Quality of care of patients hospitalized with acute coronary syndromes

Background: Measurement and improvement of quality of care is a priority issue in health care. Patients hospitalized with acute coronary syndromes (ACS) constitute a high-risk population whose care, if shown to be suboptimal on the basis of available research evidence, may benefit from quality improvement interventions. Aim: To evaluate the quality of in-hospital care for patients with ACS, using explicit quality indicators. Methods: Retrospective case note review was undertaken of 397 patients admitted to three teaching hospitals in Brisbane, Queensland, Australia, between 1 October 2000 and 17 April 2001. The main out-come measures were 12 process-of-care quality indicators, calculated as either: (i) the proportion of all patients who received specific interventions or (ii) the proportion of ideal patients who received -specific interventions (i.e. patients with clear indi-cations and lacking contraindications). Results: Quality indicators with values above 80% included: (i) patient selection for thrombolysis (100%) and discharge prescription of beta-blockers (84%), (ii) antiplatelet agents (94%) and (iii) lipid-lowering agents (82%). Indicators with values between 50% and 80% included: (i) timely per-formance of electrocardiogram (ECG) on admission (61%), (ii) early coronary angiography (75%), (iii) measurement of serum lipids (71%) and (iv) discharge prescription of angiotensin-converting-enzyme (ACE) inhibitors (73%). Indicators with values <50% included: (i) timely administration of thrombolysis (35%), (ii) non-invasive risk assessment (23%) and (ii) formal in-hospital and post-hospital cardiac rehabilitation (47% and 7%, respectively). Conclusion: There were delays in performing ECG and administering thrombolysis to patients who presented to emergency departments with ACS. Improvement is warranted in use of non-invasive procedures for identifying high-risk patients who may benefit from coronary revascularization as well as use of serum lipid measurements, ACE inhibitors and cardiac rehabilitation.

Production of the baculovirus-expressed dengue virus glycoprotein NS1 can be improved dramatically with optimised regimes for fed-batch cultures and the addition of the insect moulting hormone, 20-Hydroxyecdysone

A perennial problem in recombinant protein expression is low yield of the product of interest. A strategy which has been shown to increase the production of baculovirus-expressed proteins is to utilise fed-batch cultures. One disadvantage of this approach is the time-consuming task of optimising the feeding strategy. Previously, a statistical optimisation routine was applied to develop a feeding strategy that increased the yield of beta-Galactosidase (beta-Gal) by 2.4-fold (Biotechnol. Bioeng, 59 (1998) 178). This involves the single addition of nutrient concentrates (amino acids, lipids. glucose and yeastolate ultrafiltrate) into Sf9 cell cultures grown in SF900II medium. In this study, it is demonstrated that this optimised fed-batch strategy developed for a high-yielding intracellular product beta-Gal could be applied successfully to a relatively low-yielding glycosylated and secreted product such as the dengue virus glycoprotein NS1. Optimised batch infections yielded 4 mug/ml of NS1 at a peak cell density of 4.2 x 10(6) cells/ml. In contrast. optimised fed-batch infections exhibited a 3-fold improvement in yield, with 12 mug ml of NS1 produced at a peak cell density of 11.3 x 10(6) cells/ml. No further improvements in yield were recorded when the feed volumes were doubled and the peak cell density was increased to 23 x 10(6) cells/ml, unless the cultures were stimulated by the addition of 4 mug/ml of 20-Hydroxyecdysone (an insect moulting hormone). In this case, the NS1 yield was increased to 20 mug/ml. which was nearly 5-fold higher than optimised batch cultures. (C) 2002 Elsevier Science B.V. All rights reserved.

