Clinical relationships and ethical problems in primary care, Sao Paulo, SP, Brazil

Objectives: Main Objective: to identify ethical problems in primary care according to nurses` and doctors` perceptions. Secondary Objective: to know ethical issues of patient-professional relationships in primary care. Design: Synthesis to integrate and reinterpret primary results of qualitative studies. Setting: Primary healthcare centers, Sao Paulo, SP, Brazil. Participants and/or context: Incidental sample of 34 nurses and 36 medical doctors working in primary healthcare centers selected by convenience. Methods: Individual, semi-structured interviews to identity situations considered as sources of ethical problems. The sample is socially representative of primary care health centers and professionals. Data collection assured discourse saturation. Hermeneutic-dialectical discourse analysis was used to study the results. Results: Patient-professional relationships and team work were the main sources of ethical problems. The most important problems were patient information, privacy, confidentiality, interpersonal relationship, linkage and patient autonomy. These issues reflect the recent changes in clinical relation ships and show the peculiarities of primary care with its continuous care which lasts a long time. Healthcare involves multiprofessional team work in the midst of the patient claims for autonomy. Good care of patients needs requires a relationship based on communication and cooperation, and includes feelings and values, with communication skills. Conclusions: Ethical problems in primary care are common situations. For quality and humane primary care the relationship should consist of dialogue, trust and cooperation. (C) 2009 Elsevier Espana, S.L. All rights reserved.

Effects of Varenicline in Adult Smokers: A Multinational, 24-Week, Randomized, Double-Blind, Placebo-Controlled Study

Background: Prevalence rates of smoking are rising in developing countries. Previous trials evaluating the efficacy and tolerability of the smoking-cessation medication varenicline have used largely participants of Caucasian origin. Objective: This study was conducted to evaluate the efficacy and tolerability of varenicline in populations of participants from Latin America, Africa, and the Middle East to investigate potential differences in the therapeutic response to varenicline. Methods: This multinational, randomized, double-blind, placebo-controlled trial was conducted at 42 centers in 11 countries (Latin America: Brazil, Colombia, Costa Rica, Mexico, and Venezuela; Africa: Egypt and South Africa; Middle East: Jordan, Lebanon, Saudi Arabia, and the United Arab Emirates). Participants were male and female smokers aged 18 to 75 years who were motivated to stop smoking; smoked >= 10 cigarettes/d, with no cumulative period of abstinence >3 months in the previous year; and who had no serious or unstable disease within the previous 6 months. Subjects were randomized in a 2:1 ratio to receive varenicline 1 mg or placebo, BID for 12 weeks, with a 12-week nontreatment follow-up. Brief smoking-cessation counseling was provided. The main outcome measures were carbon monoxide confirmed continuous abstinence rate (CAR) at weeks 9 to 12 and weeks 9 to 24. Adverse events (AEs) were recorded for tolerability assessment. Results: Overall, 588 subjects (varenicline, 390; placebo, 198) were randomized and treated. The mean (SD) ages of subjects in the varenicline and placebo groups were 43.1 (10.8) and 43.9 (10.8) years, respectively; 57.7% and 65.7% were male; and the mean (SD) weights were 75.0 (16.0) and 76.7 (16.3) kg (range, 40.0-130.0 and 45.6-126.0 kg). CAR at weeks 9 to 12 was significantly higher with varenicline than with placebo (53.59% vs 18.69%; odds ratio [OR] = 5.76; 95% CI, 3.74-8.88; P < 0.0001), and this rate was maintained during weeks 9 to 24 (39.74% vs 13.13%; OR = 4.78; 95% CI, 2.97-7.68; P < 0.0001). Nausea, headache, and insomnia were the most commonly reported AEs with varenicline and were reported numerically more frequently in the varenicline group compared with the placebo group. Serious AEs (SAEs) were reported in 2.8% of varenicline recipients compared with 1.0% in the placebo group, with 6 subjects reporting psychiatric SAEs compared with none in the placebo group. Conclusion: Based on these data, varenicline was apparently efficacious and generally well tolerated as a smoking-cessation aid in smokers from selected sites in Latin America, Africa, and the Middle East. ClinicalTrials. gov identifier: NCT00594204. (Clin Ther. 2011;33:465-477) (C) 2011 Published by Elsevier HS Journals, Inc.

