Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42\ub74% vs 44\ub72%; absolute difference \u20131\ub769 [\u20139\ub758 to 6\ub711] p=0\ub767; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5\u20138] vs 6 [5\u20138] cm H2O; p=0\ub70011). ICU mortality was higher in MICs than in HICs (30\ub75% vs 19\ub79%; p=0\ub70004; adjusted effect 16\ub741% [95% CI 9\ub752\u201323\ub752]; p<0\ub70001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0\ub780 [95% CI 0\ub775\u20130\ub786]; p<0\ub70001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status. Funding: No funding

Photography-based taxonomy is inadequate, unnecessary, and potentially harmful for biological sciences

The question whether taxonomic descriptions naming new animal species without type specimen(s) deposited in collections should be accepted for publication by scientific journals and allowed by the Code has already been discussed in Zootaxa (Dubois & Nemésio 2007; Donegan 2008, 2009; Nemésio 2009a–b; Dubois 2009; Gentile & Snell 2009; Minelli 2009; Cianferoni & Bartolozzi 2016; Amorim et al. 2016). This question was again raised in a letter supported by 35 signatories published in the journal Nature (Pape et al. 2016) on 15 September 2016. On 25 September 2016, the following rebuttal (strictly limited to 300 words as per the editorial rules of Nature) was submitted to Nature, which on 18 October 2016 refused to publish it. As we think this problem is a very important one for zoological taxonomy, this text is published here exactly as submitted to Nature, followed by the list of the 493 taxonomists and collection-based researchers who signed it in the short time span from 20 September to 6 October 2016

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Rheological and some physicochemical characteristics of selected floral honeys from plants of caatinga

The aim of this paper was to investigate the physicochemical characteristics and rheological behavior of some floral honeys from species of wild plants found in the Caatinga biome, as well as, correlate honey viscosities with its chemical composition. Thus, five honeys with floral predominance of typical plants foraged by honeybees in Caatinga were analyzed. Results showed that moisture content of honeys ranged from 17.45 to 21.50 g/100g. The samples exhibited higher fructose content (37.58 - 43.95 g/100g) and lower glucose content (27.41- 33.80 g/100g). The glucose-water ratio ranged from 1.55 to 1.80. Sucrose contents, excluding Croton campestris honey sample, exhibited values above the highest sucrose content (6.0 g/100g) allowed by Brazilian norm. The ash content ranged from 0.02 to 0.19 %. The insoluble solids content were above 0.1 g/100 g. The electrical conductivity ranged between 144.90 and 412.55 µS.cm–1. All the honey samples behaved as Newtonian fluids. The viscosity values, measured at 293 K, varied from 1.90 to 8.55 Pa.s. An empirical mathematical model adapted from the Arrhenius model provides a good description of honey viscosity as a function of combined effects of temperature and moisture content

Serum and liver copper, iron, molybdenum and zinc concentration in goats and sheep in the state of Paraíba, Brazil

ABSTRACT: This study aimed to determine Cu, Fe, Mo, and Zn liver and serum concentration in sheep and goats raised in the rangelands of the semiarid region of the state of Paraíba, Brazil, during the dry and rainy seasons, and to establish if Cu deficiency is primary or secondary to high ingestion of Mo or Fe. Cu, Zn, Mo and Fe concentrations were determined by atomic absorption spectrometry coupled to mass (ICP-Plasma) in 253 liver and serum samples randomly selected in a slaughterhouse. The mean serum concentrations of Cu in the goats and sheep were 11.82±3.28μmol/L and 10.97±3.61μmol/L respectively. The liver Cu concentrations were 160.37±11.77mg/kg in goats and 152.12±13.16mg/kg in sheep. The mean serum Fe concentrations were 16.38±4.51μmol/L in goats and 25.41±9.76μmol/L in sheep. The mean Fe concentrations in the liver were 189.37±6.51mg/kg in goats and 313.70±12.89mg/kg in sheep. The mean serum concentrations of Mo were 0.14±0.04μmol/L in goats and 0.29±0.06μmol/L in sheep. The mean Mo concentrations in the liver were 6.09±0.23mg/kg in goats and 6.22±0.15mg/kg in sheep. The mean serum Zn concentrations were 8.30±1.91μmol/L in goats and 8.63±2.22μmol/L in sheep. The mean Zn concentrations in the liver were 132.80±3.39mg/kg in goats and 130.70±2.99mg/kg in sheep. These results show low or marginal serum and liver concentrations of Cu and Zn, indicating that these minerals should be supplemented. The normal or even low concentrations of Mo and the high concentration of Fe suggest that Cu deficiency may be primary, due to low Cu ingestion, or secondary due to high Fe ingestion

Resistência mecânica de compósitos cimentícios leves utilizando resíduos industriais e fibras de sisal Mechanical resistence of lightweight cement composites utilizing industrial residues and fibers of sisal

