Acute kidney injury in pregnancy: a clinical challenge

The incidence of acute kidney injury in pregnancy declined significantly over the second half of the 20th century; however, it is still associated with major maternal and perinatal morbidity and mortality. A set of systemic and renal physiological adaptive mechanisms occur during a normal gestation that will constrain several changes in laboratory parameters of renal function, electrolytes, fluid and acid-base balances. The diagnosis of acute kidney injury in pregnancy is based on the serum creatinine increase. The usual formulas for estimating glomerular filtration rate are not validated in this population. During the first trimester of gestation, acute kidney injury develops most often due to hyperemesis gravidarum or septic abortion. In the third trimester, the differential diagnosis is more challenging for the obstetrician and the nephrologist and comprises some pathologies that are reviewed in this article: preeclampsia/HELLP syndrome, acute fatty liver of pregnancy and thrombotic microangiopathies

O ETHOS DO ASSISTENTE SOCIAL NA PERSPECTIVA GRAMSCIANA DE ESTADO

O artigo discute o ethos do assistente social, como modo de serprofissional, a partir do conceito de Estado de Gramsci. Para isso, apresenta-seum paralelo entre o conceito de Estado “ampliado” em Gramsci no início doséculo XX e o conceito de Estado “restrito” de Marx e Engels em meados doséculo XIX. De ambas acepções de Estado decorrem as respectivas teoriasrevolucionárias: em Marx e Engels, no contexto do Manifesto do PartidoComunista, como insurreição armada e explosiva - tomada violenta do Estado;em Gramsci, como busca pela hegemonia – conquista processual. Tratamos porfim da diferenciação entre o ethos da perfectibilidade, que determina um fim apriori, e o ethos da mobilidade, que se constrói no cotidiano, na realidadeconcreta em que o assistente social se encontra. Desse modo, parece-noslegítimo aproximar o ethos da mobilidade com a abordagem do Estado“ampliado” em Gramsci, já que este autor compreende o movimento socialcomo um espaço aberto de luta pela conquista da hegemonia de determinadomodelo político e econômico.Palavras-chave: Gramsci. Estado. ethos. perfectibilidade. mobilidade

INSTRUCTIONAL DESIGN AND ASSESSMENT An Elective Course in Adult Acute Care Medicine Using a Hybrid Delivery System

Objective. To develop and assess the effectiveness of an elective course modeled after activities students encounter on internal medicine advanced pharmacy practice experiences (APPEs). Design. This hybrid elective course used a Web-based course management system linking pre-class lectures and assignments, classroom discussions, and projects to promote active student learning. Assessment. Assessment of student performance was based on assignments, quizzes, and participation in classroom discussions. Students were surveyed to ascertain their opinion of the elective. Conclusion. This elective in adult acute care medicine increased student exposure to inpatient settings and provided students additional opportunities to communicate effectively, evaluate medical literature, and think critically

Reply to: Comments on “Particle Swarm Optimization with Fractional-Order Velocity”

We agree with Ling-Yun et al. [5] and Zhang and Duan comments [2] about the typing error in equation (9) of the manuscript [8]. The correct formula was initially proposed in [6, 7]. The formula adopted in our algorithms discussed in our papers [1, 3, 4, 8] is, in fact, the following: ..

A sensor fusion layer to cope with reduced visibility in SLAM

Mapping and navigating with mobile robots in scenarios with reduced visibility, e.g. due to smoke, dust, or fog, is still a big challenge nowadays. In spite of the tremendous advance on Simultaneous Localization and Mapping (SLAM) techniques for the past decade, most of current algorithms fail in those environments because they usually rely on optical sensors providing dense range data, e.g. laser range finders, stereo vision, LIDARs, RGB-D, etc., whose measurement process is highly disturbed by particles of smoke, dust, or steam. This article addresses the problem of performing SLAM under reduced visibility conditions by proposing a sensor fusion layer which takes advantage from complementary characteristics between a laser range finder (LRF) and an array of sonars. This sensor fusion layer is ultimately used with a state-of-the-art SLAM technique to be resilient in scenarios where visibility cannot be assumed at all times. Special attention is given to mapping using commercial off-the-shelf (COTS) sensors, namely arrays of sonars which, being usually available in robotic platforms, raise technical issues that were investigated in the course of this work. Two sensor fusion methods, a heuristic method and a fuzzy logic-based method, are presented and discussed, corresponding to different stages of the research work conducted. The experimental validation of both methods with two different mobile robot platforms in smoky indoor scenarios showed that they provide a robust solution, using only COTS sensors, for adequately coping with reduced visibility in the SLAM process, thus decreasing significantly its impact in the mapping and localization results obtained

