Nursing intervention versus usual care to improve delirium among home-dwelling older adults receiving homecare after hospitalization: feasibility and acceptability of a Randomized Controlled Trail.

BACKGROUND: Delirium is an acute cognitive impairment among older hospitalized patients. It can persist until discharge and for months after that. Despite proof that evidence-based nursing interventions are effective in preventing delirium in acute hospitals, interventions among home-dwelling older patients is lacking. The aim was to assess feasibility and acceptability of a nursing intervention designed to detect and reduce delirium in older adults after discharge from hospital. METHODS: Randomized clinical pilot trial with a before/after design was used. One hundred and three older adults were recruited in a home healthcare service in French-speaking Switzerland and randomized into an experimental group (EG, n = 51) and a control group (CG, n = 52). The CG received usual homecare. The EG received usual homecare plus five additional nursing interventions at 48 and 72 h and at 7, 14 and 21 days after discharge. These interventions were tailored for detecting and reducing delirium and were conducted by a geriatric clinical nurse (GCN). All patients were monitored at the start of the study (M1) and throughout the month for symptoms of delirium (M2). This was documented in patients' records after usual homecare using the Confusion Assessment Method (CAM). At one month (M2), symptoms of delirium were measured using the CAM, cognitive status was measured using the Mini-Mental State Examination (MMSE), and functional status was measured using Katz and Lawton Index of activities of daily living (ADL/IADL). At the end of the study, participants in the EG and homecare nurses were interviewed about the acceptability of the nursing interventions and the study itself. RESULTS: Feasibility and acceptability indicators reported excellent results. Recruitment, retention, randomization, and other procedures were efficient, although some potentially issues were identified. Participants and nurses considered organizational procedures, data collection, intervention content, the dose-effect of the interventions, and methodology all to be feasible. Duration, patient adherence and fidelity were judged acceptable. Nurses, participants and informal caregivers were satisfied with the relevance and safety of the interventions. CONCLUSIONS: Nursing interventions to detect/improve delirium at home are feasible and acceptable. These results confirm that developing a large-scale randomized controlled trial would be appropriate. TRIAL REGESTRATION: ISRCTN registry no: 16103589 - 19 February 2016.

A Meta-Analysis of Trabecular Bone Score in Fracture Risk Prediction and Its Relationship to FRAX.

Trabecular bone score (TBS) is a gray-level textural index of bone microarchitecture derived from lumbar spine dual-energy X-ray absorptiometry (DXA) images. TBS is a bone mineral density (BMD)-independent predictor of fracture risk. The objective of this meta-analysis was to determine whether TBS predicted fracture risk independently of FRAX probability and to examine their combined performance by adjusting the FRAX probability for TBS. We utilized individual-level data from 17,809 men and women in 14 prospective population-based cohorts. Baseline evaluation included TBS and the FRAX risk variables, and outcomes during follow-up (mean 6.7 years) comprised major osteoporotic fractures. The association between TBS, FRAX probabilities, and the risk of fracture was examined using an extension of the Poisson regression model in each cohort and for each sex and expressed as the gradient of risk (GR; hazard ratio per 1 SD change in risk variable in direction of increased risk). FRAX probabilities were adjusted for TBS using an adjustment factor derived from an independent cohort (the Manitoba Bone Density Cohort). Overall, the GR of TBS for major osteoporotic fracture was 1.44 (95% confidence interval [CI] 1.35-1.53) when adjusted for age and time since baseline and was similar in men and women (p > 0.10). When additionally adjusted for FRAX 10-year probability of major osteoporotic fracture, TBS remained a significant, independent predictor for fracture (GR = 1.32, 95% CI 1.24-1.41). The adjustment of FRAX probability for TBS resulted in a small increase in the GR (1.76, 95% CI 1.65-1.87 versus 1.70, 95% CI 1.60-1.81). A smaller change in GR for hip fracture was observed (FRAX hip fracture probability GR 2.25 vs. 2.22). TBS is a significant predictor of fracture risk independently of FRAX. The findings support the use of TBS as a potential adjustment for FRAX probability, though the impact of the adjustment remains to be determined in the context of clinical assessment guidelines. © 2015 American Society for Bone and Mineral Research.

