Factors influencing patients with stage 5 chronic kidney disease to opt for conservative management: a practitioner research study

Aims and objectives. This study explored decision-making experiences of patients with stage 5 chronic kidney disease when opting for conservative management of their renal failure.

Background. Dialysis is an invasive treatment, and for some older patients, there is an associated treatment burden of dialysis-related symptoms. An alternative choice is conservative management, but little is known about those who make this decision and how they are supported through the process.

Design. Qualitative practitioner research study.

Method. Data were generated from nine patients' naturally occurring clinic consultations with a renal clinical nurse specialist between May 2010 - July 2010. Interviews were transcribed verbatim and findings fed back at three multi-disciplinary meetings to check for relevance and resonance. Common themes were identified and codes applied.

Results. Patients reported age and having to travel three times a week to hospital for dialysis as reasons not to opt for treatment. Others felt well without dialysis not wanting to upset the 'status quo' or to burden loved ones. Most felt equipped to make the decision following explanation and discussion with the clinical nurse specialist in the renal clinic.

Conclusions. Patients opting for conservative management give numerous reasons for this including old age, travel limitations, feeling well without dialysis and not wanting to be a burden, but appear content with their decision. One-to-one discussions with the clinical nurse specialist appear helpful during the decision-making process presenting an opportunity for advancing nursing roles in the chronic kidney disease service.

Relevance to clinical practice. Understanding patients' reasons for refusing dialysis assists in supporting until death. There is an opportunity for developing nursing practice to meet the multi-faceted needs of this group.

Quando todos os caminhos levavam a Portugal:impacto da guerra dos cem anos na vida económica e política de Portugal (séculos XIV-XV)

Tese de doutoramento, História (História Medieval), Universidade de Lisboa, Faculdade de Letras, 2014

O papel dos antipsicóticos clozapina, olanzapina e risperidona na orientação espacial egocêntrica em ratos

Ratos machos Long-Evans e Wistar foram submetidos a uma tarefa de alternância de escolhas num labirinto em Y (delayed two-alternative-choice task). Esta tarefa requer orientação espacial egocêntrica (baseada na localização do animal dentro do aparelho) e, ao mesmo tempo, exclui a orientação espacial alocêntrica (baseada na detecção de elementos visuais externos ao aparelho). Os animais foram expostos a 10 sessões de treino para cada animal, os quais eram submetidos a injeção de salina (controles), ou dos antipsicóticos clozapina (0,5 ,g/kg i.m.), olanzapina (0,5 mg/kg i.p.) e risperidona (0,5 mg/kg i.p.) uma hora antes do início de cada tarefa. Na primeira sessão, os ratos eram recompensados por seguir até o final de cada braço, onde achavam comida. Nas seguintes nove corridas, os animais eram recompensados somente se eles entrassem no braço que não tinha sido previamente escolhido. Mediu-se também o tempo de corrida até o final de cada braço, com o consumo da comida. Um tempo limite foi estabelecido para esse tempo: se em 180 segundos o animal não consumasse a tarefa, o mesmo era retirado do aparelho e colocado no braço inicial. Com o objetivo de excluir orientação espacial alocêntrica (ou seja, utilizando sinais externos ao aparelho), a orientação do Y-maze foi modificada dia após dia, em uma ordem pseudo-randomizada A tarefa foi desenvolvida em dias consecutivos, sem pausa. Os resultados dos experimentos demonstraram que os antipsicóticos clozapina e olanzapina prejudicaram a orientação espacial egocêntrica no labirinto em Y. Em contrapartida, risperidona prejudicou a orientação espacial egocêntrica somente nos primeiros quatro dias; nos seguintes quatro dias não teve nenhum efeito. O tempo de corrida não foi alterado pela clozapina e foi prolongado pela olanzapina e pela risperidona. Não se observou catalepsia ou redução do comportamento cognitivo; nos animais tratados com olanzapina observou-se uma leve sedação.

