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Introduction: Older adults with dementia who are on multiple medications are more vulnerable to the use of potentially inappropriate medications (PIMs), which can significantly increase the risk of adverse events and drug-related problems. PIMs use is prevalent and varies among older adults with dementia or cognitive impairment (CI) attending memory clinics. However, the prevalence of PIMs, polypharmacy, and hyper-polypharmacy among older adults with dementia or CI who are attending memory clinics is not well understood. We will conduct a systematic review and meta-analyses to examine the overall estimate of the prevalence of the PIMs, polypharmacy, and hyper-polypharmacy use among older adults attending memory clinics, with dementia or CI. The secondary objective of this study will be to compile a list of commonly implicated PIMs and to investigate factors that may be associated with using PIMs in this population. Methods: Ovid MEDLINE, Ovid Embase, Scopus, Cochrane library, EBSCOhost CINAHL, and Ovid International Pharmaceutical Abstracts (IPA) will be systematically searched by a researcher (R.S.) with the help of a librarian (C.C.). All databases will be searched from inception to May 05, 2023. Cross-sectional, cohort, randomized clinical trials, quasi-experimental, and case-control studies will be included if they assess PIM’s use among older adults with dementia and/or CI. A step-by-step guide by Pai et al. [Natl Med J India. 2004;17(2):86–95] will be followed when conducting this systematic review (S.R.). The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist will be followed for reporting this SR. Conclusion: The findings from this SR/MA will identify the pooled prevalence of PIMs, providing a more precise estimate of the true prevalence of the PIMs, polypharmacy, hyper-polypharmacy in older adults with dementia or CI who are attending memory clinics at primary, secondary, or tertiary healthcare settings by considering the results of multiple studies.

Abstract Background Medication management capacity is a crucial component of medication adherence, particularly among older adults. Various factors, including physical abilities, cognitive functions, sensory capabilities, motivational, and environmental factors, influence older adults' ability to manage medications. It is, therefore, crucial to identify appropriate tools that allow clinicians to determine which factors may impact medication management capacity and, consequently, nonadherence to medications. Purpose 1)To identify tools that measure physical, cognitive, sensory (vision, hearing, touch), motivational, and environmental barriers to medication self-management in older adults, and 2) to understand the extent to which these tools assess various barriers. Methods The scoping review was conducted using Arksey and O'Malley's scoping review framework and the PRISMA Extension for Scoping Reviews checklist. In June 2022, the relevant literature was identified by searching PubMed (MEDLINE), Ovid Embase, Ovid IPA, EBSCOhost CINAHL, APA PsycINFO, and Scopus. Results and discussion In total, 7235 studies were identified. Following the removal of duplicates, 4607 articles were screened by title and abstract, of which 4253 did not meet the inclusion criteria. Three reviewers reviewed the full texts of the remaining 354 articles; among them, 41 articles, 4 theses and 1 conference abstract met the inclusion criteria. From the included studies, 44 tools were identified that measured a combination of physical, cognitive, sensory, motivational, and environmental barriers (n=19) or only cognition (n=13), vision (n=5), environmental factors (n=3), auditory (n=1), and motivational factors (n=1). The review also examined the psychometric properties of the identified tools and found that most of them had reported validity and reliability data. Several tools have demonstrated promise in assessing a combination of barriers with validity and reliability. These tools include the Self-Medication Assessment Tool (SMAT), ManageMed Screening (MMS), Self-Medication Risk Assessment Tool (RAT), HOME-Rx revised, and Medication Management Ability Assessment (MMAA). Conclusion This scoping review identified 44 validated tools to measure various challenges that older adults encounter with medication management. However, no tool measures all five barriers (physical, cognitive, sensory, motivational, and environmental) to medication-taking at home. Therefore, utilizing a combination of tools would be most appropriate to measure these different aspects comprehensively. Further research is needed to develop a new comprehensive tool that simultaneously measures various barriers to medication self-management.

Abstract Clogging of porous concrete pavements is understood as a performance pathology within this peculiar concrete component. Albeit the clogging performance of porous concrete pavements is a sensitive topic in technical literature, most studies refer to laboratory investigations on concrete samples using different kinds of apparatus for the simulation of loss of permeability due to debris insertion on porous interstices. However, infiltration rate measurements are the basis for defining maintenance needs in actual pavements and shall be carried out periodically to measure and endorse infiltration rate adequacy as the kern of a clogging management protocol. This study dealt with a field experiment in a pervious concrete sidewalk surrounded by a wooded garden with tropical native and a variety of exotic trees. Over four years, eleven monitoring measurements were carried out using the ASTM C1701 infiltration ring test. The main contribution of this paper is a proposition of a mixed linear prediction model considering conditioned exponential distribution and a random normal intercept for the infiltration rate. From residual analysis and diagnosis plots, it can be seen that the proposed model presents a goodness of fit, allowing anticipation of infiltration rates reduction due to clogging by dense organic matter. Minimum infiltration rate is taken as 0.1 cm/s and such condition was achieved in a couple of months, awakening consciously to consider three to four intensive cleaning maintenance per year in dense wooded areas like public parks.

Anomalous right coronary artery (RCA) from the main pulmonary artery (ARCAPA) is a rare finding. Clinical presentations range from asymptomatic to sudden death. We present the case of ARCAPA in a septuagenarian initially suspected on a screening chest computed tomography (CT) and later confirmed on cardiac CT. A summary of important points related to this entity is also discussed.

Abstract Background Patient and family engagement (PFE) can positively impact the patient experience and care process outcomes. There is no unique type of PFE, and the process is usually defined by the quality management department or professionals responsible for this process in the hospital. The objective of this study is to define PFE in quality management based on the professional’s perspective. Method A survey was carried out with 90 professionals from Brazilian hospitals. There were two questions aimed at understanding the concept. The first was a multiple-choice question to identify synonyms. The second was an open-ended question to develop the definition. A content analysis methodology was employed by applying techniques for thematic and inferential analysis. Results Three words were classified as synonyms by more than 60% of respondents: involvement, participation, and centered care. The participants described patient participation at both the individual (related to the treatment) and organizational levels (related to quality improvement). The PFE in the treatment is related to the development, discussion and decision-making about the therapeutic plan, participation in each step of care, and knowledge of the institution's quality and safety processes. At the organizational level, engagement in quality improvement includes the involvement of the P/F in all processes of the institution, from strategic planning to the design or improvement processes, as well as active participation in institutional committees or commissions. Conclusion The professionals defined engagement in two levels (individual and organizational) and the results suggest that their point of view can influence the practice in the hospitals. Professionals of hospitals that implemented mechanisms of consult defined PFE more in the individual level. On the other hand, professionals of hospitals that implemented mechanisms of involvement considered PFE more focus in the organizational level.