Evaluation of alternative technical markers for the pelvic coordinate system

In this study, we evaluated alternative technical markers for the motion analysis of the pelvic segment. Thirteen subjects walked eight times while tri-dimensional kinematics were recorded for one stride of each trial. Five marker sets were evaluated, and we compared the tilt, obliquity, and rotation angles of the pelvis segment: (1) standard: markers at the anterior and posterior superior iliac spines (ASIS and PSIS); (2) markers at the PSIS and at the hip joint centers, HJCs (estimated by a functional method and described with clusters of markers at the thighs); (3) markers at the PSIS and HJCs (estimated by a predictive method and described with clusters of markers at the thighs); (4) markers at the PSIS and HJCs (estimated by a predictive method and described with skin-mounted markers at the thighs based on the Helen-Hayes marker set); (5) markers at the PSIS and at the iliac spines. Concerning the pelvic angles, evaluation of the alternative technical marker sets evinced that all marker sets demonstrated similar precision across trials (about 1 degrees) but different accuracies (ranging from 1 degrees to 3 degrees) in comparison to the standard marker set. We suggest that all the investigated marker sets are reliable alternatives to the standard pelvic marker set. (C) 2009 Elsevier Ltd. All rights reserved.

Artificial Pinning Center Studies in BI2212 Tapes and Bulks With Zirconium Oxide Inclusion

Zirconium oxide inclusion in Bi2212 superconducting tapes and bulks was studied as possible artificial pinning centers (APC). In order to analyze the zirconium oxide APC addition in Bi2212 samples, magnetization measurements were performed in bulks and transport properties measurements were performed on tapes. In magnetization measurements, the critical current densities are proportional to the width of the magnetization loop at each applied magnetic field. Addition of ZrO(2) in Bi2212 superconductors broadened the magnetization loop and enhanced the critical current densities at 4.2 K in bulks, as a clear indication that ZrO(2) addition improved the pinning and acted as APCs. In contrast, the transport critical current densities decreased in tapes.

Industrial challenges in grinding

This keynote paper aims at analyzing relevant industrial demands for grinding research. The chosen focus is to understand what are the main research challenges in the extensive industrial use of the process. Since the automotive applications are the most important driving forces for grinding development, the paper starts with an analysis on the main trends in more efficient engines and the changes in their components that will affect the grinding performance. A view from 23 machine tool builders is also presented based on a survey made in interviews and during the EMO and IMTS machine tool shows. Case studies received by the STC G members were used to show how research centers and industries are collaborating. A view from the authors and the final conclusions show hot topics for future grinding research. (C) 2009 CIRP.

Roadmapping for technology push and partnership: A contribution for open innovation environments

There are several tools in the literature that support innovation in organizations. Some of the most cited are the so-called technology roadmapping methods, also known as TRM. However, these methods are designed primarily for organizations that adopt the market pull strategy of technology-product integration. Organizations that adopt the technology push integration strategy are neglected in the literature. Furthermore, with the advent of open innovation, it is possible to note the need to consider the adoption of partnerships in the innovation process. Thus, this study proposes a method of technology roadmapping, identified as method for technology push (MTP), applicable to organizations that adopt the technology push integration strategy, such as SMEs and independent research centers in an open-innovation environment. The method was developed through action-research and was assessed from two analytical standpoints: externally, via a specific literature review on its theoretical contributions, and internally, through the analysis of potential users` perceptions on the feasibility of applying MTP. The results indicate both the unique character of the method and its perceived implementation feasibility. Future research is suggested in order to validate the method in different types of organizations (C) 2011 Elsevier Ltd. All rights reserved.

Distribution systems fault analysis considering fault resistance estimation

Fault resistance is a critical component of electric power systems operation due to its stochastic nature. If not considered, this parameter may interfere in fault analysis studies. This paper presents an iterative fault analysis algorithm for unbalanced three-phase distribution systems that considers a fault resistance estimate. The proposed algorithm is composed by two sub-routines, namely the fault resistance and the bus impedance. The fault resistance sub-routine, based on local fault records, estimates the fault resistance. The bus impedance sub-routine, based on the previously estimated fault resistance, estimates the system voltages and currents. Numeric simulations on the IEEE 37-bus distribution system demonstrate the algorithm`s robustness and potential for offline applications, providing additional fault information to Distribution Operation Centers and enhancing the system restoration process. (C) 2011 Elsevier Ltd. All rights reserved.

Friction coefficient and abrasive wear modes in ball-cratering tests conducted at constant normal force and constant pressure-Preliminary results