Transmissão de Radiação Ultravioleta Através do Pelame e da Epiderme de Bovinos

A transmissão de radiação ultravioleta de comprimentos de onda entre 250 e 360 nm através do pelame e da epiderme de bovinos foi determinada em laboratório, usando-se amostras de couro de animais recém-abatidos. A quantidade de radiação transmitida através do pelame depende da coloração e também das características estruturais do pelame (espessura da capa; comprimento, diâmetro, número e inclinação dos pêlos), pelas quais é definido o trajeto médio de um fóton pela massa de pêlos (L). A maior transmissão é proporcionada por pelames brancos com altos valores de L, ao passo que pelames negros em geral apresentam transmissão nula ou muito baixa. Quanto menos pigmentada a epiderme, maior a transmissão de radiação através da sua superfície. A melhor proteção é proporcionada por pelames negros com baixo valor de L sobre epiderme igualmente negra, mas em vista do aquecimento causado pela absorção de radiação térmica (em vacas Holandesas a temperatura das malhas negras atinge 44,1ºC ao mesmo tempo em que a das malhas brancas é 37,7ºC), a combinação ideal para ambientes tropicais é um pelame branco com baixo valor de L sobre epiderme negra, uma combinação dificilmente encontrada em animais de raças européias. Uma alternativa seria um pelame negro com um baixo valor de L. Animais vermelhos apresentam alta transmissão de radiação UV através da epiderme e do pelame, sendo desaconselhados para ambientes tropicais. Entretanto, foi observada uma vaca Holandesa com áreas isoladas de epiderme negra coberta com pelame branco, o que pode trazer perspectivas para uma seleção para combinações mais adequadas de epiderme e pelame em bovinos de raças européias.

Fatigue fracture behavior of Ti-6Al-4V PVD coated

Fatigue, corrosion and wear resistance are important parameters in aircraft components development as landing gear. High strength/weight ratio and effective corrosion resistance make of titanium alloys an alternative choice to replace steel and aluminum alloys. However, titanium alloys have poor tribological properties, which reduce devices performance under friction. PVD coatings tribological systems has been increased due to their attractive mechanical properties as low environmental impact, low friction coefficient, low wear rate and hardness up to 2000 HV.In this study the influence of TiN deposited by PVD on the fatigue strength of Ti-6Al-4V alloy was evaluated. Comparison of fatigue strength of coated specimens and base material shows also a decrease when parts are coated. It was observed that the influence is more significant in high cycle fatigue tests. Scanning electron microscopy technique (SEM) was used to observe crack origin sites and fracture features. (C) 2010 Published by Elsevier Ltd.

Abordaje conservador y mínimamente invasivo de la hipomineralización molar-incisivo (HMI) - Relato de casos clínicos

Molar-Incisor Hypomineralization (MIH) is a qualitative developmental enamel defect that affects one to four permanent first molars, with or without involvement of permanent incisors. Enamel defects may produce many symptoms that have physical, social and psychological effects and influence day-to-day living or quality of life. The available treatment modalities for teeth with MIH are extensive, ranging from prevention, restoration, to extraction. Factors such as age, patient expectations, severity of the lesion and materials should be considered in the treatment of the patient with MIH. Restoration with composite resin is an alternative choice for posterior and anterior MIH defective teeth and its use has been show acceptable results. This article describes two clinical cases involving pediatric patients with MIH whose procedure of cavity preparation was based on the use of CVD ultrasound diamond tips and restored using composite resin obtaining favorable esthetics results after a 1 year follow-up.

High precision astrometry mission for the detection and characterization of nearby habitable planetary systems with the Nearby Earth Astrometric Telescope (NEAT)

