With the introduction of quality assurance in health care delivery,there has been a proliferation of research studies that compare patient outcomes for similar conditions among many health care delivery facilities.Sin...With the introduction of quality assurance in health care delivery,there has been a proliferation of research studies that compare patient outcomes for similar conditions among many health care delivery facilities.Since the 1990s,increasing interest has been placed in the incorporation of clinical adverse events as quality indicators in hospital quality assurance programs.Adverse post-operative events,and very especially surgical site infection(SSI) rates after specif ic procedures,gained popularity as hospital quality indicators in the 1980s.For a SSI rate to be considered a valid indicator of the quality of care,it is essential that a proper adjustment for patient case mix be performed,so that meaningful comparisons of SSI rates can be made among surgeons,institutions,or over time.So far,a signif icant impediment to developing meaningful hospital-acquired infection rates that can be used for intra-and inter-hospital comparisons has been the lack of an adequate means of adjusting for case mix.This paper discusses what we have learned in the last years regarding risk adjustment of SSI rates for provider performance assessment,and identif ies areas in which signif icant improvement is still needed.展开更多
AIM： To evaluate the prevalence and clinical characteristics of Nonalcoholic fatty liver disease （NAFLD） among asymptomatic Brazilian adolescents. METHODS： Transversal observational study included asymptomatic ado...AIM： To evaluate the prevalence and clinical characteristics of Nonalcoholic fatty liver disease （NAFLD） among asymptomatic Brazilian adolescents. METHODS： Transversal observational study included asymptomatic adolescents with central obesity from private and public schools in Salvador-Bahia, northeastern Brazil. The children answered a questionnaire that in- cluded age, gender, race, and medical history, and were submitted to a complete physical exam and abdominal ultrasound. Biochemical exams included： ALT, AST, GGT, C reactive protein （CRP）, fasting glucose, insulin, cholesterol and triglycerides. Criteria for NAFLD included： the presence of steatosis in ultrasound and/or high level of ALT, negative or occasional historic of intake of alcohol （4 140 g/wk）, negative investigation for hepatitis A, B, C, auto-immune hepatitis, Wilson disease and hemochro-matosis.RESULTS： From October, 2005 to October, 2006, the study included 1801 subjects between 11 and 18 years of age and a mean age of 13.7± 2.0 years. One hun- dred ninety-nine had central obesity. The prevalence of NAFLD was 2.3%, most of whom were male and white. Insulin resistance （IR） was observed in 22.9% of them and had positive correlations with ALT and GGT （P 〈 0.05）. Elevated CRP was observed in 6.9% of the cases; however, it was not associated with WC, IR or liver enzymes. CONCLUSION： The prevalence of NAFLD in Brazilian adolescents was low. The ethnicity may have influence this frequency in the population studied, which had a large proportion of African descendents.展开更多
AIM:To evaluate the effects of soy supplementation on insulin resistance,fatty liver and alanine aminotransferase(ALT) levels in non-diabetic patients with chronic hepatitis C(CHC).METHODS:In a prospective,randomized ...AIM:To evaluate the effects of soy supplementation on insulin resistance,fatty liver and alanine aminotransferase(ALT) levels in non-diabetic patients with chronic hepatitis C(CHC).METHODS:In a prospective,randomized and singleblinded clinical trial,we compared patients with CHC who had casein as a supplement(n = 80)(control group),with patients who consumed a soy supplement diet(n = 80) [intervention group(IG)].Both groups received 32 g/d of protein for 12 wk.RESULTS:Patients' baseline features showed that 48.1% were overweight,43.7% had abdominal fat accumulation,34.7% had hepatic steatosis and 36.3% had an homeostasis model assessment index of insulin resistance(HOMA-IR) ≥ 3.0.Descriptive analysis showed that protein supplementation diet reduced hepatic steatosis in both groups;however,significant reductions in ALT levels occurred in the soy group.Multiple regression modeling indicated that in the presence of severe fibrosis(F3/F4),g glutamyl transferase elevation and high density lipoprotein(HDL) reduction,the intervention group had 75% less chance of developing hepatic steatosis(OR= 0.25;95% CI:0.06-0.82) and 55% less chance of presenting with an ALT level ≥ 1.5 × the upper limit of normal(ULN)(OR = 0.45,95% CI:0.22-0.89).Soy treatment did not have any effect on insulin resistance(OR = 1.92;95% CI:0.80-4.83),which might be attributed to the fact that the HOMAIR values at baseline in most of our patients were in the normal range.Advanced hepatic fibrosis,an ALT level > 1.5 × ULN and visceral fat were predictors of an HOMA-IR ≥ 3.The IG group had a reduced risk of an ALT level > 1.5 × ULN.An HOMA-IR ≥ 3.0 and HDL < 35 mg/dL were also risk factors for increased ALT.CONCLUSION:Soy supplementation decreased ALT levels and thus may improve liver inflammation in hepatitis C virus(HCV) patients;it also reduced hepatic steatosis in a subgroup of patients but did not change insulin resistance.It should be considered in the nutritional care of HCV patients.展开更多
