Health self-assessment by hemodialysis patients in the Brazilian Unified Health System

ABSTRACT OBJECTIVE To examine whether the level of complexity of the services structure and sociodemographic and clinical characteristics of patients in hemodialysis are associated with the prevalence of poor health self-assessment. METHODS In this cross-sectional study, we evaluated 1,621 patients with chronic terminal kidney disease on hemodialysis accompanied in 81 dialysis services in the Brazilian Unified Health System in 2007. Sampling was performed by conglomerate in two stages and a structured questionnaire was applied to participants. Multilevel multiple logistic regression was used for data analysis. RESULTS The prevalence of poor health self-assessment was of 54.5%, and in multivariable analysis it was associated with the following variables: increasing age (OR = 1.02; 95%CI 1.01–1.02), separated or divorced marital status (OR = 0.62; 95%CI 0.34–0.88), having 12 years or more of study (OR = 0.51; 95%CI 0.37–0.71), spending more than 60 minutes in commuting between home and the dialysis service (OR = 1.80; 95%CI 1.29–2.51), having three or more self-referred diseases (OR = 2.20; 95%CI 1.33–3.62), and reporting some (OR = 2.17; 95%CI 1.66–2.84) or a lot of (OR = 2.74; 95%CI 2.04–3.68) trouble falling asleep. Individuals in treatment in dialysis services with the highest level of complexity in the structure presented less chance of performing a self-assessment of their health as bad (OR = 0.59; 95%CI 0.42–0.84). CONCLUSIONS We showed poor health self-assessment is associated with age, years of formal education, marital status, home commuting time to the dialysis service, number of self-referred diseases, report of trouble sleeping, and also with the level of complexity of the structure of health services. Acknowledging these factors can contribute to the development of strategies to improve the health of patients in hemodialysis in the Brazilian Unified Health System.

Reconstructing the architectural evolution of volcanic islands from combined K/AR, morphologic, tectonic, and magnetic data. The Faial Island exemple (Azores)

The morpho-structural evolution of oceanic islands results from competition between volcano growth and partial destruction by mass-wasting processes. We present here a multi-disciplinary study of the successive stages of development of Faial (Azores) during the last 1 Myr. Using high-resolution digital elevation model (DEM), and new K/Ar, tectonic, and magnetic data, we reconstruct the rapidly evolving topography at successive stages, in response to complex interactions between volcanic construction and mass wasting, including the development of a graben. We show that: (1) sub-aerial evolution of the island first involved the rapid growth of a large elongated volcano at ca. 0.85 Ma, followed by its partial destruction over half a million years; (2) beginning about 360 ka a new small edifice grew on the NE of the island, and was subsequently cut by normal faults responsible for initiation of the graben; (3) after an apparent pause of ca. 250 kyr, the large Central Volcano (CV) developed on the western side of the island at ca 120 ka, accumulating a thick pile of lava flows in less than 20 kyr, which were partly channelized within the graben; (4) the period between 120 ka and 40 ka is marked by widespread deformation at the island scale, including westward propagation of faulting and associated erosion of the graben walls, which produced sedimentary deposits; subsequent growth of the CV at 40 ka was then constrained within the graben, with lava flowing onto the sediments up to the eastern shore; (5) the island evolution during the Holocene involves basaltic volcanic activity along the main southern faults and pyroclastic eruptions associated with the formation of a caldera volcano-tectonic depression. We conclude that the whole evolution of Faial Island has been characterized by successive short volcanic pulses probably controlled by brief episodes of regional deformation. Each pulse has been separated by considerable periods of volcanic inactivity during which the Faial graben gradually developed. We propose that the volume loss associated with sudden magma extraction from a shallow reservoir in different episodes triggered incremental downward graben movement, as observed historically, when immediate vertical collapse of up to 2 m was observed along the western segments of the graben at the end of the Capelinhos eruptive crises (1957-58).

Using remote lab networks to provide support to public secondary school education level

The advantages of networking are widely known in many areas (from business to personal ones). One particular area where networks have also proved their benefits is education. Taking the secondary school education level into account, some successful cases can be found in literature. In this paper we describe a particular remote lab network supporting physical experiments accessible to students of institutions geographically separated. The network architecture and application examples of using some of the available remote experiments are illustrated in detail.

