Is nurse-measured blood pressure a valid substitute for ambulatory blood pressure monitoring?

BACKGROUND: Because ambulatory blood pressure monitoring (ABPM) is not available everywhere, the objective of the study was to determine whether nurse-measured blood pressure could be an acceptable substitute to ABPM. METHODS: We analyzed the data of 2385 consecutive patients referred to our hypertension clinic for the performance of ABPM. Before ambulatory monitoring was performed, a nurse-measured BP was obtained three times using a Y-tube connecting the sphygmomanometer and the recorder. We compared the mean value of the three nurse-measured blood pressures with that of the 12h daytime ambulatory monitoring, considered as the reference. RESULTS: The difference between the nurse-measured and the ambulatory blood pressure was small but statistically significant, indicating that nurse-measured blood pressure tends to overestimate both diastolic and systolic blood pressure. The difference between the nurse blood pressure and ABPM was greater among treated hypertensive patients than untreated patients. To diagnose hypertension, defined as a blood pressure of over 140/90mmHg by ABPM, the positive predictive value of the nurse blood pressure was 0.81 and the negative predictive value 0.63. However, these predictive values could be improved with less stringent cut-off values of blood pressure. Thus, for a diastolic blood pressure above 100mmHg, the positive predictive value of nurse blood pressure was 0.55 and the negative predictive value 0.91. These figures were relatively similar for previously treated and untreated patients. CONCLUSION: Nurse blood pressure is less accurate than ABPM in diagnosing hypertension, defined as a blood pressure of over 140/90mmHg. It could, however, be an acceptable substitute, especially to exclude people who do not need to be treated, in situations where lower resources require a less rigorous definition of hypertension.

Problematizing the multidisciplinary residency in oncology: a practical teaching protocol from the perspective of nurse residents

Objective: To investigate practical teaching of nurse residents in a multidisciplinary residency in oncology. Method: A qualitative descriptive study grounded in the problematization methodology and its steps, represented by the Maguerez Arch. Data were analyzed using content analysis. Results: Potentiating and limiting elements of the residency guided the design of a practical teaching protocol from the perspective of residents, structured in three stages: Welcoming and ambience; Nursing care for problem situations; and, Evaluation process. Conclusion: Systematization of practical teaching promoted the autonomy of individuals and the approximation of teaching to reality, making residency less strenuous, stressful and distressing.



Get a GRIP: Should Area Revenue Coverage Be Offered through the Farm Bill or as a Crop Insurance Program? 2007

The successful expansion of the U.S. crop insurance program has not eliminated ad hoc disaster assistance. An alternative currently being explored by members of Congress and others in preparation of the 2007 farm bill is to simply remove the “ad hoc” part of disaster assistance programs by creating a standing program that would automatically funnel aid to hard-hit regions and crops. One form such a program could take can be found in the area yield and area revenue insurance programs currently offered by the U.S. crop insurance program. The Group Risk Plan (GRP) and Group Risk Income Protection (GRIP) programs automatically trigger payments when county yields or revenues, respectively, fall below a producer-elected coverage level. The per-acre taxpayer costs of offering GRIP in Indiana, Illinois, and Iowa for corn and soybeans through the crop insurance program are estimated. These results are used to determine the amount of area revenue coverage that could be offered to farmers as part of a standing farm bill disaster program. Approximately 55% of taxpayer support for GRIP flows to the crop insurance industry. A significant portion of this support comes in the form of net underwriting gains. The expected rate of return on money put at risk by private crop insurance companies under the current Standard Reinsurance Agreement is approximately 100%. Taking this industry support and adding in the taxpayer support for GRIP that flows to producers would fund a county target revenue program at the 93% coverage level.

