1) The study assessed the appropriateness of 174 patient admissions to an internal medicine ward in Portugal using the prospective Appropriateness Evaluation Protocol (AEP).
2) They found that 17.7% of admissions were inappropriate, similar to other studies in the Iberian Peninsula. The most common reason for appropriateness was intravenous therapy.
3) Patients admitted on weekends had significantly longer hospital stays than those admitted on weekdays, possibly due to lack of elective care on weekends.
This study analyzed the legibility of epicrisis reports for 108 deceased patients in the department of internal medicine at a hospital in Portugal in 2002. The reports were written by 13 different doctors, with only 6 being typewritten and fully legible. 30 reports (27.77%) had some degree of illegibility, though only 1 was fully unclear. No reports were completely illegible. Legibility defects were slightly higher for patients with shorter average stays of 5 days or less before death. The study concludes that introducing electronic epicrisis reports could help address legibility issues, and that staffing levels on weekends did not influence mortality or report quality.
This document is a CME tracker for Javier Rodriguez Vera listing the CME activities he has completed from January 2012 through December 2012. It shows that he earned a total of 52.25 credits. The activities covered topics such as glucose-lowering therapy in chronic kidney disease, assessing treatment response in PAH, biomarker-guided heart failure therapy, management of joint bleeding in hemophilia, incorporating new approaches to hyponatremia management, and more. Each activity is listed with its title, provider, date participated, and credits earned.
This study aimed to understand the magnitude and characteristics of infectious diseases among patients admitted to the internal medicine ward of a Portuguese hospital over one month. A total of 25 out of 73 patients admitted during the study period had infectious diseases, representing 41 infectious episodes. The most common infections were urinary tract infections (44%) and pneumonia (29%). The majority (83%) of cultures grew pathogens, most commonly E. coli (21%), Pseudomonas aeruginosa (11%), and fungi (11%). Infections increased patient mortality by 10% and length of stay by 3.5 days compared to other patients. Pressure ulcers accounted for 12% of infections and were all hospital-acquired. Empiric antibiotic therapy was ineffective in
1) The document summarizes key aspects of evaluating clinical trials, including types of trials and potential biases.
2) Clinical trials aim to test interventions in a controlled manner to determine safety and effectiveness. Randomized controlled trials (RCTs) are considered the gold standard for limiting biases.
3) However, biases can still influence trials in many ways, such as through selection of participants, administration of interventions, measurement of outcomes, and reporting/publication of results. It is important to critically appraise trials to assess risk of biases.
This study analyzed 30 patients admitted to a hospital in southern Portugal between 1998-2003 with spotted fever. Spotted fever is endemic to the Mediterranean region and transmitted by ticks. The average age was 43 years and 70% were male. Most cases occurred between June-August. Rural environments and contact with dogs were identified as risk factors. The most common symptoms were fever (100%) and rash (90%). Half of patients developed hepatitis and 40% thrombocytopenia. Doxycycline treatment was started early in 93% of patients and all patients recovered well with an average hospital stay of 5.9 days. The study concludes that spotted fever is common in the region likely due to rural areas, treatment with doxycy
1) The study assessed the appropriateness of 174 patient admissions to an internal medicine ward in Portugal using the prospective Appropriateness Evaluation Protocol (AEP).
2) They found that 17.7% of admissions were inappropriate, similar to other studies in the Iberian Peninsula. The most common reason for appropriateness was intravenous therapy.
3) Patients admitted on weekends had significantly longer hospital stays than those admitted on weekdays, possibly due to lack of elective care on weekends.
This study analyzed the legibility of epicrisis reports for 108 deceased patients in the department of internal medicine at a hospital in Portugal in 2002. The reports were written by 13 different doctors, with only 6 being typewritten and fully legible. 30 reports (27.77%) had some degree of illegibility, though only 1 was fully unclear. No reports were completely illegible. Legibility defects were slightly higher for patients with shorter average stays of 5 days or less before death. The study concludes that introducing electronic epicrisis reports could help address legibility issues, and that staffing levels on weekends did not influence mortality or report quality.
