Identifying an active case of tuberculosis

The best practice standards set out in chapter 2 of the Best Practice guide focus on the various aspects of identifying an active case of TB and aim to address some of the challenges associated with case detection. The importance of developing a good relationship with the patient from the start, when he or she is often most vulnerable, is emphasised. The first standard focuses on the assessment of someone who might have TB and the second gives detailed guidance about the collection of sputum for diagnosis. The standards are aimed at the health care worker, who assesses the patient when he or she presents at a health care facility and therefore needs to be familiar with the signs, symptoms and risk factors associated with TB. Having suspected TB, the health care worker then needs to ensure that the correct tests are ordered and procedures are followed so that the best quality samples possible are sent to the laboratory and all documentation is filled out clearly and correctly. The successful implementation of these standards can be measured by the accurate and prompt reporting of results, the registration of every case detected and the continued attendance of every patient who needs treatment.

Guidance for the implementation of best practice for the care of patients with tuberculosis

The first two chapters of Best practice for the care of patients with tuberculosis: a guide for low-income countries include an introduction and guidance regarding implementation of best practice. The background to how the guide was developed is significant, as it was developed in collaboration with nurses and other health workers working in the most challenging settings. It therefore provides realistic and practical guidance for best practice where patient loads are large and resources are stretched. Guidance regarding standard setting and clinical audit is an important part of enabling people to recognise the strengths that already exist in their practice and approach those areas that require change in a systematic and practical way. The guide itself consists of a series of standards covering different aspects of patient care, from the moment they seek health care with symptoms to their diagnosis to early stages of treatment, directly observed treatment, the continuation phase and transfer of treatment. There are also standards relating specifically to HIV testing and the care of patients co-infected with tuberculosis and HIV. The standards themselves will appear in full in the subsequent chapters of this series.

Upper limb assessment in tetraplegia: clinical, functional and kinematic correlations

The aim of this study was to correlate clinical and functional evaluations with kinematic variables of upper limp reach-to-grasp movement in patients with tetraplegia. Twenty chronic patients were selected to perform reach-to-grasp kinematic assessment using a target placed at a distance equal to the arm`s length. Kinematic variables (hand peak velocity, movement time, percent time-to-maximal velocity, index of curvature, number of peaks, and joint range of motion) were correlated to clinical (Standard Neurological Classification of Spinal Cord Injury-American Spinal Injury Association) and functional [Functional Independence Measure (FIM) and Spinal Cord Independence Measure II (SCIM II)) evaluation scores. Twenty control participants were also selected to obtain normal reference parameters. There was a positive correlation between total motor index and FIM (r=0.6089; P=0.0044) and SCIM II (r=0.5229; P=0.018). Both functional scores showed positive correlation with each other (r=0.8283; P<0.0001). A correlation was also observed between the right and left motor indices, the motor AM, and the SCIM II in most of the reach-to-grasp kinematic variables studied (hand peak velocity, movement time, index of curvature, and number of peaks). In contrast, for the joint range of motion (shoulder, elbow, and wrist), only the wrist in the horizontal plane showed correlation with clinical variables. This study shows that muscle strength assessed by the American Spinal Injury Association motor index influences the reach-to-grasp kinematic variables of patients with tetraplegia. However, the functional assessments did not present the same influence.

The four-element Chua`s circuit

A new circuit configuration, linearly conjugate to the standard Chua`s circuit, is presented. Its distinctive feature is that the equations now admit an additional parameter, which controls the dissipation in the network connected to the Chua diode. In the limiting case we obtain the simplest chaotic circuit, consisting of a piecewise-linear resistor and three lossless elements.