Nurse educators’ perceptions of the way nursing students protect patient privacy

The aim of this study was to assess the teaching-learning process related to patient privacy during the care process and the way nursing students’ protect patient privacy. Descriptive/correlational study using a qualitative approach and nonprobability sampling of 19 nurse educators from two schools of nursing. Data was collected using semi-structured interviews. Data analysis was undertaken using the SPSS version 20 and Alceste 2010 programs. The study complied with ethical standards. Two classes were assigned (protection of patient privacy and care process) with four subcategories (protection, empathy, relational competencies and technoscientific competencies).The findings show the need to adopt a reflective approach to the teaching-learning process by using experiential learning activities and real-life activities. We believe that intimacy and the protection of privacy should be core themes of nurse education and training.

The nurse in the management of materials in teaching hospitals

OBJECTIVETo present the nurse's integration within materials management of six teaching hospitals of Paraná - Brazil, and to describe the activities performed by nurses within this process.METHODA study of a qualitative approach and descriptive nature, conducted in teaching hospitals in Paraná, between June and August of 2013. The data collection was conducted through semi-structured interviews with eight nurses who worked in materials management; data were analyzed using content analysis.RESULTSThese showed that nurses perform ten categories of activities, distributed into four of the five steps of the materials management process.CONCLUSIONThe nurse, in performing of these activities, in addition to favoring the development of participative management, contributes to the organization, planning, and the standardization of the hospital supply process, giving greater credibility to the work with professionals who use the materials, and to the suppliers.

Intellectual Property Rights and Crop-Improving R&D under Adaptive Destruction, June 2007

This paper studies how the strength of intellectual property rights (IPRs) affects investments in biological innovations when the value of an innovation is stochastically reduced to zero because of the evolution of pest resistance. We frame the problem as a research and development (R&D) investment game in a duopoly model of sequential innovation. We characterize the incentives to invest in R&D under two competing IPR regimes, which differ in their treatment of the follow-on innovations that become necessary because of pest adaptation. Depending on the magnitude of the R&D cost, ex ante firms might prefer an intellectual property regime with or without a “research exemption” provision. The study of the welfare function that also accounts for benefit spillovers to consumers—which is possible analytically under some parametric conditions, and numerically otherwise—shows that the ranking of the two IPR regimes depends critically on the extent of the R&D cost.

Impact of High Crop Prices on Environmental Quality: A Case of Iowa and the Conservation Reserve Program, 2007

Growing demand for corn due to the expansion of ethanol has increased concerns that environmentally sensitive lands retired from agricultural production into the Conservation Reserve Program (CRP) will be cropped again. Iowa produces more ethanol than any other state in the United States, and it also produces the most corn. Thus, an examination of the impacts of higher crop prices on CRP land in Iowa can give insight into what we might expect nationally in the years ahead if crop prices remain high. We construct CRP land supply curves for various corn prices and then estimate the environmental impacts of cropping CRP land through the Environmental Policy Integrated Climate (EPIC) model. EPIC provides edge-of-field estimates of soil erosion, nutrient loss, and carbon sequestration. We find that incremental impacts increase dramatically as higher corn prices bring into production more and more environmentally fragile land. Maintaining current levels of environmental quality will require substantially higher spending levels. Even allowing for the cost savings that would accrue as CRP land leaves the program, a change in targeting strategies will likely be required to ensure that the most sensitive land does not leave the program.

The In Vitro Mass-Produced Model Mycorrhizal Fungus, Rhizophagus irregularis, Significantly Increases Yields of the Globally Important Food Security Crop Cassava.

