The exponential increase in clinical research has profoundly changed medical sciences. Evidence that has accumulated in the past three decades from clinical trials has led to the proposal that ...clinical care should not be based solely on clinical expertise and patient values, and should integrate robust data from systematic research. As a consequence, clinical research has become more complex and methods have become more rigorous, and evidence is usually not easily translated into clinical practice. Therefore, the instruction of clinical research methods for scientists and clinicians must adapt to this new reality. To address this challenge, a global distance-learning clinical research-training program was developed, based on collaborative learning, the pedagogical goal of which was to develop critical thinking skills in clinical research. We describe and analyze the challenges and possible solutions of this course after 5 years of experience (2008-2012) with this program. Through evaluation by students and faculty, we identified and reviewed the following challenges of our program: 1) student engagement and motivation, 2) impact of heterogeneous audience on learning, 3) learning in large groups, 4) enhancing group learning, 5) enhancing social presence, 6) dropouts, 7) quality control, and 8) course management. We discuss these issues and potential alternatives with regard to our research and background.
Laryngomalacia is the most common cause of stridor in infancy. Diagnosis is established by associating the clinical manifestations with laryngoscopic findings in a dynamic form.
To analyze diagnostic ...accuracy of laryngomalacia through flexible nasolaryngoscopy performed by four different examiners. Form of studying: Comparison of diagnostic tests (clinical study).
A protocol of videolaryngoscopic evaluation for patients with laryngomalacia was created encompassing the following items: anterior displacement of the arytenoids; omega-shaped epiglottis; short aryepiglottic folds; posterior displacement of epiglottis; vocal folds being visible or not; edema of the posterior larynx. Four different examiners analyzed the videolaryngoscopic examinations of 18 patients with established diagnosis of laryngomalacia previously established by clinical data, epidemiology and anatomical traits. The four observers knew previously that the patients had laryngomalacia and which criteria should be analyzed in the evaluation protocol. Observers were unaware of the results each one found.
diagnostic agreement average considering all parameters evaluated was of 88.2%.
Dynamic flexible nasolaryngoscopy is a proven diagnostic method, regardless of physician experience.
This paper presents exploratory results on the association of an Upflow Anaerobic Sludge Blanket - UASB reactor (46 L) and a submerged aerated biofilter – BF (6.3 L) for domestic sewage treatment. ...The experimental period extended for 322 days, during which the hydraulic and organic loads were gradually increased in both reactors. Having the UASB as a reference, the following hydraulic loads were tested: 0.4 m3/m2.h (θ = 16 h); 0.6m3/m2.h (θ = 10h); 0.8 m3/m2.h (θ = 8 h); 1.0 m3/m2.h (θ = 6 h) and 1.45 m3/m2.h (θ = 4h). During the experiments carried out with the UASB reactor operating at a hydraulic detention time of 6 hours, related to a θ < 11′ in the granular media of the BF, the mean removal efficiency in terms of SS, BOD5 and COD, in both reactors, were respectively 94%, 96% and 91%. The final effluent, related to the BF effluent, presented the following mean characteristics: SS = 10 mg/L, BOD5 = 9 mg/L and COD = 38 mg/L. The results obtained in the last phase of the experiments, when the hydraulic load in the UASB reactor reached 1.45 m3/m2.h (θ = 4h), were similar to those obtained in the previous phase. These results demonstrate that submerged aerated biofilters can be considered a viable alternative for the post-treatment of effluents from UASB reactors treating domestic sewage. These reactors are capable of being operated with very short hydraulic detention times.
This paper presents exploratory results on the association of an Upflow Anaerobic Sludge Blanket - UASB reactor (46 L) and a submerged aerated biofilter - BF (6.3 L) for domestic sewage treatment. ...The experimental period extended for 322 days, during which the hydraulic and organic loads were gradually increased in both reactors. Having the UASB as a reference, the following hydraulic loads were tested: 0.4 m3/m2.h (θ = 16 h); 0.6m3/m2.h (θ = 10h); 0.8 m3/m2.h (0 = 8 h); 1.0 m3/m2.h (0 = 6 h) and 1.45 m3/m2.h (0 = 4h). During the experiments carried out with the UASB reactor operating at a hydraulic detention time of 6 hours, related to a 0 <11` in the granular media of the BF, the mean removal efficiency in terms of SS, BOD5 and COD, in both reactors, were respectively 94%, 96% and 91%. The final effluent, related to the BF effluent, presented the following mean characteristics: SS = 10 mg/L, BOD5 = 9 mg/L and COD = 38 mg/L. The results obtained in the last phase of the experiments, when the hydraulic load in the UASB reactor reached 1.45 m3/m2.h (θ = 4h), were similar to those obtained in the previous phase. These results demonstrate that infmerged aerated biofilters can be considered a viable alternative for the post-treatment of effluents from UASB reactors treating domestic sewage. These reactors are capable of being operated with very short hydraulic detention times.
The goal of this paper is to present an information visualization application capable of opening and coordinating information over two or more datasets. We have chosen this approach to address some ...of the limitations of various applications. Also, the application uses multiple coordinated views and multiple simultaneous datasets. We highlight the application layout configuration by the user, including the flexibility to specify the number of data views and to associate different datasets for each visualization technique. Diferente approaches are suggested of how to deal and interact with multiple datasets.