Objectives To examine the cost-effectiveness of Multi-specialty INterprofessional Team (MINT) Memory Clinic care in comparison to the provision of usual care.Design Using a Markov-based state transition model, we performed a cost-utility (costs and quality-adjusted life years, QALY) analysis of MINT Memory Clinic care and usual care not involving MINT Memory Clinics.Setting A primary care-based Memory Clinic in Ontario, Canada.Participants The analysis included data from a sample of 229 patients assessed in the MINT Memory Clinic between January 2019 and January 2021.Primary outcome measures Effectiveness as measured in QALY, costs (in Canadian dollars) and the incremental cost-effectiveness ratio calculated as the incremental cost per QALY gained between MINT Memory Clinics versus usual care.Results MINT Memory Clinics were found to be less expensive ($C51 496 (95% Crl $C4806 to $C119 367) while slightly improving quality of life (+0.43 (95 Crl 0.01 to 1.24) QALY) compared with usual care. The probabilistic analysis showed that MINT Memory Clinics were the superior treatment compared with usual care 98% of the time. Variation in age was found to have the greatest impact on cost-effectiveness as patients may benefit from the MINT Memory Clinics more if they receive care beginning at a younger age.Conclusion Multispecialty interprofessional memory clinic care is less costly and more effective compared with usual care and early access to care significantly reduces care costs over time. The results of this economic evaluation can inform decision-making and improvements to health system design, resource allocation and care experience for persons living with dementia. Specifically, widespread scaling of MINT Memory Clinics into existing primary care systems may assist with improving quality and access to memory care services while decreasing the growing economic and social burden of dementia.

Introduction: Colitis is one of the most common immune-related adverse events in patients receiving immune checkpoint inhibitors. Although radiographic changes on computed tomography (CT), such as mild diffuse bowel thickening, mesenteric fat stranding, and mucosal enhancement, have been reported, the utility of CT in diagnosis of patients with suspected immune-related colitis is not well documented. The aim of this retrospective study was to determine the value of CT scans in diagnosis of immunotherapy-induced colitis. Methods: CT scans of the abdomen and pelvis of 34 patients receiving immunotherapy who had a clinical diagnosis of immunotherapy-induced colitis and 19 patients receiving immunotherapy without clinical symptoms of colitis (controls) were evaluated. Segments of the colon (rectum, sigmoid, descending, transverse, ascending, and cecum) were assessed independently by two abdominal imaging specialists, blinded to the clinical diagnosis. Each segment was assessed for radiographic signs such as mucosal enhancement, wall thickening, distension, and periserosal fat stranding. The presence of any of the signs was considered radiographic evidence of colitis. Results: CT findings suggestive of colitis was seen in 20 of 34 patients with symptoms of colitis and in 5 of 19 patients without symptoms of colitis. The sensitivity, specificity, positive predictive value, and negative predictive value for colitis on CT were 58.8%, 73.7%, 80%, and 50%, respectively. Conclusions: We found that CT had a low sensitivity, specificity, and negative predictive value for the diagnosis of immunotherapy-induced colitis. We therefore conclude that CT has a limited role in the diagnosis of patients with suspected uncomplicated immune-related colitis.

Persons diagnosed with dementia are often faced with challenges related to polypharmacy and inappropriate medication use and could benefit from regular medication reviews. However, the benefit of such reviews has not been examined in this population. Therefore, the current scoping review was designed to identify the gaps in the current knowledge regarding the impact of medication reviews on the clinical outcomes in older adults with dementia. Relevant studies were identified by searching three databases (Ovid MEDLINE, Ovid EMBASE, and Scopus) from inception to January 2022 with a combination of keywords and medical subject headings. After the removal of duplicates and ineligible articles, 22 publications of the initial 8346 were included in this review. A total of 57 outcomes were identified, including those pertaining to the evaluation of medication use (n = 17), drug-related interventions (n = 11), drug-related problems (n = 10), dementia-related behavioral symptoms (n = 8), cost-effectiveness (n = 2), drug-related hospital admissions (n = 1), as well as outcomes classified as other (n = 7). Gaps identified through this scoping review included the paucity of studies measuring the impact of medication reviews on the medication management capacity and medication adherence, quality of life, and mortality.

Abstract Background Many primary care sites have implemented models to improve detection, diagnosis, and management of dementia, as per Canadian guidelines. The aim of this study is to describe the responses of clinicians, managers, and staff of sites that have implemented these models when presented with audit results, their insights on the factors that explain their results, their proposed solutions for improvement and how these align to one another. Methods One audit and feedback cycle was carried out in eight purposefully sampled sites in Ontario, Canada, that had previously implemented dementia care models. Audit consisted of a) chart review to assess quality of dementia care indicators, b) questionnaire to assess the physicians’ knowledge, attitudes and practice toward dementia care, and c) semi-structured interviews to understand barriers and facilitators to implementing these models. Feedback was given to clinicians, managers, and staff in the form of graphic and oral presentations, followed by eight focus groups (one per site). Discussions revolved around: what audit results elicited more discussion from the participants, 2) their insights on the factors that explain their audit results, and 3) solutions they propose to improve dementia care. Deductive content and inductive thematic analyses, grounded in causal pathways models’ theory was performed. Findings The audit and feedback process allowed the 63 participants to discuss many audit results and share their insights on a) organizational factors (lack of human resources, the importance of organized links with community services, clear roles and support from external memory clinics) and b) clinician factors (perceived competency practice and attitudes on dementia care), that could explain their audit results. Participants also provided solutions to improve dementia care in primary care (financial incentives, having clear pathways, adding tools to improve chart documentation, establish training on dementia care, and the possibility of benchmarking with other institutions). Proposed solutions were well aligned with their insights and further nuanced according to contextual details. Conclusions This study provides valuable information on solutions proposed by primary care clinicians, managers, and staff to improve dementia care in primary care. The solutions are grounded in clinical experience and will inform ongoing and future dementia strategies.

Cadmium (Cd) is a toxic element that can accumulate in edible plant tissues and negatively impact human health. Traditional Cd quantification methods are time-consuming, expensive, and generate a lot of toxic waste, slowing development of methods to reduce uptake. The objective of this study was to determine whether hyperspectral imaging (HSI) and machine learning (ML) can be used to predict Cd concentrations in plants using kale (Brassica oleracea) and basil (Ocimum basilicum) as model crops. The experiments were conducted in an automated phenotyping facility where all environmental conditions except soil Cd concentration were kept constant. Cd concentrations were determined at harvest using traditional methods and used to train the ML models with data collected from the imaging sensor. Visible/near infrared (VNIR) images were also collected at harvest and processed to calculate reflectance at 473 bands between 400 to 998 nm. All reflectance spectra were subject to the feature selection algorithm ReliefF and Principal Component Analysis (PCA) to generate data and provide input to evaluate three ML classification models: artificial neural network (ANN), ensemble learning (EL), and support vector machine (SVM). Plants were categorized according to Cd concentrations higher or lower than the safety threshold of 0.2 mg kg−1 Cd. Wavelengths with the highest ranks for Cd detection were between 519 and 574, and 692 and 732 nm, indicating that Cd content likely altered the plants’ chlorophyll content and altered leaf internal structure. All models were able to sort the plants into groups, though the model with the best F1 score was the ANN for the validation subset that utilized reflectance from all wavelengths. This study demonstrates that HSI and ML are promising technologies for the fast and precise diagnosis of Cd in leafy green plants, though additional studies are needed to adapt this approach for more complex field environments.

