was constituted by 48 women, between the first and last trimester of pregnancy or whilst breastfeeding. Information was collected during group meetings by oral interview, using a questionnaire, as script. The nature of the study was a qualitative analysis. The results were based on reports about the use of medicinal plants by pregnant women during group meetings: use, indication of use, knowledge about risks. All participants received written and oral information about the study and they gave a written informed consent. The use of medicinal plants is a reality among pregnant and lactating women of the "baby on board" NGO. They reported that they feel that "natural" products are not harmful for their health. The primary information sources for the majority of women about medicinal plants during pregnancy are family, neighbors and herbalists. The plants most cited (in popular name in Brazil) were: senna, chamomile, boldo, lemon balm, lemon grass. They were used mainly for: nausea, heartburn, indigestion, flatulence, intestinal and abdominal pain, anxiety, intestinal constipation and low milk production. The pregnant and lactating women lacked knowledge about the health risks of the use of medicinal plants and herbal medicines in pregnancy and lactation. They also reported difficulties in clarifying some questions about the use of medicinal plants with their doctors. The results of the present study showed that educative actions about the rational use of medicinal plants in pregnancy and breastfeeding could be part of the operating protocols to promote the maternal and child health programs in Araraquara. Thus, our results also suggest the importance of creating institutionalized places, to the implementation of continued education programs about rational use of medicinal plants in pregnancy and lactation. These targeted programs are not only for health professionals, but also for community members, pregnant women and breastfeeding. Our results pointed out the importance of guidance of doctors and healthcare professionals on the scientific studies about medicinal plants and herbal medicines and the risk/benefit of using herbs during pregnancy. Finally, it is noted the importance of the health professionals to inform women of childbearing on risks to their health, as well as on possibilities of utilization of herbs during fertile period, giving special attention to the potential risk of self-medication.

Influence of time evolution in the modulus of elasticity of concrete reinforced by carbon fibers

The modulus of elasticity is an important property for the behavior analysis of concrete structures. This research evaluated the strain difference between concrete specimens with and without the application of laminate carbon fiber composites as well as the variation time, in months, of the axial strength compression and modulus of elasticity. Through the experimental results, it is concluded that increases in compressive strength and modulus of elasticity are more significant in the specimens without reinforcement.

Perception of the Internet as an Enabler of Scholarship among Postgraduate Students of the University of Ibadan, Oyo State, Nigeria

This paper investigates postgraduate students' perceptions of the Internet as an enabler of scholarship.The specific objectives of the study are: to ascertain the perception held by the postgraduate students on the Internet usage as an enabler of scholarship, and to determine what interventions are necessary to facilitate postgraduate students' adoption of the Internet as a tool for learning and research. The subjects of study are the postgraduate students of the University of Ibadan, Nigeria. A random sample of 100 students was selected with representation from each faculty of the university. A questionnaire instrument with a 12-item scale was designed and administered. Data analysis was done using the chi-square statistical method. The results show that majority of the postgraduate students have positive perceptions of the Internet as an enabler of information sourcing for learning and research. However some of these students have low self-efficacy in Internet use for information sourcing.

The Perception of Natural, Cell Phone, and Computer-Synthesized Speech During The Performance Of Simultaneous Visual-Motor Tasks

This study investigated the influence of top-down and bottom-up information on speech perception in complex listening environments. Specifically, the effects of listening to different types of processed speech were examined on intelligibility and on simultaneous visual-motor performance. The goal was to extend the generalizability of results in speech perception to environments outside of the laboratory. The effect of bottom-up information was evaluated with natural, cell phone and synthetic speech. The effect of simultaneous tasks was evaluated with concurrent visual-motor and memory tasks. Earlier works on the perception of speech during simultaneous visual-motor tasks have shown inconsistent results (Choi, 2004; Strayer & Johnston, 2001). In the present experiments, two dual-task paradigms were constructed in order to mimic non-laboratory listening environments. In the first two experiments, an auditory word repetition task was the primary task and a visual-motor task was the secondary task. Participants were presented with different kinds of speech in a background of multi-speaker babble and were asked to repeat the last word of every sentence while doing the simultaneous tracking task. Word accuracy and visual-motor task performance were measured. Taken together, the results of Experiments 1 and 2 showed that the intelligibility of natural speech was better than synthetic speech and that synthetic speech was better perceived than cell phone speech. The visual-motor methodology was found to demonstrate independent and supplemental information and provided a better understanding of the entire speech perception process. Experiment 3 was conducted to determine whether the automaticity of the tasks (Schneider & Shiffrin, 1977) helped to explain the results of the first two experiments. It was found that cell phone speech allowed better simultaneous pursuit rotor performance only at low intelligibility levels when participants ignored the listening task. Also, simultaneous task performance improved dramatically for natural speech when intelligibility was good. Overall, it could be concluded that knowledge of intelligibility alone is insufficient to characterize processing of different speech sources. Additional measures such as attentional demands and performance of simultaneous tasks were also important in characterizing the perception of different kinds of speech in complex listening environments.