Thermal characterization of a cross-flow heat exchanger with a new flow arrangement

The objective of the present paper is to thermally characterize a cross-flow heat exchanger featuring a new cross-flow arrangement, which may find application in contemporary refrigeration and automobile industries. The new flow arrangement is peculiar in the sense that it possesses two fluid circuits extending in the form of two tube rows, each with two tube lines. To assess the heat exchanger performance, it is compared against that for the standard two-pass counter-cross-flow arrangement. The two-part comparison is based on the thermal effectiveness and the heat exchanger efficiency for several combinations of the heat capacity rate ratio, C*, and the number of transfer units, NTU. In addition, a third comparison is made in terms of the so-called ""heat exchanger reversibility norm"" (HERN) through the influence of various parameters such as the inlet temperature ratio, T, and the heat capacity rate ratio, C*, for several fixed NTU values. The proposed new flow arrangement delivers higher thermal effectiveness and higher heat exchanger efficiency, resulting in lesser entropy generation over a wide range of C* and NTU values. These metrics are quantified with respect to the arrangement widely used in refrigeration industry due to its high effectiveness, namely, the standard two-pass counter-cross-flow heat exchanger. The new flow arrangement seems to be a promising avenue in situations where cross-flow heat exchangers for single-phase fluid have to be used in refrigeration units. (c) 2009 Elsevier Masson SAS. All rights reserved.

Anaerobic fluidized bed reactor with expanded clay as support for hydrogen production through dark fermentation of glucose

This study evaluated hydrogen production in an anaerobic fluidized bed reactor (AFBR) fed with glucose-based synthetic wastewater. Particles of expanded clay (2.8-3.35 mm) were used as a support material for biomass immobilization. The reactor was operated with hydraulic retention times (HRT) ranging from 8 to 1 h. The hydrogen yield production increased from 1.41 to 2.49 mol H(2) Mol(-1) glucose as HRT decreased from 8 to 2 h. However, when HRT was 1 h, there was a slight decrease to 2.41 mol H(2) Mol(-1) glucose. The biogas produced was composed of H(2) and CO(2), and the H(2) content increased from 8% to 35% as HRT decreased. The major soluble metabolites during H(2) fermentation were acetic acid (HAc) and butyric acid (HBu), accounting for 36.1-53.3% and 37.7-44.9% of total soluble metabolites, respectively. Overall, the results demonstrate the potential of using expanded clay as support material for hydrogen production in AFBRs. (c) 2008 International Association for Hydrogen Energy. Published by Elsevier Ltd. All rights reserved.

Biodeterioration of painted mortar surfaces in tropical urban and coastal situations: Comparison of four paint formulations

Four different architectural acrylic paint formulations were tested by exposure to weathering for 7 years in the urban site of Sao Paulo and the coastal site of Ubatuba, South-East Brazil. Surface discolorations and detachment of coatings were assessed and the components of the biofilms were identified by standard microbiological methods. The painted surfaces of the mortar panels were much more discolored in Ubatuba, where major components of the biofilms were the cyanobacteria Gloeocapsa and Scytonema. In two of the four paint films, a pink coloration on the surface at this coastal site, caused mainly by red-pigmented Gloeocapsa, produced high discoloration ratings, but low degradation (as measured by detachment). Biofilms in Sao Paulo contained the same range of phototrophs, but in lesser quantity. However, fungal numbers, as determined by plating, were higher. Detachment ratings in this urban site were only slightly lower than in Ubatuba. The matt paint performed worst of the four, with silk and semi-gloss finishes giving lowest biodeterioration ratings. The matt elastomeric paint performed well at both sites, apart from becoming almost 100% covered by the pink biofilm in Ubatuba. Unpainted mortar panels became intensely discolored with a black biofilm, showing that all the paints had achieved one of their objectives, that of surface protection of the substrate. The value of PVC (pigment volume content) as an indicator of coatings biosusceptibility, is questioned. (C) 2011 Elsevier Ltd. All rights reserved.

Functionality of the approach of hierarchical analysis in the full cost accounting in the IRP of a metropolitan airport

This work shows the application of the analytic hierarchy process (AHP) in the full cost accounting (FCA) within the integrated resource planning (IRP) process. For this purpose, a pioneer case was developed and different energy solutions of supply and demand for a metropolitan airport (Congonhas) were considered [Moreira, E.M., 2005. Modelamento energetico para o desenvolvimento limpo de aeroporto metropolitano baseado na filosofia do PIR-O caso da metropole de Sao Paulo. Dissertacao de mestrado, GEPEA/USP]. These solutions were compared and analyzed utilizing the software solution ""Decision Lens"" that implements the AHP. The final part of this work has a classification of resources that can be considered to be the initial target as energy resources, thus facilitating the restraints of the IRP of the airport and setting parameters aiming at sustainable development. (C) 2007 Elsevier Ltd. All rights reserved.