A magnitude de carga permitida para o transporte rodoviário no Brasil é regida pela “lei da balança”, que permite uma tolerância, na pesagem dos veículos comerciais em seu peso bruto total e em cada eixo. Essas tolerâncias vêm sendo justificadas por possíveis desvios inerentes nos equipamentos de pesagem e pela movimentação da carga dentro do veículo. As tolerâncias de 5% no PBT e de 5% nos eixos, introduzidas na década de 80, foram modificadas para 7,5% nos eixos na década de 90 e, em julho de 2014, com base na Resolução do CONTRAN n°. 489, foram estendidas mais uma vez para 10% nos eixos. Este trabalho apresenta os resultados de uma análise de dados referentes a um período de 6 anos de pesagem de caminhões em uma balança de uma rodovia brasileira de elevado volume de tráfego, que opera 24 horas por dia, 7 dias por semana, e aponta as alterações do transporte de carga, fruto da alteração de julho de 2014. Os resultados mostram que há aumento da sobrecarga, o que evidencia o uso da tolerância pelo transportador de carga e consequências das sobrecargas no dimensionamento dos pavimentos asfálticos, ou na redução de sua vida útil.

Background Patient and family engagement (PFE) is considered an essential element of the transformation of the healthcare system. However, it is characterised by its complexity and a small number of institutions that have implemented the mechanisms of engagement.Objective To understand PFE in quality management (QM) in the hospital environment.Design A qualitative approach was guided by the grounded theory based in Straussian perspective. Data were gathered using semistructured interviews. The coding was performed by excerpts, using an inductive approach and the constant comparison technique.Setting and participants A total of seven Brazilian hospitals were selected based on the theoretical sampling technique.Results A total of five categories emerged, namely: patient partner, mechanisms of engagement, internal structure for engagement, maturity of the QM system and openness to change. Externally, three contextual factors can impact the engagement: the local health system, the profile of the community and the change in access to the information. At the centre of the change is the balance in power relations between patients and professionals, the sharing of information from the hospital and a proactive attitude towards improving services.Conclusions The PFE involves a cultural and process change. Cultural change is represented by ‘openness’, that is, openness to learn, to listen and to consider new perspectives. The change in processes is in turn characterised by the phrase ‘test and venture’ because the model to be adopted may be different between hospitals. The patient’s perspective allows actions to be driven towards what really matters to them, ensuring quality of service and safety, obtaining a new perspective to understand and solve problems, and stimulating a sense of urgency, more empathy and compassion in professionals.

Purpose: To describe how central venous access devices (CVADs) are utilized for ambulatory oncology patients and to evaluate the rate of complications. Method: Single institution retrospective study of oncology patients with CVADs who received systemic treatment at the Walker Family Cancer Centre (WFCC) between 1 January and 31 December 2018. Results: A total of 480 CVADS were placed in 305 patients, of which 408 (85%) were peripherally inserted central catheters (PICCs) and 72 (15%) were implanted vascular access devices (PORTs). The incidence of early and late complications was 9% and 24%, respectively. For the entire cohort, the rate of venous thromboembolism (VTE) was 16%, of which 9% were CVAD-related thrombosis (CRTs) and 7% were distant VTE. The CRT rates were similar for PICCs and PORTs (9% vs. 7%). A total of 6% of CVADs were complicated by infection (i.e., localized infections and bacteremia), with a total infection rate of 0.43 and 0.26 per 1000 indwelling days for PICCs and PORTs, respectively. The incidence of central line associated bloodstream infections (CLABSI) was greater for PICCs than PORTs, at a rate of 0.22 compared with 0.08 per 1000 indwelling days, respectively. The premature catheter removal rate was 26% for PICCs and 18% for PORTs. PORTs required more additional hospital visits. Conclusions: PICCs were utilized more frequently than PORTs and had a higher rate of premature removal. The rates of VTE and CRT were similar for both CVAD types. PORTs had a lower rate of infection per 1000 indwelling days. However, the management of PORT related complications required more visits to the hospital and oncology clinic.

Doublecortin (DCX) is a microtubule (MT)-associated protein that regulates MT structure and function during neuronal development and mutations in DCX lead to a spectrum of neurological disorders. The structural properties of MT-bound DCX that explain these disorders are incompletely determined. Here, we describe the molecular architecture of the DCX–MT complex through an integrative modeling approach that combines data from X-ray crystallography, cryo-electron microscopy, and a high-fidelity chemical crosslinking method. We demonstrate that DCX interacts with MTs through its N-terminal domain and induces a lattice-dependent self-association involving the C-terminal structured domain and its disordered tail, in a conformation that favors an open, domain-swapped state. The networked state can accommodate multiple different attachment points on the MT lattice, all of which orient the C-terminal tails away from the lattice. As numerous disease mutations cluster in the C-terminus, and regulatory phosphorylations cluster in its tail, our study shows that lattice-driven self-assembly is an important property of DCX.

The traffic of overloaded trucks is a critical problem in highways. It affects pavement performance life, reduces the service life of bridges, and has a negative impact on road safety, average speed and level of service. There are several practices to prevent the truck overloading issue, i.e., enforcement activities to verify the truck's compliance with the legal weight limits. This paper investigates the development of a method that uses available weigh-in-motion (WIM) data to identify overloaded truck weight and travel patterns. The proposed approach is based on regression trees method, a simple and easily understandable analytic tool used to build prediction models from a large set of data. An overall analysis of the overloaded truck regression tree model shows that the most important variable to classify and predict overloading is the truck type. Regarding the axle overloading, the most significant variable is the time of the day (most of the overloaded trucks travel at late night or early morning). The regression tree results can be used to optimize the efficiency of administration activities by planning truck enforcement operations based on the more critical scenarios. Also, the results improve the knowledge about the load characteristics of trucks, which can lead to more effective pavement management systems and more assertive pavement structure designs.

