Incidents occurring during anesthesia for total hip arthroplasty: a comparison of general versus regional anaesthesia

Background: The type of anesthesia to be used for total hip arthroplasty (THA) is still a matter of debate. We compared the occurrence of per- and post-anesthesia incidents in patients receiving either general (GA) or regional anesthesia (RA). Methods: We used data from 29 hospitals, routinely collected in the Anaesthesia Databank Switzerland register between January 2001 and December 2003. We used multi-level logistic regression models. Results: There were more per- and post-anesthesia incidents under GA compared to RA (35.1% vs 32.7 %, n = 3191, and 23.1% vs 19.4%, n = 3258, respectively). In multi-level logistic regression analysis, RA was significantly associated with a lower incidence of per-anesthetic problems, especially hypertension, compared with GA. During the post-anesthetic period, RA was also less associated with pain. Conversely, RA was more associated with post-anesthetic hypotension, especially for epidural technique. In addition, age and ASA were more associated with incidents under GA compared to RA. Men were more associated with per-anesthetic problems under RA compared to GA. Whereas increased age (>67), gender (male), and ASA were linked with the choice of RA, we noticed that this choice depended also on hospital practices after we adjusted for the other variables. Conclusions: Compared to RA, GA was associated with an increased proportion of per- and post-anesthesia incidents. Although this study is only observational, it is rooted in daily practice. Whereas RA might be routinely proposed, GA might be indicated because of contraindications to RA, patients' preferences or other surgical or anaesthesiology related reasons. Finally, the choice of a type of anesthesia seems to depend on local practices that may differ between hospitals.