Modeling extended Petri nets compatible with GHENeSys IEC61131 for industrial automation

Petri net (PN) modeling is one of the most used formal methods in the automation applications field, together with programmable logic controllers (PLCs). Therefore, the creation of a modeling methodology for PNs compatible with the IEC61131 standard is a necessity of automation specialists. Different works dealing with this subject have been carried out; they are presented in the first part of this paper [Frey (2000a, 2000b); Peng and Zhou (IEEE Trans Syst Man Cybern, Part C Appl Rev 34(4):523-531, 2004); Uzam and Jones (Int J Adv Manuf Technol 14(10):716-728, 1998)], but they do not present a completely compatible methodology with this standard. At the same time, they do not maintain the simplicity required for such applications, nor the use of all-graphical and all-mathematical ordinary Petri net (OPN) tools to facilitate model verification and validation. The proposal presented here completes these requirements. Educational applications at the USP and UEA (Brazil) and the UO (Cuba), as well as industrial applications in Brazil and Cuba, have already been carried out with good results.

Influence of Microstructures on Polarization Resistance and Hydrogen-Induced Cracking of a Micro-Alloyed Steel Submitted to Different Cooling Rates

The effect of different microstructures on the polarization resistance (Rp) and the hydrogen-induced cracking (HIC) of a micro-alloyed steel austenitized and submitted to different cooling rates was studied. Samples 19.1 x 6 x 2 mm, containing the whole thickness of the plate were extracted from a 20 mm plate and heat treated on a quenching dilatometer, were submitted to Rp and HIC corrosion tests. Both Rp and HIC tests followed as close as possible ASTM G59 and NACE standard TM0284-2003, in this case, modified only with regard to the size of the samples. Steel samples transformed from austenite by a slow cooling (cooling rate of 0.5 degrees C.s(-1)) showed higher susceptibility to hydrogen-induced cracking, with large cracks in the middle of the sample propagating along segregation bands, corresponding to the centerline of the plate thickness. For cooling rates of 10 degrees C.s(-1), only small cracks were found in the matrix and micro cracks nucleated at non-metallic inclusions. For higher cooling rates (40 degrees C.s(-1)) very few small cracks were detected, linked to non-metallic inclusions. This result suggests that structures formed by polygonal structures and segregation bands (were cutectoid microconstituents predominate) have higher susceptibility to HIC. Structures predominantly formed by acicular ferrite make it difficult to propagate the cracks among non-oriented and interlaced acicular ferrite crystals. Smaller segregation bands containing eutectoid products also help inhibit cracking and crack propagation; segregation bands can function as pipelines for hydrogen diffusion and offer a path of stress concentration for the propagation of cracks, frequently associated to non-metallic inclusions. Polarization resistance essays performed on the steel in theas received condition, prior to any heat treatment, showed larger differences between the regions of the plate, with a considerably lower Rp in the centerline. The austenitization heat treatments followed by cooling rates of 0.5 e 10 degrees C.s(-1) made more uniform the corrosion resistance along the thickness of the plate. The effects of heat treatments on the corrosion resistance are probably related to the microconstituent formed, allied to the chemical homogenization of the impurities concentrated on the centerline of the plate.

Effects of weld strength mismatch on J and CTOD estimation procedure for SE(B) specimens

This work examines the effect of weld strength mismatch on fracture toughness measurements defined by J and CTOD fracture parameters using single edge notch bend (SE(B)) specimens. A central objective of the present study is to enlarge on previous developments of J and CTOD estimation procedures for welded bend specimens based upon plastic eta factors (eta) and plastic rotational factors (r (p) ). Very detailed non-linear finite element analyses for plane-strain models of standard SE(B) fracture specimens with a notch located at the center of square groove welds and in the heat affected zone provide the evolution of load with increased crack mouth opening displacement required for the estimation procedure. One key result emerging from the analyses is that levels of weld strength mismatch within the range +/- 20% mismatch do not affect significantly J and CTOD estimation expressions applicable to homogeneous materials, particularly for deeply cracked fracture specimens with relatively large weld grooves. The present study provides additional understanding on the effect of weld strength mismatch on J and CTOD toughness measurements while, at the same time, adding a fairly extensive body of results to determine parameters J and CTOD for different materials using bend specimens with varying geometries and mismatch levels.