Background: Gastric cancer is the third most incident malignancy and the fifth leading cause of death in the world. In Brazil, it is the fourth most common tumour in men and the fifth in women. Familial aggregation of...Background: Gastric cancer is the third most incident malignancy and the fifth leading cause of death in the world. In Brazil, it is the fourth most common tumour in men and the fifth in women. Familial aggregation of this tumour is being studied and discussed by experts. Aim: Determine the frequency of family history of cancer in patients with gastric cancer, suggesting familial aggregation or increased risk for hereditary cancer syndromes. Methods: This is a retrospective cross-sectional study carried out from January 2011 to March 2015 at the Department of Abdominal and Pelvic Surgery of the Brazilian National Cancer Institute (INCA). Data were collected from electronic medical records and analyzed using SPSS Statistics? version 20. Results: 873 patients with gastric adenocarcinoma were analyzed. A family history of cancer was reported by 451 patients (51.6%), which reported cancer in 878 relatives, of which 110 (12.6%), reported having more than three relatives with any type of cancer. The most prevalent malignancies among these relatives were gastric cancer (21.3%) and breast cancer (9.5%). Conclusion: Most of the patients had cancer family history, being gastric cancer the most common. The high percentage of cancer family history confirms the importance of collecting this information, whose lack reflects professional negligence, as family history study can serve as a low-cost tool, favoring prevention and early diagnosis, situations where morbidity and mortality are smaller, thus reducing health costs and assistance and preserving lives.展开更多
In the present paper, the attention is focused on the effect of local porous material on aerodynamic sound radiated from two-dimensional airfoil. We measured the aerodynamic sound radiated from the airfoil with porous...In the present paper, the attention is focused on the effect of local porous material on aerodynamic sound radiated from two-dimensional airfoil. We measured the aerodynamic sound radiated from the airfoil with porous material, tripping wire and porous plate which are mounted locally on the surface of the airfoils near the leading edge. At the normal airfoil, discrete frequency noise is clearly observed at small attack angle. However, it is clear that its noise generated from the airfoil decreased with the local porous material on the surface of pressure side of the airfoil. The porous material is effective to reduce this noise compared with the others. And the sound absorbing coefficient and the air permeability were measured for test porous material. The sound absorbing coefficient increased at the high frequency band, and the air permeability became small for porous materials. As the attack angle increased, the discrete frequency noise was not generated from the normal airfoil. The broadband noises were almost same for all test airfoils.展开更多
In the present paper the attention is focused on effect of arrangement of tube banks on acoustic resonance which occurred in the two-dimensional model of boiler. We have examined the characteristics of vortex shedding...In the present paper the attention is focused on effect of arrangement of tube banks on acoustic resonance which occurred in the two-dimensional model of boiler. We have examined the characteristics of vortex shedding and acoustic resonance generated from in-line and staggered tube banks. At the small tube pitch ratio in in-line tube banks, acoustic resonance of third and fourth mode in the transverse direction occurred. As the tube pitch ratio in the flow direction decreased, the vortex shedding frequency became broad-band. The alternative vortex shed from in-line tube banks. The multiple resonance modes were generated within the broad-band vortex shedding frequency. And the acoustic resonances of lower-order modes occurred at the higher gap velocity. On the other hand, at the small tube pitch ratio in staggered tube banks, acoustic resonance did not occurred, although the vortex shed at the resonance frequency in tube banks. The pressure drop at staggered tube banks was larger than that of in-line tube banks. The symmetric vortices were observed inside staggered tube banks at the small tube pitch ratio.展开更多