Background: Understanding the needs of families of hospital patients, especially those in intensive care units is key to providing comprehensive, effective support. The aim of this study is to determine the needs of families of Intensive Care Unit (ICU) patients in four Palestinian hospitals. Materials and Methods: This was a cross-sectional, analytic study including 240 participants selected using convenience sampling. Data was obtained from participants from September 2016 to April 2018. The Critical Care Family Needs Inventory (CCFNI) was distributed to examine their needs. Descriptive analysis, t-tests, and Analysis of Variance (ANOVA) were conducted to analyze relationships between demographic characteristics of respondents and their needs. Differences were considered significant at p < 0.05. Results: The results revealed that the assurance domain was the most important, but participants had some unmet needs from the support domain. Parents reported higher levels of importance of all needs than other types of relatives of patients. In addition, participants with a higher level of education reported a significantly higher level of importance in the dimensions of assurance (F3,236= 2.85, p = 0.038), proximity (F3,236= 4.36, p = 0.006), and support (F3,236= 4.13, p = 0.007). Also, married participants had a higher need for all dimensions. Family members of patients who stayed more than 7 days had higher needs for support (F2,237= 3.39, p = 0.035) and comfort (F2,237= 3.92, p = 0.021). Conclusions: Family members of ICU patients have certain unmet needs, which require attention from healthcare professionals and administration in Palestinian hospitals. In addition, sociodemographic variables influence family member needs.

Social-ecological change has placed unprecedented stress on water resources throughout the world. This has driven water users to employ a diverse range of adaptation strategies and necessitates new governance structures, such as adaptive water governance (AWG), which have the capacity to manage resources in the midst of uncertainty and complexity. As such, AWG has the potential to support household adaptation strategies; however, little empirical work has been done to identify the factors that facilitate the emergence of AWG. To address this gap, we conducted a household survey of 448 households in northwestern Pakistan, a post-conflict, water-scarce area where adaptive governance is needed to support rural livelihoods in the midst of numerous socioeconomic and environmental transformations. Indeed, we found that households in our study area perceived a range of changes to the water system, including but not limited to declines of fish populations, decreased quality and amount of river water, and an increase of local tourism. Respondents reported a range of adaptation strategies including increasing agricultural inputs, planting new crop varieties, and changing their domestic water supply system. In some cases, households employed these adaptation strategies despite economic barriers, and although many were willing to go against friends’ and community leaders’ opinions to adapt, and they were less likely to counter the opinions of family members. This reveals that households negotiate multiple factors in their decisions to adapt to social-ecological change; as such, there is a great need for flexible and collaborative governance systems such as AWG to support this complexity in household adaptation decision making. Further, we argue that the varying roles of social influence should be considered to align governance structures with household decision-making processes. Thus, we suggest that AWG will be more likely to emerge when decision makers involved in water management draw on existing informal institutions and cross-sectoral collaboration to reflect the complex ways water users adapt to social-ecological change.

Introduction Dementia is on the rise in Canada and globally. Ensuring accessibility to diagnosis, treatment and management throughout the course of the disease is a very significant problem worldwide. In order to provide comprehensive care to patients and their caregivers, enhancing primary care-based dementia care is seen as the way forward. In many Canadian provinces various collaborative care models (collCMs) anchored in primary care to improve dementia care have been developed and implemented. The overall objective of our research programme is to identify key factors for the successful implementation of collCMs, and to facilitate dissemination and scale-up of dementia best practices.Methods and analysis We will use a convergent mixed-methods design. An observational study using chart review (2014–2016) and questionnaires (2014–2018; repeated in 2020) will measure application of guidelines and implementation of collCMs. This study will be complemented with a qualitative descriptive study using interviews (2017–2020) conducted in parallel. Quantitative and qualitative results will be further integrated using a matrix representing sites and findings. An integrated knowledge exchange strategy will ensure uptake by principal stakeholders throughout the research.Ethics and dissemination Our study has been approved by all relevant ethics committees. Our dissemination plan follows an integrated knowledge transfer strategy using provincial, national and international councils. We will present the results individually to the clinical sites and then to these councils. Our research will be the first provincial and cross jurisdictional evaluation of primary care models for patients living with dementia, providing evidence on the ongoing debate on the respective role of clinicians in primary care and specialists in caring for patients with dementia.

Objective: To gather consumer perspectives of a mental health screening protocol and to identify the incidence of previously unrecognized mental health concerns (case finding). Design: Pilot study using mixed methods: quantitative (survey) and qualitative (interviews). Setting: Primary care health team in Kitchener, Ontario, Canada. Participants: Patients (N=15) with spinal cord injury living in the community. Participants ranged in age from 21 to 81 years of age (mean=46); 12 were men, 8 had tetraplegia and 5 paraplegia. The number of years since injury ranged from 1 to 32 (mean=13). Intervention: Implementation of a mental health screening protocol consisting of standardized screening tools for depression, anxiety, substance abuse, social isolation, somatoform disorder, functional status, chronic pain, and cognitive impairment. Main Outcome Measures: Positive results on screening tool, acceptability of the screening process, perceptions of the value of screening, and intentions to follow resulting treatment recommendations. Results: Screening identified 11 of 15 individuals with a chronic pain condition; 1 individual screened positive for depression, 1 for anxiety, 3 for potential substance abuse, and 1 for social isolation. Most of the participants (12/13) rated the screening protocol as very acceptable. All but 1 individual intended to follow resulting treatment recommendations. Interview analyses generated themes related to disclosure of experiences that were incomplete that concealed important information and perceptions that the screening protocol failed to assess resiliency. Although perceived as valuable, participants felt screening tools alone did not capture information important to them. Conclusions: Screening tools alone may not identify mental health issues. Interviews in addition to screening tools are needed to accurately identify mental health issues in this population. Identification of mental health issues is critical to ensuring access to effective interventions and improving health outcomes and quality of life for individuals with SCI. Keywords: Mental health, Rehabilitation, Screening, Spinal cord injuries

Abstract Introduction Earlier diagnosis of neurocognitive disorders and neurodegenerative disease is needed to implement preventative interventions, minimize harm, and reduce risk of exploitation in the context of undetected disease. Along the spectrum from subjective cognitive decline (SCD) to dementia, evidence continues to emerge with respect to detection, staging, and monitoring. Updates to previous guidelines are required for clinical practice. Methods A subcommittee of the 5th Canadian Consensus Conference on Diagnosis and Treatment of Dementia (CCCDTD) reviewed emerging evidence to address the following: (1) Is there a role for screening at‐risk patients without clinical concerns? In what context is assessment for dementia appropriate? (2) What tools can be used to evaluate patients in whom cognitive decline is suspected? (3) What important information can be gained from an informant, using which measures? (4) What instruments can be used to get more in‐depth information to diagnose mild cognitive impairment (MCI) or dementia? (5) What is the approach to those with cognitive concerns but without objective changes (ie, SCD)? (6) How do we track response to treatment and change over time? The Grading of Recommendations Assessment, Development, and Evaluation system was used to rate quality of the evidence and strength of the recommendations. Results We recommend instruments to assess and monitor cognition, behavior, and function across the cognitive spectrum, including reports from patient and informant. We recommend against screening asymptomatic older adults but recommend investigation for self‐ or informant reports of changes in cognition, emergence of behavioral or psychiatric symptoms, or decline in function or self‐care. Standardized assessments should be used for cognitive and behavioral change that have sufficient validity for use in clinical practice. Discussion The CCCDTD5 provides evidence‐based recommendations for detection, assessment, and monitoring of neurocognitive disorders. Although these guidelines were developed for use in Canada, they may also be useful in other jurisdictions.

