Incentive spirometry for prevention of postoperative pulmonary complications in upper abdominal surgery

BackgroundThis is an update of a Cochrane Review first published in The Cochrane Library 2008, Issue 3.Upper abdominal surgical procedures are associated with a high risk of postoperative pulmonary complications. The risk and severity of postoperative pulmonary complications can be reduced by the judicious use of therapeutic manoeuvres that increase lung volume. Our objective was to assess the effect of incentive spirometry compared to no therapy or physiotherapy, including coughing and deep breathing, on all-cause postoperative pulmonary complications andmortality in adult patients admitted to hospital for upper abdominal surgery.ObjectivesOur primary objective was to assess the effect of incentive spirometry (IS), compared to no such therapy or other therapy, on postoperative pulmonary complications and mortality in adults undergoing upper abdominal surgery.Our secondary objectives were to evaluate the effects of IS, compared to no therapy or other therapy, on other postoperative complications, adverse events, and spirometric parameters.Search methodsWe searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 8), MEDLINE, EMBASE, and LILACS (from inception to August 2013). There were no language restrictions. The date of the most recent search was 12 August 2013. The original search was performed in June 2006.Selection criteriaWe included randomized controlled trials (RCTs) of IS in adult patients admitted for any type of upper abdominal surgery, including patients undergoing laparoscopic procedures.Data collection and analysisTwo authors independently assessed trial quality and extracted data.Main resultsWe included 12 studies with a total of 1834 participants in this updated review. The methodological quality of the included studies was difficult to assess as it was poorly reported, so the predominant classification of bias was 'unclear'; the studies did not report on compliance with the prescribed therapy. We were able to include data from only 1160 patients in the meta-analysis. Four trials (152 patients) compared the effects of IS with no respiratory treatment. We found no statistically significant difference between the participants receiving IS and those who had no respiratory treatment for clinical complications (relative risk (RR) 0.59, 95% confidence interval (CI) 0.30 to 1.18). Two trials (194 patients) IS compared incentive spirometry with deep breathing exercises (DBE). We found no statistically significant differences between the participants receiving IS and those receiving DBE in the meta-analysis for respiratory failure (RR 0.67, 95% CI 0.04 to 10.50). Two trials (946 patients) compared IS with other chest physiotherapy. We found no statistically significant differences between the participants receiving IS compared to those receiving physiotherapy in the risk of developing a pulmonary condition or the type of complication. There was no evidence that IS is effective in the prevention of pulmonary complications.Authors' conclusionsThere is low quality evidence regarding the lack of effectiveness of incentive spirometry for prevention of postoperative pulmonary complications in patients after upper abdominal surgery. This review underlines the urgent need to conduct well-designed trials in this field. There is a case for large RCTs with high methodological rigour in order to define any benefit from the use of incentive spirometry regarding mortality.

Prevalence of health promotion programs in primary health care units in Brazil

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Characteristics of physical activity programs in the Brazilian primary health care system

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Gestão do conhecimento na educação ambiental: estudo de casos em programas de educação ambiental em universidades brasileiras

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Cardiac risk stratification in cardiac rehabilitation programs: a review of protocols

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Estudo das principais políticas para melhoria da eficiência energética no setor elétrico

This paper aims at comparing the national and international incentive policies in energy efficiency investment and presenting the main trends, measures adopted and economical and environmental results obtained, as well as possible improvements and expansions of these programs. This analysis is justified by the current moment, not only of the Brazilian Power Systems (SEB) but also of the global power systems with the constant increase of demand and depletion of natural resources implying in a need of a better use of them and of the power they generate, which directly affects the losses on the generation, transmission, distribution and consumption of energy, in addition to reducing the impacts on the environment. At last but not least, through this study it was possible to gleam not only at new possible ways for these programs, but also failures and inefficiencies that can be improved in the measures currently being used

Ecological and toxicological responses in a multistressor scenario: are monitoring programs showing the stressors or just showing stress? A case study in Brazil

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Gamificação: modelagem de conteúdos para programas e aplicativos educativos no ambiente da TV digital interativa

With the deployment of Digital TV in Brazil, there is a need to foment the development and production of interactive audiovisual quality content, especially for programs that present educational messages from the entertainment concept - defined as Edutertainment. The objective of this study is to propose application of the gamification as a link of communication to encourage and modify user behavior, through a narrative that encourages intrinsic motivation for learning and entertainment in this media. This paper points out that there are few models of screenplays for applications production, particularly educational, with simultaneous interactive applications for television flow or complementary programming content offered. For this reason, a special attention is given to the screenplay, by virtue of inserting in its construction, the elements that make up the mechanics and dynamics of games. As a result, is shown the entry "Gamification-iDTV", which defines these two scenarios, as well as the development of a modeling methodology of a content and process, supported by conceptual maps, wireframes and roadmaps, substantiating the conception and elaboration of screenplay's prototype with elements of gamification for educational programs and its interaction applications.

