Promoting the use of BaP as a marker for PAH exposure in UK soils

Polycyclic aromatic hydrocarbons (PAHs) are ubiquitous environmental pollutants that frequently accumulate in soils. There is therefore a requirement to determine their levels in contaminated environments for the purposes of determining impacts on human health. PAHs are a suite of individual chemicals, and there is an ongoing debate as to the most appropriate method for assessing the risk to humans from them. Two methods predominate: the surrogate marker approach and the toxic equivalency factor. The former assumes that all chemicals in a mixture have an equivalent toxicity. The toxic equivalency approach estimates the potency of individual chemicals relative to the usually most toxic Benzo(a)pyrene. The surrogate marker approach is believed to overestimate risk and the toxic equivalency factor to underestimate risk. When analysing the risks from soils, the surrogate marker approach is preferred due to its simplicity, but there are concerns because of the potential diversity of the PAH profile across the range of impacted soils. Using two independent data sets containing soils from 274 sites across a diverse range of locations, statistical analysis was undertaken to determine the differences in the composition of carcinogenic PAH between site locations, for example, rural versus industrial. Following principal components analysis, distinct population differences were not seen between site locations in spite of large differences in the total PAH burden between individual sites. Using all data, highly significant correlations were seen between BaP and other carcinogenic PAH with the majority of r2 values > 0.8. Correlations with the European Food Standards Agency (EFSA) summed groups, that is, EFSA2, EFSA4 and EFSA8 had even higher correlations (r2 > 0.95). We therefore conclude that BaP is a suitable surrogate marker to represent mixtures of PAH in soil during risk assessments.

Desert dust deposition on Mt. Elbrus, Caucasus Mountains, Russia in 2009-2012 as recorded in snow and shallow ice core: high-resolution "provenancing", transport patterns, physical properties and soluble ionic composition

A record of dust deposition events between 2009 and 2012 on Mt. Elbrus, Caucasus Mountains derived from a snow pit and a shallow ice core is presented for the first time for this region. A combination of isotopic analysis, SEVIRI red-green-blue composite imagery, MODIS atmospheric optical depth fields derived using the Deep Blue algorithm, air mass trajectories derived using the HYSPLIT model and analysis of meteorological data enabled identification of dust source regions with high temporal (hours) and spatial (cf. 20–100 km) resolution. Seventeen dust deposition events were detected; fourteen occurred in March–June, one in February and two in October. Four events originated in the Sahara, predominantly in north-eastern Libya and eastern Algeria. Thirteen events originated in the Middle East, in the Syrian Desert and northern Mesopotamia, from a mixture of natural and anthropogenic sources. Dust transportation from Sahara was associated with vigorous Saharan depressions, strong surface winds in the source region and mid-tropospheric south-westerly flow with daily winds speeds of 20–30 m s−1 at 700 hPa level and, although these events were less frequent, they resulted in higher dust concentrations in snow. Dust transportation from the Middle East was associated with weaker depressions forming over the source region, high pressure centered over or extending towards the Caspian Sea and a weaker southerly or south-easterly flow towards the Caucasus Mountains with daily wind speeds of 12–18 m s−1 at 700 hPa level. Higher concentrations of nitrates and ammonium characterise dust from the Middle East deposited on Mt. Elbrus in 2009 indicating contribution of anthropogenic sources. The modal values of particle size distributions ranged between 1.98 μm and 4.16 μm. Most samples were characterised by modal values of 2.0–2.8 μm with an average of 2.6 μm and there was no significant difference between dust from the Sahara and the Middle East.

