A multicentre randomized controlled trial of an empowerment-inspired intervention for adolescents starting continuous subcutaneous insulin infusion : a study protocol

Background. Continuous subcutaneous insulin infusion (CSII) treatment among children with type 1 diabetes is increasing in Sweden. However, studies evaluating glycaemic control in children using CSII show inconsistent results. Omitting bolus insulin doses using CSII may cause reduced glycaemic control among adolescents. The distribution of responsibility for diabetes self-management between children and parents is often unclear and needs clarification. There is much published support for continued parental involvement and shared diabetes management during adolescence. Guided Self-Determination (GSD) is an empowerment-based, person-centred, reflection and problem solving method intended to guide the patient to become self-sufficient and develop life skills for managing difficulties in diabetes self-management. This method has been adapted for adolescents and parents as Guided Self-Determination-Young (GSD-Y). This study aims to evaluate the effect of an intervention with GSD-Y in groups of adolescents starting on insulin pumps and their parents on diabetes-related family conflicts, perceived health and quality of life (QoL), and metabolic control. Here, we describe the protocol and plans for study enrolment. Methods. This study is designed as a randomized, controlled, prospective, multicentre study. Eighty patients between 12-18 years of age who are planning to start CSII will be included. All adolescents and their parents will receive standard insulin pump training. The education intervention will be conducted when CSII is to be started and at four appointments in the first 4 months after starting CSII. The primary outcome is haemoglobin A1c levels. Secondary outcomes are perceived health and QoL, frequency of blood glucose self-monitoring and bolus doses, and usage of carbohydrate counting. The following instruments will be used to evaluate perceived health and QoL: Disabkids, 'Check your health', the Diabetes Family Conflict Scale and the Swedish Diabetes Empowerment Scale. Outcomes will be evaluated within and between groups by comparing data at baseline, and at 6 and 12 months after starting treatment. Results and discussion. In this study, we will assess the effect of starting an insulin pump together with the model of Guided Self-Determination to determine whether this approach leads to retention of improved glycaemic control, QoL, responsibility distribution and reduced diabetes-related conflicts in the family. Trial registration: Current controlled trials: ISRCTN22444034

Mother’s experiences and perceptions of a continuous caring model with fathers after caesarean section : a qualitative study

Background: In Chile, mothers and newborns are separated after caesarean sections. The caesarean section rate in Chile is approximately 40%. Once separated, newborns will miss out on the benefits of early contact unless a suitable model of early newborn contact after caesarean section is initiated. Aim: To describe mothers experiences and perceptions of a continuous parental model of newborn care after caesarean section during mother-infant separation. Methods: A questionnaire with 4 open ended questions to gather data on the experiences and perceptions of 95 mothers in the obstetric service of Sótero Del Rio Hospital in Chile between 2009 and 2012. Data were analyzed using qualitative content analysis. Results: One theme family friendly practice after caesarean section and four categories. Mothers described the benefits of this model of caring. The fathers presence was important to mother and baby. Mothers were reassured that the baby was not left alone with staff. It was important for the mothers to see that the father could love the baby as much as the mother. This model of care helped create ties between the father and newborn during the period of mother-infant separation and later with the mother. Conclusions: Family friendly practice after caesarean section was an important health care intervention for the whole family. This model could be stratified in the Chilean context in the case of complicated births and all caesarean sections. Clinical Implications: In the Chilean context, there is the potential to increase the number of parents who get to hold their baby immediately after birth and for as long as they like. When the mother and infant are separated after birth, parents can be informed about the benefits of this caring model. Further research using randomized control trials may support biological advantages.

Just which Reality do you Mean? Users' Experiences of Virtual Spaces

Virtual Reality is a relatively new technology in the relatively young field of computer science. The design of Virtual Reality has only recently come into discussion, as well as the implications for this sort of design. I hope to determine how a user can work most efficiently and accurately in a Virtual World. By studying this, I hope to help in the standardization of Virtual Reality design.

On equilibrium prices in continuous time

We combine general equilibrium theory and théorie générale of stochastic processes to derive structural results about equilibrium state prices.