Integration of teacher education into the Swiss higher education system

The integration of specific institutions for teacher education into the higher education system represents a milestone in the Swiss educational policy and has broad implications. This thesis explores organizational and institutional change resulting from this policy reform, and attempts to assess structural change in terms of differentiation and convergence within the system of higher education. Key issues that are dealt with are, on the one hand, the adoption of a research function by the newly conceptualized institutions of teacher education, and on the other, the positioning of the new institutions within the higher education system. Drawing on actor-centred approaches to differentiation, this dissertation discusses system-level specificities of tertiarized teacher education and asks how this affects institutional configurations and actor constellations. On the basis of qualitative and quantitative empirical data, a comparative analysis has been carried out including case studies of four universities of teacher education as well as multivariate regression analysis of micro-level data on students' educational choices. The study finds that the process of system integration and adaption to the research function by the various institutions have unfolded differently depending on the institutional setting and the specific actor constellations. The new institutions have clearly made a strong push to position themselves as a new institutional type and to find their identity beyond the traditional binary divide which assigns the universities of teacher education to the college sector. Potential conflicts have been identified in divergent cognitive normative orientations and perceptions of researchers, teacher educators, policy-makers, teachers, and students as to the mission and role of the new type of higher education institution. - L'intégration dans le système d'enseignement supérieur d'institutions qui ont pour tâche spécifique de former des enseignants peut être considérée comme un événement majeur dans la politique éducative suisse, qui se trouve avoir des conséquences importantes à plusieurs niveaux. Cette thèse explore les changements organisationnels et institutionnels résultant de cette réforme politique, et elle se propose d'évaluer en termes de différentiation et de convergence les changements structurels intervenus dans le système d'éducation tertiaire. Les principaux aspects traités sont d'une part la nouvelle mission de recherche attribuée à ces institutions de formation pédagogique, et de l'autre la place par rapport aux autres institutions du système d'éducation tertiaire. Recourant à une approche centrée sur les acteurs pour étudier les processus de différen-tiation, la thèse met en lumière et en discussion les spécificités inhérentes au système tertiaire au sein duquel se joue la formation des enseignants nouvellement conçue et soulève la question des effets de cette nouvelle façon de former les enseignants sur les configurations institutionnelles et les constellations d'acteurs. Une analyse comparative a été réalisée sur la base de données qualitatives et quantitatives issues de quatre études de cas de hautes écoles pédagogiques et d'analyses de régression multiple de données de niveau micro concernant les choix de carrière des étudiants. Les résultats montrent à quel point le processus d'intégration dans le système et la nouvelle mission de recherche peuvent apparaître de manière différente selon le cadre institutionnel d'une école et la constellation spécifique des acteurs influents. A pu clairement être observée une forte aspiration des hautes écoles pédagogiques à se créer une identité au-delà de la structure binaire du système qui assigne la formation des enseignants au secteur des hautes écoles spéciali-sées. Des divergences apparaissent dans les conceptions et perceptions cognitives et normatives des cher-cheurs, formateurs, politiciens, enseignants et étudiants quant à la mission et au rôle de ce nouveau type de haute école. - Die Integration spezieller Institutionen für die Lehrerbildung ins Hochschulsystem stellt einen bedeutsamen Schritt mit weitreichenden Folgen in der Entwicklung des schweizerischen Bildungswesens dar. Diese Dissertation untersucht die mit der Neuerung verbundenen Veränderungen auf organisatorischer und institutioneller Ebene und versucht, die strukturelle Entwicklung unter den Gesichtspunkten von Differenzierung und Konvergenz innerhalb des tertiären Bildungssystems einzuordnen. Zentrale Themen sind dabei zum einen die Einführung von Forschung und Entwicklung als zusätzlichem Leistungsauftrag in der Lehrerbildung und zum andern die Positionierung der pädagogischen Hochschulen innerhalb des Hochschulsystems. Anhand akteurzentrierter Ansätze zur Differenzierung werden die Besonderheiten einer tertiarisierten Lehrerbildung hinsichtlich der Systemebenen diskutiert und Antworten auf die Frage gesucht, wie die Reform die institutionellen Konfigurationen und die Akteurkonstellationen beeinflusst. Auf der Grundlage qualitativer und quantitativer Daten wurde eine vergleichende Analyse durchgeführt, welche Fallstudien zu vier pädagogischen Hochschulen umfasst sowie Regressionsanalysen von Mikrodaten zur Studienwahl von Maturanden. Die Ergebnisse machen deutlich, dass sich der Prozess der Systemintegration und die Einführung von Forschung in die Lehrerbildung in Abhängigkeit von institutionellen Ordnungen und der jeweiligen Akteurkonstellation unterschiedlich gestalten. Es lässt sich bei den neu gegründeten pädagogischen Hochschulen ein starkes Bestreben feststellen, sich als neuen Hochschultypus zu positionieren und sich eine Identität zu schaffen jenseits der herkömmlichen binären Struktur, welche die pädagogischen Hochschulen dem Fachhochschul-Sektor zuordnet. Potentielle Konflikte zeichnen sich ab in den divergierenden kognitiven und normativen Orientierungen und Wahrnehmungen von Forschern, Ausbildern, Bildungspolitikern, Lehrern und Studierenden hinsichtlich des Auftrags und der Rolle dieses neuen Typs Hochschule.

The daily energy expenditure in stable chronic obstructive pulmonary disease.

Resting energy expenditure is frequently increased in chronic obstructive pulmonary disease (COPD), but it is unknown if this hypermetabolism holds true over 24 h. The aim of this study was to measure the actual 24-h energy expenditure (24-h EE) in patients with stable COPD. Energy expenditure was measured by indirect calorimetry, using a metabolic chamber for 24-h EE and a canopy for basal metabolic rate (BMR). Physical activity was detected in the chamber by a radar system, and its duration was quantified. Two groups matched for age and height were studied: 16 male ambulatory patients with stable COPD and 12 male normal subjects. Body weight was 92 +/- 12% of ideal body weight in the group with COPD and 108 +/- 11% in the control group (p = 0.01). BMR was 120 +/- 7% of predicted in the group with COPD and 108 +/- 12% in the control group (p < 0.01). However, 24-h EE was similar in the two groups, amounting to 1,935 +/- 259 kcal in patients with COPD and 2,046 +/- 253 kcal in the control group (NS). This corresponded to 145% and 137% of predicted BMR, and to 121% and 126% of measured BMR in patients with COPD and the control group, respectively (NS). Patients were allowed to pursue their usual treatment within the chamber, and a positive correlation existed between 24-h EE and the daily dose of inhaled beta 2-agonists (p < 0.03). During daytime, physical activity was lower in patients with COPD. This study shows that patients with stable COPD are characterized by a normal daily energy expenditure in controlled conditions in spite of an increased basal metabolic rate. They appear to save energy by reducing their spontaneous level of physical activity.