This document is a CME tracker for Javier Rodriguez Vera listing the CME activities he has completed from January 2012 through December 2012. It shows that he earned a total of 52.25 credits. The activities covered topics such as glucose-lowering therapy in chronic kidney disease, assessing treatment response in PAH, biomarker-guided heart failure therapy, management of joint bleeding in hemophilia, incorporating new approaches to hyponatremia management, and more. Each activity is listed with its title, provider, date participated, and credits earned.
This study aimed to understand the magnitude and characteristics of infectious diseases among patients admitted to the internal medicine ward of a Portuguese hospital over one month. A total of 25 out of 73 patients admitted during the study period had infectious diseases, representing 41 infectious episodes. The most common infections were urinary tract infections (44%) and pneumonia (29%). The majority (83%) of cultures grew pathogens, most commonly E. coli (21%), Pseudomonas aeruginosa (11%), and fungi (11%). Infections increased patient mortality by 10% and length of stay by 3.5 days compared to other patients. Pressure ulcers accounted for 12% of infections and were all hospital-acquired. Empiric antibiotic therapy was ineffective in
1) The document summarizes key aspects of evaluating clinical trials, including types of trials and potential biases.
2) Clinical trials aim to test interventions in a controlled manner to determine safety and effectiveness. Randomized controlled trials (RCTs) are considered the gold standard for limiting biases.
3) However, biases can still influence trials in many ways, such as through selection of participants, administration of interventions, measurement of outcomes, and reporting/publication of results. It is important to critically appraise trials to assess risk of biases.
This study analyzed 30 patients admitted to a hospital in southern Portugal between 1998-2003 with spotted fever. Spotted fever is endemic to the Mediterranean region and transmitted by ticks. The average age was 43 years and 70% were male. Most cases occurred between June-August. Rural environments and contact with dogs were identified as risk factors. The most common symptoms were fever (100%) and rash (90%). Half of patients developed hepatitis and 40% thrombocytopenia. Doxycycline treatment was started early in 93% of patients and all patients recovered well with an average hospital stay of 5.9 days. The study concludes that spotted fever is common in the region likely due to rural areas, treatment with doxycy
Este estudo avaliou a adequação de 72 admissões hospitalares num serviço de medicina interna em Portugal utilizando o Protocolo de Avaliação da Apropriação (AEP). 20,8% das admissões foram consideradas inadequadas, principalmente para exames ou tratamentos que poderiam ter sido realizados em ambulatório. O AEP é uma ferramenta útil para avaliar a utilização de recursos e melhorar a eficiência dos hospitais.
Adequaçao do Internamento num Serviço de Medicina INterna Utilizando o AEP. A...Javier Rodriguez-Vera
Este artigo avalia a adequação das admissões e estadias hospitalares de pacientes internados em uma enfermaria de medicina interna utilizando a versão concorrente do Appropriateness Evaluation Protocol (AEP). Os resultados mostraram que todas as admissões foram consideradas adequadas, com a necessidade de terapia endovenosa sendo o critério mais comum. No entanto, 27,3% das estadias foram consideradas inadequadas de acordo com o AEP.
El estudio evaluó la adecuación de ingresos y estancias en un servicio de medicina interna utilizando la versión concurrente del AEP. Se encontró que un 15.3% de los ingresos y un 33% de las estancias fueron inadecuados, siendo las causas más frecuentes agilizar estudios ambulatorios e esperar resultados de pruebas, respectivamente. El estudio proporciona información sobre el uso de recursos que puede ayudar a mejorar la eficiencia.
Reingreso hospitalario como indicador de la calidad asistencialJavier Rodriguez-Vera
RODRIGUEZ-VERA, F. J.; ALCOUCER DIAZ, M. R.; MARIN FERNANDEZ, Y. y PUJOL DE LA LLAVE, E. An. Med. Interna (Madrid). 2002, vol.19, n.5, pp. 66-67. ISSN 0212-7199.