Effects of rainfall on water quality in six sequentially disposed fishponds with continuous water flow

O estudo foi efetuado durante o período de chuva (dezembro-fevereiro) em seis viveiros de produção semi-intensiva de peixes, a fim de avaliar o efeito da chuva na qualidade da água de viveiros que apresentam fluxo contínuo de água, a qual é passada de um viveiro para outro sem tratamento prévio. Foram amostrados oito pontos de coleta nas saídas dos viveiros. O viveiro P1 (próximo à nascente) apresentou as menores concentrações físicas e químicas da água e as maiores no viveiro P4 (considerado um ponto crítico recebendo material alóctone proveniente de outros viveiros e do escoamento do setor de criação de rãs). A disposição seqüencial dos viveiros estudados promoveu aumento nas concentrações dos nutrientes, clorofila-a e condutividade. As chuvas características desta época do ano aumentaram o fluxo de água nos viveiros e conseqüentemente, carreando material particulado e dissolvido de um viveiro para outro e, promovendo um aumento das variáveis limnológicas em direção do P3 ao P6. Os resultados sugerem que a chuva no período de estudo afetou positivamente a qualidade da água dos viveiros estudados, porém, como os sistemas analisados estão dispostos em distribuição seqüencial e escoamento constante da água de viveiros e tanques paralelos sem tratamento prévio, cuidados devem ser averiguados para que o aumento do fluxo de água provocado pelas chuvas não tenha efeito adverso nos viveiros estudados.

Continuous infusion of ketamine in hypovolemic dogs anesthetized with desflurane

Objective: To evaluate the cardiorespiratory effects of continuous infusion of ketamine in hypovolemic dogs anesthetized with desflurane.Design: A prospective experimental study.Animals: Twelve mixed breed dogs allocated into 2 groups: saline (n=6) and ketamine (n=6).Interventions: After obtaining baseline measurements (time [T] 0) in awake dogs, hypovolemia was induced by the removal of 40 mL of blood/kg over 30 minutes. Anesthesia was induced and maintained with desflurane (1.5 minimal alveolar concentration) and 30 minutes later (T75) a continuous intravenous (IV) infusion of saline or ketamine (100 mu g/kg/min) was initiated. Cardiorespiratory evaluations were obtained 15 minutes after hemorrhage (T45), 30 minutes after desflurane anesthesia, and immediately before initiating the infusion (T75), and 5 (T80), 15 (T90), 30 (T105) and 45 (T120) minutes after beginning the infusion.Measurements and main results: Hypovolemia (T45) reduced the arterial blood pressures (systolic arterial pressure, diastolic arterial pressure [DAP] and mean arterial pressure [MAP]), cardiac (CI) and systolic (SI) indexes, and mean pulmonary arterial pressure (PAP) in both groups. After 30 minutes of desflurane anesthesia (T75), an additional decrease of MAP in both groups was observed, heart rate was higher than T0 at T75, T80, T90 and T105 in saline-treated dogs only, and the CI was higher in the ketamine group than in the saline group at T75. Five minutes after starting the infusion (T80), respiratory rate (RR) was lower and the end-tidal CO(2) (ETCO(2)) was higher compared with values at T45 in ketamine-treated dogs. Mean values of ETCO(2) were higher in ketamine than in saline dogs between T75 and T120. The systemic vascular resistance index (SVRI) was decreased between T80 and T120 in ketamine when compared with T45.Conclusions: Continuous IV infusion of ketamine in hypovolemic dogs anesthetized with desflurane induced an increase in ETCO(2), but other cardiorespiratory alterations did not differ from those observed when the same concentration of desflurane was used as the sole anesthetic agent. However, this study did not evaluate the effectiveness of ketamine infusion in reducing desflurane dose requirements in hypovolemic dogs or the cardiorespiratory effects of ketamine-desflurane balanced anesthesia.