The effect of sodium chloride supplementation on the milk production of grazing Holstein Friesian cows during summer and autumn in a humid sub-tropical environment

Two studies were conducted to examine the effects of including NaCl at various rates in grain-based supplements for Friesian cows grazing established, dominant (>90%), rainfed kikuyu (Pennisetum clandestinum cv. Common) pastures during summer and autumn in a humid sub-tropical environment. In study 1 (19 January-27 March 1998), 48 cows (36 multiparous, 12 primiparous; 27-96 days postpartum) were allocated to one of four groups based on genetic merit, milk production, liveweight (LW) and days postpartum. They were fed (2.7 kg dry matter (DM) per cow, twice-a-day) one of four isoenergetic and isonitrogenous barley grain-based concentrates containing NaCl at concentrations (% as-fed) of either 0 (SC1), 1.1 (SC2), 2.2 (SC3) or 3.3 (SC4). Maximum temperature humidity index (THImax) was greater than or equal to78 during 50% of the experimental period. Concentrate NaCl content had no effect (P>0.05) on daily milk yield or LW change but daily yields of 4% fat corrected milk (FCM), fat and protein were higher (P0.05) among treatments at 7.6+/-1.24 kg DM per cow. In study 2 (18 January 1999-1 March 1999), 48 cows (32 pluriparous, 16 primiparous: 32-160 days postpartum) were fed (2.7 kg DM per cow twice-a-day) one of two isoenergetic and isonitrogenous barley grain-based concentrates containing NaCl at concentrations (% as-fed) of 0 (control) or 2.2 (HSC). THImax was greater than or equal to78 during 34% of days in the experimental period. Yields of milk, FCM, fat and protein were lower (P0.05) by concentrate NaCl content. These studies indicate that NaCl supplementation can be beneficial in terms of milk production during warm, humid conditions as opposed to milder conditions. (C) 2002 Elsevier Science B.V. All rights reserved.

Production of mosquitoes in rainwater tanks and wells on Yorke Island, Torres Strait: Preliminary study

The Torres Strait in northernmost Queensland, Australia, is subject to periodic outbreaks of dengue. A large outbreak of dengue 2 in 1996-97 affected five islands, resulting in 200 confirmed cases. On most of the affected islands, rainwater tanks were a common breeding site for vector mosquitoes. Rainwater tanks, wells and household containers filled with water are the most common breeding sites for dengue mosquitoes (Aedes aegypti), the primary vector of dengue in Queensland. We report on surveys conducted in February 2002 to measure the productivity of rainwater tanks and wells on Yorke Is. (Torres Strait), the first time the productivity of rainwater tanks has been measured in Australia. Of 60 rainwater tanks sampled, 10 had broken screens. Using a sticky emergence trap, 179 adult mosquitoes were collected, consisting of 63 Aedes scutellaris and 116 Culex quinquefasciatus. One unscreened tank produced 177 (99%) of the adults. A plankton net was used to sample 16 wells; 12 positive wells yielded 111 immature (larvae and pupae) mosquitoes, consisting of 57% and 43% Ae. scutellaris and Cx. quinquefasciatus, respectively. The apparent displacement of Ae. aegypti by Ae. scutellaris is discussed. Measures to reduce the likelihood of future dengue outbreaks are recommended.

Quality of care of patients hospitalized with congestive heart failure

Background: Congestive heart failure (CHF) is an increasingly prevalent poor-prognosis condition for which effective interventions are available. It is -therefore important to determine the extent to which patients with CHF receive appropriate care in Australian hospitals and identify ways for improving suboptimal care, if it exists. Aim: To evaluate the quality of in-hospital acute care of patients with CHF using explicit quality indicators based on published guidelines. Methods: A retrospective case note review was -performed, involving 216 patients admitted to three teaching hospitals in Brisbane, Queensland, Australia, between October 2000 and April 2001. Outcome measures were process-of-care quality -indicators calculated as proportions of all, or strongly -eligible (ideal), patients who received -specific interventions. Results: Assessment of underlying causes and acute precipitating factors was undertaken in 86% and 76% of patients, respectively, and objective evaluation of left ventricular function was performed in 62% of patients. Prophylaxis for deep venous thrombosis (DVT) was used in only 29% of ideal patients. Proportions of ideal patients receiving pharmacological treatments at discharge were: (i) angiotensin--converting enzyme inhibitors (ACEi) (82%), (ii) target doses of ACEi (61%), (iii) alternative vasodilators in patients ineligible for ACEi (20%), (iv) beta-blockers (40%) and (v) warfarin (46%). Conclusions: Opportunities exist for improving quality of in-hospital care of patients with CHF, -particularly for optimal prescribing of: (i) DVT prophylaxis, (ii) ACEi, (iii) second-line vasodilators, (iv) beta-blockers and (v) warfarin. More research is needed to identify methods for improving quality of in-hospital care.