Abstract Background Nursing home residents are frail, have multiple medical comorbidities, and are at high risk for delirium. Most of the existing evidence base on delirium is derived from studies in the acute in-patient population. We examine the association between clinical characteristics and medication use with the incidence of delirium during the nursing home stay. Methods This is a retrospective cohort study of 1571 residents from 12 nursing homes operated by a single care provider in Ontario, Canada. Residents were over the age of 55 and admitted between February 2010 and December 2015 with no baseline delirium and a minimum stay of 180 days. Residents with moderate or worse cognitive impairment at baseline were excluded. The baseline and follow-up characteristics of residents were collected from the Resident Assessment Instrument-Minimal Data Set 2.0 completed at admission and repeated quarterly until death or discharge. Multivariate logistic regression was used to identify characteristics and medication use associated with the onset of delirium. Results The incidence of delirium was 40.4% over the nursing home stay (mean LOS: 32 months). A diagnosis of dementia (OR: 2.54, p

Introduction Home care clients are increasingly medically complex, have limited access to effective chronic disease management and have very high emergency department (ED) visitation rates. There is a need for more appropriate and targeted supportive chronic disease management for home care clients. We aim to evaluate the effectiveness and preliminary cost effectiveness of a targeted, person-centred cardiorespiratory management model.Methods and analysis The Detection of Indicators and Vulnerabilities of Emergency Room Trips (DIVERT) — Collaboration Action Research and Evaluation (CARE) trial is a pragmatic, cluster-randomised, multicentre superiority trial of a flexible multicomponent cardiorespiratory management model based on the best practice guidelines. The trial will be conducted in partnership with three regional, public-sector, home care providers across Canada. The primary outcome of the trial is the difference in time to first unplanned ED visit (hazard rate) within 6 months. Additional secondary outcomes are to identify changes in patient activation, changes in cardiorespiratory symptom frequencies and cost effectiveness over 6 months. We will also investigate the difference in the number of unplanned ED visits, number of inpatient hospitalisations and changes in health-related quality of life. Multilevel proportional hazard and generalised linear models will be used to test the primary and secondary hypotheses. Sample size simulations indicate that enrolling 1100 home care clients across 36 clusters (home care caseloads) will yield a power of 81% given an HR of 0.75.Ethics and dissemination Ethics approval was obtained from the Hamilton Integrated Research Ethics Board as well as each participating site’s ethics board. Results will be submitted for publication in peer-reviewed journals and for presentation at relevant conferences. Home care service partners will also be informed of the study’s results. The results will be used to inform future support strategies for older adults receiving home care services.Trial registration number NCT03012256.

Recurrent mutations in the spliceosome are observed in several human cancers, but their functional and therapeutic significance remains elusive. SF3B1, the most frequently mutated component of the spliceosome in cancer, is involved in the recognition of the branch point sequence (BPS) during selection of the 3′ splice site (ss) in RNA splicing. Here, we report that common and tumor-specific splicing aberrations are induced by SF3B1 mutations and establish aberrant 3′ ss selection as the most frequent splicing defect. Strikingly, mutant SF3B1 utilizes a BPS that differs from that used by wild-type SF3B1 and requires the canonical 3′ ss to enable aberrant splicing during the second step. Approximately 50% of the aberrantly spliced mRNAs are subjected to nonsense-mediated decay resulting in downregulation of gene and protein expression. These findings ascribe functional significance to the consequences of SF3B1 mutations in cancer.

Os Veículos Aéreos Não Tripulados (VANT) vem se tornando uma poderosa ferramenta em aplicações de uso civil e militar no campo das Geotecnologias. Em geral, os VANT são equipados com câmeras métricas convencionais ou multiespectrais de pequeno formato e também podem ser equipados com sensores LiDAR (Light Detection And Ranging). Em atividades de monitoramento de linhas de transmissão de energia elétrica, por exemplo, o uso do VANT equipado com sensores LiDAR possibilita monitorar o risco da vegetação existente sob as linhas a partir da classiï¬cação automática da nuvem de pontos. Além disso, o uso combinado dos dados de imageamento multiespectral possibilita identiï¬car diferentes tipos de uso e cobertura do solo, bem como a altura da vegetação existente sob as linhas de transmissão. Entretanto, para essas e outras atividades, há uma combinação de parâmetros do VANT e do sensor que deve ser analisada de modo a se obter dados corretamente dimensionados para a aplicação. Dessa forma, o uso de um planejamento de experimentos (em inglês - Design of Experiments - DoE) permite identiï¬car qual(ais) a(s) melhor(es) combinação(ões) de parâmetros para se obter a(s) melhor(es) resposta(s) conforme ï¬nalidade de uso. No presente estudo, os critérios para selecionar um experimento são discutidos e um experimento tipo Split-split plot fatorial fracionado 2x2x23-1 é proposto para ser executado devido às características dos fatores. A conclusão é que com o emprego do modelo DoE é possível propor uma combinação de fatores menores que quantidade original, permitindo que esses fatores possam ser avaliados em diversas aplicações.

Background. Chronic Obstructive Pulmonary Disease (COPD) is underdiagnosed in primary care. Aim. To explore the utility of proactive identification of COPD in patients 75 years of age and older in a Canadian primary care setting. Methods. Canadian Thoracic Society (CTS) screening questions were administered to patients with a smoking history of 20 pack-years or more; those with a positive screen were referred for postbronchodilator spirometry. Results. A total of 107 patients (21%), of 499 screened, had a 20-pack-year smoking history; 105 patients completed the CTS screening. Forty-four (42%) patients were positive on one or more questions on the screening; significantly more patients with a previous diagnosis of COPD (64%) were positive on the CTS compared to those without a previous diagnosis of COPD (30%). Of those who were not previously diagnosed with COPD (N = 11), four (36%) were newly diagnosed with COPD. Conclusion. A systematic two-stage method of screening for COPD, using CTS screening questions followed by spirometric confirmation, is feasible in the context of a busy primary care setting. More research is needed to assess the value of restricting screening to patients with a smoking history of 20 pack-years and on the sensitivity and specificity of these measures.

This paper discusses the problem of the estimation of the proportion p when the inspection system is imperfect (subject to diagnosis errors) and the sampled items are classified repeatedly m times. One assumes that no relevant information of the prior distributions of these errors is available and consequently a posterior distribution for the proportion p with high variability is generated due to non-informative prior distributions for those errors. In this paper, the authors suggest to split randomly the sample into two subsamples. Parameters of prior distributions are estimated by the first sample and a Bayesian inferential procedure is proceeded by the second sample. Numerical results indicate that such procedure yields better performance (lower variance for the posteriori distribution) rather than a single sample of size n= n1+n2 and non-informative prior distributions for the classification errors.