A complete census of planetary systems around a volume-limited sample of solar-type stars (FGK dwarfs) in the Solar neighborhood (d a parts per thousand currency signaEuro parts per thousand 15 pc) with uniform sensitivity down to Earth-mass planets within their Habitable Zones out to several AUs would be a major milestone in extrasolar planets astrophysics. This fundamental goal can be achieved with a mission concept such as NEAT-the Nearby Earth Astrometric Telescope. NEAT is designed to carry out space-borne extremely-high-precision astrometric measurements at the 0.05 mu as (1 sigma) accuracy level, sufficient to detect dynamical effects due to orbiting planets of mass even lower than Earth's around the nearest stars. Such a survey mission would provide the actual planetary masses and the full orbital geometry for all the components of the detected planetary systems down to the Earth-mass limit. The NEAT performance limits can be achieved by carrying out differential astrometry between the targets and a set of suitable reference stars in the field. The NEAT instrument design consists of an off-axis parabola single-mirror telescope (D = 1 m), a detector with a large field of view located 40 m away from the telescope and made of 8 small movable CCDs located around a fixed central CCD, and an interferometric calibration system monitoring dynamical Young's fringes originating from metrology fibers located at the primary mirror. The mission profile is driven by the fact that the two main modules of the payload, the telescope and the focal plane, must be located 40 m away leading to the choice of a formation flying option as the reference mission, and of a deployable boom option as an alternative choice. The proposed mission architecture relies on the use of two satellites, of about 700 kg each, operating at L2 for 5 years, flying in formation and offering a capability of more than 20,000 reconfigurations. The two satellites will be launched in a stacked configuration using a Soyuz ST launch vehicle. The NEAT primary science program will encompass an astrometric survey of our 200 closest F-, G- and K-type stellar neighbors, with an average of 50 visits each distributed over the nominal mission duration. The main survey operation will use approximately 70% of the mission lifetime. The remaining 30% of NEAT observing time might be allocated, for example, to improve the characterization of the architecture of selected planetary systems around nearby targets of specific interest (low-mass stars, young stars, etc.) discovered by Gaia, ground-based high-precision radial-velocity surveys, and other programs. With its exquisite, surgical astrometric precision, NEAT holds the promise to provide the first thorough census for Earth-mass planets around stars in the immediate vicinity of our Sun.

Arthroscopic stabilisation of an acute acromioclavicular dislocation grade III in a patient with ectopic insertion of the pectoralis minor: technical considerations

The different approaches used in arthroscopic stabilisation of the acromioclavicular joint are well known. However, and despite a great incidence of ectopic pectoralis minor insertion, an alternative choice for the use of arthroscopic portal has not being sufficiently described. Here, we describe a case of acute acromioclavicular dislocation grade III. The arthroscopic stabilisation was achieved using the TightRope (Arthrex, Naples, USA) implant. Through this technique, the approach to the articular portion of the coracoid process can be made intra-articularly or from the subacromial space. We accessed intra-articularly, by opening the rotator interval to reach the coracoid process from the joint cavity. After opening the rotator interval, an ectopic insertion of the pectoralis minor was observed. The choice of approach of the coracoid process from the subacromial space would have complicated the intervention, making it necessary to sever the ectopic tendon to complete the technique, lengthening the surgical time and increasing the chance of complications. For this reason, the use of a standard posterior portal providing intra-articular arthroscopic access through the rotator interval is recommended since the aforementioned anatomical variation is not infrequent. Level of evidence Therapeutic studies—investigating the results of treatment, Level V.

Multicriteria Evaluation and Optimization of Hierarchical Systems

It is shown that any multicriteria problem can be represented by a hierarchical system. Separate properties of the object are evaluated at the lower level of the system, using a criteria vector, and a composition mechanism is used to evaluate the object as a whole at the upper level. The paper proposes a method to solve complex multicriteria problems of evaluation and optimization. It is based on nested scalar convolutions of vector- valued criteria and allows simple structural and parametrical synthesis of multicriteria hierarchical systems.

Advances in characterisation, calibration and data processing speed of optical coherence tomography systems

This thesis describes advances in the characterisation, calibration and data processing of optical coherence tomography (OCT) systems. Femtosecond (fs) laser inscription was used for producing OCT-phantoms. Transparent materials are generally inert to infra-red radiations, but with fs lasers material modification occurs via non-linear processes when the highly focused light source interacts with the materials. This modification is confined to the focal volume and is highly reproducible. In order to select the best inscription parameters, combination of different inscription parameters were tested, using three fs laser systems, with different operating properties, on a variety of materials. This facilitated the understanding of the key characteristics of the produced structures with the aim of producing viable OCT-phantoms. Finally, OCT-phantoms were successfully designed and fabricated in fused silica. The use of these phantoms to characterise many properties (resolution, distortion, sensitivity decay, scan linearity) of an OCT system was demonstrated. Quantitative methods were developed to support the characterisation of an OCT system collecting images from phantoms and also to improve the quality of the OCT images. Characterisation methods include the measurement of the spatially variant resolution (point spread function (PSF) and modulation transfer function (MTF)), sensitivity and distortion. Processing of OCT data is a computer intensive process. Standard central processing unit (CPU) based processing might take several minutes to a few hours to process acquired data, thus data processing is a significant bottleneck. An alternative choice is to use expensive hardware-based processing such as field programmable gate arrays (FPGAs). However, recently graphics processing unit (GPU) based data processing methods have been developed to minimize this data processing and rendering time. These processing techniques include standard-processing methods which includes a set of algorithms to process the raw data (interference) obtained by the detector and generate A-scans. The work presented here describes accelerated data processing and post processing techniques for OCT systems. The GPU based processing developed, during the PhD, was later implemented into a custom built Fourier domain optical coherence tomography (FD-OCT) system. This system currently processes and renders data in real time. Processing throughput of this system is currently limited by the camera capture rate. OCTphantoms have been heavily used for the qualitative characterization and adjustment/ fine tuning of the operating conditions of OCT system. Currently, investigations are under way to characterize OCT systems using our phantoms. The work presented in this thesis demonstrate several novel techniques of fabricating OCT-phantoms and accelerating OCT data processing using GPUs. In the process of developing phantoms and quantitative methods, a thorough understanding and practical knowledge of OCT and fs laser processing systems was developed. This understanding leads to several novel pieces of research that are not only relevant to OCT but have broader importance. For example, extensive understanding of the properties of fs inscribed structures will be useful in other photonic application such as making of phase mask, wave guides and microfluidic channels. Acceleration of data processing with GPUs is also useful in other fields.