Rice grown in nutrient solution with doses of manganese and silicon

Although silicon is not recognized as a nutrient, it may benefit rice plants and may alleviate the Mn toxicity in some plant species. The dry matter yield (root, leaf, sheaths and leaf blade) and plant architecture (angle of leaf insertion and leaf arc) were evaluated in rice plants grown in nutrient solutions with three Mn doses, with and without Si addition. The treatments were arranged in a 2 x 3 factorial [with and without (2 mmol L-1) Si; three Mn doses (0.5; 2.5 and 10 µmol L-1)], in a randomized block design with 4 replications. The experimental unit was a 4 L plastic vase with 4 rice (Metica-1 cultivar) plants. Thirty nine days after keeping the seedlings in the nutrient solution the plant dry matter yield was determined; the angle of leaf insertion in the sheath and the leaf arc were measured; and the Si and Mn concentrations in roots, sheaths and leaves were determined. The analysis of variance (F test at 5 and 1 % levels) and the regression analysis (for testing plant response to Mn with the Si treatments) were performed. The Si added to the nutrient solution increased the dry matter yield of roots, sheaths and leaf blades and also decreased the angle of leaf blade insertion into the sheath and the foliar arc in the rice plant. Additionally, it ameliorated the rice plant architecture which allowed an increase in the dry matter yield. Similarly, the addition of Mn to the solution improved the architecture of the rice plants with gain in dry matter yield. As Si was added to the nutrient solution, the concentration of Mn in leaves decreased and in roots increased thus alleviating the toxic effects of Mn on the plants.

Remaining phosphorus estimated by pedotransfer function

Although the determination of remaining phosphorus (Prem) is simple, accurate values could also be estimated with a pedotransfer function (PTF) aiming at the additional use of soil analysis data and/or Prem replacement by an even simpler determination. The purpose of this paper was to develop a pedotransfer function to estimate Prem values of soils of the State of São Paulo based on properties with easier or routine laboratory determination. A pedotransfer function was developed by artificial neural networks (ANN) from a database of Prem values, pH values measured in 1 mol L-1 NaF solution (pH NaF) and soil chemical and physical properties of samples collected during soil classification activities carried out in the State of São Paulo by the Agronomic Institute of Campinas (IAC). Furthermore, a pedotransfer function was developed by regressing Prem values against the same predictor variables of the ANN-based PTF. Results showed that Prem values can be calculated more accurately with the ANN-based pedotransfer function with the input variables pH NaF values along with the sum of exchangeable bases (SB) and the exchangeable aluminum (Al3+) soil content. In addition, the accuracy of the Prem estimates by ANN-based PTF were more sensitive to increases in the experimental database size. Although the database used in this study was not comprehensive enough for the establishment of a definitive pedotrasnfer function for Prem estimation, results indicated the inclusion of Prem and pH NaF measurements among the soil testing evaluations as promising ind order to provide a greater database for the development of an ANN-based pedotransfer function for accurate Prem estimates from pH NaF, SB, and Al3+ values.

Comment on "Reappraisal of experimental values of third-order elastic constants of some cubic semiconductors and metals"

In a recent paper A. S. Johal and D. J. Dunstan [Phys. Rev. B 73, 024106 (2006)] have applied multivariate linear regression analysis to the published data of the change in ultrasonic velocity with applied stress. The aim is to obtain the best estimates for the third-order elastic constants in cubic materials. From such an analysis they conclude that uniaxial stress data on metals turns out to be nearly useless by itself. The purpose of this comment is to point out that by a proper analysis of uniaxial stress data it is possible to obtain reliable values of third-order elastic constants in cubic metals and alloys. Cu-based shape memory alloys are used as an illustrative example.