文摘With the introduction of quality assurance in health care delivery,there has been a proliferation of research studies that compare patient outcomes for similar conditions among many health care delivery facilities.Since the 1990s,increasing interest has been placed in the incorporation of clinical adverse events as quality indicators in hospital quality assurance programs.Adverse post-operative events,and very especially surgical site infection(SSI) rates after specif ic procedures,gained popularity as hospital quality indicators in the 1980s.For a SSI rate to be considered a valid indicator of the quality of care,it is essential that a proper adjustment for patient case mix be performed,so that meaningful comparisons of SSI rates can be made among surgeons,institutions,or over time.So far,a signif icant impediment to developing meaningful hospital-acquired infection rates that can be used for intra-and inter-hospital comparisons has been the lack of an adequate means of adjusting for case mix.This paper discusses what we have learned in the last years regarding risk adjustment of SSI rates for provider performance assessment,and identif ies areas in which signif icant improvement is still needed.
基金Supported by Fundao de Amparo a Pesquisa do Estado da Bahia
文摘AIM： To evaluate the prevalence and clinical characteristics of Nonalcoholic fatty liver disease （NAFLD） among asymptomatic Brazilian adolescents. METHODS： Transversal observational study included asymptomatic adolescents with central obesity from private and public schools in Salvador-Bahia, northeastern Brazil. The children answered a questionnaire that in- cluded age, gender, race, and medical history, and were submitted to a complete physical exam and abdominal ultrasound. Biochemical exams included： ALT, AST, GGT, C reactive protein （CRP）, fasting glucose, insulin, cholesterol and triglycerides. Criteria for NAFLD included： the presence of steatosis in ultrasound and/or high level of ALT, negative or occasional historic of intake of alcohol （4 140 g/wk）, negative investigation for hepatitis A, B, C, auto-immune hepatitis, Wilson disease and hemochro-matosis.RESULTS： From October, 2005 to October, 2006, the study included 1801 subjects between 11 and 18 years of age and a mean age of 13.7± 2.0 years. One hun- dred ninety-nine had central obesity. The prevalence of NAFLD was 2.3%, most of whom were male and white. Insulin resistance （IR） was observed in 22.9% of them and had positive correlations with ALT and GGT （P 〈 0.05）. Elevated CRP was observed in 6.9% of the cases; however, it was not associated with WC, IR or liver enzymes. CONCLUSION： The prevalence of NAFLD in Brazilian adolescents was low. The ethnicity may have influence this frequency in the population studied, which had a large proportion of African descendents.
基金Supported by Gold Nutrition Indústria e Comercio and Centro colaborador Nordeste II/Ministério da Saúde,Brazil
文摘AIM:To evaluate the effects of soy supplementation on insulin resistance,fatty liver and alanine aminotransferase(ALT) levels in non-diabetic patients with chronic hepatitis C(CHC).METHODS:In a prospective,randomized and singleblinded clinical trial,we compared patients with CHC who had casein as a supplement(n = 80)(control group),with patients who consumed a soy supplement diet(n = 80) [intervention group(IG)].Both groups received 32 g/d of protein for 12 wk.RESULTS:Patients' baseline features showed that 48.1% were overweight,43.7% had abdominal fat accumulation,34.7% had hepatic steatosis and 36.3% had an homeostasis model assessment index of insulin resistance(HOMA-IR) ≥ 3.0.Descriptive analysis showed that protein supplementation diet reduced hepatic steatosis in both groups;however,significant reductions in ALT levels occurred in the soy group.Multiple regression modeling indicated that in the presence of severe fibrosis(F3/F4),g glutamyl transferase elevation and high density lipoprotein(HDL) reduction,the intervention group had 75% less chance of developing hepatic steatosis(OR= 0.25;95% CI:0.06-0.82) and 55% less chance of presenting with an ALT level ≥ 1.5 × the upper limit of normal(ULN)(OR = 0.45,95% CI:0.22-0.89).Soy treatment did not have any effect on insulin resistance(OR = 1.92;95% CI:0.80-4.83),which might be attributed to the fact that the HOMAIR values at baseline in most of our patients were in the normal range.Advanced hepatic fibrosis,an ALT level > 1.5 × ULN and visceral fat were predictors of an HOMA-IR ≥ 3.The IG group had a reduced risk of an ALT level > 1.5 × ULN.An HOMA-IR ≥ 3.0 and HDL < 35 mg/dL were also risk factors for increased ALT.CONCLUSION:Soy supplementation decreased ALT levels and thus may improve liver inflammation in hepatitis C virus(HCV) patients;it also reduced hepatic steatosis in a subgroup of patients but did not change insulin resistance.It should be considered in the nutritional care of HCV patients.