High-resolution provenance of desert dust deposited on Mt. Elbrus, Caucasus in 2009–2012 using snow pit and firn core records

The first record of dust deposition events on Mt. Elbrus, Caucasus Mountains derived from a snow pit and a shallow firn core is presented for the 2009–2012 period. A combination of isotopic analysis, SEVIRI red-greenblue composite imagery, MODIS atmospheric optical depth fields derived using the Deep Blue algorithm, air mass trajectories derived using the HYSPLIT model and analyses of meteorological data enabled identification of dust source regions with high temporal (hours) and spatial (ca. 20–100 km) resolution. Seventeen dust deposition events were detected; fourteen occurred in March–June, one in February and two in October. Four events originated in the Sahara, predominantly in northeastern Libya and eastern Algeria. Thirteen events originated in the Middle East, in the Syrian Desert and northern Mesopotamia, from a mixture of natural and anthropogenic sources. Dust transportation from Sahara was associated with vigorous Saharan depressions, strong surface winds in the source region and mid-tropospheric southwesterly flow with daily winds speeds of 20–30 m s−1 at 700 hPa level. Although these events were less frequent than those originating in the Middle East, they resulted in higher dust concentrations in snow. Dust transportation from the Middle East was associated with weaker depressions forming over the source region, high pressure centred over or extending towards the Caspian Sea and a weaker southerly or southeasterly flow towards the Caucasus Mountains with daily wind speeds of 12–18 m s−1 at 700 hPa level. Higher concentrations of nitrates and ammonium characterised dust from the Middle East deposited on Mt. Elbrus in 2009 indicating contribution of anthropogenic sources. The modal values of particle size distributions ranged between 1.98 µm and 4.16 µm. Most samples were characterised by modal values of 2.0– 2.8 µm with an average of 2.6 µm and there was no signifi- cant difference between dust from the Sahara and the Middle East.

The AeroCom evaluation and intercomparison of organic aerosol in global models

This paper evaluates the current status of global modeling of the organic aerosol (OA) in the troposphere and analyzes the differences between models as well as between models and observations. Thirty-one global chemistry transport models (CTMs) and general circulation models (GCMs) have participated in this intercomparison, in the framework of AeroCom phase II. The simulation of OA varies greatly between models in terms of the magnitude of primary emissions, secondary OA (SOA) formation, the number of OA species used (2 to 62), the complexity of OA parameterizations (gas-particle partitioning, chemical aging, multiphase chemistry, aerosol microphysics), and the OA physical, chemical and optical properties. The diversity of the global OA simulation results has increased since earlier AeroCom experiments, mainly due to the increasing complexity of the SOA parameterization in models, and the implementation of new, highly uncertain, OA sources. Diversity of over one order of magnitude exists in the modeled vertical distribution of OA concentrations that deserves a dedicated future study. Furthermore, although the OA / OC ratio depends on OA sources and atmospheric processing, and is important for model evaluation against OA and OC observations, it is resolved only by a few global models. The median global primary OA (POA) source strength is 56 Tg a−1 (range 34–144 Tg a−1) and the median SOA source strength (natural and anthropogenic) is 19 Tg a−1 (range 13–121 Tg a−1). Among the models that take into account the semi-volatile SOA nature, the median source is calculated to be 51 Tg a−1 (range 16–121 Tg a−1), much larger than the median value of the models that calculate SOA in a more simplistic way (19 Tg a−1; range 13–20 Tg a−1, with one model at 37 Tg a−1). The median atmospheric burden of OA is 1.4 Tg (24 models in the range of 0.6–2.0 Tg and 4 between 2.0 and 3.8 Tg), with a median OA lifetime of 5.4 days (range 3.8–9.6 days). In models that reported both OA and sulfate burdens, the median value of the OA/sulfate burden ratio is calculated to be 0.77; 13 models calculate a ratio lower than 1, and 9 models higher than 1. For 26 models that reported OA deposition fluxes, the median wet removal is 70 Tg a−1 (range 28–209 Tg a−1), which is on average 85% of the total OA deposition. Fine aerosol organic carbon (OC) and OA observations from continuous monitoring networks and individual field campaigns have been used for model evaluation. At urban locations, the model–observation comparison indicates missing knowledge on anthropogenic OA sources, both strength and seasonality. The combined model–measurements analysis suggests the existence of increased OA levels during summer due to biogenic SOA formation over large areas of the USA that can be of the same order of magnitude as the POA, even at urban locations, and contribute to the measured urban seasonal pattern. Global models are able to simulate the high secondary character of OA observed in the atmosphere as a result of SOA formation and POA aging, although the amount of OA present in the atmosphere remains largely underestimated, with a mean normalized bias (MNB) equal to −0.62 (−0.51) based on the comparison against OC (OA) urban data of all models at the surface, −0.15 (+0.51) when compared with remote measurements, and −0.30 for marine locations with OC data. The mean temporal correlations across all stations are low when compared with OC (OA) measurements: 0.47 (0.52) for urban stations, 0.39 (0.37) for remote stations, and 0.25 for marine stations with OC data. The combination of high (negative) MNB and higher correlation at urban stations when compared with the low MNB and lower correlation at remote sites suggests that knowledge about the processes that govern aerosol processing, transport and removal, on top of their sources, is important at the remote stations. There is no clear change in model skill with increasing model complexity with regard to OC or OA mass concentration. However, the complexity is needed in models in order to distinguish between anthropogenic and natural OA as needed for climate mitigation, and to calculate the impact of OA on climate accurately.