O uso das tecnologias da informação e comunicação no ensino de geografia: aplicação da página protótipo Desenvolvimento Urbano do atlas municipal escolar de Ourinhos

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Assessing the Free Land Programs for Reversing Rural Depopulation

A number of small towns in the Great Plains have recently started to offer free land and other incentives to entice new residents in the hope of reversing persistent depopulation. Based on in-depth interviews, this study assesses the initial performance of the free land programs in six small towns in central Kansas and analyzes the factors that have affected the migration decisions of the new residents. The initial results of these programs have been impressive. Not only have they attracted multiple new residents and increased enrollments in local schools, but they have also elevated long-time residents' pride in their community and created a positive synergy. The new residents' migration decisions were influenced by a number of push and pull factors. The free land and other incentives are not enough to trigger migration, but they have effectively changed some migrants' destination choice to a small town in central Kansas. Without the free land, most new residents, particularly those from out of state, would not have moved there. Contrary to our expectations, the relative locations of small towns with respect to larger cities do not appear to have affected new residents' destination choice.

Landscape Genetics of Raccoons (Procyon lotor) Associated with Ridges and Valleys of Pennsylvania: Implications for Oral Rabies Vaccination Programs

Raccoons are the reservoir for the raccoon rabies virus variant in the United States. To combat this threat, oral rabies vaccination (ORV) programs are conducted in many eastern states. To aid in these efforts, the genetic structure of raccoons (Procyon lotor) was assessed in southwestern Pennsylvania to determine if select geographic features (i.e., ridges and valleys) serve as corridors or hindrances to raccoon gene flow (e.g., movement) and, therefore, rabies virus trafficking in this physiographic region. Raccoon DNA samples (n = 185) were collected from one ridge site and two adjacent valleys in southwestern Pennsylvania (Westmoreland, Cambria, Fayette, and Somerset counties). Raccoon genetic structure within and among these study sites was characterized at nine microsatellite loci. Results indicated that there was little population subdivision among any sites sampled. Furthermore, analyses using a model-based clustering approach indicated one essentially panmictic population was present among all the raccoons sampled over a reasonably broad geographic area (e.g., sites up to 36 km apart). However, a signature of isolation by distance was detected, suggesting that widths of ORV zones are critical for success. Combined, these data indicate that geographic features within this landscape influence raccoon gene flow only to a limited extent, suggesting that ridges of this physiographic system will not provide substantial long-term natural barriers to rabies virus trafficking. These results may be of value for future ORV efforts in Pennsylvania and other eastern states with similar landscapes.

Comparative Anylysis of Recyling Programs: A Case Study of Three Universities

Abstract The goal of this study was to conduct a comparative analysis of three university recycling programs. This study looked at several aspects of the programs that included the diversion rates, per capita ratios of materials recycled and disposed, and the average net costs of waste disposal and waste diversion. The universities included in this study were the University of Nebraska-Lincoln, the University of Colorado at Boulder, and the University of Oregon. To gather the information necessary for this analysis, I contacted each of the university’s recycling coordinators. To determine the average net costs of waste disposal and waste diversion I requested both the recycling budget and solid waste budget from each university for the fiscal years of interest which included: 2006-2007, 2007-2008, and 2008-2009. To calculate the diversion rates and per capita ratios, I requested performance records from each university listing the tonnage of materials recycled and disposed for the same years. This study’s findings reported that the average net costs for waste diversion in all three universities were $22-$122 less per ton than costs for waste collection and disposal. This study also indicated that the universities with the highest diversion and recycling rates were the University of Colorado at Boulder and the University of Oregon. The university with the lowest waste generated per capita was the University of Oregon followed by the University of Nebraska-Lincoln.

A Survery of Western United States Instream Flow Programs and The Policies that Protect a River's Ecosystem

The Western United States can best be described as a vast, varying land, with the high plains to the east and the jagged horizons of Rockies to the west. However there is one common trait shared by these states: the lack of water resources. With the continued development of this land, the fact that water is scarce is becoming more real. This issue became more difficult to handle as the public became more aware that many competing uses existed for the finite resource, and those different uses were degrading the natural environments of the surface waters. With this realization instream flow policies provides a comprehensive account of the policy framework a selected number of western states have established in order to protect instream flows and the overall health of a river's ecosystem. Also included is the identification of key policies that should be promoted or removed from a state's instream flow program. Ultimately, this thesis continues to add the the ever-evolving process of modernizing water law frameworks.

PHOTOGRAPHIC RECORDS — THEIR IMPORTANCE IN TODAY'S ENVIRONMENTALLY SENSITIVE BIRD MANAGEMENT PROGRAMS

We are living in a day of change. Environmental awareness is a part of our everyday life in a way unprecedented in history. The courts, in their infinite wisdom, have initiated the joint and several liability (deep pocket) rules that make everyone at risk in almost all situations. Bird management programs, by their very nature, are extremely sensitive. Any project, if not evaluated, planned, carried out, and documented properly can result in adverse regulatory agency action, bad publicity, and even fines or lawsuits. Proper photographic documentation can play a vital part in helping to provide the necessary records to help prevent problems and/or defend yourself in case of lawsuit or regulatory action. In the preparation of this paper, we surveyed state pesticide lead agencies, state Department of Conservation (Fish and Wildlife) agencies, some U.S. Fish and Wildlife Law Enforcement personnel, and several individuals to get their reaction to and their comments about this concept of supplemental recordkeeping. Of those responding, a majority thought the concept of supplemental photographic recordkeeping would be an asset to individuals and organi¬zations conducting bird management projects.

"BREAKING THROUGH THE SOFT SPOKEN STEREOTYPE: THE VOICES OF ASIAN WOMEN IN DOCTORAL PROGRAMS"

This panel session explores how the dynamics of race and gender within university settings influence Asian women’s experiences in graduate psychology programs.