Comparison between monopolar and bipolar microsecond range pulsed electric fields in enhancement of apple juice extraction

The effect of monopolar and bipolar shaped pulses in additional yield of apple juice extraction is evaluated. The applied electric field strength, pulsewidth, and number of pulses are assessed for both pulse types, and divergences are analyzed. Variation of electric field strength is ranged from 100 to 1300 V/cm, pulsewidth from 20 to 300 mu s, and the number of pulses from 10 to 200, at a frequency of 200 Hz. Two pulse trains separated by 1 s are applied to apple cubes. Results are plotted against reference untreated samples for all assays. Specific energy consumption is calculated for each experiment as well as qualitative indicators for apple juice of total soluble dry matter and absorbance at 390-nm wavelength. Bipolar pulses demonstrated higher efficiency, and specific energetic consumption has a threshold where higher inputs of energy do not result in higher juice extraction when electric field variation is applied. Total soluble dry matter and absorbance results do not illustrate significant differences between application of monopolar and bipolar pulses, but all values are inside the limits proposed for apple juice intended for human consumption.

Pulsed electric field pre-treatment for apple juice extraction: Evaluation of monopolar and bipolar pulses effects

Additional apple juice extraction with pulsed electric field pretreated apple cubes towards control samples is evaluated. Monopolar and bipolar shaped pulses are compared and their effect is studied with variation of electric field, pulse width and number of pulses. Variation of electric field strength is ranged from 100 V/cm to 1300 V/cm, pulse width from 20 mu s to 300 mu s and number of pulses from 10 to 200, at frequency of 200Hz. Two pulse trains separated by 1 second are applied to all samples. Bipolar pulses showed higher apple juice yields with all studied parameters. Calculation of specific energies consumed was assessed and a threshold where higher energy inputs do not increase juice yield is found for a number of used parameters. Qualitative parameters of total soluble matter (Brix) and absorbance at 390 nm wavelength were determined for each sample and results show that no substantial differences are found for PEF pre-treated and control samples.

Malaria at Humaita county, Amazonas state, Brazil: XVII — immune response in patients with Plasmodium falciparum according to gametocytes

In August 1983 the Authors studied 36 patients with Plasmodium falciparum malaria and 14 normal individuals born in Humaita region who had never had malaria, had no spleen enlargement and had negative parasitemia as well as passive hemagglutination. Medical histories were obtained and complete physical examination were performed in all of them just as blood tests, parasite density and lymphocyte typing. The lymphocytes were separated and then frozen in liquid nitrogen for later typing by rosette formation. The patients were divided in two groups according to the presence (13 patients) or abscence (23 patients) of gametocytes before treatment. Severe malaria was predominant in the group without gametocytes. The results showed a decrease in the T-cell numbers in Plasmodium falciparum acute malaria patients both with or without gametocytes before the treatment, while B-cell numbers were normal only in the patients with gametocytes. These observations as like as those previously reported by the Authors, permit to associate the presence of gametocytes in peripheral blood and normal number of B-cells in patients with mild Plasmodium falciparum malaria.

Processo de Bolonha e mudanças na educação superior: um estudo no Ensino Superior Politécnico português

Tese de Doutoramento

Efeito hipotensivo de uma sessão de exercício aeróbio em idosos hipertensos

Introdução: As doenças cardiovasculares, entre elas, a hipertensão arterial constituem um dos problemas de saúde de maior prevalência, principalmente na população idosa. Alguns estudos têm apontado o exercício físico aeróbio como uma medida não farmacológica, eficaz, para a prevenção/controlo da hipertensão arterial. Objetivo: Este estudo avaliou o efeito agudo hipotensivo de uma sessão isolada de exercício físico aeróbio num grupo de idosos hipertensos. Metodologia: A amostra foi composta por 20 idosos, de ambos os géneros, hipertensos, pertencentes a três centros de convívio distintos. Os indivíduos foram divididos aleatoriamente em dois grupos, o grupo que fez a sessão de exercício (n=10, idade 81,2 ± 4,71 anos) e o grupo de controlo (n=10, idade 81,2 ± 3,12 anos). O grupo de exercício participou numa sessão de exercício físico aeróbio que teve 35 minutos de duração, sendo constituída por 5 minutos de aquecimento seguidos por duas frações de marcha a uma intensidade de 40-60% da frequência cardíaca (FC) de reserva, cada uma delas com a duração de 10 minutos, separadas por um intervalo de recuperação de 5 minutos, terminando com 5 minutos de retorno à calma. O grupo controlo permaneceu 35 minutos em repouso sentado. Todos indivíduos foram sujeitos à avaliação da pressão arterial (PA) e FC, antes, no intervalo, no término, 20 e 40 minutos após a sessão de exercício/35 minutos de repouso. Resultados: Observou-se que no grupo que fez o exercício físico a PA sistólica medida aos 40 minutos (123,04 ± 23,07 mmHg) após a sessão de exercício foi significativamente inferior aos restantes momentos de avaliação, incluindo o valor observado em repouso (135,57 ± 19,43 mmHg). A PA diastólica medida também aos 40 minutos (61,94 ± 7,49 mmHg) após a sessão foi inferior à obtida ao intervalo da sessão (72,40 ± 8,51 mmHg). A FC foi significativamente superior ao intervalo e no término da sessão comparativamente a todos os outros momentos de avaliação. Quanto ao grupo controlo não se verificaram diferenças significativas em nenhum dos parâmetros avaliados. Conclusão: Uma sessão isolada de exercício aeróbio de curta promove a ocorrência do fenómeno hipotensão pós-exercício em idosos hipertensos.