The over-production of US sports and the new International Division of Cultural Labor

This article focuses on how US professional sports utilize the New International Division of Cultural Labor to supplement an overly costly local labor pool and over-supplied local market. We argue that while the classic problem of over-production is slowly eroding the sealed-off nature of US culture, the forces of its hyper-protectionist capitalism continue to characterize sports, precluding equal exchange.

Production of proteinases by psychrotrophic bacteria in raw milk stored at low temperature

Raw milk samples from two different sources were stored at 2degreesC, 4degreesC and 7degreesC for 10 days and the growth of psychrotrophic bacteria, production of proteinase and proteolysis in the milks were measured during storage. Peptide analyses by the fluorescamine method and RP-HPLC were used in determination of proteolysis and proteinase activity. The average times taken for the psychrotroph counts to reach 10(7) cfu/mL at 2degreesC, 4degreesC and 7degreesC were approximately 9, 7 and 4 days, although there was considerable variation in growth rates in the different milks. There was little correlation between psychrotroph counts and either proteolysis or proteinase activity levels. At 2degreesC, no milk stored showed significant proteolysis by the fluorescamine method after 10 days' storage, but significant proteinase activity could be measured in some of these milks at 8 and 10 days. RP-HPLC analysis was a more sensitive means of detecting peptides than the fluorescamine method.

Production of cabbage grown in pots containing legumes' root and shoot

Roots effect is not generally considered in studies assessing the performance of crops in response to green manuring. However, such effect can contribute to a better understanding of crop rotation. The aim of this study was to assess the effect of root and shoot of two legumes on the production of cabbage. The experiment was conducted in pots of 10 liters containing substrate of 2:1 soil/sand. The experiment was arranged in a factorial scheme (2x3 + 2) in a randomized block design with five replicates using two legume species (Crotalaria juncea L. and Canavalia ensiformis L), three plant parts (root, shoot, or whole plant), and two additional treatments (mineral fertilization with 100% and 50% of the recommended dose of N for growing cabbage). Pots with legume treatments received mineral fertilizer with 50% of the recommended dose of N for growing cabbage. The experimental plot consisted of a pot containing one plant of cabbage. Legumes were grown in pots and harvested at 78 days. The root biomass was determined in extra pots. Production was assessed using head fresh and dry weight. The application of the whole plant of both legume species reduced cabbage production. However, root or shoot of both legume species was equivalent to 50% of mineral N fertilization required for the cultivation of cabbage.

Production of basic potato seed minitubers in substrate and different nitrogen rates

The optimal dose of nitrogen (N) in potato crop depends on the production system. The objective of this study was to determine the optimal dose of N for the production of basic potato seed minitubers and evaluate the effect of N rates on physiological and nitrogen indices in the youngest fully developed leaf (fourth leaf) and in the oldest leaf of the plants at 60 days after planting. The experiment was conducted in a greenhouse at the Departamento de Fitotecnia da Universidade Federal de Viçosa. The treatments consisted of five N rates (0, 45, 90, 180 and 360 mg dm-3), with 10% of each dose applied at planting and the remainder through irrigation water, daily, for 30 days. The nitrogen rates positively influenced the physiological indices (length, width, leaf area, number of leaves, fresh mass and dry mass) and nitrogen (level and content of N and N-NO³ in the dry mass and SPAD) both in the fourth leaf and in the oldest leaf. Likewise, the N rates positively influenced the number and mass of harvested tubers. The largest number (5.44 tubers/plant) and the maximum mass of tubers (243.5 g/plant) were obtained with 360.0 and 332.9 mg N dm-3, respectively. Therefore, the mass and number of tubers were not optimized by the same N rate. The critical SPAD index was 38.8 in the fourth leaf, which was more sensitive to the effect of N rates than the oldest leaf.