A sensor fusion layer to cope with reduced visibility in SLAM

Mapping and navigating with mobile robots in scenarios with reduced visibility, e.g. due to smoke, dust, or fog, is still a big challenge nowadays. In spite of the tremendous advance on Simultaneous Localization and Mapping (SLAM) techniques for the past decade, most of current algorithms fail in those environments because they usually rely on optical sensors providing dense range data, e.g. laser range finders, stereo vision, LIDARs, RGB-D, etc., whose measurement process is highly disturbed by particles of smoke, dust, or steam. This article addresses the problem of performing SLAM under reduced visibility conditions by proposing a sensor fusion layer which takes advantage from complementary characteristics between a laser range finder (LRF) and an array of sonars. This sensor fusion layer is ultimately used with a state-of-the-art SLAM technique to be resilient in scenarios where visibility cannot be assumed at all times. Special attention is given to mapping using commercial off-the-shelf (COTS) sensors, namely arrays of sonars which, being usually available in robotic platforms, raise technical issues that were investigated in the course of this work. Two sensor fusion methods, a heuristic method and a fuzzy logic-based method, are presented and discussed, corresponding to different stages of the research work conducted. The experimental validation of both methods with two different mobile robot platforms in smoky indoor scenarios showed that they provide a robust solution, using only COTS sensors, for adequately coping with reduced visibility in the SLAM process, thus decreasing significantly its impact in the mapping and localization results obtained

The perception of suicide as an inseparable way of violence according to young indigenous population: a study made with the Dourados Indigenous Reserve

This essay is focused to study and analyze the consequences of attempted implementation, through the Sistema Único de Saúde-SUS (Health Unique System), of the mental health protocol - DC-10 – among the indigenous population. In this specific case, based on a qualitative research, applying a methodology of intercultural action/participation, this essay has been made in the Dourados Indigenous Reserva (Reserva Indigena de Dourados – RID), with the young people and their leaders into the Young Indigenous Population Actions - Ação dos Jovens Indígenas – AJI, acting as an informal school into the RID (Dourados Indigenous Reserva). The necessity of presenting the young indigenous people perception about their suffering, does not only brief a biomedical interpretation, but also the trauma effect they had and still have that we may define as colonial, post traumatic cultural illness. Whatever the name we use, they are young and already carry a silent pain which cannot be reduced as a biomedical hegemonic vision, which brings the necessity to measure how this vision may cause them traumatic experience. This situation is based on an interdisciplinary and polyphonic vision upon the phenomenology and for this reason it consists in a think/make condition.Esse trabalho foca estudar e analisar as consequências da tentativa de implementar, via Sistema Único de Saúde - SUS, o protocolo de saúde mental DC-10 na população indígena. Nesse caso, esse estudo, baseado numa pesquisa qualitativa com metodologia de pesquisa ação/participação/intercultural, foi e está sendo realizado na Reserva Indígena de Dourados - RID, e conta com a participação dos jovens e das lideranças jovens da Ação dos Jovens Indígenas – AJI, a qual atua como uma escola não formal dentro da RID. A necessidade de apresentar a percepção dos/as jovens indígenas sobre o sofrimento que carregam não se resume numa interpretação biomédica, mas sim, efeito dos traumas que sofreram e sofrem que se pode nomear de colonial, post traumatic cultural illness. Seja qual for o nome, são jovens que carregam um sofrimento silenciado e que não pode ser reduzido à visão hegemônica biomédica, o que leva à necessidade de avaliar em que medida essa visão lhes acrescenta experiências traumáticas. Essa discussão se pauta numa visão interdisciplinar e polifônica baseada na fenomenologia e, por isso, constitui-se num pensar/fazer

Numerical simulation of blood flow and pressure drop in the pulmonary arterial and venous circulation

A novel multiscale mathematical and computational model of the pulmonary circulation is presented and used to analyse both arterial and venous pressure and flow. This work is a major advance over previous studies by Olufsen et al. (Ann Biomed Eng 28:1281–1299, 2012) which only considered the arterial circulation. For the first three generations of vessels within the pulmonary circulation, geometry is specified from patient-specific measurements obtained using magnetic resonance imaging (MRI). Blood flow and pressure in the larger arteries and veins are predicted using a nonlinear, cross-sectional-area-averaged system of equations for a Newtonian fluid in an elastic tube. Inflow into the main pulmonary artery is obtained from MRI measurements, while pressure entering the left atrium from the main pulmonary vein is kept constant at the normal mean value of 2 mmHg. Each terminal vessel in the network of ‘large’ arteries is connected to its corresponding terminal vein via a network of vessels representing the vascular bed of smaller arteries and veins. We develop and implement an algorithm to calculate the admittance of each vascular bed, using bifurcating structured trees and recursion. The structured-tree models take into account the geometry and material properties of the ‘smaller’ arteries and veins of radii ≥ 50 μ m. We study the effects on flow and pressure associated with three classes of pulmonary hypertension expressed via stiffening of larger and smaller vessels, and vascular rarefaction. The results of simulating these pathological conditions are in agreement with clinical observations, showing that the model has potential for assisting with diagnosis and treatment for circulatory diseases within the lung