Decadal predictability of the Atlantic meridional overturning circulation and climate in the IPSL-CM5A-LR model

This study explores the decadal potential predictability of the Atlantic Meridional Overturning Circulation (AMOC) as represented in the IPSL-CM5A-LR model, along with the predictability of associated oceanic and atmospheric fields. Using a 1000-year control run, we analyze the prognostic potential predictability (PPP) of the AMOC through ensembles of simulations with perturbed initial conditions. Based on a measure of the ensemble spread, the modelled AMOC has an average predictive skill of 8 years, with some degree of dependence on the AMOC initial state. Diagnostic potential predictability of surface temperature and precipitation is also identified in the control run and compared to the PPP. Both approaches clearly bring out the same regions exhibiting the highest predictive skill. Generally, surface temperature has the highest skill up to 2 decades in the far North Atlantic ocean. There are also weak signals over a few oceanic areas in the tropics and subtropics. Predictability over land is restricted to the coastal areas bordering oceanic predictable regions. Potential predictability at interannual and longer timescales is largely absent for precipitation in spite of weak signals identified mainly in the Nordic Seas. Regions of weak signals show some dependence on AMOC initial state. All the identified regions are closely linked to decadal AMOC fluctuations suggesting that the potential predictability of climate arises from the mechanisms controlling these fluctuations. Evidence for dependence on AMOC initial state also suggests that studying skills from case studies may prove more useful to understand predictability mechanisms than computing average skill from numerous start dates.

Observations on the feeding habits of Lutzomyia longipalpis (Lutz & Neiva, 1912) (Diptera: Psychodidae: Phlebotominae) in Campo Grande, an endemic area of visceral leishmaniasis in Mato Grosso do Sul, Brazil

Sand flies were captured weekly with CDC light traps from December 2003 to November 2005 in three areas of Campo Grande, in the Brazilian state of Mato Grosso do Sul. These areas incorporated two patches of remnant forest and five houses. The blood meals of engorged female sand flies were identified using the avidin-biotin system of immunoenzymatic ELISA capture. Most (327/355) of the females analysed were Lutzomyia longipalpis, of which 66.4% reacted with human blood, 64.8% with that of birds and 8.9% with that of dogs. Females that had taken human blood predominated in the residential areas and two forest patches. The following combinations of blood were also detected for L. longipalpis in some of the samples analysed: bird + human (43.4%), bird + human + dog (6.1%). The combination bird + human + dog + pig was also found for Nyssomyia whitmani. Dogs and pigs appear to have little attractiveness for L. longipalpis. The results obtained demonstrate the eclecticism and high anthropophily of L. longipalpis and raise new questions with regard to the importance of dogs in VL epidemiology and the possible role of man as a source of infection for sand flies. (C) 2008 Elsevier B.V. All rights reserved.