The micro-scale abrasive wear test by rotative ball has gained large acceptance in universities and research centers, being widely used in studies on the abrasive wear of materials. Two wear modes are usually observed in this type of test: ""rolling abrasion"" results when the abrasive particles roll on the surface of the tested specimen, while ""grooving abrasion"" is observed when the abrasive particles slide; the type of wear mode has a significant effect on the overall behaviour of a tribological system. Several works on the friction coefficient during abrasive wear tests are available in the literature, but only a few were dedicated to the friction coefficient in micro-abrasive wear tests conducted with rotating ball. Additionally, recent works have identified that results may also be affected by the change in contact pressure that occurs when tests are conducted with constant applied force. Thus, the purpose of this work is to study the relationship between friction coefficient and abrasive wear modes in ball-cratering wear tests conducted at ""constant normal force"" and ""constant pressure"". Micro-scale abrasive wear tests were conducted with a ball of AISI52100 steel and a specimen of AISIH10 tool steel. The abrasive slurry was prepared with black silicon carbide (SiC) particles (average particle size of 3 mu m) and distilled water. Two constant normal force values and two constant pressure values were selected for the tests. The tangential and normal loads were monitored throughout the tests and their ratio was calculated to provide an indication of the friction coefficient. In all cases, optical microscopy analysis of the worn craters revelated only the presence of grooving abrasion. However, a more detailed analysis conducted by SEM has indicated that different degrees of rolling abrasion have also occurred along the grooves. The results have also shown that: (i) for the selected values of constant normal force and constant pressure, the friction coefficient presents, approximately, the same range of values and (ii) loading conditions play an important role on the occurrence of rolling abrasion or grooving abrasion and, consequently, on the average value and scatter of the friction coefficient in micro-abrasive wear tests. (C) 2009 Elsevier B.V. All rights reserved.

Logística para agregados (brita e areia) em grandes centros urbanos

One of the human being`s basic needs is housing. In Brazil, the basic element for this is concrete, artificial stone, which demands a great amount of aggregates, such as sand and gravel. The sand and rocks are abundant in nature and gravel can be produced at low cost. However, transportation to the area of product utilization can be an incremental factor in the final cost logistics. Both sand and gravel have expressive price variations, which are not necessarily related to mining activities, but to logistic activities, mainly their distribution. Restrictive measures adopted in large urban centers, such as prohibition of hauling trucks in certain areas or during certain hours, alternate license plate end number system (even number plate ending can circulate on even-numbered days and visa versa), and axle-control, generate a need for a larger and more diversified fleet, not to mention more employees.

Modeling of Effect of Plastic Deformation on Barkhausen Noise and Magnetoacoustic Emission in Iron With 2% Silicon

Before one models the effect of plastic deformation on magnetoacoustic emission (MAE), one must first treat non-180 degrees domain wall motion. In this paper, we take the Alessandro-Beatrice-Bertotti-Montorsi (ABBM) model and modify it to treat non-180 degrees wall motion. We then insert a modified stress-dependent Jiles-Atherton model, which treats plastic deformation, into the modified ABBM model to treat MAE and magnetic Barkhausen noise (HBN). In fitting the dependence of these quantities on plastic deformation, we apply a model for when deformation gets into the stage where dislocation tangles are formed, noting two chief effects, one due to increased density of emission centers owing to increased dislocation density, and the other due to a more gentle increase in the residual stress in the vicinity of the dislocation tangles as deformation is increased.

Variability on red blood cell transfusion practices among Brazilian neonatal intensive care units

BACKGROUND: Guidelines for red blood cell (RBC) transfusions exist; however, transfusion practices vary among centers. This study aimed to analyze transfusion practices and the impact of patients and institutional characteristics on the indications of RBC transfusions in preterm infants. STUDY DESIGN AND METHODS: RBC transfusion practices were investigated in a multicenter prospective cohort of preterm infants with a birth weight of less than 1500 g born at eight public university neonatal intensive care units of the Brazilian Network on Neonatal Research. Variables associated with any RBC transfusions were analyzed by logistic regression analysis. RESULTS: Of 952 very-low-birth-weight infants, 532 (55.9%) received at least one RBC transfusion. The percentages of transfused neonates were 48.9, 54.5, 56.0, 61.2, 56.3, 47.8, 75.4, and 44.7%, respectively, for Centers 1 through 8. The number of transfusions during the first 28 days of life was higher in Center 4 and 7 than in other centers. After 28 days, the number of transfusions decreased, except for Center 7. Multivariate logistic regression analysis showed higher likelihood of transfusion in infants with late onset sepsis (odds ratio [OR], 2.8; 95% confidence interval [CI], 1.8-4.4), intraventricular hemorrhage (OR, 9.4; 95% CI, 3.3-26.8), intubation at birth (OR, 1.7; 95% CI, 1.0-2.8), need for umbilical catheter (OR, 2.4; 95% CI, 1.3-4.4), days on mechanical ventilation (OR, 1.1; 95% CI, 1.0-1.2), oxygen therapy (OR, 1.1; 95% CI, 1.0-1.1), parenteral nutrition (OR, 1.1; 95% CI, 1.0-1.1), and birth center (p < 0.001). CONCLUSIONS: The need of RBC transfusions in very-low-birth-weight preterm infants was associated with clinical conditions and birth center. The distribution of the number of transfusions during hospital stay may be used as a measure of neonatal care quality.