Evolution of spirituality and religiousness in chronic schizophrenia or schizo-affective disorders: A 3 years follow-up study

Purpose : Spirituality and religiousness have been shown to be highly prevalent in patients with schizophrenia. Religion can help instil a positive sense of self, decrease the impact of symptoms and provide social contacts. Religion may also be a source of suffering. In this context, this research explores whether religion remains stable over time. Methods : From an initial cohort of 115 out-patients, 80% completed the 3-years follow-up assessment. In order to study the evolution over time, a hierarchical cluster analysis using average linkage was performed on factorial scores at baseline and follow-up and their differences. A sensitivity analysis was secondarily performed to check if the outcome was influenced by other factors such as changes in mental states using mixed models. Results : Religion was stable over time for 63% patients; positive changes occurred for 20% (i.e., significant increase of religion as a resource or a transformation of negative religion to a positive one) and negative changes for 17% (i.e., decrease of religion as a resource or a transformation of positive religion to a negative one). Change in spirituality and/or religiousness was not associated with social or clinical status, but with reduced subjective quality of life and self-esteem; even after controlling for the influence of age, gender, quality of life and clinical factors at baseline. Conclusions : In this context of patients with chronic schizophrenia, religion appeared to be labile. Qualitative analyses showed that those changes expressed the struggles of patients and suggest that religious issues need to be discussed in clinical settings.

Influence of organic-mineral fertilization of an oxisol on soil chemical properties and Bracharia brizantha production

The use of organic-mineral fertilizer produced by the manufacturing industry of lysine and threonine amino acids can improve the fertility of tropical soils. The objective of this study was to evaluate the influence of different doses of the organic-mineral fertilizer named Ajifer L-14 on chemical properties and on the response with increased production of a forage on a Red Latosol in the northwestern region of São Paulo State, Brazil. A randomized block design was used with seven treatments and four replications. The treatments consisted of: T1- control (without application of Ajifer L-14); T2- control (natural vegetation); T3- mineral fertilization according to crop requirements and soil analysis (application of 1.35 kg plot-1 of urea, 2.20 single superphosphate, and 0.51 KCl, corresponding to 60 of N, 40 P2O5 and 30 kg ha-1 of K2O); T4- fertilization with Ajifer L-14 according to the recommendation resulting from the soil chemical analysis (40 L plot-1, corresponding to 60 kg ha-1 N); T5- fertilization with Ajifer L-14, at a rate of 150 % of the recommended values (60 L plot-1, corresponding to 90 kg ha-1 N); T6- fertilization with Ajifer L-14 at a rate of 50 % of the recommended values (20 L plot-1, corresponding to 30 kg ha-1 N); T7- fertilization with Ajifer L-14 at a rate of 125 % of the recommended values (50 L plot-1, corresponding to 75 kg ha-1 N); T8- fertilization with Ajifer L-14 at a rate of 75 % of the recommended values (30 L plot-1, corresponding to 45 kg ha-1 N). The following soil chemical properties were evaluated (layers 0.0-0.1 and 0.1-0.2 m): P, organic matter, pH, K+, Ca2+, Mg2+, cation exchange capacity, potential acidity, and base saturation. The application of this organic-mineral fertilizer does not influence the soil chemical properties. Regression analysis indicated a polynomial relationship between the application rates of organic-mineral fertilizer and the production of dry matter and crude protein of Bracharia Brizantha.

Proposal for an index to classify irrigation water quality: a case study in northeastern Brazil

One way of classifying water quality is by means of indices, in which a series of parameters analyzed are joined a single value, facilitating the interpretation of extensive lists of variables or indicators, underlying the classification of water quality. The objective of this study was to develop a statistically based index to classify water according to the Irrigation Water Quality Index (IWQI), to evaluate the ionic composition of water for use in irrigation and classify it by its source. For this purpose, the database generated during the Technology Generation and Adaptation (GAT) program was used, in which, as of 1988, water samples were collected monthly from water sources in the states of Paraíba, Rio Grande do Norte and Ceará. To evaluate water quality, the electrical conductivity (EC) of irrigation water was taken as a reference, with values corresponding to 0.7 dS m-1. The chemical variables used in this study were: pH, EC, Ca, Mg, Na, K, Cl, HCO3, CO3, and SO4. The data of all characteristics evaluated were standardized and data normality was confirmed by Lilliefors test. Then the irrigation water quality index was determined by an equation that relates the standardized value of the variable with the number of characteristics evaluated. Thus, the IWQI was classified based on indices, considering normal distribution. Finally, these indices were subjected to regression analysis. The method proposed for the IWQI allowed a satisfactory classification of the irrigation water quality, being able to estimate it as a function of EC for the three water sources. Variation in the ionic composition was observed among the three sources and within a single source. Although the water quality differed, it was good in most cases, with the classification IWQI II.