Understanding the strategies of late-movers in International Manufacturing

This paper analyzes the internationalization of new multinationals from emerging countries. It also focuses on Production`s role in firm internationalization, a subject seldom addressed because the discipline of International Manufacturing is still embryonic, while International Business tends to overlook production. The authors integrate International Business and International Manufacturing concepts and frameworks in order to analyze new multinationals from emerging countries, using the empirical evidence of a survey plus case studies of Brazilian multinationals for understanding late-movers` strategies and competences, with emphasis on production. (C) 2009 Elsevier B.V. All rights reserved.

Analog performance of standard and strained triple-gate silicon-on-insulator nFinFETs

This work shows a comparison between the analog performance of standard and strained Si n-type triple-gate FinFETs with high-K dielectrics and TiN gate material. Different channel lengths and fin widths are studied. It is demonstrated that both standard and strained FinFETs with short channel length and narrow fins have similar analog properties, whereas the increase of the channel length degrades the early voltage of the strained devices, consequently decreasing the device intrinsic voltage gain with respect to standard ones. Narrow strained FinFETs with long channel show a degradation of the Early voltage if compared to standard ones suggesting that strained devices are more subjected to the channel length modulation effect. (C) 2008 Elsevier Ltd. All rights reserved.

How rare is too rare to harvest? Management challenges posed by timber species occurring at low densities in the Brazilian Amazon

Tropical forests are characterized by diverse assemblages of plant and animal species compared to temperate forests. Corollary to this general rule is that most tree species, whether valued for timber or not, occur at low densities (<1 adult tree ha(-1)) or may be locally rare. In the Brazilian Amazon, many of the most highly valued timber species occur at extremely low densities yet are intensively harvested with little regard for impacts on population structures and dynamics. These include big-leaf mahogany (Swietenia macrophylla), ipe (Tabebuia serratifolia and Tabebuia impetiginosa), jatoba (Hymenaea courbaril), and freijo cinza (Cordia goeldiana). Brazilian forest regulations prohibit harvests of species that meet the legal definition of rare - fewer than three trees per 100 ha - but treat all species populations exceeding this density threshold equally. In this paper we simulate logging impacts on a group of timber species occurring at low densities that are widely distributed across eastern and southern Amazonia, based on field data collected at four research sites since 1997, asking: under current Brazilian forest legislation, what are the prospects for second harvests on 30-year cutting cycles given observed population structures, growth, and mortality rates? Ecologically `rare` species constitute majorities in commercial species assemblages in all but one of the seven large-scale inventories we analyzed from sites spanning the Amazon (range 49-100% of total commercial species). Although densities of only six of 37 study species populations met the Brazilian legal definition of a rare species, timber stocks of five of the six timber species declined substantially at all sites between first and second harvests in simulations based on legally allowable harvest intensities. Reducing species-level harvest intensity by increasing minimum felling diameters or increasing seed tree retention levels improved prospects for second harvests of those populations with a relatively high proportion of submerchantable stems, but did not dramatically improve projections for populations with relatively flat diameter distributions. We argue that restrictions on logging very low-density timber tree populations, such as the current Brazilian standard, provide inadequate minimum protection for vulnerable species. Population declines, even if reduced-impact logging (RIL) is eventually adopted uniformly, can be anticipated for a large pool of high-value timber species unless harvest intensities are adapted to timber species population ecology, and silvicultural treatments are adopted to remedy poor natural stocking in logged stands. (C) 2008 Elsevier B.V. All rights reserved.

The relationship of flow cytometry results with classical measures of bacterial counts in raw refrigerated milk

Bulk milk was collected from 100 farms throughout the year and analysed after storage for either 24, 48 or 72 h, using flow cytometry. The total bacterial counts obtained by two methods - flow cytometry and standard plate count were compared and the conversion relationship between them was assessed: the results showed no effect of the age of the samples relationship between these two methods.