Salt subtraction in patients on maintenance hemodialysis. Efficacy and limitations.

In 6 hypertensive patients with terminal renal failure maintained on hemodialysis, the effects of 'salt subtraction' and of sequential ultrafiltrating were evaluated. Following each of 3 weekly hemodialysis sessions, salt subtraction was carried out by ultrafiltrating 1 liter and simultaneously infusing an equal volume of 5% dextrose. This resulted in a net sodium loss without hypovolemia. After a 2-week period of this procedure, the blood pressure prior to dialysis was lower (156/76 +/- 12/5 mm Hg) than after a comparable number of sequential ultrafiltration sessions (181/88 +/- 10/6 mm Hg; mean +/- SEM). This difference was not statistically significant. At the same time, body weight was comparable at 64.4 +/- 3 and 64.7 +/- 4 kg, respectively. Neither plasma renin activity nor plasma catecholamines responded with a clear increase to either procedure. The limited effect on blood pressure and the renin system of a marked sodium removal during salt subtraction suggests that sodium must still be present in excess in these patients. The procedure of salt subtraction appears safe and subjectively well tolerated, but it can probably not be used as the sole means of decreasing total body sodium without associating dietary measures to reduce sodium intake.

Aplicação de um modelo de Balanced Scorecard na Clínica Medicentro: Vantagens e desvantagens

Este trabalho procura descrever uma aplicação de uma ferramenta de gestão, designada de Balanced Scorecard, numa Clínica privada. Para fundamentação de todo o trabalho, iniciamos com uma revisão bibliográfica dos diversos conceitos relacionados com o Balanced Scorecard, nomeadamente os seus componentes, os seus princípios, as suas vantagens e desvantagens, bem como também as suas diversas fases de implementação. Posteriormente, foi desenvolvido um estudo de caso numa Clínica privada, onde fizemos uma proposta de aplicação de um instrumento de gestão, neste caso o Balanced Scorecard. Para a recolha de dados, aplicámos um guião de entrevista aos responsáveis da Medicentro, um questionário aos pacientes, utilizámos documentos fornecidos pela Instituição, e ainda utilizámos a técnica da observação directa. Neste estudo, optámos por seguir uma metodologia de implementação proposta por RUSSO (2006), adaptadas às PME, onde, em primeiro lugar, fizemos uma análise da estratégia, através de um diagnóstico da situação da Clínica, e,posteriormente, uma formulação da mesma onde foram abordados a visão da Clínica, os factores críticos de sucesso e os diversos componentes do Balanced Scorecard. Nesta metodologia proposta por RUSSO, não é evidenciado o Mapa Estratégico, logo elaborámos o mesmo, e colocamo-lo nos apêndices. Os resultados obtidos com o estudo revelaram que a Clínica possui algumas insuficiências no que concerne a sua gestão, derivadas principalmente da sua situação financeira. This work seeks to describe an application of a management tool called the balanced scorecard, in a private Clinic. Strategically we began with a literature review of the various concepts related to the balanced scorecard, including its components, their principles, their advantages and disadvantages and also their several stages of implementation. On the second step, we developed a case study in a private clinic where we made a proposal for implementation of a management tool, that is, the balanced scorecard. For data collection, we have applied an interview guide to the responsible for Medicentro, a questionnaire to patients, using documents supplied by the Institution and, in addition, of a direct observation. In this study, we have followed a methodology of implementation proposed by Russo (2006), adapted SMEs, where in first place we made an analysis of the strategy through a diagnosis of the situation of the Clinic, and later a formulation of the same were addressed to Clinical view, the critical factors of success, and the various components of the balanced scorecard. This methodology proposed by Russo is not evidenced the strategic map. Therefore we elaborated the same and we have placed it in the appendices. The results obtained from the study revealed that the Clinic has some inadequacies in what concern its management because of its financial situation.

Renal effects of selective cyclooxygenase-2 inhibition in normotensive salt-depleted subjects.

PURPOSE: To compare the renal hemodynamic and tubular effects of celecoxib, a selective inhibitor of cyclooxygenase-2 (COX-2) to those of naproxen, a nonselective inhibitor of cyclooxygenases in salt-depleted subjects. METHODS AND SUBJECTS: Forty subjects were randomized into four parallel groups to receive 200 mg celecoxib twice a day, 400 mg celecoxib twice a day, 500 mg naproxen twice a day, or a placebo for 7 days according to a double-blind study design. Blood pressure, renal hemodynamics, and urinary water and electrolyte excretion were measured before and for 3 hours after drug intake on days 1 and 7. RESULTS: Celecoxib had no effect on systemic blood pressure, but short-term transient decreases in renal blood flow and glomerular filtration rate were found with the highest dose of 400 mg on day 1. On the first day, both celecoxib and naproxen decreased urine output (P < .05) and sodium, lithium, and potassium excretion (P < .01). On day 7, similar effects on water and sodium excretion were observed. During repeated administration, a significant sodium retention occurred during the first 3 days. CONCLUSION: In salt-depleted subjects, selective inhibition of COX-2 causes sodium and potassium retention. This suggests that an increased selectivity for COX-2 does not spare the kidney, at least during salt depletion.