Inadecuación de ingresos y estancias hospitalarias en una seción de digestivoJavier Rodriguez-Vera
Este estudio evaluó la inadecuación de ingresos y estancias en la sección de digestivo de un hospital durante enero y febrero de 2000 utilizando el protocolo de evaluación de adecuación. El 15.7% de los pacientes no cumplían criterios de ingreso y la causa más común fue la necesidad de realizar estudios de forma rápida. La estancia media fue de 6.11 días y el 28.57% de las estancias inadecuadas se debió a procedimientos que podrían haberse realizado de forma externa. El estudio conclu
Lo que nunca se ve: resúmenes de estudios enviados para presentación en Congr...Javier Rodriguez-Vera
Not all the studies sent for presentation to a Congress are accepted. Although less selective than a journal, an abstract has to comply with criteria of quality and scientific interest. As higher the number of abstracts sent, more rigurous the selection becomes.
Este documento estudia la relación entre la comorbilidad crónica de los pacientes y la duración de sus estancias hospitalarias. Analizó los registros médicos de 117 pacientes y calculó su índice de comorbilidad de Charlson. Encontró que los pacientes con mayor comorbilidad tuvieron estancias más largas, especialmente debido a más días de estancia adecuados, probablemente para estabilizar sus condiciones. Además, detectó que el 11% de las estancias fueron inadecuadas, una tasa menor que otros estudios simil
SADEMI 2001 (Abstract of non accepted study): Factores estructurales que dete...Javier Rodriguez-Vera
This is the case: I found interesting to analyze if there were another factors not related with the requirements of acute care causing innappropriateness. Results showed facts, from my perspective, not appropriate to be changed.
This abstract was accepted, the Director Medicine making despective comments about importance, pertinence and Interest of the study. During the Congress, it was a study calling the attention of many assistens. My boss (Director of Medicine and friend), mantained his position: it´s a "cute" study to be presented on a regional meeting, but that´s all. the study was published as an original article on the Journal of the Royal Society of Medicine, presenting a high individual impact factor. Chiefs can also be wrong.
Este documento contiene información personal de Francisco Javier Rodríguez-Vera, incluyendo su nombre, lugar de trabajo en el Hospital Juan Ramón Jiménez de Huelva como médico interno, dirección, códigos postales y correo electrónico.
Este documento evalúa el uso de la versión concurrente del Protocolo de Evaluación de la Adecuación (AEP) en un servicio de medicina interna para evaluar la adecuación de ingresos y estancias. El estudio encontró que el 15.3% de los ingresos y el 25.97% de las estancias fueron inadecuados, principalmente debido a la espera de resultados de pruebas e interconsultas. La conclusión es que el AEP puede identificar la sobreutilización de recursos y que agilizar pruebas y colaboración entre especial
Este documento evalúa el uso de la versión concurrente del Protocolo de Evaluación de la Adecuación (AEP) en un servicio de medicina interna para evaluar la adecuación de ingresos y estancias. El estudio encontró que el 15.3% de los ingresos y el 25.97% de las estancias fueron inadecuados, principalmente debido a la espera de resultados de pruebas e interconsultas. La conclusión es que el AEP puede identificar la sobreutilización de recursos y que agilizar pruebas y colaboración entre especial
Este documento contiene un protocolo de estudio de pluripatología para un paciente. Recopila datos personales del paciente como nombre, edad, sexo y número de historia clínica. También incluye información sobre ingresos hospitalarios previos, categorías de patologías crónicas, comorbilidades según la escala de Charlson y detalles sobre la continuidad asistencial tras el último alta hospitalaria.
El paciente pluripatológico en los Servicios de Medicina InternaJavier Rodriguez-Vera
This study was carried out as a part of a multicenter-based, global study to find out the real weight of patients with high comorbidity admitted to the wards of Internal Medicine, thus making possible developing strategies to improve delivery of care and acesibility to health care to avoid progression of any intercurrent condition that, utreated, alter the fragile balance of the clinical status of the affected, requirring an admission on an acute care unit.
