STRUCTURAL AND FUNCTIONAL CORRELATES OF EXERCISE VENTILATORY INEFFICIENCY IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE PATIENTS WITH MILD-TO-MODERATE SPIROMETRIC ABNORMALITIES

Background: Individuals with chronic obstructive pulmonary disease (COPD) have higher than normal ventilatory equivalents for carbon dioxide (VE/VCO2) during exercise. There is growing evidence that emphysema on thoracic computed tomography (CT) scans is associated with poor exercise capacity in COPD patients with only mild-to-moderate airflow obstruction. We hypothesized that emphysema is an underlying cause of microvascular dysfunction and ventilatory inefficiency, which in turn contributes to reduced exercise capacity. We expected ventilatory inefficiency to be associated with a) the extent of emphysema; b) lower diffusing capacity for carbon monoxide; c) a reduced pulmonary blood flow response to exercise; and d) reduced exercise capacity. Methods: In a cross-sectional study, 19 subjects with mild-to-moderate COPD (mean ± SD FEV1= 82 ± 13% predicted, 12 GOLD grade 1) and 26 age-, sex-, and activity-matched controls underwent a ramp-incremental symptom-limited exercise test on a cycle ergometer. Ventilatory inefficiency was assessed by the minimum VE/VCO2 value (nadir). A subset of subjects also completed repeated constant work rate exercise bouts with non-invasive measurements of pulmonary blood flow. Emphysema was quantified as the percentage of attenuation areas below -950 Housefield Units on CT scans. An electronic scoresheet was used to keep track of emphysema sub-types. Results: COPD subjects typically had centrilobular emphysema (76.8 ± 10.1% of total emphysema) in the upper lobes (upper/lower lobe ratio= 0.82 ± 0.04). They had lower peak oxygen uptake (VO2), higher VE/VCO2 nadir and greater dyspnea scores than controls (p<0.05). Lower peak O2 and worse dyspnea were found in COPD subjects with VE/VCO2 nadirs ≥ 30. COPD subjects had blunted increases in pulmonary blood flow from rest to iso-VO2 exercise (p<0.05). Higher VE/VCO2 nadir in COPD subjects correlated with emphysema severity (r= 0.63), which in turn correlated with reduced lung diffusing capacity (r= -0.72) and blunted changes in pulmonary blood flow from rest to exercise (r= -0.69) (p<0.01). Conclusions: Ventilation “wasted” in emphysematous areas is associated with reduced exercise ventilatory efficiency in mild-to-moderate COPD. Exercise ventilatory inefficiency links structure (emphysema) and function (gas transfer) to a key clinical outcome (reduced exercise capacity) in COPD patients with modest spirometric abnormalities.

Modelo basado en ITIL para la Gestión de los Servicios de TI en la Cooperativa de Caficultores de Manizales

Esta tesis comprende el diseño de un modelo para la Gestión de los servicios de TI acorde con las necesidades del área de tecnología de información de la Cooperativa de Caficultores de Manizales. El modelo se fundamenta en ITIL por ser el más completo de los referentes de ITSM actualmente, el cual pretende la medición y la mejora continua de la calidad de los servicios ofrecidos por el Área de TI, tanto desde la perspectiva del cliente como de la organización. El modelo fue desarrollado según la metodología mencionada, soportada en el Ciclo Deming, enfocado a la mejora continua de procesos y columna vertebral del ciclo de vida del servicio propuesto por ITIL. Inicialmente se realizó el diagnóstico de los procesos y la Gestión de Servicios de TI desarrollados por el área. En segundo lugar, se determinaron los elementos relevantes de ITIL aplicables al área de TI, evaluando el nivel de madurez actual y deseada de los procesos, apoyado en el modelo CMMI. En tercer lugar, fue elaborada la mejora de la adaptación de los procesos seleccionados fundamentados en ITIL, estructurándose procesos, roles, funciones y métricas. Finalmente, la propuesta se valida mediante la aplicación en el Servicio de Soporte a usuarios, derivándose los procesos ITIL de Gestión de Incidentes y Gestión de Peticiones. Dado que ITIL es un marco de trabajo que permite ser implementado de acuerdo con los requerimientos de la organización, la aplicación de este modelo puede ser realizado en otro tipo de organizaciones, adicionalmente que agrega valor a través de las áreas de TI.