Management information systems: The balanced scorecard in Spanish public universities

Organisations are becoming increasingly aware of the need for management information systems, due largely to the changing environment and a continuous process of globalisation. All of this means that managers need to adapt the structures of their organisations to the changes and, therefore, to plan, control and manage better. The Spanish public university cannot avoid this changing (demographic, economic and social changes) and globalising (among them the convergence of European qualifications) environment, to which we must add the complex organisation structure, characterised by a high dispersion of authority for decision making in different collegiate and unipersonal organs. It seems obvious that these changes must have repercussions on the direction, organisation and management structures of those public higher education institutions, and it seems natural that, given this environment, the universities must adapt their present management systems to the demand by society for the quality and suitability of the services they provide.

Rate of convergence of a particle method to the solution of the Mc Kean-Vlasov's equation

This paper studies the rate of convergence of an appropriatediscretization scheme of the solution of the Mc Kean-Vlasovequation introduced by Bossy and Talay. More specifically,we consider approximations of the distribution and of thedensity of the solution of the stochastic differentialequation associated to the Mc Kean - Vlasov equation. Thescheme adopted here is a mixed one: Euler/weakly interactingparticle system. If $n$ is the number of weakly interactingparticles and $h$ is the uniform step in the timediscretization, we prove that the rate of convergence of thedistribution functions of the approximating sequence in the $L^1(\Omega\times \Bbb R)$ norm and in the sup norm is of theorder of $\frac 1{\sqrt n} + h $, while for the densities is ofthe order $ h +\frac 1 {\sqrt {nh}}$. This result is obtainedby carefully employing techniques of Malliavin Calculus.

The struggle against creative accounting: Is "true and fair view" part of the problem or part of the solution?

Creative accounting is a growing issue of interest in Spain. In this article we argue that the concept true and fair view can limit or promote the use of creative accounting depending upon its interpretation. We review the range of meanings that true and fair view can take at an international level and compare the experience of the United Kingdom with the Australian one by analysing the use of true and fair view to limit creative accounting. Finally, we suggest lines of action to be considered by the Spanish accounting standards-setting institutions.

Diversity of social wasps (Hymenoptera, Vespidae, Polistinae) in three fragments of semideciduous seasonal forest in the northwest of São Paulo State, Brazil

Human exploitation of the forest in the northwest of São Paulo State has generated enormous fragmentation of that forest. Such disturbance has reduced the populations of insects in general. This work was a survey of social wasps (Hymenoptera, Vespidae; Polistinae) in three areas in different stages of regeneration: Paulo de Faria - SP (435 ha), Pindorama - SP (128 ha) and Neves Paulista - SP (1 ha). These three areas were chosen for comparative purposes. To capture the wasps, it was used: active collecting with attractant liquid (solution of water, salt and sugar) with the aid of a dorsal spray bag. During the period from July to December 2006, 414 social wasps were collected in Paulo de Faria, constituting seven species belonging to four genera; 111 social wasps were collected in Pindorama, constituting six species belonging to four genera, and 129 social wasps were collected in Neves Paulista constituting 12 species belonging to seven genera. In order to compare these three areas ecological indexes were calculated. Neves Paulista had the greatest diversity, and Paulo de Faria presented greater abundance. These factors were probably caused by neighboring areas and ecological corridors, which were limited in Paulo de Faria and Pindorama.

Inducible kidney-specific Sgk1 knockout mice show a salt-losing phenotype.

The expression of the serum- and glucocorticoid-regulated kinase 1 (Sgk1) is induced by mineralocorticoids and, in turn, upregulates the renal epithelial Na(+) channel (ENaC). Total inactivation of Sgk1 has been associated with transient urinary Na(+) wasting with a low-Na(+) diet, while the aldosterone-mediated ENaC channel activation was unchanged in the collecting duct. Since Sgk1 is ubiquitously expressed, we aimed to study the role of renal Sgk1 and generated an inducible kidney-specific knockout (KO) mouse. We took advantage of the previously described TetOn/CreLoxP system, in which rtTA is under the control of the Pax8 promotor, allowing inducible inactivation of the floxed Sgk1 allele in the renal tubules (Sgk1fl/fl/Pax8/LC1 mice). We found that under a standard Na(+) diet, renal water and Na(+)/K(+) excretion had a tendency to be higher in doxycycline-treated Sgk1 KO mice compared with control mice. The impaired ability of Sgk1 KO mice to retain Na(+) increased significantly with a low-salt diet despite higher plasma aldosterone levels. On a low-Na(+) diet, the Sgk1 KO mice were also hyperkaliuric and lost body weight. This phenotype was accompanied by a decrease in systolic and diastolic blood pressure. At the protein level, we observed a reduction in phosphorylation of the ubiquitin protein-ligase Nedd4-2 and a decrease in the expression of the Na(+)-Cl(-)-cotransporter (NCC) and to a lesser extent of ENaC.