The arbuscular mycorrhizal symbiosis is formed between arbuscular mycorrhizal fungi (AMF) and plant roots. The fungi provide the plant with inorganic phosphate (P). The symbiosis can result in increased plant growth. Although most global food crops naturally form this symbiosis, very few studies have shown that their practical application can lead to large-scale increases in food production. Application of AMF to crops in the tropics is potentially effective for improving yields. However, a main problem of using AMF on a large-scale is producing cheap inoculum in a clean sterile carrier and sufficiently concentrated to cheaply transport. Recently, mass-produced in vitro inoculum of the model mycorrhizal fungus Rhizophagus irregularis became available, potentially making its use viable in tropical agriculture. One of the most globally important food plants in the tropics is cassava. We evaluated the effect of in vitro mass-produced R. irregularis inoculum on the yield of cassava crops at two locations in Colombia. A significant effect of R. irregularis inoculation on yield occurred at both sites. At one site, yield increases were observed irrespective of P fertilization. At the other site, inoculation with AMF and 50% of the normally applied P gave the highest yield. Despite that AMF inoculation resulted in greater food production, economic analyses revealed that AMF inoculation did not give greater return on investment than with conventional cultivation. However, the amount of AMF inoculum used was double the recommended dose and was calculated with European, not Colombian, inoculum prices. R. irregularis can also be manipulated genetically in vitro, leading to improved plant growth. We conclude that application of in vitro R. irregularis is currently a way of increasing cassava yields, that there is a strong potential for it to be economically profitable and that there is enormous potential to improve this efficiency further in the future.

Egg parasitoids of Edessa meditabunda (Fabricius) (Pentatomidae) in lettuce crop

Egg parasitoids of Edessa meditabunda (Fabricius) (Pentatomidae) in lettuce crop. This study evaluated the occurrence of parasitoids in eggs of the stink bug, Edessa meditabunda (Fabricius, 1794) (Heteroptera, Pentatomidae) found on lettuce crop in Mato Grosso State, Brazil. Samples were collected in the vegetable garden "Cheiro Verde", in the municipality of Tangará da Serra, in curly lettuce. A bed of lettuce was selected randomly, where the eggs of E. meditabunda were collected. Five-hundred and seventy eight eggs of E. meditabunda were collected, 86.3% of them parasitized by Telenomus podisi Ashmead, 1893 (Hymenoptera, Platygastridae), Trissolcus urichi Crawford, 1913 (Hymenoptera, Platygastridae) and Neorileya albipes Girault, 1913 (Hymenoptera, Eurytomidae), representing respectively 57.0%, 38.2% and 4.8% of the emerged individuals. This is the first record of these three species parasitizing eggs of E. meditabunda in lettuce.

Biological aspects of Leucothyreus alvarengai Frey and Leucothyreus aff. semipruinosus Ohaus (Coleoptera, Melolonthidae, Rutelinae) in crop succession at central Brazil

Biological aspects of Leucothyreus alvarengai Frey and Leucothyreus aff. semipruinosus Ohaus (Coleoptera, Melolonthidae, Rutelinae) in crop succession at central Brazil. Beetles of the family Melolonthidae make up a large group and some species are considered pests of planted crops. Little information is available on the basic biological aspects of the genus Leucothyreus, such as association with cultivated crops and their occurrence periods. Therefore studies were developed in soybean and corn crops in Tangará da Serra, Mato Grosso, Brazil, with the objective of studying the occurrence and biological aspects of Leucothyreus alvarengai Frey and Leucothyreus aff. semipruinosus Ohaus. For acquisition of immature specimens of both species, in April 2011 sampling was performed in corn fields, in July and October in the fallow area, and in soybeans fields planted in December; in 2012 sampling was performed in January and February in soybean fields and in March in corn fields. In 2011 the total number of larvae obtained in April, July, October and December were 100, 6, 30 and 27, and in January, February and March of 2012 these quantities were 32, 52 and 65 larvae, respectively. In all sampling events the larvae of L. alvarengai were collected in greater quantity. At the beginning of the reproductive period of L. alvarengai and L. aff. semipruinosus, it was observed that the adults began to fly and soon after started oviposition in the field in September. The appearance of larvae coincides with the time of soybean planting in the field, thus the larvae feed on roots of soybean plants at the beginning of their development and the cycle from egg to adult of the two species was completed in one year.

Iowa Crop and Weather Report, August 3, 2009

Report produced by the The Department of Agriculture and Land Stewardship, Climatology Bureau. Iowa Secretary of Agriculture Bill Northey today commented on the Iowa Crops and Weather report released by the USDA National Agricultural Statistical Service. The report is released weekly from April through October.