BackgroundExistence of inequalities in quality and access to healthcare services at subnational levels has been identified despite a decline in maternal and perinatal mortality rates at national ...levels, leading to the need to investigate such conditions using geographical analysis. The need to assess the accuracy of global demographic distribution datasets at all subnational levels arises from the current emphasis on subnational monitoring of maternal and perinatal health progress, by the new targets stated in the Sustainable Development Goals.MethodsThe analysis involved comparison of four models generated using Worldpop methods, incorporating region-specific input data, as measured through the Community Level Intervention for Pre-eclampsia (CLIP) project. Normalised root mean square error was used to determine and compare the models’ prediction errors at different administrative unit levels.ResultsThe models’ prediction errors are lower at higher administrative unit levels. All datasets showed the same pattern for both the live birth and pregnancy estimates. The effect of improving spatial resolution and accuracy of input data was more prominent at higher administrative unit levels.ConclusionThe validation successfully highlighted the impact of spatial resolution and accuracy of maternal and perinatal health data in modelling estimates of pregnancies and live births. There is a need for more data collection techniques that conduct comprehensive censuses like the CLIP project. It is also imperative for such projects to take advantage of the power of mapping tools at their disposal to fill the gaps in the availability of datasets for populated areas.
Control of power electronic inverters in AC microgrids is a challenging research field, and the deployment of control strategies to real-life implementations requires intensive theoretical and ...experimental prior assessment. Moreover, teaching in the microgrid field is not trivial due to the complexity of demonstrating the integrated operation of multiple power electronic devices. Thus, this paper aims at discussing the flexible layout of a 10 kVA single-phase microgrid comprising multiple inverters and operationalities, which was assembled at a research laboratory. Such microgrid prototype holds a modular feature that intends to support diverse experimental assessments of control strategies, also serving as an educational resource for teaching and technical training. The equivalent circuit of the microgrid, the multiple possibilities of use, prototype pictures, as well as experimental results are shown to depict its operation flexibilities, serving as a possible reference for the development of new microgrid setups, as well as to be replicated for use in research and educational purposes.
Acquisition of detailed knowledge of the structure and evolution of Trypanosoma cruzi populations is essential for control of Chagas disease. We profiled 75 strains of the parasite with five nuclear ...microsatellite loci, 24Salpha RNA genes, and sequence polymorphisms in the mitochondrial cytochrome oxidase subunit II gene. We also used sequences available in GenBank for the mitochondrial genes cytochrome B and NADH dehydrogenase subunit 1. A multidimensional scaling plot (MDS) based in microsatellite data divided the parasites into four clusters corresponding to T. cruzi I (MDS-cluster A), T. cruzi II (MDS-cluster C), a third group of T. cruzi strains (MDS-cluster B), and hybrid strains (MDS-cluster BH). The first two clusters matched respectively mitochondrial clades A and C, while the other two belonged to mitochondrial clade B. The 24Salpha rDNA and microsatellite profiling data were combined into multilocus genotypes that were analyzed by the haplotype reconstruction program PHASE. We identified 141 haplotypes that were clearly distributed into three haplogroups (X, Y, and Z). All strains belonging to T. cruzi I (MDS-cluster A) were Z/Z, the T. cruzi II strains (MDS-cluster C) were Y/Y, and those belonging to MDS-cluster B (unclassified T. cruzi) had X/X haplogroup genotypes. The strains grouped in the MDS-cluster BH were X/Y, confirming their hybrid character. Based on these results we propose the following minimal scenario for T. cruzi evolution. In a distant past there were at a minimum three ancestral lineages that we may call, respectively, T. cruzi I, T. cruzi II, and T. cruzi III. At least two hybridization events involving T. cruzi II and T. cruzi III produced evolutionarily viable progeny. In both events, the mitochondrial recipient (as identified by the mitochondrial clade of the hybrid strains) was T. cruzi II and the mitochondrial donor was T. cruzi III.
To identify characteristics associated with complications during pregnancy and puerperium in patients with rheumatic mitral stenosis.
Forty-one pregnant women (forty-five pregnancies) with mitral ...stenosis, followed-up from 1991 to 1999 were retrospectively evaluated.
the mitral valve area (MVA), measured by echocardiogram, and functional class (FC) before pregnancy (NYHA criteria). Maternal events: progression of heart failure, need for cardiac surgery or balloon mitral valvulotomy, death, and thromboembolism. Fetal/neonatal events: abortion, fetal or neonatal death, prematurity or low birth weight (<2,500 g), and extended stay in the nursery or hospitalization in newborn ICU.
The mean +/- SD of age of the patients was 28.8+/-4.6 years. The eventful and uneventful patients were similar in age and percentage of first pregnancies. As compared with the level 1 MVA, the relative risk (RR) of maternal events was 5.5 (95% confidence interval (CI) =0.8-39.7) for level 2 MVA and 11.4 (95% CI=1.7-74.5) for level 3 MVA. The prepregnancy FC (FC > or = II and III versus I) was also associated with risk for maternal events (RR=2.7; 95% CI=1.4-5.3).MVA and FC were not importantly associated with these events, although a smaller frequency of fetal/neonatal events was observed in patients who had undergone balloon valvulotomy.
In pregnant women with mitral stenosis, the MVA and the FC are strongly associated with maternal complications but are not associated with fetal/neonatal events. Balloon mitral valvulotomy could have contributed to reducing the risks of fetal/neonatal events in the more symptomatic patients who had to undergo this procedure during pregnancy.
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