A risk infection simulation model for fusarium head blight of wheat

Fusarium Head Blight (FHB) is a disease of great concern in wheat (Triticum aestivum). Due to its relatively narrow susceptible phase and environmental dependence, the pathosystem is suitable for modeling. In the present work, a mechanistic model for estimating an infection index of FHB was developed. The model is process-based driven by rates, rules and coefficients for estimating the dynamics of flowering, airborne inoculum density and infection frequency. The latter is a function of temperature during an infection event (IE), which is defined based on a combination of daily records of precipitation and mean relative humidity. The daily infection index is the product of the daily proportion of susceptible tissue available, infection frequency and spore cloud density. The model was evaluated with an independent dataset of epidemics recorded in experimental plots (five years and three planting dates) at Passo Fundo, Brazil. Four models that use different factors were tested, and results showed all were able to explain variation for disease incidence and severity. A model that uses a correction factor for extending host susceptibility and daily spore cloud density to account for post-flowering infections was the most accurate explaining 93% of the variation in disease severity and 69% of disease incidence according to regression analysis.

MODELING A COMPUTER APPLICATION FOR MANAGEMENT OF MAINTENANCE ACTIVITIES OF UNPAVED ROADS

ABSTRACTThis study presents a contribution to the modeling of a computer application employing a method of serviceability performance for unpaved roads, aiming the management of maintenance/restoration activities of the primary surface layer. The proposed methodology consisted of field inspections during dry (April to September) and rainy (October to March) periods, during which objective evaluations were performed to survey of defects and their densities and degrees of severity. To aid the functional classification of analyzed road sections and the determination of the defect with major influence on the serviceability of these roads, the method of serviceability performance proposed by Silva (2009)was implemented in the Visual Basic for Applications (VBA) language in Microsoft Excel software. With the use of the computer application proposed it was possible to identify among the defects analyzed in field, through the index of serviceability of the sampling unit per defect type (ISUdef), which one had the greatest influence on determining the relative serviceability index per road section (IST). The results allow us to conclude that the computer application Road achieved satisfactory results, since the objective evaluation criteria applied to road sections denotes consistency regarding their serviceability.

NATURAL REGENERATION STRATUM AS AN INDICATOR OF RESTORATION IN AREA OF ENVIRONMENTAL COMPENSATION FOR MINING LIMESTONE, MUNICIPALITY OF BARROSO, MG, BRAZIL

ABSTRACT This study was conducted in a forest under restoration process, which belongs to the company Holcim Brasil S/A, in the municipality of Barroso, state of Minas Gerais (21º00'to 22º00'S and 43º00' to 44º00'W), where 40 plots (2 x 2 m) were set, spaced at 10 m, forming eight strata parallel to the watercourse present in the area. Floristic composition and natural regeneration stratum were characterized, and the formed strata allowed evaluating whether the riparian vegetation and watercourse influence on the local regeneration. It was found 162 individuals of 13 families, 18 genera and 22 species, and 10,125 individuals/ha were estimated. Successional classes from pioneer and early secondary and zoochory dispersion syndrome prevailed among species and individuals. The watercourse and riparian vegetation did not exercise significant influence (p> 0.05) on the number of species and regenerating individuals among the different strata of the forest. The diversity index of Shannon-Wiener (H') and equability of Pielou (J') were 2.691 and 0.870, respectively. The species Psidium guajava and Myrtaceae families presented the highest VI (value of importance). Natural regeneration analysis showed the low floristic diversity in the area, suggesting that corrective management actions should be adopted.

