Management of diabetes mellitus and associated cardiovascular risk factors in Brazil – the Brazilian study on the practice of diabetes care

Abstract Background The Brazilian Study on the Practice of Diabetes Care main objective was to provide an epidemiological profile of individuals with type 1 and 2 diabetes mellitus (DM) in Brazil, concerning therapy and adherence to international guidelines in the medical practice. Methods This observational, cross-sectional, multicenter study collected and analyzed data from individuals with type 1 and 2 DM attending public or private clinics in Brazil. Each investigator included the first 10 patients with type 2 DM who visited his/her office, and the first 5 patients with type 1 DM. Results A total of 1,358 patients were analyzed; 375 (27.6%) had type 1 and 983 (72.4%) had type 2 DM. Most individuals were women, Caucasian, and private health care users. High prevalence rates of hypertension, dyslipidemia and central obesity were observed, particularly in type 2 DM. Only 7.3% and 5.1% of the individuals with types 1 and 2 DM, respectively, had optimal control of blood pressure, plasma glucose and lipids. The absence of hypertension and female sex were associated with better control of type 1 DM and other cardiovascular risk factors. In type 2 DM, older age was also associated with better control. Conclusions Female sex, older age, and absence of hypertension were associated with better metabolic control. An optimal control of plasma glucose and other cardiovascular risk factors are obtained only in a minority of individuals with diabetes. Local numbers, compared to those from other countries are worse.

Avaliação funcional de idosos com déficit cognitivo

OBJETIVO: Descrever o perfil social e a capacidade funcional de idosos com déficit cognitivo. MÉTODOS: Estudo de abordagem quantitativa, descritivo, transversal, com 503 idosos de 60 anos e mais com déficit cognitivo, residentes em Dourados, (MS) e assistidos pela Estratégia Saúde da Família (ESF). A coleta de dados foi realizada por meio de entrevistas domiciliares, com um questionário estruturado para variáveis sociodemográficas e condições de saúde, o Miniexame do Estado Mental e a Medida de Independência Funcional. RESULTADOS: Foram identificados 215 idosos com déficit cognitivo, dos quais 32 (14,9%) apresentavam algum grau de dependência. Houve maior grau de dependência no sexo masculino e na faixa etária de 80 anos e mais. As dimensões locomoção e cognição apresentaram os menores valores. CONCLUSÃO: Os diagnósticos cognitivos e funcionais são fundamentais para o planejamento de ações que favoreçam a promoção e manutenção da capacidade funcional do idoso.

Influence of the substitutional solute on the mechanical properties of Ti-Nb binary alloys for biomedical use

Titanium alloys are widely used in the manufacture of biomedical implants because they possess an excellent combination of physical properties and outstanding biocompatibility. Today, the most widely used alloy is Ti-6Al-4V, but some studies have reported adverse effects with the long-term presence of Al and V in the body, without mentioning that the elasticity modulus value of this alloy is far superior to the bone. Thus, there is a need to develop new Ti-based alloys without Al and V that have a lower modulus, greater biocompatibility, and similar mechanical strength. In this paper, we investigated the effect of Nb as a substitutional solute on the mechanical properties of Ti-Nb alloys, prepared in an arc-melting furnace and characterized by density, X-ray diffraction, optical microscopy, hardness and elasticity modulus measurements. The X-ray and microscopy measurements show a predominance of the α phase. The microhardness values showed a tendency to increase with the concentration of niobium in the alloy. Regarding the elasticity modulus, it was observed a nonlinear behavior with respect to the concentration of niobium. This behavior is associated with the presence of the α phase.

Pattern-based segmentation of digital documents: model and implementation

This thesis proposes a new document model, according to which any document can be segmented in some independent components and transformed in a pattern-based projection, that only uses a very small set of objects and composition rules. The point is that such a normalized document expresses the same fundamental information of the original one, in a simple, clear and unambiguous way. The central part of my work consists of discussing that model, investigating how a digital document can be segmented, and how a segmented version can be used to implement advanced tools of conversion. I present seven patterns which are versatile enough to capture the most relevant documents’ structures, and whose minimality and rigour make that implementation possible. The abstract model is then instantiated into an actual markup language, called IML. IML is a general and extensible language, which basically adopts an XHTML syntax, able to capture a posteriori the only content of a digital document. It is compared with other languages and proposals, in order to clarify its role and objectives. Finally, I present some systems built upon these ideas. These applications are evaluated in terms of users’ advantages, workflow improvements and impact over the overall quality of the output. In particular, they cover heterogeneous content management processes: from web editing to collaboration (IsaWiki and WikiFactory), from e-learning (IsaLearning) to professional printing (IsaPress).