The Appropriateness Evaluation protocol (AEP) presents as a limiting factor, the need to do long, time-sparing, studies, which provides information of past events. As we had obtained a very good feedback from this tool, a one-day-study was done, with patients inward at the time and compared results with the other versions (preospective and restrospective AEP). Although data were not useful for stattistic study, they do presented a view of inappropriateness and its causes with a minimum investment in terms of time, thus favouring rapid and synchronic interventions to correct this parameter.
One of the first persons I attended as an independent Physician on my third year of Internship. I found the clinical feature extremely vague, since data collected before the admission were focused on diarrhea, weight loss, anemia, and blood tests suggesting a mild liver dysfunction with an INR of 5 at admission. All these data, together with the fact of the patient being 56yo, made me think in an intestinal neosplasm. results of Thyroid function tests were avalaible after an important part of the workup had been done.
The case, besides presenting clinical interest, is the startpoint of a polemic about the need of considering delay of the resultsof tests when a diagnostic process is going to be initiated.
El documento presenta el caso de un paciente de 60 años que sufrió un infarto de miocardio y recibió tratamiento con estreptoquinasa. Cuatro días después desarrolló síntomas vasculares periféricos y livedo reticularis en las extremidades inferiores, lo que sugirió una enfermedad ateroembólica. Se realizaron biopsias de piel que confirmaron la presencia de cristales de colesterol, y el paciente se recuperó con tratamiento sintomático a pesar de requerir la amputación de un
This document provides information about the 29th World Congress of Internal Medicine being held in Buenos Aires, Argentina in 2008. It discusses the long candidacy and organization process for the Congress. It highlights that over 800 participants from 47 countries will participate in the scientific program through 119 sessions and around 900 poster presentations. The Congress aims to define the role of internal medicine, analyze changes in major diseases over the next 30 years, update advances in internal medicine, and update subspecialties from an internist perspective. It also pays tribute to the doctors who organized the 8th World Congress of Internal Medicine in Buenos Aires in 1964.
Este documento discute evidências sobre o uso de insulina no tratamento de diabetes mellitus tipo 2. Apresenta estudos que mostram que o controle glicêmico estrito com insulina ou sulfonilureias reduz o risco de complicações microvasculares. Também mostra que a adição de insulina quando a terapia máxima com sulfonilureias é inadequada pode melhorar o controle glicêmico sem aumentar o risco de hipoglicemia ou ganho de peso. Além disso, a combinação de insulina com sulfonilureias
The document provides an overview of evidence-based medicine, including what it is, why it is important, where evidence comes from, levels of evidence, and the steps to practice evidence-based medicine. It discusses formulating a clear clinical question, searching for relevant information and studies, critically appraising the evidence, and applying the evidence to a specific patient case. Key aspects covered include evaluating the validity, importance, and applicability of various types of studies to determine the strength and relevance of the evidence. The goal is to systematically review and apply the best available research findings to clinical decision making.
Gender and Mental Health - Counselling and Family Therapy Applications and In...PsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Chapter wise All Notes of First year Basic Civil Engineering.pptxDenish Jangid
Chapter wise All Notes of First year Basic Civil Engineering
Syllabus
Chapter-1
Introduction to objective, scope and outcome the subject
Chapter 2
Introduction: Scope and Specialization of Civil Engineering, Role of civil Engineer in Society, Impact of infrastructural development on economy of country.
Chapter 3
Surveying: Object Principles & Types of Surveying; Site Plans, Plans & Maps; Scales & Unit of different Measurements.
Linear Measurements: Instruments used. Linear Measurement by Tape, Ranging out Survey Lines and overcoming Obstructions; Measurements on sloping ground; Tape corrections, conventional symbols. Angular Measurements: Instruments used; Introduction to Compass Surveying, Bearings and Longitude & Latitude of a Line, Introduction to total station.
Levelling: Instrument used Object of levelling, Methods of levelling in brief, and Contour maps.