Magnetic susceptibility to identify landscape segments on a detailed scale in the region of Jaboticabal, São Paulo, Brazil

The agricultural potential is generally assessed and managed based on a one-dimensional vision of the soil profile, however, the increased appreciation of sustainable production has stimulated studies on faster and more accurate evaluation techniques and methods of the agricultural potential on detailed scales. The objective of this study was to investigate the possibility of using soil magnetic susceptibility for the identification of landscape segments on a detailed scale in the region of Jaboticabal, São Paulo State. The studied area has two slope curvatures: linear and concave, subdivided into three landscape segments: upper slope (US, concave), middle slope (MS, linear) and lower slope (LS, linear). In each of these segments, 20 points were randomly sampled from a database with 207 samples forming a regular grid installed in each landscape segment. The soil physical and chemical properties, CO2 emissions (FCO2) and magnetic susceptibility (MS) of the samples were evaluated represented by: magnetic susceptibility of air-dried fine earth (MS ADFE), magnetic susceptibility of the total sand fraction (MS TS) and magnetic susceptibility of the clay fraction (MS Cl) in the 0.00 - 0.15 m layer. The principal component analysis showed that MS is an important property that can be used to identify landscape segments, because the correlation of this property within the first principal component was high. The hierarchical cluster analysis method identified two groups based on the variables selected by principal component analysis; of the six selected variables, three were related to magnetic susceptibility. The landscape segments were differentiated similarly by the principal component analysis and by the cluster analysis using only the properties with higher discriminatory power. The cluster analysis of MS ADFE, MS TS and MS Cl allowed the formation of three groups that agree with the segment division established in the field. The grouping by cluster analysis indicated MS as a tool that could facilitate the identification of landscape segments and enable the mapping of more homogeneous areas at similar locations.

Estimating subsoil resistance to nitrate leaching from easily measurable pedological properties

Leaching of nitrate (NO3-) can increase the groundwater concentration of this anion and reduce the agronomical effectiveness of nitrogen fertilizers. The main soil property inversely related to NO3- leaching is the anion exchange capacity (AEC), whose determination is however too time-consuming for being carried out in soil testing laboratories. For this reason, this study evaluated if more easily measurable soil properties could be used to estimate the resistance of subsoils to NO3- leaching. Samples from the subsurface layer (20-40 cm) of 24 representative soils of São Paulo State were characterized for particle-size distribution and for chemical and electrochemical properties. The subsoil content of adsorbed NO3- was calculated from the difference between the NO3- contents extracted with 1 mol L-1 KCl and with water; furthermore, NO3- leaching was studied in miscible displacement experiments. The results of both adsorption and leaching experiments were consistent with the well-known role exerted by AEC on the nitrate behavior in weathered soils. Multiple regression analysis indicated that in subsoils with (i) low values of remaining phosphorus (Prem), (ii) low soil pH values measured in water (pH H2O), and (iii) high pH values measured in 1 moL L-1 KCl (pH KCl), the amounts of surface positive charges tend to be greater. For this reason, NO3- leaching tends to be slower in these subsoils, even under saturated flow condition.

Nutrition, dry matter accumulation and partitioning and phosphorus use efficiency of potato grown at different phosphorus levels in nutrient solution

High rates of phosphate fertilizers are applied to potato (Solanum tuberosum L.), which may cause antagonistic interactions with other nutrients and limit crop yields when over-supplied. The purpose of this study was to evaluate the influence of phosphorus (P) levels in nutrient solution on P use efficiency, nutritional status and dry matter (DM) accumulation and partitioning of potato plants cv. Ágata. The experiment was carried out in a greenhouse, arranged in a completely randomized block design with four replications. Treatments consisted of seven P levels in nutrient solution (0, 2, 4, 8, 16, 31, and 48 mg L-1). Plants were harvested after 28 days of growth in nutrient solution, and separated in roots, stems and leaves for evaluations. The treatment effects were analyzed by regression analysis. Phosphorus levels of up to 8 mg L-1 increased the root and shoot DM accumulation, but drastically decreased the root/shoot ratio of potato cv. Ágata. Higher P availability increased P concentration, accumulation and absorption efficiency, but decreased P use efficiency. Higher P levels increased the N, P, Mg, Fe, and Mn concentrations in roots considerably and decreased K, S, Cu, and Zn concentrations. In shoot biomass, N, P, K, and Ca concentrations were significantly increased by P applied in solution, unlike Mg and Cu concentrations. Although higher P levels (> 8 mg L-1) in nutrient solution increased P concentration, accumulation and absorption efficiency, the DM accumulation and partitioning of potato cv. Ágata were not affected.