INVESTIGATION OF PATIENT PERCEPTION OF HOSPITAL NOISE AND SOUND LEVEL MEASUREMENTS: BEFORE, DURING, AND AFTER RENOVATIONS OF A HOSPITAL WING

Acoustic conditions in hospitals have been shown to influence a patient’s physical and psychological health. Noise levels in an Omaha, Nebraska, hospital were measured and compared between various times: before, during, and after renovations of a hospital wing. The renovations included cosmetic changes and the installation of new in-room patient audio-visual systems. Sound pressure levels were logged every 10-seconds over a four-day period in three different locations: at the nurses' station, in the hallway, and in a nearby patient’s room. The resulting data were analyzed in terms of the hourly A-weighted equivalent sound pressure levels (

A comparison of time-motion performance between age groups in judo matches

The aim of this study was to compare time-motion indicators during judo matches performed by athletes from different age groups. The following age groups were analysed: Pre-Juvenile (13-14 years, n=522), Juvenile (15-16 years, n 353); Junior (19 years, n = 349) and Senior (>20 years, n = 587). The time-motion indicators included: Total Combat Time, Standing Combat Time, Displacement Without Contact, Gripping Time, Groundwork Combat Time and Pause Time. Analysis of variance (ANOVA) one-way and the Tukey test, as well as the Kruskal-Wallis test and Mann-Whitney (for non-parametric data), were conducted, using P < 0.05 as significance level. The results showed that all analysed groups obtained a median of 7 (first quantile - 3, third quantile - 12) sequences of combat/pause cycles. In total time of combat, the result was: for Total Combat Time, Standing Combat Time and Gripping Time: Pre-Juvenile and Senior were significantly longer than Juvenile and Junior. Considering Displacement Without Contact, Junior was significantly longer than all other age groups. For Groundwork Combat Time, Senior was significantly longer than all other age groups and Pre-Juvenile was longer than Junior. These results can be used to improve the physiological performance in intermittent practices, as well as technicaltactical training during judo sessions.

Evolution of time-control mechanisms in subterranean organisms: cave fishes under light-dark cycles (Teleostei: Siluriformes, Characiformes)

Subterranean organisms are excellent models for chronobiological studies, yet relatively few taxa have been investigated with this focus. Former results were interpreted as a pattern of regression of circadian locomotor activity rhythms in troglobitic (exclusively subterranean) species. In this paper we report results of experiments with cave fishes showing variable degrees of troglomorphism (reduction of eyes, melanic pigmentation and other specializations related to the hypogean life) submitted to light-dark cycles, preceded and followed by several days in constant darkness. Samples from seven species have been monitored in our laboratory for the detection of significant circadian rhythms in locomotor activity: S. typhlops, an extremely troglomophic species, presented the lowest number of significant components in the circadian range (only one individual out of eight in DD1 and three other fish in LD), all weak (low values of spectral power). Higher incidence of circadian components was observed for P. kronei - only one among six studied catfish without significant circadian rhythms under DD1 and DD2; spectral powers were generally high. Intermediate situations were observed for the remaining species, however all of them presented relatively strong significant rhythms under LD. Residual oscillations (circadian rhythms in DD2) were detected in at least part of the studied individuals of all species but S. typhlops, without a correlation with spectral powers of LD rhythms, i.e., individuals exhibiting residual oscillations were not necessarily those with the strongest LD rhythms. In conclusion, the accumulated evidence for troglobitic fishes strongly supports the hypothesis of external, environmental selection for circadian locomotor rhythms.

Stochastic simulation of time-series models combined with geostatistics to predict water-table scenarios in a Guarani Aquifer System outcrop area, Brazil

Stochastic methods based on time-series modeling combined with geostatistics can be useful tools to describe the variability of water-table levels in time and space and to account for uncertainty. Monitoring water-level networks can give information about the dynamic of the aquifer domain in both dimensions. Time-series modeling is an elegant way to treat monitoring data without the complexity of physical mechanistic models. Time-series model predictions can be interpolated spatially, with the spatial differences in water-table dynamics determined by the spatial variation in the system properties and the temporal variation driven by the dynamics of the inputs into the system. An integration of stochastic methods is presented, based on time-series modeling and geostatistics as a framework to predict water levels for decision making in groundwater management and land-use planning. The methodology is applied in a case study in a Guarani Aquifer System (GAS) outcrop area located in the southeastern part of Brazil. Communication of results in a clear and understandable form, via simulated scenarios, is discussed as an alternative, when translating scientific knowledge into applications of stochastic hydrogeology in large aquifers with limited monitoring network coverage like the GAS.