Chapter 4
Buildings: Selection of site for Buildings, Layout of Building Plan, Types of buildings, Plinth area, carpet area, floor space index, Introduction to building byelaws, concept of sun light & ventilation. Components of Buildings & their functions, Basic concept of R.C.C., Introduction to types of foundation
Chapter 5
Transportation: Introduction to Transportation Engineering; Traffic and Road Safety: Types and Characteristics of Various Modes of Transportation; Various Road Traffic Signs, Causes of Accidents and Road Safety Measures.
Chapter 6
Environmental Engineering: Environmental Pollution, Environmental Acts and Regulations, Functional Concepts of Ecology, Basics of Species, Biodiversity, Ecosystem, Hydrological Cycle; Chemical Cycles: Carbon, Nitrogen & Phosphorus; Energy Flow in Ecosystems.
Water Pollution: Water Quality standards, Introduction to Treatment & Disposal of Waste Water. Reuse and Saving of Water, Rain Water Harvesting. Solid Waste Management: Classification of Solid Waste, Collection, Transportation and Disposal of Solid. Recycling of Solid Waste: Energy Recovery, Sanitary Landfill, On-Site Sanitation. Air & Noise Pollution: Primary and Secondary air pollutants, Harmful effects of Air Pollution, Control of Air Pollution. . Noise Pollution Harmful Effects of noise pollution, control of noise pollution, Global warming & Climate Change, Ozone depletion, Greenhouse effect
Text Books:
1. Palancharmy, Basic Civil Engineering, McGraw Hill publishers.
2. Satheesh Gopi, Basic Civil Engineering, Pearson Publishers.
3. Ketki Rangwala Dalal, Essentials of Civil Engineering, Charotar Publishing House.
4. BCP, Surveying volume 1
Este estudo avaliou a adequação de 72 admissões hospitalares num serviço de medicina interna em Portugal utilizando o Protocolo de Avaliação da Apropriação (AEP). 20,8% das admissões foram consideradas inadequadas, principalmente para exames ou tratamentos que poderiam ter sido realizados em ambulatório. O AEP é uma ferramenta útil para avaliar a utilização de recursos e melhorar a eficiência dos hospitais.
Adequaçao do Internamento num Serviço de Medicina INterna Utilizando o AEP. A...Javier Rodriguez-Vera
Este artigo avalia a adequação das admissões e estadias hospitalares de pacientes internados em uma enfermaria de medicina interna utilizando a versão concorrente do Appropriateness Evaluation Protocol (AEP). Os resultados mostraram que todas as admissões foram consideradas adequadas, com a necessidade de terapia endovenosa sendo o critério mais comum. No entanto, 27,3% das estadias foram consideradas inadequadas de acordo com o AEP.
El estudio evaluó la adecuación de ingresos y estancias en un servicio de medicina interna utilizando la versión concurrente del AEP. Se encontró que un 15.3% de los ingresos y un 33% de las estancias fueron inadecuados, siendo las causas más frecuentes agilizar estudios ambulatorios e esperar resultados de pruebas, respectivamente. El estudio proporciona información sobre el uso de recursos que puede ayudar a mejorar la eficiencia.
Reingreso hospitalario como indicador de la calidad asistencialJavier Rodriguez-Vera
RODRIGUEZ-VERA, F. J.; ALCOUCER DIAZ, M. R.; MARIN FERNANDEZ, Y. y PUJOL DE LA LLAVE, E. An. Med. Interna (Madrid). 2002, vol.19, n.5, pp. 66-67. ISSN 0212-7199.
Inadecuación de ingresos y estancias hospitalarias en una seción de digestivoJavier Rodriguez-Vera
Este estudio evaluó la inadecuación de ingresos y estancias en la sección de digestivo de un hospital durante enero y febrero de 2000 utilizando el protocolo de evaluación de adecuación. El 15.7% de los pacientes no cumplían criterios de ingreso y la causa más común fue la necesidad de realizar estudios de forma rápida. La estancia media fue de 6.11 días y el 28.57% de las estancias inadecuadas se debió a procedimientos que podrían haberse realizado de forma externa. El estudio conclu
Lo que nunca se ve: resúmenes de estudios enviados para presentación en Congr...Javier Rodriguez-Vera
Not all the studies sent for presentation to a Congress are accepted. Although less selective than a journal, an abstract has to comply with criteria of quality and scientific interest. As higher the number of abstracts sent, more rigurous the selection becomes.