Genomic and nongenomic dose-dependent biphasic effect of aldosterone on Na(+)/H(+) exchanger in proximal S3 segment: role of cytosolic calcium

Leite-Dellova DC, Oliveira-Souza M, Malnic G, Mello-Aires M. Genomic and nongenomic dose-dependent biphasic effect of aldosterone on Na(+)/H(+) exchanger in proximal S3 segment: role of cytosolic calcium. Am J Physiol Renal Physiol 295: F1342-F1352, 2008. First published August 20, 2008; doi:10.1152/ajprenal.00048.2008.-The effects of aldosterone on the intracellular pH recovery rate (pHirr) via Na(+)/H(+) exchanger and on the [Ca(2+)](i) were investigated in isolated rat S3 segment. Aldosterone [10(-12), 10(-10), or 10(-8) M with 1-h, 15- or 2-min preincubation (pi)] caused a dose-dependent increase in the pHirr, but aldosterone (10(-6) M with 1-h, 15- or 2-min pi) decreased it (these effects were prevented by HOE694 but not by S3226). After 1 min of aldosterone pi, there was a transient and dose-dependent increase of the [Ca(2+)](i) and after 6-min pi there was a new increase of [Ca(2+)](i) that persisted after 1 h. Spironolactone, actinomycin D, or cycloheximide did not affect the effects of aldosterone (15 -or 2-min pi) but inhibited the effects of aldosterone (1-h pi) on pHirr and on [Ca(2+)](i). RU 486 prevented the stimulatory effect of aldosterone (10(-12) M, 15 -or 2-min pi) on both parameters and maintained the inhibitory effect of aldosterone (10(-6) M, 15- or 2-min pi) on the pHirr but reversed its stimulatory effect on the [Ca(2+)](i) to an inhibitory effect. The data indicate a genomic (1 h, via MR) and a nongenomic action (15 or 2 min, probably via GR) on [Ca(2+)](i) and on the basolateral NHE1 and are compatible with stimulation of the NHE1 by increases in [Ca(2+)](i) in the lower range (at 10(-12) M aldosterone) and inhibition by increases at high levels (at 10(-6) M aldosterone) or decreases in [Ca(2+)](i) (at 10(-6) M aldosterone plus RU 486).

Contributions to the theory of magnetorotational instability and waves in a rotating plasma

The one-fluid magnetohydrodynamic (MHD) theory of magnetorotational instability (MRI) in an ideal plasma is presented. The theory predicts the possibility of MRI for arbitrary 0, where 0 is the ratio of the plasma pressure to the magnetic field pressure. The kinetic theory of MRI in a collisionless plasma is developed. It is demonstrated that as in the ideal MHD, MRI can occur in such a plasma for arbitrary P. The mechanism of MRI is discussed; it is shown that the instability appears because of a perturbed parallel electric field. The electrodynamic description of MRI is formulated under the assumption that the dispersion relation is expressed in terms of the permittivity tensor; general properties of this tensor are analyzed. It is shown to be separated into the nonrotational and rotational parts. With this in mind, the first step for incorporation of MRI into the general theory of plasma instabilities is taken. The rotation effects on Alfven waves are considered.

Efeitos da mal nutrição protéica sobre o metabolismo da glicina em cerebelo de ratos durante o seu desenvolvimento

Malnutrition is a worldwide problem affecting millions of unborn and young children during the most vulnerable stages of brain development (1). All restriction of protein during the perinatal period of life can alter the development of mammalian fetus and have marked repercussions on development of the Central Nervous System (CNS). The brain is vulnerable to protein malnutrition with altered morphologic and biochemical maturation, leading to impaired functions. The focus of this study is to investigate [U-14C]glycine metabolism in malnourished rats submitted to pre- and postnatal protein deprivation (diet: 8% protein with addition and without addition of L-methionine) on glycine metabolism of rats (normonourished group: 25% protein). It was observed that protein malnutrition alters oxidation to CO2, conversion to lipids and protein synthesis from [U-14C]glycine in cerebellum of malnourished rats without addition of L-methionine on a diet at 7 and 21 days of postnatal life. Our results also indicate that protein malnutrition causes a retardation in the normally ordered progression of brain development, and the malnourished groups have smaller cells, reduction in cell numbers and smaller cerebellar weight comparing to the control group.