O líder enquanto dinamizador da comunicação interna nas organizações

Dissertação apresentada à Escola Superior de Comunicação Social como parte dos requisitos para obtenção de grau de mestre em Gestão Estratégica das Relações Públicas.

The Neogene of Portugal

After a brief historical introduction, this paper deals with the main concerned geotectonic units: the Lower Tagus and Alvalade basins, the Western and Southern borders, and their infillings. Most of the Neogene events and record concern areas South of the Iberian Central Chain, a nearly inverse situation as that of Paleogene times. In the most important of these units, the Lower Tagus basin, there are quite thick detrital series, mostly marine in its distal part near Lisboa (albeit with several continental intercalations), and mainly continental in its inner part. Sedimentological record is almost complete since Lowermost to Upper Miocene. The richness ofdata (paleontology, isotope chronology, paleoclimate, etc.) it gives and the possibility of direct marine-continental correlations render this basin one of the more interesting ones in Western Europe. Alvalade basin is separated from the previous one by a barrier of Paleozoic rocks. Two transgressions events (Upper Tortonian and Messinian in age) are recorded. Active sedimentation may be correlated to Late Miocene tectonics events. In Algarve, chiefly marine units from Lower to Upper Miocene are well developped. The Lower unit (Lagos-Portimão Formation) is best exposed in Western Algarve, but desappears eastwards. Middle Miocene is not as well known, whereas Upper Miocene main outcrops are in Eastern Algarve. Cacela Formation is remarquable for its beautiful fossils. Sedimentation as a whole refletcts the tectonic activity and in special the evolution of the Algarve flexures. There is scant evidence of post-Lower Miocene volcanism, the latest known in Portugal. Pliocene has not been recognized there beyond doubt. Miocene sediments are much less important to the North of the Central Iberian Chain. Continental beds near Leiria that yielded the well-known "Hisp anotherium fauna" are lower Middle Miocene. Pliocene corresponds to dramatic changes in paleogeography. At Setiibal Peninsula there is some evidence of a minor Lower Pliocene transgression. Continental detrital sediments, often coarse, occupy rather large areas. In Western Portugal between the Setúbal Peninsula and Pombal there is good evidence of a marine Upper Pliocene transgression, followed up by dune sands overlain by marsh clays, diatomites, lignites and boghead levels that can be partly Pleistocene in age.

Significado regional dos depósitos neogénicos continentais da área de Vila de Rei (Portugal Central)

In the Vila de Rei area (Central Portugal) the continental deposits of the Lower Tagus Tertiary Basin lay upon the pediment of the Portuguese Central Chain. Three conglomerate units are recorded from the base upwards, separated by regional or basinal unconformities; Conglomerados de Rio de Moinhos (RM); Conglomerados de Serra de Almeirim (SA) and Conglomerados de Vila de Rei (VR). The first two units (RM and SA) have been sites of gold exploitation in huge open pit mines probably during Roman colonisation times. The contact of this units, on the Paleozoic basement or on the Paleogene unit Grés de Monsanto, is unconform, defining in both limits a large nondepositional and/or erosional hiatus. Those conglomerates seal the sedimentation of the Lower Tagus Tertiary Basin along its northern border. Taking into account the significance assigned to their basinal unconformity limits, the uplift of the Portuguese Central Chain, and the fact of this continental units yielded no fossils with chronostratigraphic significance, they have been considered ranging from Upper Miocene to the beginning of the Quaternary. Finally, a lithostraligraphic equivalence with the Neogenic units of the Bierzo and Duerna basins (NW of the Iberian Peninsula), where exploitations from Roman times are also evident, is presented.