Balanced Scorecard como um Sistema de Avaliação de Desempenho: Uma Proposta de Implementação numa Instituição de Ensino Superior Privada

O presente trabalho insere-se no âmbito do Curso de Licenciatura em Contabilidade e Administração, ramo Administração e Controlo Financeiro no Instituto Superior de Ciências Económicas e Empresariais (ISCEE). Intitulado Balanced Scorecard como um sistema de avaliação de desempenho – uma proposta de implementação numa Instituição de Ensino Superior privada, este estudo teve como objectivo conceber um modelo de Balanced Scorecard aplicável numa Instituição de Ensino Superior (IES), evidenciando as necessárias adaptações para que tal seja possível. A sustentação deste trabalho baseou-se inicialmente numa revisão da literatura, fazendo-se um enquadramento teórico dos conceitos relacionados com o Balanced Scorecard. Depois desenvolveu-se o estudo de caso numa Instituição de Ensino Superior, partindo de uma abordagem qualitativa e quantitativa. A colecta de informações processou-se com base em entrevistas semi-directivas, análise documental e à aplicação de questionários aos docentes a tempo integral, discentes e funcionários, elaborados em coerência com os objectivos preconizados para este estudo. Buscou-se identificar a missão, visão estratégica, valores e estratégias adoptadas pela instituição, uma vez que tais variáveis constituem os pilares da construção de um modelo de Balanced Scorecard. Pretendeu-se, também, identificar quais as perspectivas que deveriam ser adoptadas pela instituição, evidenciando a sua ordenação, de acordo com o principal foco da instituição em questão. A seguir definiu-se os objectivos estratégicos e os indicadores para as diferentes perspectivas, demonstrando as relações de causaefeito entre elas. Também foram identificados os factores críticos de sucesso e apresentadas as acções que permitirão alcançar os objectivos preconizados. Para levar a cabo a realização do estudo de caso, fez-se uma adaptação do modelo apresentado por Rocha (2000). Dos resultados obtidos, apresentou-se um modelo aplicável à instituição em questão. Constatou-se também que o Balanced Scorecard poderá ser eficaz para a gestão da instituição, desencadeando o processo de formulação estratégica, que até então não se encontra definido e permitindo avaliar o seu desempenho, considerando várias perspectivas.

Trends in hours, balanced growth and the role of technology in the business cycle

The present paper revisits a property embedded in most dynamic macroeconomic models: the stationarity of hours worked. First, I argue that, contrary to what is often believed, there are many reasons why hours could be nonstationary in those models, while preserving the property of balanced growth. Second, I show that the postwar evidence for most industrialized economies is clearly at odds with the assumption of stationary hours per capita. Third, I examine the implications of that evidence for the role of technology as a source of economic fluctuations in the G7 countries.

One-sided tolerance interval in a two-way balanced nested model with mixed effects

In many research areas (such as public health, environmental contamination, and others) one deals with the necessity of using data to infer whether some proportion (%) of a population of interest is (or one wants it to be) below and/or over some threshold, through the computation of tolerance interval. The idea is, once a threshold is given, one computes the tolerance interval or limit (which might be one or two - sided bounded) and then to check if it satisfies the given threshold. Since in this work we deal with the computation of one - sided tolerance interval, for the two-sided case we recomend, for instance, Krishnamoorthy and Mathew [5]. Krishnamoorthy and Mathew [4] performed the computation of upper tolerance limit in balanced and unbalanced one-way random effects models, whereas Fonseca et al [3] performed it based in a similar ideas but in a tow-way nested mixed or random effects model. In case of random effects model, Fonseca et al [3] performed the computation of such interval only for the balanced data, whereas in the mixed effects case they dit it only for the unbalanced data. For the computation of twosided tolerance interval in models with mixed and/or random effects we recomend, for instance, Sharma and Mathew [7]. The purpose of this paper is the computation of upper and lower tolerance interval in a two-way nested mixed effects models in balanced data. For the case of unbalanced data, as mentioned above, Fonseca et al [3] have already computed upper tolerance interval. Hence, using the notions persented in Fonseca et al [3] and Krishnamoorthy and Mathew [4], we present some results on the construction of one-sided tolerance interval for the balanced case. Thus, in order to do so at first instance we perform the construction for the upper case, and then the construction for the lower case.