Este documento estudia la relación entre la comorbilidad crónica de los pacientes y la duración de sus estancias hospitalarias. Analizó los registros médicos de 117 pacientes y calculó su índice de comorbilidad de Charlson. Encontró que los pacientes con mayor comorbilidad tuvieron estancias más largas, especialmente debido a más días de estancia adecuados, probablemente para estabilizar sus condiciones. Además, detectó que el 11% de las estancias fueron inadecuadas, una tasa menor que otros estudios simil
SADEMI 2001 (Abstract of non accepted study): Factores estructurales que dete...Javier Rodriguez-Vera
This is the case: I found interesting to analyze if there were another factors not related with the requirements of acute care causing innappropriateness. Results showed facts, from my perspective, not appropriate to be changed.
This abstract was accepted, the Director Medicine making despective comments about importance, pertinence and Interest of the study. During the Congress, it was a study calling the attention of many assistens. My boss (Director of Medicine and friend), mantained his position: it´s a "cute" study to be presented on a regional meeting, but that´s all. the study was published as an original article on the Journal of the Royal Society of Medicine, presenting a high individual impact factor. Chiefs can also be wrong.
Este documento contiene información personal de Francisco Javier Rodríguez-Vera, incluyendo su nombre, lugar de trabajo en el Hospital Juan Ramón Jiménez de Huelva como médico interno, dirección, códigos postales y correo electrónico.
Este documento evalúa el uso de la versión concurrente del Protocolo de Evaluación de la Adecuación (AEP) en un servicio de medicina interna para evaluar la adecuación de ingresos y estancias. El estudio encontró que el 15.3% de los ingresos y el 25.97% de las estancias fueron inadecuados, principalmente debido a la espera de resultados de pruebas e interconsultas. La conclusión es que el AEP puede identificar la sobreutilización de recursos y que agilizar pruebas y colaboración entre especial
Este documento evalúa el uso de la versión concurrente del Protocolo de Evaluación de la Adecuación (AEP) en un servicio de medicina interna para evaluar la adecuación de ingresos y estancias. El estudio encontró que el 15.3% de los ingresos y el 25.97% de las estancias fueron inadecuados, principalmente debido a la espera de resultados de pruebas e interconsultas. La conclusión es que el AEP puede identificar la sobreutilización de recursos y que agilizar pruebas y colaboración entre especial
Este documento contiene un protocolo de estudio de pluripatología para un paciente. Recopila datos personales del paciente como nombre, edad, sexo y número de historia clínica. También incluye información sobre ingresos hospitalarios previos, categorías de patologías crónicas, comorbilidades según la escala de Charlson y detalles sobre la continuidad asistencial tras el último alta hospitalaria.
El paciente pluripatológico en los Servicios de Medicina InternaJavier Rodriguez-Vera
This study was carried out as a part of a multicenter-based, global study to find out the real weight of patients with high comorbidity admitted to the wards of Internal Medicine, thus making possible developing strategies to improve delivery of care and acesibility to health care to avoid progression of any intercurrent condition that, utreated, alter the fragile balance of the clinical status of the affected, requirring an admission on an acute care unit.
The Appropriateness Evaluation protocol (AEP) presents as a limiting factor, the need to do long, time-sparing, studies, which provides information of past events. As we had obtained a very good feedback from this tool, a one-day-study was done, with patients inward at the time and compared results with the other versions (preospective and restrospective AEP). Although data were not useful for stattistic study, they do presented a view of inappropriateness and its causes with a minimum investment in terms of time, thus favouring rapid and synchronic interventions to correct this parameter.