Spatio-temporal modelling of the duration of the cotton cycle in the State Of Goiás, Brazil

The objective of this work was to develop and validate a mathematical model to estimate the duration of cotton (Gossypium hirsutum L. r. latifolium hutch) cycle in the State of Goiás, Brazil, by applying the method of growing degree-days (GD), and considering, simultaneously, its time-space variation. The model was developed as a linear combination of elevation, latitude, longitude, and Fourier series of time variation. The model parameters were adjusted by using multiple-linear regression to the observed GD accumulated with air temperature in the range of 15°C to 40°C. The minimum and maximum temperature records used to calculate the GD were obtained from 21 meteorological stations, considering data varying from 8 to 20 years of observation. The coefficient of determination, resulting from the comparison between the estimated and calculated GD along the year was 0.84. Model validation was done by comparing estimated and measured crop cycle in the period from cotton germination to the stage when 90 percent of bolls were opened in commercial crop fields. Comparative results showed that the model performed very well, as indicated by the Pearson correlation coefficient of 0.90 and Willmott agreement index of 0.94, resulting in a performance index of 0.85.

Application of fuzzy logic for the evaluation of livestock slaughtering

The fuzzy logic admits infinite intermediate logical values between false and true. With this principle, it developed in this study a system based on fuzzy rules, which indicates the body mass index of ruminant animals in order to obtain the best time to slaughter. The controller developed has as input the variables weight and height, and as output a new body mass index, called Fuzzy Body Mass Index (Fuzzy BMI), which may serve as a detection system at the time of livestock slaughtering, comparing one another by the linguistic variables "Very Low", "Low", "Average ", "High" and "Very High". For demonstrating the use application of this fuzzy system, an analysis was made with 147 Nellore beeves to determine Fuzzy BMI values for each animal and indicate the location of body mass of any herd. The performance validation of the system was based on a statistical analysis using the Pearson correlation coefficient of 0.923, representing a high positive correlation, indicating that the proposed method is appropriate. Thus, this method allows the evaluation of the herd comparing each animal within the group, thus providing a quantitative method of farmer decision. It was concluded that this study established a computational method based on fuzzy logic that mimics part of human reasoning and interprets the body mass index of any bovine species and in any region of the country.

Environmental comfort in constructions for Sindi and Guzera calves in the agreste region of the State of Paraiba, Brazil

The objective of this study was to evaluate the quality of air, bioclimatic indexes of facilities and physiological indices of Guzera and Sindhi calves, reared in climatic conditions of Agreste. The study was conducted at the experimental station of Alagoinha, PB, Brazil, using 16 calves of Sindi and Guzerá races. The average concentration of oxygen (20.85%), ammonia (1.99 ppm), carbon monoxide (<0.01 ppm), methane (0.13 ppm) and hydrogen sulfide (<0.01) within facilities, were within the limits established by the Brazilian and international standards, for both animals and workers. The bioclimatic index of temperature and humidity and the temperature of the black globe and humidity index were within the thermal comfort zone for cattle in most of the experimental period, the mean values of respiratory frequency (26.0 min mov-1) and skin temperature (32.3 °C) were higher in the hottest time of the day (1 pm) and rectal temperature (39.3 ºC) in the late afternoon (5 pm), but remained within normal ranges for the studied races. The races have good adaptability to climatic conditions in the region of the Paraibano Agreste, Brazil.

Thermal performance and concentration of gases in facilities for pigs in semiarid region from State of Paraiba - Brazil

The study was conducted in a facility for pigs during the nursery and finishing in the town of 'Montadas', in the semiarid of the state of Paraiba, Brazil, in the rainy and dry season, aiming to evaluate the concentration of oxygen, methane, carbon monoxide and ammonia, and the bioclimatic indexes: ambient temperature (AT), relative humidity (RH) and the index of black globe temperature and humidity (IBGTH). These indexes differed significantly (P>0.05) between the periods and times. The AT in the rainy season was in the thermal comfort zone(TCZ) in most of the times in the nursery; for the finishing phase, thermal discomfort occurred; during the dry season, there was thermal comfort in the nursery phase; in the finishing phase the thermal discomfort occurred at all times. In the rainy season, the IBGTH was in TCZ; in the dry season, it was above the TCZ. The RH in the rainy period was in the TCZ; in the dry season, in most of the times, below the range of the TCZ. The concentration of gases showed no differences (P > 0.05) between periods and between the times, and the carbon monoxide, hydrogen sulfide and methane were below 1.0 ppm, and the ammonia showed a mean of 5.2 ppm. None of the analyzed gases exceeded the limits established by Brazilian and international standards for animals and workers.