With the aging population, escalating demand for seniors’ care and limited specialist resources, new care delivery models are needed to improve capacity for primary health care for older adults. This paper describes the “C5-75” (Case-finding for Complex Chronic Conditions in Seniors 75+) program, an innovative care model aimed at identifying frailty and commonly associated geriatric conditions among older adults within a Canadian family practice setting and targeting interventions for identified conditions using a feasible, systematic, evidence-informed multi-disciplinary approach. We screen annually for frailty using gait speed and handgrip strength, screen for previously undiagnosed comorbid conditions, and offer frail older adults multi-faceted interventions that identify and address unrecognized medical and psychosocial needs. To date, we have assessed 965 older adults through this program; 14% were identified as frail based on gait speed alone, and 5% identified as frail based on gait speed with grip strength. The C5-75 program aims to re-conceptualize care from reactive interventions post-diagnosis for single disease states to a more proactive approach aimed at identifying older adults who are at highest risk of poor health outcomes, case-finding for unrecognized co-existing conditions, and targeting interventions to maintain health and well-being and potentially reduce vulnerability and health destabilization.

Este artigo visa conhecer o estado de colaboração em logística entre indústrias fornecedoras e redes de supermercados do Brasil, por meio do estudo da relação entre os elementos de colaboração e os elementos de desempenho logístico e de custos de transação identificados na relação de parceria. A metodologia é composta por uma análise qualitativa (por meio de observação participativa) e quantitativa, composta por uma amostra de 125 representantes dos fornecedores de 87 fabricantes de bens de consumo. Foram avaliadas as quatro maiores redes supermercadistas atuantes no país. Por meio de testes estatísticos e modelos de regressão, os resultados mostraram que alguns elementos de colaboração influenciam positivamente o desempenho logístico dos fornecedores, principalmente tratando-se de desempenho logístico diferenciado (entregas urgentes e em períodos de demanda alta). A integração interpessoal é a que mais contribui para a maior intensidade de colaboração, seguida da integração estratégica e integração tática. A maior intensidade de integração estratégica e de ações conjuntas (relacionadas aos elementos de integração tática) contribui para a diminuição de incertezas entre os participantes e essas ações conjuntas contribuem para o aumento do investimento em ativos específicos.This paper aims to ascertain the current state of collaborative logistics in the Brazilian supermarket retail chain through two quantitative studies: one concerning collaboration elements and logistics performance, and the other quantitative study focusing on collaboration elements and transaction costs. All of these elements are identified among the partners. The methodology consists of a qualitative analysis (using participative observations) and a quantitative analysis consisting of 125 representatives from 87 suppliers who evaluated Brazil's four largest retailers. From statistical tests and regression analysis, the results confirmed that some collaborative elements positively influence the logistics performance of the firms, mainly when it concerns a differentiated logistic performance (urgent deliveries and deliveries in periods of high demand). Interpersonal integration contributes most to a higher intensity of collaboration, followed by strategic integration and tactical integration. Moreover, the increase in strategic collaboration and joint actions (tactical integration elements) contributes to the reduction in uncertainties between the participants and these joint actions also help to increase investment in specific assets.

O objetivo deste trabalho é identificar os principais aspectos da implementação dos programas de qualidade em empresas brasileiras, a partir dos modelos mais difundidos e implementados como a certificação de sistemas de qualidade nas normas ISO 9000, o Seis Sigma e o Total Quality Management (TQM), fazendo uma análise comparativa e crítica de sua adoção pelas organizações e estudando as relações existentes entre eles, a complementaridade e as redundâncias. O tema é extremamente relevante no cenário atual, em que as companhias investem quantias significativas em diversos programas de melhoria da qualidade e possuem enormes dificuldades para avaliar o impacto estratégico, bem como o respectivo valor agregado. A metodologia adotou elementos da análise quantitativa, isto é, uma pesquisa do tipo survey. O universo para a coleta de dados foi extraído da relação "Ranking Valor 1.000", que contém as 1.000 maiores empresas brasileiras, publicadas no anuário do jornal "Valor Econômico", ano-base de 2004, partindo-se do pressuposto de que, nestas empresas, estarão os embriões dos modelos emergentes de gestão da qualidade. Posteriormente, as respostas obtidas por meio de questionários foram analisadas com o auxílio de um programa estatístico. A análise concluiu que as empresas que implantaram o programa Seis Sigma são as de maior tradição em qualidade, ou seja, adotaram outros programas anteriormente; as organizações que mais investiram em qualidade, pela adoção de programas, obtiveram sucesso nos indicadores de desempenho; e as principais causas do insucesso dos programas de qualidade ISO 9000, Seis Sigma e TQM nas organizações analisadas foram a escassez de recursos financeiros para a correta implantação e o frágil apoio da direção da empresa.This research aims to identify the main trends in the implementation of Quality Programs in Brazilian companies and is based on the most widely known and implemented models, such as the certification of quality systems according to the ISO 9000 Program, the Six Sigma and the TQM Program (Total Quality Management Program). This study provides a comparative and critical analysis of the implementation of those systems in Brazilian organizations as well as the existing relations among them, their complementary and redundancies. This issue is extremely relevant nowadays as companies invest heavily in different programs in order to improve quality, but still face huge difficulties to evaluate their strategic impact as well as their respective added value. In order to carry out this study, we have evaluated the references available about the subject. The methodology used in this research was based on a quantitative survey. The population of this search consists of a list the 1000 top Brazilian companies ranked according to their published sales figures according to "Ranking Valor 1.000", published in Valor Econômico yearbook (2004). This analysis assumed that new emerging quality management models could be found in this list Responses to questionnaires and to interviews made during visits to those companies were analyzed employing a statistical software. The analysis points out that the companies had implemented the Six Sigma Program are those with the strongest tradition in quality programs since they had earlier implemented other quality programs; as more the companies invest in quality programs more is the improvement in their performance; and the main causes for failures in ISO 9000, Six Sigma and TQM programs implementation were due to lack of financial resources for a correct implementation and a fragile support provided by the company management team.

Considere um modelo de confiabilidade descrito por uma regressão Weibull cujos parâmetros são estimadores pelo método da máxima verossimilhança. Eles serão utilizados para estimar outras quantidades como tempo médio de falha e quantis que por sua vez desempenham uma função importante numa análise de confiabilidade. O objetivo deste estudo é apresentar melhorias nos estimadores do tempo médio de falha e quantis uma vez que seus estimadores de máxima verossimilhança são viciados principalmente quanto envolve um tamanho de amostra reduzida. O procedimento de reamostragem Bootstrap é proposto para corrigir estes vícios. Através de um estudo de simulação é possível quantificar o vício uma vez que sua determinação analítica é um tanto complicada. Um exemplo ilustra o procedimento proposto.Consider a reliability model described by a Weibull regression, whose parameters are estimated by the maximum likelihood method. These parameters are used to estimate other quantities of interest such as MTTF (mean time to failure) and quantiles, which in turn play an important role in a reliability analysis. This paper proposes improvements in MTTF and quantile estimators, whose maximum likelihood estimates (MLEs) are biased, particularly in cases involving small sample sizes. A Bootstrap procedure is presented to correct such biases. The proposed procedure is evaluated based on simulations in which the sample size, censoring mechanisms, and percentiles of censored data are varied. These simulations allow one to quantify the bias, since the analytical expression is highly complex. The proposed procedure is illustrated through an example.