Cost-effective experimental design to support modeling of concentration-response functions

Modeling concentration-response function became extremely popular in ecotoxicology during the last decade. Indeed, modeling allows determining the total response pattern of a given substance. However, reliable modeling is consuming in term of data, which is in contradiction with the current trend in ecotoxicology, which aims to reduce, for cost and ethical reasons, the number of data produced during an experiment. It is therefore crucial to determine experimental design in a cost-effective manner. In this paper, we propose to use the theory of locally D-optimal designs to determine the set of concentrations to be tested so that the parameters of the concentration-response function can be estimated with high precision. We illustrated this approach by determining the locally D-optimal designs to estimate the toxicity of the herbicide dinoseb on daphnids and algae. The results show that the number of concentrations to be tested is often equal to the number of parameters and often related to the their meaning, i.e. they are located close to the parameters. Furthermore, the results show that the locally D-optimal design often has the minimal number of support points and is not much sensitive to small changes in nominal values of the parameters. In order to reduce the experimental cost and the use of test organisms, especially in case of long-term studies, reliable nominal values may therefore be fixed based on prior knowledge and literature research instead of on preliminary experiments

Impact of targeted antifungal prophylaxis in heart transplant recipients at high risk for early invasive fungal infection.

BACKGROUND: Invasive fungal infection (IFI) is associated with high mortality after heart transplantation (HTx). After two undiagnosed fatal cases of early disseminated fungal infections in our heart transplant program, a retrospective analysis was conducted to identify risk factors for the development of IFI and implement a new antifungal prophylaxis policy. METHODS: Clinical characteristics of HTx recipients hospitalized in our center (2004-2010) were recorded (Period 1), and risk factors associated with IFI were investigated using Cox regression analysis. From October 2010 to October 2012 (Period 2), targeted caspofungin prophylaxis was administered to all recipients at high risk for IFI, based on the results of the Period 1 analysis. RESULTS: During Period 1, 10% (6/59) of the patients developed IFI at a median onset of 9 days after transplantation. By multivariate analysis, the use of posttransplant extracorporeal membrane oxygenation (ECMO) was the strongest predictor for fungal infection (OR, 29.93; 95% CI, 1.51-592.57, P=0.03), whereas renal replacement therapy (RRT) and Aspergillus colonization were significant predictors only by univariate analysis. During Period 2, only 4% (1/26) of the patients developed IFI. In patients at high risk for IFI, antifungal prophylaxis was administered to 17% (4/23) in Period 1 versus 100% (13/13) in Period 2 (P<0.01). By survival analysis, antifungal prophylaxis was associated with a reduction in 90-day IFI incidence (HR, 0.14; 95% CI, 0.03-0.84, P=0.03) and 30-day mortality (HR, 0.25; 95% CI, 0.09-0.8, P=0.02). CONCLUSION: Extracorporeal membrane oxygenation was identified an important risk factor for IFI after HTx, and its use may require targeted administration of antifungal prophylaxis in the immediate posttransplant period.

Potential acidity estimated by SMP pH in soils of the state of Pará

The use of SMP pH to estimate the potential acidity (H + Al) is more practical than the method of 0.5 mol L-1 calcium acetate for routine laboratory analyses. The objective was to fit an equation to estimate the H + Al from SMP pH values of soils of the State of Pará. From various regions of the state, 177 soil samples were collected, in which the SMP pH was determined in 0.01 mol L-1 CaCl2 solution and H + Al in 0.5 mol L-1 calcium acetate and the results were related by regression analysis. The equation H + Al = 77.77 + 20.61 SMP pH - 1.435 SMP pH² (R² = 0.90) expressed the H + Al values (in cmol c dm-3) best. When the SMP pH values were used in equations referring to other regions or states in Brazil, the H +Al values were over- or underestimated. The potential acidity in soils of Pará can be estimated by the method of SMP pH.