Factors promoting the exposure to bioaerosols among crop workers

Introduction. Agricultural workers are among the professional groups most at risk of developing acute or chronic respiratory problems. Despite this fact, the etiology of these occupational diseases is poorly known, even in important sectors of agriculture such as the crops sector. Cereals can be colonized by a large number of fungal species throughout the plants' growth, but also during grain storage. Some of these fungi deliver toxins that can have a serious impact on human health when they are ingested via wheat products. Although International and European legislation on contaminants in food, including mycotoxins, include measures to ensure protection of public health by setting down the maximum levels for certain contaminants, the risks associated with the inhalation of such molecules during grain handling remains poorly documented. Goal of study. This project's objective was to characterize worker exposure to pathogenic, irritative or allergenic microorganisms and to identify the abiotic or biotic factors that reduce the growth of these microorganisms in crops. Indeed, the proliferation of microorganisms on wheat is dependent on temperature, rainfall and human disturbance (e.g. usage of tillage, addition of fungicides). A change in the concentration of these microorganisms in the substrate will directly result in a change in the concentration of aerosolized particles of the same microorganisms. Therefore, the exposure of worker to bioaérosols will also change. The Vaud region of Switzerland is a perfect region for conduct such a project as weather conditions vary and agricultural land management programs are divers at a small geographic scale. Methods. Bioaerosols and wheat dust have been sampled during wheat harvesting of summer 2010 at 100 sites uniformly distributed in the Vaud region that are representative of the different agriculture practices. Personal exposure has been evaluated for different wheat related activities: harvesting, grain unload, baling straw, the cleaning of harvesters and silos. Aerosols have been sampled at a rate of 2L/min between 15 min to 4 hours (t) on a 5m PVC filter for estimating the total dust inhaled, on gelatine filter for the identification and quantification of molds, and on a 0.45um polycarbonate filter for endotoxin quantification. Altitude, temperature and annual average rainfall were considered for each site. The physical and chemical characteristics of soils were determined using the methods in effect at Sol Council (Nyon). Total dust has been quantified following NIOSH 0500 method. Reactive endotoxine activity has been determined with Limulus Amebocyte Lysate Assay. All molds have been identified by the pyrosequencing of ITS2 amplicons generated from bioaerosol or wheat dust genomic DNA. Results & Conclusions. Our results confirm the previous quantitative data on the worker exposure to wheat dust. In addition, they show that crop workers are systematically exposed to complex mixtures of allergens, irritants or cytotoxic components. The novelty of our study is the systematic detection of molds such as Fusarium - that is a mycotoxins producer - in the bioaerosols. The results are interpreted by taking in account the agriculture practice, the Phosphorus : Carbon : Nitrogen ratio of the soil, the altitude and the average of rainy days per year.

Timing, location and crop species influence the magnitude of amelioration of aluminum toxicity by magnesium

The protective effect of cations, especially Ca and Mg, against aluminum (Al) rhizotoxicity has been extensively investigated in the last decades. The mechanisms by which the process occurs are however only beginning to be elucidated. Six experiments were carried out here to characterize the protective effect of Mg application in relation to timing, location and crop specificity: Experiment 1 - Protective effect of Mg compared to Ca; Experiment 2 - Protective effect of Mg on distinct root classes of 15 soybean genotypes; Experiment 3 - Effect of timing of Mg supply on the response of soybean cvs. to Al; Experiment 4 - Investigating whether the Mg protective effect is apoplastic or simplastic using a split-root system; Experiment 5 - Protective effect of Mg supplied in solution or foliar spraying, and Experiment 6 - Protective effect of Mg on Al rhizotoxicity in other crops. It was found that the addition of 50 mmol L-1 Mg to solutions containing toxic Al increased Al tolerance in 15 soybean cultivars. This caused soybean cultivars known as Al-sensitive to behave as if they were tolerant. The protective action of Mg seems to require constant Mg supply in the external medium. Supplying Mg up to 6 h after root exposition to Al was sufficient to maintain normal soybean root growth, but root growth was not recovered by Mg addition 12 h after Al treatments. Mg application to half of the root system not exposed to Al was not sufficient to prevent Al toxicity on the other half exposed to Al without Mg in rooting medium, indicating the existence of an external protection mechanism of Mg. Foliar spraying with Mg also failed to decrease Al toxicity, indicating a possible apoplastic role of Mg. The protective effect of Mg appeared to be soybean-specific since Mg supply did not substantially improve root elongation in sorghum, wheat, corn, cotton, rice, or snap bean when grown in the presence of toxic Al concentrations.