About the Multi Criteria Ranging Problem in the Fuzzy Environment

Decision making and technical decision analysis demand computer-aided techniques and therefore more and more support by formal techniques. In recent years fuzzy decision analysis and related techniques gained importance as an efficient method for planning and optimization applications in fields like production planning, financial and economical modeling and forecasting or classification. It is also known, that the hierarchical modeling of the situation is one of the most popular modeling method. It is shown, how to use the fuzzy hierarchical model in complex with other methods of Multiple Criteria Decision Making. We propose a novel approach to overcome the inherent limitations of Hierarchical Methods by exploiting multiple criteria decision making.

Computational approaches to emotional decision making

Findings on the role that emotion plays in human behavior have transformed Artificial Intelligence computations. Modern research explores how to simulate more intelligent and flexible systems. Several studies focus on the role that emotion has in order to establish values for alternative decision and decision outcomes. For instance, Busemeyer et al. (2007) argued that emotional state affects the subjectivity value of alternative choice. However, emotional concepts in these theories are generally not defined formally and it is difficult to describe in systematic detail how processes work. In this sense, structures and processes cannot be explicitly implemented. Some attempts have been incorporated into larger computational systems that try to model how emotion affects human mental processes and behavior (Becker-Asano & Wachsmuth, 2008; Marinier, Laird & Lewis, 2009; Marsella & Gratch, 2009; Parkinson, 2009; Sander, Grandjean & Scherer, 2005). As we will see, some tutoring systems have explored this potential to inform user models. Likewise, dialogue systems, mixed-initiative planning systems, or systems that learn from observation could also benefit from such an approach (Dickinson, Brew & Meurers, 2013; Jurafsky & Martin, 2009). That is, considering emotion as interaction can be relevant in order to explain the dynamic role it plays in action and cognition (see Boehner et al., 2007).

The choice of alternative 5' splice sites in influenza virus M1 mRNA is regulated by the viral polymerase complex.

The influenza virus M1 mRNA has two alternative 5' splice sites: a distal 5' splice site producing mRNA3 that has the coding potential for 9 amino acids and a proximal 5' splice site producing M2 mRNA encoding the essential M2 ion-channel protein. Only mRNA3 was made in uninfected cells transfected with DNA expressing M1 mRNA. Similarly, using nuclear extracts from uninfected cells, in vitro splicing of M1 mRNA yielded only mRNA3. Only when the mRNA3 5' splice site was inactivated by mutation was M2 mRNA made in uninfected cells and in uninfected cell extracts. In influenza virus-infected cells, M2 mRNA was made, but only after a delay, suggesting that newly synthesized viral gene product(s) were needed to activate the M2 5' splice site. We present strong evidence that these gene products are the complex of the three polymerase proteins, the same complex that functions in the transcription and replication of the viral genome. Gel shift experiments showed that the viral polymerase complex bound to the 5' end of the viral M1 mRNA in a sequence-specific and cap-dependent manner. During in vitro splicing catalyzed by uninfected cell extracts, the binding of the viral polymerase complex blocked the mRNA3 5' splice site, resulting in the switch to the M2 mRNA 5' splice site and the production of M2 mRNA.