Tertiary evolution of the São Vicente and Setúbal submarine canyons, Southwest Portugal: insights from seismic stratigraphy

The Setúbal and São Vicente canyons are two major modern submarine canyons located in the southwest Iberian margin of Portugal. Although recognised as Pliocene to Quaternary features, their development during the Tertiary has not been fully understood up to date. A grid of 2D seismic data has been used to characterise the sedimentary deposits of the adjacent flanks to the submarine canyons. The relationship between the geological structure of the margin and the canyon's present location has been investigated. The interpretation of the main seismic units allowed the recognition of three generations of ravinements probably originated after middle Oligocene. Six units grouped in two distinctive seismic sequences have been identified and correlated with offshore stratigraphic data. Seismic Sequence 2 (SS2), the oldest, overlies Mesozoic and upper Eocene deformed units. Seismic Sequence I (SS1) is composed of four different seismic packages separated from SS2 by an erosional surface. The base of the studied sediment ridges is marked by an extensive erosional surface derived from a early/middle Oligocene relative sea-level fall. Deposition in the adjacent area to the actual canyons was reinitiated in late Oligocene in the form of transgressive and channel-fill deposits. A new depositional hiatus is recorded onshore during the Burdigalian, coincident with the unconformity separating SS1 and SS2. This can be correlated with the Arrábida unconformity and with the paroxysmal Burdigalian phase of the Betic domain. Presently, the Setúbal and São Vicente submarine canyons locally cut SS1 and SS2, forming distinctive channels from those recognised on the seismic data. On the upper shelf both dissect highly deformed areas subject to important erosion.

L’instabilité dynamique pendant le Toarcien dans le Moyen Atlas (Maroc): mise en évidence de glissements synsédimentaires dans le synclinal de Bou Angar

During the Toarcian, shelves undergo block-faulting with mechanisms of tilting. It results the break up of the Middle Atlas basin in subsident sectors separated by resistant ridges. This device is highlighted by strong variations of facies, more or less extended lacunar zones, reefs aligned on the ridges and of synsedimentary tectonics structures. Within the framework of mapping survey carried out in the south-west of Middle Atlas, a meticulous prospection of Bou Angar synclinal allowed the description of a new outcrop of Toarcian. This one offers good examples of extensional structures and bio-accumulations. These data, supplemented by other witnesses of the dynamic instability in the rest of the Middle Atlas, permit to propose a paleogeographic map of the Middle Atlas basin during the Toarcian.