Comparison between two methods for cardiac output measurement in propofol-anesthetized dogs: thermodilution and Doppler

ObjectiveTo compare cardiac output (CO) measured by Doppler echocardiography and thermodilution techniques in spontaneously breathing dogs during continuous infusion of propofol. To do so, CO was obtained using the thermodilution method (CO(TD)) and Doppler evaluation of pulmonary flow (CO(DP)) and aortic flow (CO(DA)).Study designProspective cohort study.AnimalsEight adult dogs weighing 8.3 +/- 2.0 kg.MethodsPropofol was used for induction (7.5 +/- 1.9 mg kg-1 IV) followed by a continuous rate infusion at 0.7 mg kg-1 minute-1. The animals were positioned in left lateral recumbency on an echocardiography table that allowed for positioning of the transducer at the 3rd and 5th intercostal spaces of the left hemithorax for Doppler evaluation of pulmonary and aortic valves, respectively. CO(DP) and CO(DA) were calculated from pulmonary and aortic velocity spectra, respectively. A pulmonary artery catheter was inserted via the jugular vein and positioned inside the lumen of the pulmonary artery in order to evaluate CO(TD). The first measurement of CO(TD), CO(DP) and CO(DA) was performed 30 minutes after beginning continuous infusion (T0) and then at 15-minute intervals (T15, T30, T45 and T60). Numeric data were submitted to two-way anova for repeated measurements, Pearson's correlation coefficient and Bland & Altman analysis. Data are presented as mean +/- SD.ResultsAt T0, CO(TD) was lower than CO(DA). CO(DA) was higher than CO(TD) and CO(DP) at T30, T45 and T60. The difference between the CO(TD) and CO(DP), when all data were included, was -0.04 +/- 0.22 L minute-1 and Pearson's correlation coefficient (r) was 0.86. The difference between the CO(TD) and CO(DA) was -0.87 +/- 0.54 L minute-1 and r = 0.69. For CO(TD) and CO(DP), the difference was -0.82 +/- 0.59 L minute-1 and r = 0.61.ConclusionDoppler evaluation of pulmonary flow was a clinically acceptable method for assessing the CO in propofol-anesthetized dogs.

Comparative validation using quantitative real-time PCR (qPCR) and conventional PCR of bovine semen centrifuged in continuous density gradient

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

Microbiology quality in continuous water flow fish ponds

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

A estética da Commedia dell Arte: contribuições para o ensino das Artes Cênicas

Theatrical phenomenon borned in the Italy the Comedy dell Art concerned to it climax in the XVI century and spreading itself by the word than can be sight like the theatre base modern. Lasting parallel the conventional theatre since the three hundred years, this gender influenced significativly the making theatrical in the Europe graces the popular character of its simulation turned for the improvise. In spite of treat a theatric manifestation no more existing in the present time, we understand that the Comedy dell Art was constituted in one artistic language whose esthetics centralized in the popular fanciful and in the improvise permitted a rich possibility of verbal and not-verbal communication that today can to be taken again in contemporary productions theatricals. Departing of an approach of esthetics, this work has with purpose concentrate the references esthetics that configure that one artistic manifestation such that one references can contribute for the Arts teaches in the present times. We appeal the text and image of Comedy dell Art, such this historical reference that in context, with fountain investigated that mean and if complementary in one esthetic reflection for the creation of meaning diverse and news interpretations for the purpose investigated if having with base some analysis categories such as: the actor s body, the actuations spaces and the esthetics categories such the ugly, the comic and the absurd. To investigate the Comedy dell Art esthetic in the ambit of the teach of Arts Scenics is a manner of be understand the artistic universe of three century behind that can be meant, revived, in the marking possibilities of an art teach able to incentive the critical, the appreciation, the discussion and the transgression of instituted true. Having investigated the exhibition Comedy dell Art esthetic we rebound four stich that we judge significative for we think the Arts Scenics teach, they are: the articulation between actor s body, the text and the space actuation in the play; statement what it is given between actor s body and the on-looker and the every gesture that did share of scene in a popular scenic space; a conception actor s body that transgress with the true duty socially that is capable the to admit its dimension Dionysian, creative and ambiguous in the to do theatrical; the text conception that get beyond the ambit the word writing by the dramatist and talked by actors, if spreading the other elements significance in the scene like gesture, the parody, the recent news, the gags and the word used in the day-to-day; the scenic space like a statement symbolic between actors and on-looker that make a quality of amusement pact supported by the scenic true of artist that actuate in not usual spaces bid at an auctioning degrees of participation in the building the scenic phenomenon; and the importance of esthetics categories such as the ugly, the comic and the absurd, those categories that foundation like a do scenic transgressor make a possible exchange mutual between actor and appreciator. The statement of esthetics categories in joint continuous between the body, the text and the scenic space evident themselves in doing theatrical and in the its appreciation. We believe that the reflection esthetic about the Comedy dell Art in the arts class, consider the stich detached, can favor possibilities of to share discovery, ideas, feelings and attitudes, and can permit the observation of different stich of view, establishing the statement of individual with the group in a participative and democratic form