Desenvolvimento de sistemas de informação com base em objetos de negócios : um protocolo de análise com vistas à reutilização de software

O objetivo da pesquisa atém-se primeiramente em elaborar um protocolo que permita analisar, por meio de um conjunto de indicadores, o processo de reutilização de software no desenvolvimento de sistemas de informação modelando objetos de negócios. O protocolo concebido compõe-se de um modelo analítico e de grades de análise, a serem empregadas na classificação e tabulação dos dados obtidos empiricamente. Com vistas à validação inicial do protocolo de análise, realiza-se um estudo de caso. A investigação ocorre num dos primeiros e, no momento, maior projeto de fornecimento de elementos de software reutilizáveis destinados a negócios, o IBM SANFRANCISCO, bem como no primeiro projeto desenvolvido no Brasil com base no por ele disponibilizado, o sistema Apontamento Universal de Horas (TIME SHEET System). Quanto à aplicabilidade do protocolo na prática, este se mostra abrangente e adequado à compreensão do processo. Quanto aos resultados do estudo de caso, a análise dos dados revela uma situação em que as expectativas (dos pesquisadores) de reutilização de elementos de software orientadas a negócio eram superiores ao observado. Houve, entretanto, reutilização de elementos de baixo nível, que forneceram a infra-estrutura necessária para o desenvolvimento do projeto. Os resultados contextualizados diante das expectativas de reutilização (dos desenvolvedores) são positivos, na medida em que houve benefícios metodológicos e tecnológicos decorrentes da parceria realizada. Por outro lado, constatam-se alguns aspectos restritivos para o desenvolvedor de aplicativos, em virtude de escolhas arbitrárias realizadas pelo provedor de elementos reutilizáveis.

Organizational design as an enabler for innovation: evidence from a German Mechanical Engineering Company

Over the past two decades there has been a profusion of empirical studies of organizational design and its relationship to efficiency, productivity and flexibility of an organization. In parallel, there has been a wide range of studies about innovation management in different kind of industries and firms. However, with some exceptions, the organizational and innovation management bodies of literature tend to examine the issues of organizational design and innovation management individually, mainly in the context of large firms operating at the technological frontier. There seems to be a scarcity of empirical studies that bring together organizational design and innovation and examine them empirically and over time in the context of small and medium sized enterprises. This dissertation seeks to provide a small contribution in that direction. This dissertation examines the dynamic relationship between organizational design and innovation. This relationship is examined on the basis of a single-case design in a medium sized mechanical engineering company in Germany. The covered time period ranges from 1958 until 2009, although the actual focus falls on the recent past. This dissertation draws on first-hand qualitative empirical evidence gathered through extensive field work. The main findings are: 1. There is always a bundle of organizational dimensions which impacts innovation. These main organizational design dimensions are: (1) Strategy & Leadership, (2) Resources & Capabilities, (3) Structure, (4) Culture, (5) Networks & Partnerships, (6) Processes and (7) Knowledge Management. However, the importance of the different organizational design dimensions changes over time. While for example for the production of simple, standardized parts, a simple organizational design was appropriate, the company needed to have a more advanced organizational design in order to be able to produce customized, complex parts with high quality. Hence the technological maturity of a company is related to its organizational maturity. 2. The introduction of innovations of the analyzed company were highly dependent on organizational conditions which enabled their introduction. The results of the long term case study show, that some innovations would not have been introduced successfully if the organizational elements like for example training and qualification, the build of network and partnerships or the acquisition of appropriate resources and capabilities, were not in place. Hence it can be concluded, that organizational design is an enabling factor for innovation. These findings contribute to advance our understanding of the complex relationship between organizational design and innovation. This highlights the growing importance of a comprehensive, innovation stimulating organizational design of companies. The results suggest to managers that innovation is not only dependent on a single organizational factor but on the appropriate, comprehensive design of the organization. Hence manager should consider to review regularly the design of their organizations in order to maintain a innovation stimulating environment.