A conceptual model for sheet-flow drawn from rapid granular flow theories

33rd IAHR Congress: Water Engineering for a Sustainable Environment

Unmixing hyperspectral data: independent and dependent component analysis

The development of high spatial resolution airborne and spaceborne sensors has improved the capability of ground-based data collection in the fields of agriculture, geography, geology, mineral identification, detection [2, 3], and classification [4–8]. The signal read by the sensor from a given spatial element of resolution and at a given spectral band is a mixing of components originated by the constituent substances, termed endmembers, located at that element of resolution. This chapter addresses hyperspectral unmixing, which is the decomposition of the pixel spectra into a collection of constituent spectra, or spectral signatures, and their corresponding fractional abundances indicating the proportion of each endmember present in the pixel [9, 10]. Depending on the mixing scales at each pixel, the observed mixture is either linear or nonlinear [11, 12]. The linear mixing model holds when the mixing scale is macroscopic [13]. The nonlinear model holds when the mixing scale is microscopic (i.e., intimate mixtures) [14, 15]. The linear model assumes negligible interaction among distinct endmembers [16, 17]. The nonlinear model assumes that incident solar radiation is scattered by the scene through multiple bounces involving several endmembers [18]. Under the linear mixing model and assuming that the number of endmembers and their spectral signatures are known, hyperspectral unmixing is a linear problem, which can be addressed, for example, under the maximum likelihood setup [19], the constrained least-squares approach [20], the spectral signature matching [21], the spectral angle mapper [22], and the subspace projection methods [20, 23, 24]. Orthogonal subspace projection [23] reduces the data dimensionality, suppresses undesired spectral signatures, and detects the presence of a spectral signature of interest. The basic concept is to project each pixel onto a subspace that is orthogonal to the undesired signatures. As shown in Settle [19], the orthogonal subspace projection technique is equivalent to the maximum likelihood estimator. This projection technique was extended by three unconstrained least-squares approaches [24] (signature space orthogonal projection, oblique subspace projection, target signature space orthogonal projection). Other works using maximum a posteriori probability (MAP) framework [25] and projection pursuit [26, 27] have also been applied to hyperspectral data. In most cases the number of endmembers and their signatures are not known. Independent component analysis (ICA) is an unsupervised source separation process that has been applied with success to blind source separation, to feature extraction, and to unsupervised recognition [28, 29]. ICA consists in finding a linear decomposition of observed data yielding statistically independent components. Given that hyperspectral data are, in given circumstances, linear mixtures, ICA comes to mind as a possible tool to unmix this class of data. In fact, the application of ICA to hyperspectral data has been proposed in reference 30, where endmember signatures are treated as sources and the mixing matrix is composed by the abundance fractions, and in references 9, 25, and 31–38, where sources are the abundance fractions of each endmember. In the first approach, we face two problems: (1) The number of samples are limited to the number of channels and (2) the process of pixel selection, playing the role of mixed sources, is not straightforward. In the second approach, ICA is based on the assumption of mutually independent sources, which is not the case of hyperspectral data, since the sum of the abundance fractions is constant, implying dependence among abundances. This dependence compromises ICA applicability to hyperspectral images. In addition, hyperspectral data are immersed in noise, which degrades the ICA performance. IFA [39] was introduced as a method for recovering independent hidden sources from their observed noisy mixtures. IFA implements two steps. First, source densities and noise covariance are estimated from the observed data by maximum likelihood. Second, sources are reconstructed by an optimal nonlinear estimator. Although IFA is a well-suited technique to unmix independent sources under noisy observations, the dependence among abundance fractions in hyperspectral imagery compromises, as in the ICA case, the IFA performance. Considering the linear mixing model, hyperspectral observations are in a simplex whose vertices correspond to the endmembers. Several approaches [40–43] have exploited this geometric feature of hyperspectral mixtures [42]. Minimum volume transform (MVT) algorithm [43] determines the simplex of minimum volume containing the data. The MVT-type approaches are complex from the computational point of view. Usually, these algorithms first find the convex hull defined by the observed data and then fit a minimum volume simplex to it. Aiming at a lower computational complexity, some algorithms such as the vertex component analysis (VCA) [44], the pixel purity index (PPI) [42], and the N-FINDR [45] still find the minimum volume simplex containing the data cloud, but they assume the presence in the data of at least one pure pixel of each endmember. This is a strong requisite that may not hold in some data sets. In any case, these algorithms find the set of most pure pixels in the data. Hyperspectral sensors collects spatial images over many narrow contiguous bands, yielding large amounts of data. For this reason, very often, the processing of hyperspectral data, included unmixing, is preceded by a dimensionality reduction step to reduce computational complexity and to improve the signal-to-noise ratio (SNR). Principal component analysis (PCA) [46], maximum noise fraction (MNF) [47], and singular value decomposition (SVD) [48] are three well-known projection techniques widely used in remote sensing in general and in unmixing in particular. The newly introduced method [49] exploits the structure of hyperspectral mixtures, namely the fact that spectral vectors are nonnegative. The computational complexity associated with these techniques is an obstacle to real-time implementations. To overcome this problem, band selection [50] and non-statistical [51] algorithms have been introduced. This chapter addresses hyperspectral data source dependence and its impact on ICA and IFA performances. The study consider simulated and real data and is based on mutual information minimization. Hyperspectral observations are described by a generative model. This model takes into account the degradation mechanisms normally found in hyperspectral applications—namely, signature variability [52–54], abundance constraints, topography modulation, and system noise. The computation of mutual information is based on fitting mixtures of Gaussians (MOG) to data. The MOG parameters (number of components, means, covariances, and weights) are inferred using the minimum description length (MDL) based algorithm [55]. We study the behavior of the mutual information as a function of the unmixing matrix. The conclusion is that the unmixing matrix minimizing the mutual information might be very far from the true one. Nevertheless, some abundance fractions might be well separated, mainly in the presence of strong signature variability, a large number of endmembers, and high SNR. We end this chapter by sketching a new methodology to blindly unmix hyperspectral data, where abundance fractions are modeled as a mixture of Dirichlet sources. This model enforces positivity and constant sum sources (full additivity) constraints. The mixing matrix is inferred by an expectation-maximization (EM)-type algorithm. This approach is in the vein of references 39 and 56, replacing independent sources represented by MOG with mixture of Dirichlet sources. Compared with the geometric-based approaches, the advantage of this model is that there is no need to have pure pixels in the observations. The chapter is organized as follows. Section 6.2 presents a spectral radiance model and formulates the spectral unmixing as a linear problem accounting for abundance constraints, signature variability, topography modulation, and system noise. Section 6.3 presents a brief resume of ICA and IFA algorithms. Section 6.4 illustrates the performance of IFA and of some well-known ICA algorithms with experimental data. Section 6.5 studies the ICA and IFA limitations in unmixing hyperspectral data. Section 6.6 presents results of ICA based on real data. Section 6.7 describes the new blind unmixing scheme and some illustrative examples. Section 6.8 concludes with some remarks.