Nutrient accumulation and biomass production of alfafa after soil amendment with silicates

Studies on the use of silicate correctives in agriculture show that they have great potential to improve soil chemical characteristics, however, little information is available on the reactivity rates of their particle-size fractions. This study investigated whether the reactivity rates obtained experimentally could be considered in the calculation of ECC (effective calcium carbonate) for soil liming, promoting adequate development of alfalfa plants. Six treatments were evaluated in the experiment, consisting of two slag types applied in two rates. The experimental ECC was used to calculate one of the rates and the ECC determined in the laboratory was used to calculate the other. Rates of limestone and wollastonite were based on the ECC determined in laboratory. The rates of each soil acidity corretive were calculated to increase the base saturation to 80%. The treatments were applied to a Rhodic Hapludox and an Alfisol Ferrudalfs. The methods for ECC determination established for lime can be applied to steel slag. The application of slag corrected soil acidity with consequent accumulation of Ca, P, and Si in alfalfa, favoring DM production.

Application of GA3 and girdling of branches on the production of extemporaneous fruits of 'Tahiti' acid lime

The objective of this study was to evaluate the effect of girdling of branches and the application of GA3, still in the main crop flowering on the formation of reproductive structures, the fruit set of the following extemporaneous flowering of 'Tahiti' acid lime. This work used a randomized block design with five replications in a 4x3 factorial design. The first factor was the foliar application of GA3, 88 days before extemporaneous flowering at five concentrations (0, 7, 14 and 21 mg.L-1). The second factor was the girdling times, 108 days before flowering onset (A108AF), 78 days before flowering (A78AF) plus no-girdling control (NG). In extemporaneous flowering, the proportion of buds, flowers and fruits that abscised was 38.75, 31.25 and 18.64% respectively and 11.34% of all reproductive structures formed were collected. GA3 did not affect fruit set. Girdling increased fruit set by 229 and 256% at A108DAF and A78DAF respectively, in relation to NG plants. The GA3 reduced the formation of floral structures, which resulted in a quadratic increase in field production by reducing the competition for photoassimilates among fruits. The concentration of 21 mg.L-1 was the most productive, with 15.97 fruit.plant-1.

Accountability and co-production of information and control: social observatories and their relationship with government agencies

Abstract:Through the development of a proposal to categorize accountability into four stages - classical, cross-sectional, systemic, and diffused -, this article aims to identify characteristics of co-production of information and socio-political control of public administration in the work of Brazilian social observatories in relationship with government control agencies. The study analyses data from 20 social observatories and, particularly, three experiences of co-production of information and control, based on a systemic perspective on accountability and a model with four categories: Political and cultural; valuing; systemic-organizational, and production. The conclusions summarize characteristics of these practices, specific phases in the accountability processes, as well as the potentialities and challenges of co-production of information and control, which not only influences, but it is also influenced by the accountability system.

Production of surfactants from bio-materials

Este trabalho foi desenvolvido no âmbito de um projecto europeu, BIOPRODUCTION, tendo em vista o desenvolvimento de dois tipos de biomaterias funcionais: ésteres de açúcares com ácidos gordos (SFAE) e metacrilatos funcionais. A síntese laboratorial do biosurfactante SFAE foi efectuada utilizando como matérias-primas diferentes sacáridos, nomeadamente sacarose, glucose e melaço de cana-de-açúcar (mistura de polissacáridos), e ésteres metílicos de ácidos gordos (FAME) de óleos vegetais, tais como colza e coco. Esta síntese é constituída por dois passos: acilação dos açúcares com anidrido acético, e transesterificação do açúcar acilado com FAME, utilizando triflatos de lantanídeos como catalisador. Diferentes estequiometrias foram testadas, bem como diferentes processos de modo a evitar a degradação dos açúcares. Foram efectuados testes preliminares de emulsão e calculou-se, empiricamente, o respectivo HLB. Procedeu-se à caracterização do produto através de FTIR e RMN e também à optimização iterativa do processo de síntese. A modificação, à escala laboratorial, de metacrilatos de metilo (MMA) realizou-se recorrendo à sua transesterificação com polióis convencionais. Efectuaram-se testes de reticulação do produto com diferentes catalisadores e iniciadores para posterior aplicação em revestimentos de borracha. Por fim, para ambos os produtos serão necessários estudos adicionais de caracterização, nomeadamente tensão superficial para os biosurfactantes e propriedades mecânicas para polímeros modificados com MMA.