Neste estudo é realizada uma comparação entre dois modelos de planejamento econômico de gráficos de controle Xbarra-R. O primeiro modelo propõe que a distribuição do tempo em que o processo se mantém sob controle tem por propriedade a falta de memória; este modelo é apropriado para modelar processos não regenerativos. No segundo modelo, esta propriedade não é mais válida, sendo adequada para processos regenerativos.A comparison of two economic designs of Xbarra-R charts is made in this study. The first model assumes that the distribution of the time that the process remains under statistical control has the lack of memory property. This model is appropriate to model non-regenerative process. In the second model, the property of lack of memory does not hold being more appropriate to describe regenerative process.

Este artigo apresenta uma aplicação de sistemas de informações geográficas relacionada à distribuição espacial de empresas, na região metropolitana de uma cidade brasileira. Dados cadastrais e econômicos foram usados e integrados via um modelo de Data Envelopment Analyze (DEA), para compor cenários urbanos em duas épocas diferentes. Um índice de instalação foi criado utilizando variáveis de entrada e de saída no DEA. As variáveis de entrada foram: o número de empresas instaladas no município em 1998 e em 2003 (antes e depois da construção do trecho oeste do Rodoanel de São Paulo) e a distância media dessas empresas ao acesso ao Rodoanel (visto como uma vantagem para as empresas se localizarem). As variáveis de saída foram: a população e renda média (obtidas dos censos nacionais de 1991 e 2000, respectivamente) e o preço médio das propriedades (a partir de arquivos municipais de 1994 e 2005). Os resultados da aplicação do modelo são mostrados via um sistema de informações geográficas (SIG). Análises comparativas revelam que companhias se mudaram da área central do município para o entorno do Rodoanel e que a ocupação da região difere daquela prevista na legislação.

Vascular endothelial growth factor (VEGF) plays a dominant role in angiogenesis. While inhibitors of the VEGF pathway are approved for the treatment of a number of tumor types, the effectiveness is limited and evasive resistance is common. One mechanism of evasive resistance to inhibition of the VEGF pathway is upregulation of other pro-angiogenic factors such as fibroblast growth factor (FGF) and epidermal growth factor (EGF). Numerous in vitro assays examine angiogenesis, but many of these assays are performed in media or matrix with multiple growth factors or are driven by VEGF. In order to study angiogenesis driven by other growth factors, we developed a basal medium to use on a co-culture cord formation system of adipose derived stem cells (ADSCs) and endothelial colony forming cells (ECFCs). We found that cord formation driven by different angiogenic factors led to unique phenotypes that could be differentiated and combination studies indicate dominant phenotypes elicited by some growth factors. VEGF-driven cords were highly covered by smooth muscle actin, and bFGF-driven cords had thicker nodes, while EGF-driven cords were highly branched. Multiparametric analysis indicated that when combined EGF has a dominant phenotype. In addition, because this assay system is run in minimal medium, potential proangiogenic molecules can be screened. Using this assay we identified an inhibitor that promoted cord formation, which was translated into in vivo tumor models. Together this study illustrates the unique roles of multiple anti-angiogenic agents, which may lead to improvements in therapeutic angiogenesis efforts and better rational for anti-angiogenic therapy.

In this paper, a zero-defect acceptance sampling with rectification is used to evaluate the quality of spatial database. In such case, quadrats are the area sampling frames and theoptimum sample size to be extracted in a digital file generated from a conversion process; the size of the team of inspectors is determined so as to satisfy economic criteria. For theimplementation, a program was developed using the software Matlab and it is available for readers in the Appendix. The proposed procedure is illustrated by the application to digitaldata on the water distribution network.

Generally, production systems that use automatic control as automatic welding process, production of ceramic products, making clothes use on-line process control to evaluate the quality of their production processes. The control system consists of a periodic inspection of one item after every m produced items. If the number of non-conformities meets the control limit then it is decided that the process is in-control, otherwise the process is stopped for adjustment. The process starts in-control with a non-conformities rate and, after an assignable cause, this rate increases leading the system to operate out of control. The process remains in these conditions until the change is detected and the process adjusted. After adjustment, the process returns to operate in-control. The aim of this paper is to present an economic approach to monitor the rate of non-conformities in a production by on-line process control. To design such type of process, an average cost per item produced is achieved through the properties of an ergodic Markov chain and the two required parameters: the inspection interval and the upper control limit are obtained by minimizing the average cost per produced item. A numerical example illustrates the proposed procedure.

G protein-Coupled Receptors (GPCRs) kinases (GRKs) play a crucial role in regulating cardiac hypertrophy. Recent data from our lab has shown that, following ventricular pressure overload, GRK5, a primary cardiac GRK, facilitates maladaptive myocyte growth via novel nuclear localization. In the nucleus, GRK5's newly discovered kinase activity on histone deacetylase 5 induces hypertrophic gene transcription. The mechanisms governing the nuclear targeting of GRK5 are unknown. We report here that GRK5 nuclear accumulation is dependent on Ca(2+)/calmodulin (CaM) binding to a specific site within the amino terminus of GRK5 and this interaction occurs after selective activation of hypertrophic Gq-coupled receptors. Stimulation of myocytes with phenylephrine or angiotensinII causes GRK5 to leave the sarcolemmal membrane and accumulate in the nucleus, while the endothelin-1 does not cause nuclear GRK5 localization. A mutation within the amino-terminus of GRK5 negating CaM binding attenuates GRK5 movement from the sarcolemma to the nucleus and, importantly, overexpression of this mutant does not facilitate cardiac hypertrophy and related gene transcription in vitro and in vivo. Our data reveal that CaM binding to GRK5 is a physiologically relevant event that is absolutely required for nuclear GRK5 localization downstream of hypertrophic stimuli, thus facilitating GRK5-dependent regulation of maladaptive hypertrophy.

Rituximab has improved the treatment of B-cell non-Hodgkin lymphomas. While it is generally well tolerated, serious adverse effects including infusion reactions with hemodynamic compromise and cardiac arrhythmias or ischemia are possible. We report a case of coronary vasospasm occurring during a rituximab infusion in a patient with minimal tumour burden and who had no cardiac risk factors. This case highlights that determination of the cause of ischemia is important and may identify some patients who can be successfully rechallenged.