Spatial variability of yield and other parameters associated with pear trees

In the last few years, precision agriculture has become commonly used with many crops, particularly cereals, and there is also interest in precision horticulture. Pear is a seasonal fruit and well appreciated by Brazilian people, although it is mostly imported. Brazilian farmers are nowadays trying to increase pear production. Thus, this research aimed at mapping the yield of pear trees in order to study the spatial variability of yield as well as its comparison with spatial variability of soil and plant attributes. The experimental field had 146 pear trees, variety 'Pêra d'água', distributed on a 1.24 ha. Four harvests were performed according to the fruit ripening and from each tree; only the ripe fruits were harvested. In each harvest, all the fruits were weighed and the total yield was obtained based on the sum of each harvest. The soil attributes analyzed were P, K, Ca, Mg, pH in CaCl2, C, Cu, Zn, Fe, Mn and base saturation, and the plant attributes were fruit length, diameter and yield. Yield had low correlation with soil and plant attributes. An index of spatial variability was suggested in this study and helped in classifying levels of spatial dependence of the various soil and plant attributes: very low (fruit length); low (P, fruit diameter), medium (Mg, pH, Cu, Zn, Fe), high (Ca, K, base saturation and yield), and very high (Mn and C).

Selection of microorganisms producer of lipase for fat removal from biodiesel purification water

The objective this study has been the selection of lipase productor microorganism, for removal of oils and grease, in the pre-treatment of biodiesel wastewater washing. For this, analyses of the physicist-chemistries characteristics had been made with the wastewater of the biodiesel washing, and then it had been isolated and chosen, by means of determinations of the lipase activity. Following, it was made a test of fat biodegradation, in the conditions: pH (5.95), temperature (35 ºC), rotation (180 rpm) and ammonium sulfate as nitrogen source (3 g L-1) and establishing as variable the two microorganism preselected and the time (24; 48; 72; 96 and 120 h). The biodiesel purification wastewater had presented high potential of environmental impact, presenting a concentration of O of 6.76 g L-1. From the six isolated microbiological cultures, two microorganisms (A and B) had been selected, with enzymatic index of 0.56 and 0.57, respectively. The treatment of the wastewater using the isolated microorganism (Klebsiella oxytoca) had 80% of the fatty removal in 48 h.

Spatial influence of physical and chemical parameters on management zone definition in apple orchards

ABSTRACT Precision agriculture adoption in Brazilian apple orchards is still incipient. This study aimed at evaluating the spatial variability of certain soil properties as soil density, soil penetration resistance, electrical conductivity, yield, and fruit quality in an apple orchard through digital mapping, as well as assessing the correlation between these factors by means of geostatistics, establishing management zones. Forty representative points were set within 2.5 hectares of apple orchard, wherein soil samples were collected and analyzed, besides measurements of fruit quality (Brix degree, size or diameter, pulp firmness and color) to generate an overall index quality. We concluded that the fruit quality indexes, when isolated, did not show strong spatial dependence, unlike the index of fruit quality (FQI), derived from a combination of these parameters, allowing orchard planning according to management zones based on quality.