Crop sequences in no-tillage system: effects on soil fertility and soybean, maize and rice yield

Decomposing crop residues in no-tillage system can alter soil chemical properties, which may consequently influence the productivity of succession crops. The objective of this study was to evaluate soil chemical properties and soybean, maize and rice yield, grown in the summer, after winter crops in a no-tillage system. The experiment was carried out in Jaboticabal, SP, Brazil (21 ° 15 ' 22 '' S; 48 ° 18 ' 58 '' W) on a Red Latosol (Oxisol), in a completely randomized block design, in strip plots with three replications. The treatments consisted of four summer crop sequences (maize monocrop, soybean monocrop, soybean/maize rotation and rice/bean/cotton rotation) combined with seven winter crops (maize, sunflower, oilseed radish, pearl millet, pigeon pea, grain sorghum and sunn hemp). The experiment began in September 2002. After the winter crops in the 2005/2006 growing season and before the sowing of summer crops in the 2006/2007 season, soil samples were collected in the layers 0-2.5; 2.5-5.0; 5-10; 10-20; and 20-30 cm. Organic matter, pH, P, K+, Ca2+, Mg2+, and H + Al were determined in each soil sample. In the summer soybean/maize rotation and in maize the organic matter contents and P levels were lower, in the layers 0-10 cm and 0-20 cm, respectively. Summer rice/bean/cotton rotation increased soil K levels at 0-10 cm depth when sunn hemp and oilseed radish had previously been grown in the winter, and in the 0-2.5 cm layer for millet. Sunn hemp, millet, oilseed radish and sorghum grown in the winter increased organic matter contents in the soil down to 30 cm. Higher P levels were found at the depths 0-2.5 cm and 0-5 cm, respectively, when sunn hemp and oilseed radish were grown in the winter. Highest grain yields for soybean in monoculture were obtained in succession to winter oilseed radish and sunn hemp and in rotation with maize, after oilseed radish, sunn hemp and millet. Maize yields were highest in succession to winter oilseed radish, millet and pigeon pea. Rice yields were lowest when grown after sorghum.

Spatial and temporal variability of crop yield and some Rhodic Hapludox properties under no-tillage

Soil properties are closely related with crop production and spite of the measures implemented, spatial variation has been repeatedly observed and described. Identifying and describing spatial variations of soil properties and their effects on crop yield can be a powerful decision-making tool in specific land management systems. The objective of this research was to characterize the spatial and temporal variations in crop yield and chemical and physical properties of a Rhodic Hapludox soil under no-tillage. The studied area of 3.42 ha had been cultivated since 1985 under no-tillage crop rotation in summer and winter. Yield and soil property were sampled in a regular 10 x 10 m grid, with 302 sample points. Yields of several crops were analyzed (soybean, maize, triticale, hyacinth bean and castor bean) as well as soil chemical (pH, Soil Organic Matter (SOM), P, Ca2+, Mg2+, H + Al, B, Fe, Mn, Zn, CEC, sum of bases (SB), and base saturation (V %)) and soil physical properties (saturated hydraulic conductivity, texture, density, total porosity, and mechanical penetration resistance). Data were analyzed using geostatistical analysis procedures and maps based on interpolation by kriging. Great variation in crop yields was observed in the years evaluated. The yield values in the Northern region of the study area were high in some years. Crop yields and some physical and soil chemical properties were spatially correlated.