A high percentage of patients with the myeloproliferative disorder polycythemia vera (PV) harbor a Val617→Phe activating mutation in the Janus kinase 2 (JAK2) gene, and both cell culture and mouse models have established a functional role for this mutation in the development of this disease. We describe the properties of MRLB-11055, a highly potent inhibitor of both the WT and V617F forms of JAK2, that has therapeutic efficacy in erythropoietin (EPO)-driven and JAK2V617F-driven mouse models of PV. In cultured cells, MRLB-11055 blocked proliferation and induced apoptosis in a manner consistent with JAK2 pathway inhibition. MRLB-11055 effectively prevented EPO-induced STAT5 activation in the peripheral blood of acutely dosed mice, and could prevent EPO-induced splenomegaly and erythrocytosis in chronically dosed mice. In a bone marrow reconstituted JAK2V617F-luciferase murine PV model, MRLB-11055 rapidly reduced the burden of JAK2V617F-expressing cells from both the spleen and the bone marrow. Using real-time in vivo imaging, we examined the kinetics of disease regression and resurgence, enabling the development of an intermittent dosing schedule that achieved significant reductions in both erythroid and myeloid populations with minimal impact on lymphoid cells. Our studies provide a rationale for the use of non-continuous treatment to provide optimal therapy for PV patients.

Diversas abordagens de gestão da qualidade têm sido adotadas em todos os continentes há décadas. Uma das mais recentes, o programa Seis Sigma, vem sendo implementado por um número crescente de empresas. O Seis Sigma surge no atual cenário, em que as organizações realizam grandes investimentos na implementação de programas de melhoria da qualidade e se deparam com situações críticas como a mensuração do retorno sobre o capital investido, bem como a análise criteriosa dos benefícios alcançados. A proposta deste artigo é identificar as principais características do Seis Sigma, discutir quais os fatores críticos na sua implementação, as ferramentas e técnicas que suportam este processo, bem como sua relação com outros consagrados programas de melhoria da qualidade. A abordagem metodológica utilizada foi o estudo de múltiplos casos, desenvolvido em dez grandes empresas brasileiras de diferentes setores industriais. A pesquisa concluiu que existe sinergia entre o Seis Sigma e os demais programas e as organizações que adotaram o Seis Sigma obtiveram benefícios financeiros e de qualidade.

Conditions are given for the continuity and differentiability of solutions of initial value problems and boundary value problems for the nth order finite difference equation, u(m+n)=f(m,u(m),u(m+1),…,u(m+n−1)),m∈ℤ.

Qualidade é comumente usada para indicar superioridade de um bem manufaturado ou o grau de excelência de um produto, serviço ou desempenho. Uma base de dados pode ser vista como resultado de um processo de produção e a confiabilidade desta impacta o seu valor e a sua utilidade. Neste sentido, procedimentos de amostragem podem ser aplicados para avaliar se a base de dados satisfaz critérios especificados pelo usuário. Neste artigo mostra-se um procedimento para se extrair uma amostra de tamanho ótimo de um arquivo digital preparado para um sistema de informações geográficas, obtido através de um processo de conversão de dados. Dispositivos de geometria similar a um quadrado ou retângulo (quadrats) foram utilizados como unidade amostral num processo de amostragem com critério de aceitação contendo zero defeitos através de retificação. O procedimento foi implementado através do software Matlab e foi desenvolvida uma aplicação, ilustrativa, sobre dados digitais referentes a quadras de uma parte da cidade de São Paulo.

Os efeitos das temperaturas de imersão em nitrogênio líquido e dos métodos de remoção dos crioprotetores foram avaliados em mórulas de camundongos congeladas em etilenoglicol (E), propilenoglicol (P) e glicerol (G). Os embriões foram equilibrados em E (1,5M), P (1,5M) ou G (1,4M) por 10 minutos e envasados em palhetas de 0,25 ml com crioprotetor nas três colunas (E1, P1 G1) ou PBS nas colunas das extremidades (E2, P2). As palhetas foram resfriadas a 0,5ºC/minuto até -25 ou -30ºC e imersas em nitrogênio líquido. A descongelação dos embriões foi feita em água a 22ºC por 20 segundos. O crioprotetor dos embriões congelados em glicerol (Gl) foi removido em 3 etapas, dos congelados em etilenoglicol e propilenoglicol com crioprotetor nas 3 colunas (El e Pl) removido diretamente em PBS e dos congelados em etilenoglicol e propilenoglicol com PBS nas colunas das extremidades (E2, P2), após mistura das três colunas dentro da palheta, em PBS. Não houve influência da temperatura de imersão sobre o desenvolvimento embrionário in vitro, observando maior taxa (p < 0,0001) para El (69,2%) que para E2 (60,3%), Gl (51,9%) e a combinação P1 e P2 (46,9%). Para o desenvolvimento in vivo, a taxa de fetos foi menor (p < 0,07) para o grupo E1-25 do que para o Controle; Gl-30ºC; El-30ºC e E2-25ºC. Pode-se concluir que in vitro o melhor crioprotetor foi o etilenoglicol com remoção direta em PBS e que in vivo o etilenoglicol e o glicerol foram semelhantes a -30ºC.

The randomly amplified polymorphic DNA (RAPD) technique was used to distinguish nucellar and zygotic seedlings resulting from crosses between the ‘Montenegrina’ (Citrus deliciosa Tenore) and‘ King’ (C. nobilis Loureiro) tangerines. The aim of the present study was to develop tangerine varieties with a reduced number of seeds and organoleptic characteristics similar to the ‘Montenegrina’ tangerine. Embryos were isolated from seeds, cultivated in vitro, and acclimated in a greenhouse. Four random primers were used to identify 54 plants of sexual origin from a total of 202 individuals. The degree of polymorphism of each primer was reflected in the number of zygotic plants obtained per primer. Cluster analysis of parents and progeny separated the individuals into distinct groups with a maximum genetic dissimilarity of 20%.A técnica RAPD (random amplified polymorphic DNA) foi utilizada para distinguir plântulas nucelares e zigóticas resultantes do cruzamento entre as tangerineiras ‘Montenegrina’ (Citrus deliciosa Tenore) e ‘King’ (C. nobilis Loureiro). Este cruzamento foi realizado objetivando a obtenção de variedades de tangerineiras com características organolépticas de fruto semelhantes à tangerina ‘Montenegrina’ e menor número de sementes. Embriões foram isolados das sementes e cultivados in vitro e aclimatizados em casa de vegetação. Utilizando-se de 4 primers de seqüência randômica foram identificadas 54 plantas de origem sexual de um total de 202 indivíduos. O grau de polimorfismo de cada primer refletiu no número de plantas zigóticas obtidas por primer, sendo o total de zigóticos identificados pela soma das informações geradas pelos 4 primers. Análise de agrupamento com os parentais e a progênie separou os indivíduos em grupos distintos com uma dissimilaridade genética máxima de 20%.