Increased MMA concentration and body mass index are associated with spontaneous abortion in Brazilian women A pilot study

Background: The pathophysiology of spontaneous abortion is complex and may involve the interaction of genetic and environmental factors. We evaluated the predictors of spontaneous abortion in Brazilian pregnant women. The effects of age, gestational age. body mass index (BMI), cigarette smoking, alcohol ingestion, use of multivitamins and concentrations of vitamins (folate, cobalamin and vitamin 136) and vitamin-dependent metabolites were analyzed. Methods: Study population included 100 healthy women that attended pre-natal care in 2 health centers of Sao Paulo, Brazil, and in whom pregnancy outcome was known. Folate and cobalamin status was measured in blood specimens collected between 4 and 16 weeks. The genotypes for 8 gene polymorphisms were evaluated by PCR-RFLP. Results: Eighty-eight women had normal pregnancy outcome (Group 1), while 12 experienced a miscarriage after blood collection (Group 2). Increased methylmalonic acid (MMA) concentrations were found in Group 2 (median [25th-75th percentile]=274 [149-425] nmol/l) relative to Group 1 (138 [98-185]) (P<0.01). No differences between the groups were observed for serum cobalamin, serum or red cell folate, and serum total homocysteine or allele frequencies for 8 polymorphisms. In a conditional logistic regression analysis including age, gestational age, serum creatinine, MMA, cystathionine, body mass index (BMI), cigarette smoking, alcohol ingestion and use of multivitamins the risk of abortion was significantly associated with MMA (OR [95% CI] = 3.80 [1.36, 10.62] per quartile increase in MMA), BMI (OR [95% CI] = 5.49 [1.29,23.39] per quartile) and gestational age (OR [95% CI] = 0.10 [0.01, 0.77] per increase of interval in gestational age). Conclusions: Increased serum MMA and BMI concentrations are associated with spontaneous abortion in Brazilian women. (C) 2009 Elsevier B.V. All rights reserved.

WHO comparative evaluation of serologic assays for Chagas disease

Evaluation of commercially available test kits for Chagas disease for use in blood bank screening is difficult due to a lack of large and well-characterized specimen panels. This study presents a collaborative effort of Latin American blood centers and the World Health Organization (WHO) to establish such a panel. A total of 437 specimens, from 10 countries were collected and sent to the WHO Collaborating Center in Sao Paulo and used to evaluate 19 screening assays during 2001 through 2005. Specimens were assigned a positive or negative status based on concordant results in at least three of the four confirmatory assays (indirect immunofluorescence, Western blot, radioimmunoprecipitation assay, and recombinant immunoblot). Of the 437 specimens, 168 (39%) were characterized as positive, 262 (61%) were characterized as negative, and 7 (2%) were judged inconclusive and excluded from the analysis. Sensitivity and specificity varied considerably: 88 to 100 and 60 to 100 percent, respectively. Overall, enzyme immunoassays (EIAs) performed better than the other screening assays. Four EIAs had both parameters higher than 99 percent. Of the four confirmatory assays, only the RIPA gave a 100 percent agreement with the final serologic status of the specimens. The sensitivities and specificities of at least four of the commercially available EIAs for Chagas disease are probably high enough to justify their use for single-assay screening of blood donations. Our data suggest that the majority of commercially available indirect hemagglutination assays should not be used for blood donor screening and that the RIPA could be considered a gold standard for evaluating the performance of other assays.

Probing the electronic delocalization in a cyclic pyrazine ruthenium cluster hexamer

[Ru(3)O(CH(3)COO)(6)(pz)(CO)](6) is a cyclic hexamer species encompassing six triangular ruthenium cluster centers bridged by pyrazine ligands. The electronic communication among the cluster units strongly depends on their oxidation states, and has been successfully probed by means of cyclic voltammetry and UV-vis spectroelectrochemistry. (C) 2010 Elsevier B.V. All rights reserved.

The use of complementary and alternative therapies by patients with cancer

The aim of this research was to assess the prevalence and predictors of complementary and alternative therapy (CAT) use among cancer patients in Australia. A total of 1492 cancer patients attending nine major public cancer treatment centers in New South Wales, Australia, were asked to complete the Supportive Care Needs Survey. Of the 1354 consenting patients, 888 (65%) returned a completed survey. This article reports the secondary analyses of the survey data, specifically focusing on CAT use. For all cancers, 17.1% of patients were using at least one CAT. The two main demographic characteristics of CAT users were gender and age, where females were more likely to use CAT than males and that CAT use declined as age increased. Time since diagnosis was identified as the only significant clinical predictor of CAT use, where CAT use increased with time until 5 years since diagnosis. Our research shows that herbal treatments and naturopathy are the most popular CAT used by cancer patients (constituting over 30% of all CAT use recorded). The use of CAT among cancer patients is a significant issue in cancer care, especially considering the potential interactions between CAT and conventional medicines. Given that many cancer patients may not be aware of potential risks associated with these interactions it is important that oncologists and others involved in cancer patient care are informed about CAT and its use amongst their patients.