As duas faces das técnicas de gestão: aprendizagem e inovação evidências de empresa do setor siderúrgico no Brasil

Ao longo dos últimos 20 anos tem havido uma profusão de estudos que examinam, no âmbito de empresas, a contribuição dos mecanismos de aprendizagem e da adoção de técnicas de gestão para o processo de acumulação tecnológica. No entanto, ainda são escassos os estudos que examinem, de maneira conjunta e sob uma perspectiva dinâmica, o relacionamento entre a adoção de técnicas de gestão, mecanismos de aprendizagem e trajetórias de acumulação de capacidades tecnológicas. Mais que isto, faltam estudos que examinem o duplo papel das técnicas de gestão, ora como parte do estoque de capacidades tecnológicas, ora como um processo de aprendizagem tecnológica em si. Esta dissertação objetiva oferecer uma contribuição para preencher esta lacuna neste campo de estudo. O enfoque desta dissertação deriva de observações empíricas, realizadas em empresas, e inspira-se no clássico estudo Innovation and Learning: the two faces of R&D, de Cohen e Levinthal (1989). Assim a dissertação baseia-se em um estudo de caso individual, realizado em uma empresa do setor siderúrgico no Brasil, no período de 1984 a 2008, examinando estas questões à luz de modelos analíticos disponíveis na literatura internacional. Neste sentido, adotou-se o entendimento de capacidade tecnológica como o conjunto de recursos necessários para gerar e gerir mudanças tecnológicas, sendo construída e acumulada de forma gradual, a partir do engajamento em processos de aprendizagem e da coordenação de bases de conhecimentos acumulados em diferentes dimensões, simbioticamente relacionadas. As métricas utilizadas identificam tipos e níveis de capacidade tecnológica para diferentes funções e identifica quatro tipos de processos de aprendizagem tecnológica e os avalia em termos de suas características-chave. Tomando-se por base evidências empíricas qualitativas e quantitativas, colhidas em primeira mão, a base de trabalho de campo, este estudo verificou que: 1. A empresa acumulou níveis inovativos de capacidades tecnológicas em todas as funções examinadas, sendo o nível Inovativo Intermediário (Nível 5) nas funções Engenharia de Projetos (de forma incompleta) e Equipamentos e o nível Intermediário Avançado (Nível 6) nas funções Processos e Organização da Produção e Produtos. 2. Os mecanismos de aprendizagem subjacentes à acumulação destes níveis de capacidade tecnológica apresentaram resultados relevantes em termos de suas características-chave, principalmente no que diz respeito à variedade e intensidade: de 24 mecanismos em 1984 para um total de 59 em 2008, com uma variação de 145,8%, e com 56 dos 59 mecanismos (94,92%) utilizados atualmente de forma sistemática. 3. O período compreendido entre os anos de 1990 e 2004, no qual foram implementadas as técnicas de gestão estudadas, exceto o Plano de Sugestões, se caracteriza por apresentar a maior taxa de acumulação de capacidades tecnológicas e por dar início à utilização da quase totalidade dos 35 novos mecanismos de aprendizagem incorporados pela empresa após o início de suas operações (1984). E que as técnicas de gestão estudadas: 1. Colaboraram para o processo de aprendizagem tecnológica da AMBJF, principalmente pela necessidade de se: (i) incorporar novos mecanismos de aprendizagem que lhe permitissem acumular, antecipadamente, a base de conhecimentos necessária à implementação das técnicas de gestão estudadas; (ii) coordenar um número maior de mecanismos que dessem o adequado suporte ao aumento da complexidade de seu Sistema de Gestão Integrada (SOl). 2. Ampliaram, por si, o estoque de capacidades tecnológicas da empresa, maIS especificamente em sua dimensão organizacional, a partir da acumulação de conhecimento em procedimentos, instruções de trabalho, manuais, processos e fluxos de gestão e de produção, dentre outros. Desta forma, os resultados aqui encontrados confirmam que a adoção e a implementação das técnicas de gestão estudadas contribuíram com e influenciaram o processo de aprendizagem tecnológica e a trajetória de acumulação tecnológica da empresa, ao mesmo tempo, exercendo, portanto, um duplo papel na organização. Esta conclusão nos leva a um melhor entendimento do tema e pode contribuir para a compreensão de ações políticas e gerenciais que possam acelerar a acumulação de capacidades tecnológicas, entendendo a relevância das técnicas de gestão menos em termos de sua "mera" adoção e mais do seu processo de implementação.