A valorização de materiais alternativos incorporados com resíduos como opção ao convencional deve possibilitar a geração de um produto com qualidade, estética, produtividade e com potencial de reduzir impactos da poluição ambiental. Este trabalho foi realizado com o objetivo de desenvolver elementos construtivos para forro e divisórias, a partir de matrizes cimentícias com incorporação de resíduos industriais (resíduo cerâmico, etil vinil acetato - EVA) e fibras de sisal. Desenvolveram-se técnicas de moldagem em matrizes cimentícias autoadensáveis e se avaliou a resistência mecânica dos novos compósitos. Uma placa com resíduos de EVA foi produzida e, através de trabalhos de reologia, encontrou-se a pasta matriz de revestimento desta placa, com teor adequado de adições pozolânicas e aditivo superplastificante. Avaliaram-se as resistências mecânicas das placas, da pasta matriz de revestimento encontrada, com e sem adição de fibras, e do novo compósito formado pela união desses dois elementos. Utilizou-se a técnica de alinhamento de fibras com o intuito de incrementar resistência ao novo compósito leve. A adição da matriz com fibras alinhadas melhorou a resistência a flexão do novo compósito.<br>The appreciation of alternative materials incorporated in waste as an option to conventional material should enable to generate a product with quality, aesthetics, productivity and reduce the potential impacts of environmental pollution. This study aims to develop constructive elements for ceilings and walls from cementitious matrix incorporating industrial waste (ceramic waste, ethyl vinyl acetate - EVA) and sisal fibers. Moulding techniques to produce self-compacting cementitious matrices were developed and the strength of the new composites were evaluated. A plate with EVA waste was produced and through rheology studies, a matrix plaster for coating of plate surface was found, with appropriate content of pozzolanic and superplasticizer additions. The mechanical resistance of the plates, the pulp coating matrix, with and without added fiber and the new composite formed by the union of these two elements was assessed. The technique of fiber alignment with the aim of increasing resistance of the new lightweight composite was used. The addition of the matrix with aligned fibers improved the flexural strength of the new composite

Aspectos técnicos da monitorização da pressão intracraniana pelo método subaracnóideo no traumatismo craniencefálico grave Technical aspects of intracranial pressure monitoring by subarachnoid method in severe head injury

Foram analisados prospectivamente 206 pacientes com traumatismo craniencefálico (TCE) grave (8 pontos ou menos na Escala de Coma de Glasgow), internados na Unidade de Terapia Intensiva do Hospital das Clínicas da Universidade Estadual de Campinas. Após avaliação por tomografia computadorizada de crânio (TC), 72 pacientes necessitaram de tratamento neurocirúrgico. Todos os pacientes foram submetidos à monitorização contínua da pressão intracraniana (PIC) pelo método subaracnóideo (11 com parafuso metálico e 195 com cateter plástico). Os níveis de PIC foram registrados continuamente na tela do monitor, sendo os seus valores de final de hora anotados em ficha padronizada. Todos os pacientes foram tratados segundo um protocolo orientado pelos níveis da PIC. Não foram observadas complicações hemorrágicas ou hematomas intracranianos relacionados ao método de monitorização em TC de controle. Para controle de infecções intracranianas, foram colhidas amostras de líquido cefalorraquidiano através de punção lateral C1-C2 em 66 pacientes com PIC abaixo de 20 mm Hg, sendo positivas as culturas para Acinetobacter sp em 2 pacientes. O resultado final na alta hospitalar mostrou 75 (36,40%) óbitos e 131 (63,6%) sobreviventes. Os níveis de PIC influenciaram significativamente o resultado final (p<0,001), o que confirma a importância de sua monitorização e controle no tratamento do TCE grave. O método subaracnóideo para a monitorização contínua da PIC foi considerado aplicável, seguro, simples, de baixo custo e útil para a orientação do tratamento. A metodologia de registro da PIC foi considerada útil e prática. Apesar dos avanços técnicos nesta área, o método subaracnóideo mostrou-se uma alternativa bastante viável para a monitorização da PIC em pacientes com traumatismo craniencefálico grave.<br>Two hundred and six patients with severe head injury (Glasgow Coma Scale of 8 points or less after nonsurgical resuscitation on admission), managed at Intensive Care Unit-Hospital das Clínicas - Universidade Estadual de Campinas were prospectively analysed. All patients were assessed by CT scan and 72 required neurosurgical intervention. All patients were continuously monitored to evaluate intracranial pressure (ICP) levels by a subarachnoid device (11 with subarachnoid metallic bolts and 195 with subarachnoid polyvinyl catheters). The ICP levels were continuously observed in the bedside pressure monitor display and their end-hour values were recorded in a standard chart. The patients were managed according to a standard protocol guided by the ICP levels. There were no intracranial haemorrhagic complications or hematomas due the monitoring method. Sixty six patients were punctured by lateral C1-C2 technique to assess infectious complications and 2 had positive cerebrospinal fluid samples for Acinetobacter sp. The final results measured at hospital discharge showed 75 deaths (36,40%) and 131 (63,60%) survivors. ICP levels had significantly influenced the final results (p<0,001). The subarachnoid method to continuously assess the ICP levels was considered aplicable, safe, simple, low cost and useful to advise the management of the patients. The ICP record methodology was practical and useful. Despite the current technical advances the subarachnoid method was considered viable to assess the ICP levels in severe head injury