Sward canopy structure and performance of beef heifers under supplementation in Brachiaria brizantha cv. Marandu pastures maintained with three grazing intensities in a continuous stocking system

The objective of this study was to assess the sward canopy structure of Brachiaria brizantha cv. Marandu pastures maintained in three grazing intensities under continuous stocking system during the rainy season, along with the behavior and performance of grazing beef heifers supplemented with mineral salt or an energy/protein supplement. Three levels of forage allowance were assessed: 2.0, 2.5 and 3.0 kg of forage/kg of live weight, combined with two supplements (ad libitum mineral salt, and an energy/protein supplement at 0.3% of live weight/day, supplied daily). The experiment was designed as a randomized block study with two replications. The supplements did not influence the variables related to the canopy structure. Canopy height was greater at higher forage allowances during the late summer and early fall. Similarly, the stem mass was greater in pastures with higher forage allowances. Animals fed protein supplement spent less time grazing than animals supplemented with mineral salt. Stocking rate was higher in pastures with lower forage allowance levels, which increased the live weight gain per grazing area. Daily weight gain did not vary according to the forage allowance levels. The use of an energy/protein supplement did not affect the stocking rate; however, it increased individual live weight gain and live weight gain per grazing area compared with mineral salt supplementation. The use of energy/protein supplements is an efficient alternative to enhance animal performance and production under grazing systems during the rainy season

Dogs can detect scat samples more efficiently than humans: an experiment in a continuous Atlantic Forest remnant

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Canopy characteristics and behavior of Nellore heifers in Brachiaria brizantha pastures under different grazing heights at a continuous stocking rate

The objective of this study was to evaluate the Brachiaria brizantha cv. Marandu canopy structure maintained at different grazing heights under a continuous stocking rate and with a dietary supplementation strategy for the animals during the rainy season. This study also intended to observe the relationships of these variables with the grazing behaviors of the heifers. The effects of three canopy heights (15, 25 and 35 cm) were evaluated in association with three types of supplements: one mineral and two protein/energy supplements, the first with a high rumen degradable protein and energy and the others with a low ratio. Both the protein/energy supplements were provided at 0.3% of body weight/day. The experimental design was completely randomized, with two replications and repeated measures, and took place during the period from January to April 2008. The supplementation strategies did not affect any variable related to the canopy structure. Total and green herbage masses and the ratio of green/dead material increased with canopy height. The leaf/stem ratio was higher in the lowest canopy height: 15 cm. Changes in the canopy structure caused variations in the grazing behavior of the animals. Animals maintained in the 15-cm-tall pasture grazed for a longer time, increasing the time for each meal, but the number of meals was lower than that of the animals grazing within the 35-cm-tall pasture. The grazing time of animals receiving the energy/protein supplement was lower only in the period of the day during which it was supplied. Canopy structure is affected by sward height, and changes animal behavior. Supplementation does not affect the canopy structure of the pastures with similar heights.

Estimates for the Poisson kernel and Hardy spaces on compact manifolds

We study Hardy spaces on the boundary of a smooth open subset or R-n and prove that they can be defined either through the intrinsic maximal function or through Poisson integrals, yielding identical spaces. This extends to any smooth open subset of R-n results already known for the unit ball. As an application, a characterization of the weak boundary values of functions that belong to holomorphic Hardy spaces is given, which implies an F. and M. Riesz type theorem. (C) 2004 Elsevier B.V. All rights reserved.