Incidência de eventos adversos em uma coorte de hipertensos

Introdução: A hipertensão é fator de risco importante para doenças cardiovasculares, mas o controle da pressão arterial é insatisfatório. Um dos motivos para o controle inadequado é a fraca adesão entre os pacientes que recebem antihipertensivos, parcialmente explicada pela ocorrência de eventos adversos. A incidência de eventos adversos chega a 28% em ensaios clínicos, mas a real magnitude do problema na prática assistencial é pouco conhecida. Métodos: Realizou-se um estudo de coorte prospectivamente planejado, acompanhada de 1989 a 2000, no ambulatório de hipertensão arterial do Hospital de Clínicas de Porto Alegre (Divisão de Cardiologia e Farmacologia Clínica do HCPA). Os objetivos foram, determinar a incidência de eventos adversos (EA) relacionadas à terapia anti-hipertensiva, referidos por pacientes hipertensos, descrever os EA mais freqüentes e os fatores de risco para ocorrência de EA. Em cada consulta, os pacientes eram indagados sobre a presença de evento adverso e, no caso de resposta positiva, era aplicada uma lista dirigida a eventos adversos específicos. Resultados: De 1957 pacientes da coorte, 1508 preencheram os critérios de inclusão e foram seguidos por 12,3 ± 12,2 meses (mediana, 10 meses), resultando em 18548 pacientes/mês. Entre todos os pacientes incluídos, 534 (35,4%) apresentaram pelo menos uma queixa de evento adverso durante o acompanhamento, resultando em 28,8 pacientes com EA /1000 pacientes/mês (IC 95% 26,4 a 31,3). Entre os pacientes em tratamento farmacológico (1366), a incidência foi de 31,3 pacientes com EA /1000 pacientes/mês (IC 95% 28,6 a 33,9) e, entre aqueles em uso de monoterapia, de 29,6 pacientes com EA /1000 pacientes / mês ( IC 95% 22,3 a 36,9). Os pacientes em uso de mais de um anti-hipertensivo apresentaram risco relativo bruto para eventos adversos de 2,10 (IC 95% 1,67 a 2,63). Houve associação entre a classe do anti-hipertensivo usado em monoterapia e a ocorrência de eventos adversos em algum momento do seguimento (P < 0,001), os quais foram mais freqüentes com bloqueadores dos canais de cálcio comparados aos tiazídicos e betabloqueadores. Entre as queixas específicas, tontura (P = 0,007), cefaléia (P = 0,003) e problemas sexuais (P= 0,045) foram mais freqüentes no primeiro grupo. Conclusões: O presente estudo descreveu a incidência de eventos adversos em uma coorte de pacientes hipertensos de um ambulatório especializado, confirmando dados de estudos observacionais e ensaios clínicos que indicam que estes são problemas freqüentes. O uso de mais de um anti-hipertensivo aumenta significativamente o risco de eventos adversos e, entre as classes de antihipertensivos usados em monoterapia, os tiazídicos mostram-se os mais seguros.