Construction and validation of a surgical skills assessment tool for general surgery residency program

Objective: To develop and validate an instrument for measuring the acquisition of technical skills in conducting operations of increasing difficulty for use in General Surgery Residency (GSR) programs. Methods: we built a surgical skills assessment tool containing 11 operations in increasing levels of difficulty. For instrument validation we used the face validaity method. Through an electronic survey tool (Survey MonKey(r)) we sent a questionnaire to Full and Emeritus members of the Brazilian College of Surgeons - CBC - all bearers of the CBC Specialist Title. Results: Of the 307 questionnaires sent we received 100 responses. For the analysis of the data collected we used the Cronbach's alpha test. We observed that, in general, the overall alpha presented with values near or greater than 0.70, meaning good consistency to assess their points of interest. Conclusion: The evaluation instrument built was validated and can be used as a method of assessment of technical skill acquisition in the General Surgery Residency programs in Brazil.

Anatomical and functional characteristics of the pelvic floor in nulliparous women submitted to three-dimensional endovaginal ultrasonography: case control study and evaluation of interobserver agreement

PURPOSE: To determine anatomical and functional pelvic floor measurements performed with three-dimensional (3-D) endovaginal ultrasonography in asymptomatic nulliparous women without dysfunctions detected in previous dynamic 3-D anorectal ultrasonography (echo defecography) and to demonstrate the interobserver reliability of these measurements. METHODS: Asymptomatic nulliparous volunteers were submitted to echo defecography to identify dynamic dysfunctions, including anatomical (rectocele, intussusceptions, entero/sigmoidocele and perineal descent) and functional changes (non-relaxation or paradoxical contraction of the puborectalis muscle) in the posterior compartment and assessed with regard to the biometric index of levator hiatus, pubovisceral muscle thickness, urethral length, anorectal angle, anorectal junction position and bladder neck position with the 3-D endovaginal ultrasonography. All measurements were compared at rest and during the Valsalva maneuver, and perineal and bladder neck descent was determined. The level of interobserver agreement was evaluated for all measurements. RESULTS: A total of 34 volunteers were assessed by echo defecography and by 3-D endovaginal ultrasonography. Out of these, 20 subjects met the inclusion criteria. The 14 excluded subjects were found to have posterior dynamic dysfunctions. During the Valsalva maneuver, the hiatal area was significantly larger, the urethra was significantly shorter and the anorectal angle was greater. Measurements at rest and during the Valsalva maneuver differed significantly with regard to anorectal junction and bladder neck position. The mean values for normal perineal descent and bladder neck descent were 0.6 cm and 0.5 cm above the symphysis pubis, respectively. The intraclass correlation coefficient ranged from 0.62-0.93. CONCLUSIONS: Functional biometric indexes, normal perineal descent and bladder neck descent values were determined for young asymptomatic nulliparous women with the 3-D endovaginal ultrasonography. The method was found to be reliable to measure pelvic floor structures at rest and during Valsalva, and might therefore be suitable for identifying dysfunctions in symptomatic patients.

Allelopathic effects of Rhynchosia capitata on germination and seedling growth of mungbean

Experiments were conducted to evaluate the allelopathic influence of Rhynchosia capitata on germination and seedling growth of mungbean (Vigna radiate) along with identification of the phytotoxic substances responsible for this activity. Water extracts of root, shoot, leaf, fruit and whole plant were prepared by soaking them in water in a ratio of 1:20 (w/v) for 24 h. All the extracts affected germination and seedling growth of mungbean, but higher inhibition was seen with R. capitata leaf water extracts. A linear decrease in the germination characteristics of mungbean was observed with the decrease in the concentration of leaf extract from 5% to 1%. The soil-incorporated residues (1-4% w/w) of R. capitata stimulated the growth of root and hypocotyl at low concentrations, while it inhibited their growth at higher concentrations. Rhynchosia capitata soil-incorporated residues (4% w/w) significantly reduced the seedling vigour index of mungbean in addition to their significant effect on total germination. A significant amount of water-soluble phenolic acids were found in R. capitata plant extracts. The content of total phenolic acids was higher in the leaf extract compared to that of the stem, fruit or root extracts. Two phenolic acids including vanillic acid and 4‑(hydroxymethyl) benzoic acid were found in R. capitata leaf extracts.