One of the first persons I attended as an independent Physician on my third year of Internship. I found the clinical feature extremely vague, since data collected before the admission were focused on diarrhea, weight loss, anemia, and blood tests suggesting a mild liver dysfunction with an INR of 5 at admission. All these data, together with the fact of the patient being 56yo, made me think in an intestinal neosplasm. results of Thyroid function tests were avalaible after an important part of the workup had been done.
The case, besides presenting clinical interest, is the startpoint of a polemic about the need of considering delay of the resultsof tests when a diagnostic process is going to be initiated.
El documento presenta el caso de un paciente de 60 años que sufrió un infarto de miocardio y recibió tratamiento con estreptoquinasa. Cuatro días después desarrolló síntomas vasculares periféricos y livedo reticularis en las extremidades inferiores, lo que sugirió una enfermedad ateroembólica. Se realizaron biopsias de piel que confirmaron la presencia de cristales de colesterol, y el paciente se recuperó con tratamiento sintomático a pesar de requerir la amputación de un
This document provides information about the 29th World Congress of Internal Medicine being held in Buenos Aires, Argentina in 2008. It discusses the long candidacy and organization process for the Congress. It highlights that over 800 participants from 47 countries will participate in the scientific program through 119 sessions and around 900 poster presentations. The Congress aims to define the role of internal medicine, analyze changes in major diseases over the next 30 years, update advances in internal medicine, and update subspecialties from an internist perspective. It also pays tribute to the doctors who organized the 8th World Congress of Internal Medicine in Buenos Aires in 1964.
Este documento discute evidências sobre o uso de insulina no tratamento de diabetes mellitus tipo 2. Apresenta estudos que mostram que o controle glicêmico estrito com insulina ou sulfonilureias reduz o risco de complicações microvasculares. Também mostra que a adição de insulina quando a terapia máxima com sulfonilureias é inadequada pode melhorar o controle glicêmico sem aumentar o risco de hipoglicemia ou ganho de peso. Além disso, a combinação de insulina com sulfonilureias
The document provides an overview of evidence-based medicine, including what it is, why it is important, where evidence comes from, levels of evidence, and the steps to practice evidence-based medicine. It discusses formulating a clear clinical question, searching for relevant information and studies, critically appraising the evidence, and applying the evidence to a specific patient case. Key aspects covered include evaluating the validity, importance, and applicability of various types of studies to determine the strength and relevance of the evidence. The goal is to systematically review and apply the best available research findings to clinical decision making.
Gender and Mental Health - Counselling and Family Therapy Applications and In...PsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Chapter wise All Notes of First year Basic Civil Engineering.pptxDenish Jangid
Chapter wise All Notes of First year Basic Civil Engineering
Syllabus
Chapter-1
Introduction to objective, scope and outcome the subject
Chapter 2
Introduction: Scope and Specialization of Civil Engineering, Role of civil Engineer in Society, Impact of infrastructural development on economy of country.
Chapter 3
Surveying: Object Principles & Types of Surveying; Site Plans, Plans & Maps; Scales & Unit of different Measurements.
Linear Measurements: Instruments used. Linear Measurement by Tape, Ranging out Survey Lines and overcoming Obstructions; Measurements on sloping ground; Tape corrections, conventional symbols. Angular Measurements: Instruments used; Introduction to Compass Surveying, Bearings and Longitude & Latitude of a Line, Introduction to total station.
Levelling: Instrument used Object of levelling, Methods of levelling in brief, and Contour maps.
Chapter 4
Buildings: Selection of site for Buildings, Layout of Building Plan, Types of buildings, Plinth area, carpet area, floor space index, Introduction to building byelaws, concept of sun light & ventilation. Components of Buildings & their functions, Basic concept of R.C.C., Introduction to types of foundation
Chapter 5
Transportation: Introduction to Transportation Engineering; Traffic and Road Safety: Types and Characteristics of Various Modes of Transportation; Various Road Traffic Signs, Causes of Accidents and Road Safety Measures.
Chapter 6
Environmental Engineering: Environmental Pollution, Environmental Acts and Regulations, Functional Concepts of Ecology, Basics of Species, Biodiversity, Ecosystem, Hydrological Cycle; Chemical Cycles: Carbon, Nitrogen & Phosphorus; Energy Flow in Ecosystems.