Estudo da viabilidade técnica para obtenção de superfície duplex em aço inoxidável martensítico AISI 410 através do processo de deposição a plasma por gaiola catódica

The technique of plasma nitriding by the cathode cage mainly stands out for its ability to produce uniform layers, even on parts with complex geometries. In this study, it was investigated the efficiency of this technique for obtaining duplex surface, when used, simultaneously, to nitriding treatment and thin film deposition at temperatures below 500°C. For this, were used samples of AISI 41 0 Martensitic Stainless Steel and performed plasma treatment, combining nitriding and deposition of thin films of Ti and/or TiN in a plasma atmosphere containing N2-H2. It was used a cathodic cage of titanium pure grade II, cylindrical with 70 mm diameter and 34 mm height. Samples were treated at temperature 420ºC for 2 and 12 hours in different working pressures. Optical Microscopy (OM), Scanning Electron Microscopy (SEM) with micro-analysis by Energy Dispersive Spectroscopy (EDS), X-Ray Diffraction (XRD), Atomic Force Microscopy (AFM) and analysis of Vickers Microhardness were used to investigate coating properties such as homogeneity and surface topography, chemical composition, layer thickness, crystalline phase, roughness and surface microhardness. The results showed there is a direct proportionality between the presence of H2 in plasma atmosphere and the quantity of titanium in surface chemical composition. It was also observed that the plasma treatment at lowpressure is more effective in formation of TiN thin film

Redução da morbi-mortalidade na síndrome de hellp completa com o uso de altas doses de dexametasona

Objective: To determine the clinical maternal and neonatal outcomes in HELLP syndrome patients treated with dexamethasone who either developed renal injury or renal insufficiency and to identify predictive values of urea and creatinine for the identification of subjects with HELLP syndrome at risk of developing renal insufficiency. Methods: Non-radomized intervention study of dexamethasone use in HELLP syndrome. A total of 62 patients were enrolled at Maternidade Escola Januário Cicco (MEJC). Patients received a total of 30 mg of dexamethasone IV, in three doses of 10 mg every 12 hours. A clinical and laboratory follow up were performed at 24, 48 and 72 hours. Patients were followed up to 6 months after delivery. Patients were grouped in accordance to renal function, i.e, normal and some type of renal lesion. Renal lesion was considered when creatinine was equal or greater than 1.3 mg/dl and diuresis less than 100 ml in 4 hours period and renal insufficiency was defined when dialysis was needed. Results: A total of 1230 patients with preeclampsia were admitted at MEJC. Of those 62 (5%) developed HELLP syndrome. There was no statistical difference in the groups with renal involvement or normal renal function with respect to the demographics, type of anesthesia used and delivery, and weight of the newborn. An improvement in the AST, ALT, LDH, haptoglobine, antithrombine, fibrinogenen and platelets was observed within 72 hours after dexamethosone use. There was a significant increase in the diuresis within the interval of 6 hours before the delivery and 24 hours after it. Of the 62 patients, 46 (74. 2%) had normal renal function and 16 (25.8%) evolved with renal lesion, with 5 (8.1%) needing dialysis. These 5 patients who received dialysis recovered the xi renal function. The delay in administering dexamethasone increased in 4.6% the risk of development of renal insufficiency. Patients with renal insufficiency had received significantly more blood products than subjects without renal lesion (p=0.03). Diuresis, leukocytes, uric acid, urea, creatinine were significantly different between the groups with normal renal function, renal lesion and renal insufficiency. The levels of creatinine 1.2mg/dl and uric acid 51mg/dl, at admission are predictive of subjects who will evolve with renal lesion (p<0.001). Maternal mortality was 3.2%. None of the subjects with renal insufficiency evolved with chronic renal disease. Conclusions: Dexamethasone in patients with HELLP syndrome seems to reduce significantly the hepatic microthrombosis and normalize hemostasis as seen by improvement of liver function. Renal injury can be considered, in HELLP syndrome, when creatinine levels are greater than 1.3 mg/dl and diuresis less than 100 ml/h in interval of 4 hours. The level of creatinine greater than 1.2 mg/dl and urea greater than 51mg/dl are predictive of subjects with HELLP syndrome who will develop renal injury. Patients who receive more red cell packs develop renal insufficiency. Finally, the delay in administering dexamethasone increases the risk of developing renal insufficiency