A imaginação na pedagogia

p. 11-17

Titanium dioxide based nanomaterials for photocatalytic water treatment

Water treatment using photocatalysis has gained extensive attention in recent years. Photocatalysis is promising technology from green chemistry point of view. The most widely studied and used photocatalyst for decomposition of pollutants in water under ultraviolet irradiation is TiO2 because it is not toxic, relatively cheap and highly active in various reactions. Within this thesis unmodified and modified TiO2 materials (powders and thin films) were prepared. Physico-chemical properties of photocatalytic materials were characterized with UV-visible spectroscopy, scanning electron microscopy (SEM), transmission electron microscopy (TEM), X-ray photoelectron spectrometry (XPS), inductively coupled plasma optical emission spectroscopy (ICP-OES), ellipsometry, time-of-flight secondary ion mass spectrometry (ToF-SIMS), Raman spectroscopy, goniometry, diffuse reflectance measurements, thermogravimetric analysis (TGA) and nitrogen adsorption/desorption. Photocatalytic activity of prepared samples in aqueous environment was tested using model compounds such as phenol, formic acid and metazachlor. Also purification of real pulp and paper wastewater effluent was studied. Concentration of chosen pollutants was measured with high pressure liquid chromatography (HPLC). Mineralization and oxidation of organic contaminants were monitored with total organic carbon (TOC) and chemical oxygen demand (COD) analysis. Titanium dioxide powders prepared via sol-gel method and doped with dysprosium and praseodymium were photocatalytically active for decomposition of metazachlor. The highest degradation rate of metazachlor was observed when Pr-TiO2 treated at 450ºC (8h) was used. The photocatalytic LED-based treatment of wastewater effluent from plywood mill using commercially available TiO2 was demonstrated to be promising post-treatment method (72% of COD and 60% of TOC was decreased after 60 min of irradiation). The TiO2 coatings prepared by atomic layer deposition technique on aluminium foam were photocatalytically active for degradation of formic and phenol, however suppression of activity was observed. Photocatalytic activity of TiO2/SiO2 films doped with gold bipyramid-like nanoparticles was about two times higher than reference, which was not the case when gold nanospheres were used.

Acilquinolina y acilfosfina complejos de Rodio (III). Síntesis, caracterización y actividad catalítica

338 p.+ anexos

School participation of students with autism spectrum disorders

This paper addresses the participation of students with autism spectrum disorders (ASD) in main- stream schools. There are different benefits for ASD students to be educated in an inclusive environment (Gena, 2006; Whitaker, 2004). They challenge the school community by presenting difficulties in essential domains for school activi- ties (Chamberlain, Kasari and Rotheram-Fuller, 2006; Eman and Farrell, 2009; Humphrey and Symes, 2010). Thus, these are students with increased difficulties participating in inclusive environments, reinforcing the need of an ade- quate inclusion process (Gena, 2006; Hall and McGregor, 2000; Hestenes and Carroll, 2000). We characterised this students ’ participation with a questionnaire to the students from mainstream classes in which ASD students were included, a questionnaire applied to each class teacher/head teacher and an interview to four of the school educational assistants. The location of the ASD student in mainstream classroom was also ana- lysed, trying to understand if it influences the quality of ASD students ’ participation, hypothesis- ing that there is an influence. Results showed a good perception of the students with ASD and their behaviour, low frequency of behaviours involving interaction with these students, good feelings about their presence at the school/class and an overall acceptance of them in the peer groups of typical development students. Results are mostly consistent across the different infor- mation sources. We found a significant effect of the location on the quality of participation. Results are mainly consistent with the literature reviewed and enlighten the need to keep making progress on inclusion practices related to ASD students in mainstream schools.

Therapeutic efficacy of alternative primaquine regimens to standard treatment in preventing relapses by Plasmodium vivax : A systematic review and meta-analysis

Objective: To compare efficacy and safety of primaquine regimens currently used to prevent relapses by Plasmodium vivax. Methods: A systematic review was carried out to identify clinical trials evaluating efficacy and safety to prevent malaria recurrences by P. vivax of primaquine regimen 0.5 mg/kg/day for 7 or 14 days compared to standard regimen of 0.25 mg/kg/day for 14 days. Efficacy of primaquine according to cumulative incidence of recurrences after 28 days was determined. The overall relative risk with fixed-effects meta-analysis was estimated. Results: For the regimen 0.5 mg/kg/day/7 days were identified 7 studies, which showed an incidence of recurrence between 0% and 20% with follow-up 60-210 days; only 4 studies comparing with the standard regimen 0.25 mg/kg/day/14 days and no difference in recurrences between both regimens (RR= 0.977, 95% CI= 0.670 to 1.423) were found. 3 clinical trials using regimen 0.5 mg/kg/day/14 days with an incidence of recurrences between 1.8% and 18.0% during 330-365 days were identified; only one study comparing with the standard regimen (RR= 0.846, 95% CI= 0.484 to 1.477). High risk of bias and differences in handling of included studies were found. Conclusion: Available evidence is insufficient to determine whether currently PQ regimens used as alternative rather than standard treatment have better efficacy and safety in preventing relapse of P. vivax. Clinical trials are required to guide changes in treatment regimen of malaria vivax.