文摘Background: Gastric cancer is the third most incident malignancy and the fifth leading cause of death in the world. In Brazil, it is the fourth most common tumour in men and the fifth in women. Familial aggregation of this tumour is being studied and discussed by experts. Aim: Determine the frequency of family history of cancer in patients with gastric cancer, suggesting familial aggregation or increased risk for hereditary cancer syndromes. Methods: This is a retrospective cross-sectional study carried out from January 2011 to March 2015 at the Department of Abdominal and Pelvic Surgery of the Brazilian National Cancer Institute (INCA). Data were collected from electronic medical records and analyzed using SPSS Statistics? version 20. Results: 873 patients with gastric adenocarcinoma were analyzed. A family history of cancer was reported by 451 patients (51.6%), which reported cancer in 878 relatives, of which 110 (12.6%), reported having more than three relatives with any type of cancer. The most prevalent malignancies among these relatives were gastric cancer (21.3%) and breast cancer (9.5%). Conclusion: Most of the patients had cancer family history, being gastric cancer the most common. The high percentage of cancer family history confirms the importance of collecting this information, whose lack reflects professional negligence, as family history study can serve as a low-cost tool, favoring prevention and early diagnosis, situations where morbidity and mortality are smaller, thus reducing health costs and assistance and preserving lives.
文摘In the present paper, the attention is focused on the effect of local porous material on aerodynamic sound radiated from two-dimensional airfoil. We measured the aerodynamic sound radiated from the airfoil with porous material, tripping wire and porous plate which are mounted locally on the surface of the airfoils near the leading edge. At the normal airfoil, discrete frequency noise is clearly observed at small attack angle. However, it is clear that its noise generated from the airfoil decreased with the local porous material on the surface of pressure side of the airfoil. The porous material is effective to reduce this noise compared with the others. And the sound absorbing coefficient and the air permeability were measured for test porous material. The sound absorbing coefficient increased at the high frequency band, and the air permeability became small for porous materials. As the attack angle increased, the discrete frequency noise was not generated from the normal airfoil. The broadband noises were almost same for all test airfoils.
文摘In the present paper the attention is focused on effect of arrangement of tube banks on acoustic resonance which occurred in the two-dimensional model of boiler. We have examined the characteristics of vortex shedding and acoustic resonance generated from in-line and staggered tube banks. At the small tube pitch ratio in in-line tube banks, acoustic resonance of third and fourth mode in the transverse direction occurred. As the tube pitch ratio in the flow direction decreased, the vortex shedding frequency became broad-band. The alternative vortex shed from in-line tube banks. The multiple resonance modes were generated within the broad-band vortex shedding frequency. And the acoustic resonances of lower-order modes occurred at the higher gap velocity. On the other hand, at the small tube pitch ratio in staggered tube banks, acoustic resonance did not occurred, although the vortex shed at the resonance frequency in tube banks. The pressure drop at staggered tube banks was larger than that of in-line tube banks. The symmetric vortices were observed inside staggered tube banks at the small tube pitch ratio.