Nuclear moments and differences in mean square charge radii of short-lived neon isotopes by collinear laser spectroscopy

Kernmomente und Kernladungsradien von kurzlebigen NeonIsotopen in der Kette 17-26,28Ne wurden mittels kollinearerLaserspektroskopie am online Massenseparator ISOLDE am CERN(Genf) vermessen. Bei kollinearer Laserspektroskopieverlangt die Bestimmung der Kernladungsradien leichterIsotope aus der Isotopeverschiebung nach einer sehr präzisenKenntnis der Ionenstrahlenergie. Zu diesem Zweck wurde eineneue, auf kollinearer Laserspektroskopie basierende Methodezur Strahlenergiemessung entwickelt und erfolgreich in denExperimenten zu Neon eingesetzt. Die experimentellenErgebnisse werden mit theoretischen Rechnungen im Rahmen desSchalenmodells und von kollektiven Kernmodellen verglichen.

Percieved Organizational Efficacy in Internationalized Companies: Application of Competing Values Approach and Collective Efficacy

This dissertation focuses on “organizational efficacy”, in particular on employees’ beliefs of organizational capacity to be efficacious. Organizational efficacy is considered from two perspectives – competing values approach and collective efficacy, and evaluated in internationalized companies. The dissertation is composed of three studies. The data were collected in thirteen Italian companies on different stages of internationalization for a total number of respondents is 358. In the first study the factorial validity of the competing values instrument (Rohrbaugh, 1981) was investigated and confirmed. Two scales were used to measure collective efficacy: a general collective efficacy scale (Bohn, 2010), and a specific collective efficacy scale, developed following suggestions of Borgogni et al. (2001), it evaluates employees’ beliefs of efficacy of organizations in the international market. The findings suggest that competing values and collective organizational efficacy instruments may provide a multi-faceted measurement of employees’ beliefs of organizational efficacy. The second study examined the relationship between organizational efficacy and collective work engagement. To measure collective work engagement the UWES-9 (Schaufeli & Bakker, 2003) was adapted at the group level; its factor structure and reliability were similar to the standard UWES-9. The findings suggest that organizational efficacy fully predicts collective work engagement. Also we investigated whether leadership moderates the relationship between organizational efficacy and collective work engagement. We operationalized leadership style with MLQ (Bass & Avolio, 1995); the results suggest that intellectual stimulation and idealized influence (transformational leadership) and contingent reward (transactional leadership) enhance the impact of organizational efficacy on collective work engagement. In the third study we investigated organizational efficacy and collective work engagement in internationalized companies. The findings show that beliefs of organizational efficacy vary across companies in different stages of internationalization, while no significant difference was found for collective work engagement. Limitations, practical implications and future studies are discussed in the conclusion.

Toxoplasma gondii in animals and the environment

Toxoplasma gondii is an obligate intracellular parasite capable of infecting virtually all warm-blooded species, including humans, but cats are the only definitive hosts. Humans or animals acquire T. gondii infection by ingesting food or water contaminated with sporulated oocysts or by ingesting tissue cysts containing bradyzoites. Toxoplasmosis has the highest human incidence among zoonotic parasitic diseases, but it is still considered an underreported zoonosis. The importance of T. gondii primary infection in livestock is related to the ability of the parasite to produce tissue cysts in infected animals, which may represent important sources of infection for humans. Consumption of undercooked mutton and pork are considered important sources of human Toxoplasma gondii. The first aim of this thesis was to develop a rapid and sensitive in- house indirect ELISA for the detection of antibodies against T. gondii in sheep sera. ROC-curve analysis showed high discriminatory power (AUC=0.999) and high sensitivity (99.4%) and specificity (99.8%) of the method. The ELISA was used to test a batch of sheep sera (375) collected in the Forli-Cesena district. The overall prevalence was estimated at 41.9% demonstrating that T. gondii infection is widely distributed in sheep reared in Forli-Cesena district. Since the epidemiological impact of waterborne transmission route of T.gondii to humans is now thought to be more significant than previously believed, the second aim of the thesis was to evaluate PCR based methods for detecting T. gondii DNA in raw and finished drinking water samples collected in Scotland. Samples were tested using a quantitative PCR on 529 bp repetitive elements. Only one raw water sample (0.3%), out of the 358 examined, tested T. gondii positive demonstrating that there is no evidence that tap water is a source of Toxoplasma infection in Scotland.