Water Pollution: Water Quality standards, Introduction to Treatment & Disposal of Waste Water. Reuse and Saving of Water, Rain Water Harvesting. Solid Waste Management: Classification of Solid Waste, Collection, Transportation and Disposal of Solid. Recycling of Solid Waste: Energy Recovery, Sanitary Landfill, On-Site Sanitation. Air & Noise Pollution: Primary and Secondary air pollutants, Harmful effects of Air Pollution, Control of Air Pollution. . Noise Pollution Harmful Effects of noise pollution, control of noise pollution, Global warming & Climate Change, Ozone depletion, Greenhouse effect
Text Books:
1. Palancharmy, Basic Civil Engineering, McGraw Hill publishers.
2. Satheesh Gopi, Basic Civil Engineering, Pearson Publishers.
3. Ketki Rangwala Dalal, Essentials of Civil Engineering, Charotar Publishing House.
4. BCP, Surveying volume 1
Communicating effectively and consistently with students can help them feel at ease during their learning experience and provide the instructor with a communication trail to track the course's progress. This workshop will take you through constructing an engaging course container to facilitate effective communication.
Beyond Degrees - Empowering the Workforce in the Context of Skills-First.pptxEduSkills OECD
Iván Bornacelly, Policy Analyst at the OECD Centre for Skills, OECD, presents at the webinar 'Tackling job market gaps with a skills-first approach' on 12 June 2024
LAND USE LAND COVER AND NDVI OF MIRZAPUR DISTRICT, UPRAHUL
This Dissertation explores the particular circumstances of Mirzapur, a region located in the
core of India. Mirzapur, with its varied terrains and abundant biodiversity, offers an optimal
environment for investigating the changes in vegetation cover dynamics. Our study utilizes
advanced technologies such as GIS (Geographic Information Systems) and Remote sensing to
analyze the transformations that have taken place over the course of a decade.
The complex relationship between human activities and the environment has been the focus
of extensive research and worry. As the global community grapples with swift urbanization,
population expansion, and economic progress, the effects on natural ecosystems are becoming
more evident. A crucial element of this impact is the alteration of vegetation cover, which plays a
significant role in maintaining the ecological equilibrium of our planet.Land serves as the foundation for all human activities and provides the necessary materials for
these activities. As the most crucial natural resource, its utilization by humans results in different
'Land uses,' which are determined by both human activities and the physical characteristics of the
land.
The utilization of land is impacted by human needs and environmental factors. In countries
like India, rapid population growth and the emphasis on extensive resource exploitation can lead
to significant land degradation, adversely affecting the region's land cover.
Therefore, human intervention has significantly influenced land use patterns over many
centuries, evolving its structure over time and space. In the present era, these changes have
accelerated due to factors such as agriculture and urbanization. Information regarding land use and
cover is essential for various planning and management tasks related to the Earth's surface,
providing crucial environmental data for scientific, resource management, policy purposes, and
diverse human activities.
Accurate understanding of land use and cover is imperative for the development planning
of any area. Consequently, a wide range of professionals, including earth system scientists, land
and water managers, and urban planners, are interested in obtaining data on land use and cover
changes, conversion trends, and other related patterns. The spatial dimensions of land use and
cover support policymakers and scientists in making well-informed decisions, as alterations in
these patterns indicate shifts in economic and social conditions. Monitoring such changes with the
help of Advanced technologies like Remote Sensing and Geographic Information Systems is
crucial for coordinated efforts across different administrative levels. Advanced technologies like
Remote Sensing and Geographic Information Systems
9
Changes in vegetation cover refer to variations in the distribution, composition, and overall
structure of plant communities across different temporal and spatial scales. These changes can
occur natural.
Main Java[All of the Base Concepts}.docxadhitya5119
This is part 1 of my Java Learning Journey. This Contains Custom methods, classes, constructors, packages, multithreading , try- catch block, finally block and more.