Survival Analysis of Patients with Heart Failure: Implications of Time-Varying Regression Effects in Modeling Mortality

Background: Several models have been designed to predict survival of patients with heart failure. These, while available and widely used for both stratifying and deciding upon different treatment options on the individual level, have several limitations. Specifically, some clinical variables that may influence prognosis may have an influence that change over time. Statistical models that include such characteristic may help in evaluating prognosis. The aim of the present study was to analyze and quantify the impact of modeling heart failure survival allowing for covariates with time-varying effects known to be independent predictors of overall mortality in this clinical setting. Methodology: Survival data from an inception cohort of five hundred patients diagnosed with heart failure functional class III and IV between 2002 and 2004 and followed-up to 2006 were analyzed by using the proportional hazards Cox model and variations of the Cox's model and also of the Aalen's additive model. Principal Findings: One-hundred and eighty eight (188) patients died during follow-up. For patients under study, age, serum sodium, hemoglobin, serum creatinine, and left ventricular ejection fraction were significantly associated with mortality. Evidence of time-varying effect was suggested for the last three. Both high hemoglobin and high LV ejection fraction were associated with a reduced risk of dying with a stronger initial effect. High creatinine, associated with an increased risk of dying, also presented an initial stronger effect. The impact of age and sodium were constant over time. Conclusions: The current study points to the importance of evaluating covariates with time-varying effects in heart failure models. The analysis performed suggests that variations of Cox and Aalen models constitute a valuable tool for identifying these variables. The implementation of covariates with time-varying effects into heart failure prognostication models may reduce bias and increase the specificity of such models.

Perception of the esthetic impact of mandibular incisor extraction treatment on laypersons, dental professionals, and dental students

Objective: To evaluate the degree of perception of laypersons, dental professionals, and dental students regarding dental esthetics in cases with mandibular central incisor extraction. Materials and Methods: Using a smile photograph of a person with normal occlusion and all teeth, modifications were made to reflect the extraction of a mandibular incisor of various compositions and sizes. For this purpose a program specifically for image manipulation (Adobe Photoshop CS3, Adobe Systems Inc) was used. After manipulation the images were printed on photographic paper, attached to a questionnaire and distributed to laypersons, dental professionals, and dental students (n = 90) to evaluate the degree of perception and esthetic using a scale of attractiveness, where 0 = hardly attractive, 5 = attractive, and 10 = very attractive. The differences between examiners were checked by the Mann-Whitney test. All the statistics were performed with a confidence level of 95%. Results: The results demonstrated the skill of the dental professionals and dental students in perceiving the difference between cases of normal occlusion and cases where an incisor was lacking (P < .05). The photograph in which the lateral incisors were shown to be larger than the central incisor was the one that obtained the highest value among the cases of extraction in all groups of evaluators. Conclusions: It can be concluded that dental professionals and dental students are more skillful at identifying deviation from normality. In addition, central incisor extraction should always be discarded when there are other treatment options available. (Angle Orthod. 2012;82:732-738.)

Challenges for nursing education in Angola: the perception of nurse leaders affiliated with professional education institutions

Background: Angola is one of the African countries with the highest morbidity and mortality rates and a devastating lack of human resources for health, including nursing. The World Health Organization stimulates and takes technical cooperation initiatives for human resource education and training in health and education, with a view to the development of countries in the region. The aim in this study was to identify how nurses affiliated with nursing education institutions perceive the challenges nursing education is facing in Angola. Methods: After consulting the National Directory of Human Resources in Angola, the nurse leaders affiliated with professional nursing education institutions in Angola were invited to participate in the study by email. Data were collected in February 2009 through the focus group technique. The group of participants was focused on the central question: what are the challenges faced for nursing education in your country? To register and understand the information, besides the use of a recorder, the reporters elaborated an interpretative report. Data were coded using content analysis. Results: Fourteen nurses participated in the meeting, most of whom were affiliated with technical nursing education institutions. It was verified that the nurse leaders at technical and higher nursing education institutions in Angola face many challenges, mainly related to the lack of infrastructure, absence of trained human resources, bureaucratic problems to regularize the schools and lack of material resources. On the opposite, the solutions they present are predominantly centered on the valuation of nursing professionals, which implies cultural and attitude changes. Conclusions: Public health education policies need to be established in Angola, including action guidelines that permit effective nursing activities. Professional education institutions need further regularizations and nurses need to be acknowledged as key elements for the qualitative enhancement of health services in the country.

Functional clustering of time series gene expression data by Granger causality

Background: A common approach for time series gene expression data analysis includes the clustering of genes with similar expression patterns throughout time. Clustered gene expression profiles point to the joint contribution of groups of genes to a particular cellular process. However, since genes belong to intricate networks, other features, besides comparable expression patterns, should provide additional information for the identification of functionally similar genes. Results: In this study we perform gene clustering through the identification of Granger causality between and within sets of time series gene expression data. Granger causality is based on the idea that the cause of an event cannot come after its consequence. Conclusions: This kind of analysis can be used as a complementary approach for functional clustering, wherein genes would be clustered not solely based on their expression similarity but on their topological proximity built according to the intensity of Granger causality among them.

Perception of social support by individuals with diabetes mellitus and foot ulcers

OBJECTIVE: To evaluate the perception of social support and the relationship of sociodemographic, clinical and metabolic control variables in individuals with diabetes mellitus and foot ulcers in an outpatient unit. METHODS: A quantitative cross-sectional approach was carried out using a social support network inventory. RESULTS: Participants had a high perception of social support; family and health professionals were identified as the main support sources. Fasting plasma glucose values were directly related with social support. CONCLUSION: Family members were identified as the main support source, which emphasizes their importance in the health care process.