Development of a biorefinery scheme for the valorization of olive mill wastewaters and grape pomaces

In the Mediterranean area, olive mill wastewater (OMW) and grape pomace (GP) are among the major agro-industrial wastes produced. These two wastes have a high organic load and high phytotoxicity. Thus, their disposal in the environment can lead to negative effects. Second-generation biorefineries are dedicated to the valorization of biowaste by the production of goods from such residual biomasses. This approach can combine bioremediation approaches to the generation of noble molecules, biomaterials and energy. The main aim of this thesis work was to study the anaerobic digestion of OMW and GP under different operational conditions to produce volatile fatti acids (VFAs) (first stage aim) and CH4 (second stage aim). To this end, a packed-bed biofilm reactor (PBBR) was set up to perform the anaerobic acidogenic digestion of the liquid dephenolized stream of OMW (OMWdeph). In parallel, the solid stream of OMW (OMWsolid), previously separated in order to allow the solid phase extraction of polyphenols, was addressed to anaerobic methanogenic digestion to obtain CH4. The latter experiment was performed in 100ml Pyrex bottles which were maintained at different temperatures (55-45-37°C). Together with previous experiments, the anaerobic acidogenic digestion of fermented GP (GPfreshacid) and dephenolized and fermented GP (GPdephacid) was performed in 100ml Pyrex bottles to estimate the concentration of VFAs achievable from each aforementioned GPs. Finally, the same matrices of GP and not pre-treated GP (GPfresh) were digested under anaerobic methanogenic condition to produce CH4. Anaerobic acidogenic and methanogenic digestion processes of GPs lasted about 33 days. Instead, the anaerobic acidogenic and methanogenic digestion process of OMWs lasted about 121 and 60 days, respectively. Each experiment was periodically monitored by analysing volume and composition of produced biogas and VFA concentration. Results showed that VFAs were produced in higher concentrations in GP compared to OMWdeph. The overall concentration of VFAs from GPfreshacid was approximately 39.5 gCOD L-1, 29 gCOD L-1 from GPdephacid, and 8.7 gCOD L-1 from OMWdeph. Concerning the CH4 production, the OMWsolid reached a high biochemical methane potential (BMP) at a thermophilic temperature (55°) than at mesophlic ones (37-45°C). The value reached was about 358.7 mlCH4 gSVsub-1. In contrast, GPfresh got a high BMP but at a mesophilic temperature. The BMP was about 207.3 mlCH4 gSVsub-1, followed by GPfreshacid with about 192.6 mlCH4 gSVsub-1 and lastly GPdephacid with about 102.2 mlCH4 gSVsub-1. In summary, based on the gathered results, GP seems to be a better carbon source for acidogenic and methanogenic microrganism compared to OMW, because higher amount of VFAs and CH4 were produced in AD of GP than OMW. In addition to these products, polyphenols were extracted by means of a solid phase extraction (SPE) procedure by another research group, and VFAs were utilised for biopolymers production, in particular polyhydroxyalkanoates (PHAs), by the same research group in which I was involved.

Predicting adverse events in children with fever and chemotherapy-induced neutropenia: the prospective multicenter SPOG 2003 FN study

PURPOSE To develop a score predicting the risk of adverse events (AEs) in pediatric patients with cancer who experience fever and neutropenia (FN) and to evaluate its performance. PATIENTS AND METHODS Pediatric patients with cancer presenting with FN induced by nonmyeloablative chemotherapy were observed in a prospective multicenter study. A score predicting the risk of future AEs (ie, serious medical complication, microbiologically defined infection, radiologically confirmed pneumonia) was developed from a multivariate mixed logistic regression model. Its cross-validated predictive performance was compared with that of published risk prediction rules. Results An AE was reported in 122 (29%) of 423 FN episodes. In 57 episodes (13%), the first AE was known only after reassessment after 8 to 24 hours of inpatient management. Predicting AE at reassessment was better than prediction at presentation with FN. A differential leukocyte count did not increase the predictive performance. The score predicting future AE in 358 episodes without known AE at reassessment used the following four variables: preceding chemotherapy more intensive than acute lymphoblastic leukemia maintenance (weight = 4), hemoglobin > or = 90 g/L (weight = 5), leukocyte count less than 0.3 G/L (weight = 3), and platelet count less than 50 G/L (weight = 3). A score (sum of weights) > or = 9 predicted future AEs. The cross-validated performance of this score exceeded the performance of published risk prediction rules. At an overall sensitivity of 92%, 35% of the episodes were classified as low risk, with a specificity of 45% and a negative predictive value of 93%. CONCLUSION This score, based on four routinely accessible characteristics, accurately identifies pediatric patients with cancer with FN at risk for AEs after reassessment.

Effect of valsartan on the incidence of diabetes and cardiovascular events

It is not known whether drugs that block the renin-angiotensin system reduce the risk of diabetes and cardiovascular events in patients with impaired glucose tolerance.