Therapeutic efficacy of alternative primaquine regimens to standard treatment in preventing relapses by Plasmodium vivax: A systematic review and meta-analysis

Objective: To compare efficacy and safety of primaquine regimens currently used to prevent relapses by Plasmodium vivax. Methods: A systematic review was carried out to identify clinical trials evaluating efficacy and safety to prevent malaria recurrences by P. vivax of primaquine regimen 0.5 mg/kg/day for 7 or 14 days compared to standard regimen of 0.25 mg/kg/day for 14 days. Efficacy of primaquine according to cumulative incidence of recurrences after 28 days was determined. The overall relative risk with fixed-effects meta-analysis was estimated. Results: For the regimen 0.5 mg/kg/day/7 days were identified 7 studies, which showed an incidence of recurrence between 0% and 20% with follow-up 60-210 days; only 4 studies comparing with the standard regimen 0.25 mg/kg/day/14 days and no difference in recurrences between both regimens (RR= 0.977, 95% CI= 0.670 to 1.423) were found. 3 clinical trials using regimen 0.5 mg/kg/day/14 days with an incidence of recurrences between 1.8% and 18.0% during 330-365 days were identified; only one study comparing with the standard regimen (RR= 0.846, 95% CI= 0.484 to 1.477). High risk of bias and differences in handling of included studies were found. Conclusion: Available evidence is insufficient to determine whether currently PQ regimens used as alternative rather than standard treatment have better efficacy and safety in preventing relapse of P. vivax. Clinical trials are required to guide changes in treatment regimen of malaria vivax.

Desempenho de juvenis de tilápia-do-nilo alimentados com rações contendo complexo enzimático

Avaliou-se o efeito da inclusão de um complexo enzimático em dietas para tilápias-do-nilo (Oreochromis niloticus) sobre o desempenho, a composição química da carcaça e a qualidade da água. Foram utilizados 200 alevinos revertidos (4,57 ± 1,24 g), distribuídos em delineamento inteiramente casualizado em 20 tanques de 500 litros, com quatro tratamentos e cinco repetições, considerando a unidade experimental uma caixa com dez peixes. Os peixes foram alimentados com dietas contendo 0; 0,033; 0,066 ou 0,099% de complexo enzimático. As dietas foram processadas na forma peletizada e fornecidas quatro vezes ao dia, às 8, 11, 14 e 17 h. Os valores médios de pH, condutividade elétrica, oxigênio dissolvido, temperatura, fósforo total, amônia e nitrato da água de cultivo não foram influenciados pela dieta. A inclusão do complexo enzimático na dieta não afetou o ganho de peso, as taxas de sobrevivência e de crescimento específico, mas influenciou o consumo de ração e a conversão alimentar, cujos valores foram maiores nos peixes alimentados com a dieta com 0,066% de complexo enzimático. Não foram observadas diferenças nos teores de matéria seca, umidade, proteína bruta, matéria mineral, cálcio e fósforo na carcaça dos peixes, no entanto, o teor de extrato etéreo reduziu de forma linear com o aumento do nível de complexo enzimático. A utilização de complexo enzimático (amilase, protease, celulase, lipase, pectinase, xilanase, β-glucanase e fitase) no nível de 0,066% em dietas para juvenis de tilápia-do-nilo piora a conversão alimentar, mas não influencia o desempenho e a composição corporal dos peixes.

Effects of changing from full range of motion to partial range of motion on squat kinetics

It is commonplace for people involved in recreational weight training to limit squat depth to lift heavier loads. This study compares differences in movement kinetics when squatting in the full range of motion (FROM) vs. partial range of motion (PROM). Ten men with a 1-year minimum of resistance training attended 4 sessions each comprising 4 sets of squats following one of FROM for 10 repetitions (FROM10) at an intensity of 67% 1 repetition maximum (1RM) FROM squat, PROM for 10 repetitions (PROM10) at 67% 1RM PROM squat, FROM for 5 repetitions (FROM5) at 83% FROM squat or PROM for 5 repetitions (PROM5) at 83% 1RM PROM squat. Movement velocity was not specified. Squat kinetics data were collected using an optical encoder. Differences between conditions were analyzed by repeated-measures analysis of variance and expressed as mean differences and standardized (Cohen) effect sizes with 95% confidence limits. The PROM5 power was substantially more than the PROM10 (98 W, -21 to 217; mean, lower and upper 95% confidence limits), FROM5 (168 W, 47-289), and FROM10 (255 W, 145-365). The force produced during PROM5 was substantially more than PROM10 (372 N, 254-490), FROM5 (854 N, 731-977), and FROM10 (1,069 N, 911-1227). The peak velocity produced during FROM10 was substantially more than FROM5 (0.105 m·s(-1), 0.044-0.166), PROM10 (0.246 m·s(-1), 0.167-0.325), and PROM5 (0.305 m·s(-1), 0.228-0.382). The FROM5 was substantially more than FROM10 (86 J, 59-113), PROM5 (142 J, 90-194), and PROM10 (211 J, 165-257). Therefore, either range of motion can have practical implications in designing resistance training programs depending on if the training goal is related to power and force development, maximizing work output or speed. Moderate-load PROM training, common among recreational weight trainers, is unlikely to provide higher movement kinetics.

Social Capital, HIV Risk Behavior and Substance Use among Recent Latino Immigrants in South Florida

Social capital, or social cohesion or group connectedness, can influence both HIV risk behavior and substance use. Because recent immigrants undergo a change in environment, one of the consequences can be a change in social capital. There may be an association among changes in social capital, and HIV risk behavior and substance use post immigration. The dissertation focused on the interface of these three variables among recent Latino immigrants (RLIs) in South Florida. The first manuscript is a systematic review of social capital and HIV risk behavior, and served as a partial background for the second and third manuscripts. Twelve papers with a measure of social capital as an independent variable and HIV risk as the dependent variable were included in the analysis. Eleven studies measured social capital at the individual level, and one study measured social capital at the group level. HIV risk was influenced by social capital, but the type of influence was dependent on the type of social capital and on the study population. Cognitive social capital, or levels of collective action, was protective against HIV in both men and women. The role of structural social capital, or levels of civic engagement/group participation, on HIV risk was dependent on the type of structural social capital and varied by gender. Microfinance programs and functional group participation were protective for women, while dysfunctional group participation and peer-level support may have increased HIV risk among men. The second manuscript was an original study assessing changes in social capital and HIV risk behavior pre to post immigration among RLIs in South Florida (n=527). HIV risk behavior was assessed through the frequency of vaginal-penile condom use, and the number of sexual partners. It was a longitudinal study using secondary data analysis to assess changes in social capital and HIV risk behavior pre immigration to two years post immigration, and to determine if there was a relationship between the two variables. There was an 8% decrease in total social capital (p ˂ .05). Reporting of ‘Never use’ of condoms in the past 90 days increased in all subcategories (p ˂ .05). Single men had a decrease in number of sexual partners (p ˂ .05). Lower social capital measured on the dimension of ‘friend and other’ was marginally associated with fewer sexual partners. The third manuscript was another original study looking at the association between social capital and substance use among RLIs in South Florida (n=527). Substance use with measured by frequency of hazardous alcoholic drinking, and illicit drug use. It was a longitudinal study of social capital and substance-use from pre to two years post immigration. Post-immigration, social capital, hazardous drinking and illicit drug use decreased (p˂.001). After adjusting for time, compared to males, females were less likely to engage in hazardous drinking (OR=.31, p˂.001), and less likely to engage in illicit drug use (OR=.67, p=.01). Documentation status was a moderator between social capital and illicit drug use. ‘Business’ and ‘Agency’ social capital were associated with changes in illicit drug use for documented immigrants. After adjusting for gender and marital status, on average, documented immigrants with a one-unit increase in ‘business’ social capital were 1.2 times more likely to engage in illicit drug use (p˂.01), and documented immigrants with one-unit increase in ‘agency’ social capital were 38% less likely to engage in illicit drug use (p˂.01). ‘Friend and other’ social capital was associated with a decrease in illicit drug use among undocumented immigrants. After adjusting for gender and marital status, on average, undocumented immigrants with a one-unit increase in ‘friend and other’ social capital were 45% less likely to engage in hazardous drinking and 44% less likely to use illicit drugs (p˂.01, p˂.05). Studying these three domains is relevant because HIV continues to be a public health issue, particularly in Miami-Dade County, which is ranked among other U.S. regions with high rates of HIV/AIDS prevalence. Substance use is associated with HIV risk behavior; in most studies, increased substance use is associated with increased chances of HIV risk behavior. Immigration, which is the hypothesized catalyst for the change in social capital, has an impact on the dynamic of a society. Greater immigration can be burdensome on the host country’s societal resources; however immigrants are also potentially a source of additional skilled labor for the workforce. Therefore, successful adaption of immigrants can have a positive influence on receiving communities. With Florida being a major receiver of immigrants to the U.S, this dissertation attempts to address an important public health issue for South Florida and the U.S. at large.