Dermatology relevance to graduates from the Universidade Estadual de Campinas Medical School

Some research indicates that physicians do not dominate the expected dermatological content for the proper exercise of the profession. This fact compromises their diagnostic and therapeutic performance, generating unnecessary costs. OBJECTIVE: The aim of this study was to evaluate the relevance of Dermatology and the knowledge acquired in the specialty during the undergraduate course in clinical practice of graduates at the State University of Campinas Medical School (FCM/UNICAMP). METHOD: A questionnaire with 22 closed questions and two open ones was electronically sent to physicians who had graduated more than 10 years ago and others for less than 10 years. In the first group, physicians were trained by the same curriculum and in the second group there were subjects trained by the old and the new curriculum. RESULTS: Of the 126 respondents, 83% had completed a specialization course. Among all, 82% did not study dermatology after graduation. The majority considered that Dermatology has high relevance in clinical practice, regardless of the group. There was a statistically significant difference between non-dermatologist doctors graduated for more than 10 years and those graduated for less than 10 years regarding confidence about lesion diagnosis, diagnostic investigation and treatment of skin diseases. Physicians who have graduated for a longer time feel more insecure in relation to patients with dermatoses. Concerning contributions offered by graduation program completion they prioritized outpatient care, ability to diagnose, knowledge of pathology, research and knowledge of lesions. CONCLUSION: This study has shown that Dermatology is relevant in medical practice and more recent graduates from the FCM/UNICAMP feel less insecure when treating a patient with dermatoses90563163

Introducing Virtual Reality for Firefighter Skills Training: Opinions from Sweden and Brazil

The emergence of immersive virtual reality (IVR) technologies has raised interest in the use of fire and rescue services (FRS) as a supplement to the established practice-based hot fire-live simulation (HF-LS) training. This is due to features such as time efficiency, portable technologies, and training in scenarios not possible in HF-LS. However, whether IVR provides realistic firefighter training situations has been called into question. Previous studies have revealed differences regarding perceived presence in, and attitudes toward IVR training between novice firefighters (who can only relate to HF-LS training) and experienced firefighters (who can relate to both HF-LS and real fires). In the present study, two groups of experienced full-time employed firefighters, 53 from Brazil and 18 from Sweden tested the same IVR technology. The hypothesis was that differences in national education and training programs and real fire experiences might influence experiences in IVR technology. This study examines the differences and similarities in experienced presence, opinions on whether the graphical representations and tasks performed convey realism, and attitudes toward the IVR-supported training format. Data were collected via systematic post-training presence questionnaires and observations. The results revealed a highly experienced presence and perceived realism of the representations by the participants from both countries. However, attitudes toward using IVR technologies differed. The motivation to utilize currently available IVR training tools was higher in Brazil than in Sweden. This may be partly explained by less frequent HF-LS training opportunities in Brazil. Nevertheless, further research is needed to investigate the training transfer of IVR technologies and how these can better support skills training

INCIDÊNCIA DE TROMBOSE VENOSA PROFUNDA EM JOELHO FLUTUANTE

Objective: To report the incidence between Deep Vein Thrombosis (DVT) in ipsilateral femur and tibia fractures (floating knee), considering its relation with hospitalization time, fracture classification, treatment implemented and comorbidities. Methods: This is a retrospective observational analytical study using the medical charts of thirty patients admitted with floating knee to a trauma hospital between October 2016 and July 2017. Results: Of the 30 patients assessed, 25 (83%) were men and 5 (17%) women. The most affected age range was between 21 and 30 years (36%). The dominant limb was affected in 17 (57%) patients. A total of 19 (63%) patients were classified as Fraser type I, 18 (60%) had open (compound) fractures, 16 (53%) fractures of the tibia and 8 (26%) of the femur. The most widely used emergency treatment was external fixation of the femur and tibia (25 patients = 83%). Seven patients used a femur plate and external fixator in the tibia as definitive treatment. Of the 30 patients studied, 14 (46%) suffered infectious complications, 9 (30%) superficial and 5 (16%) deep. Deep venous thrombosis was observed in 17% of patients (p=0.409).  Conclusion: Despite the use of antithrombotic prophylaxis, there was a high incidence of DVT in the affected limb of patients with floating knee. Fraser I fractures, being male and the non-dominant limb increases the likelihood of developing DVT. Level of Evidence: Level IObjetivo: Relatar a incidência de trombose venosa profunda (TVP) em fratura ipsilateral de fêmur e tíbia (joelho flutuante), levando-se em conta sua relação com o tempo de internação, com a classificação da fratura, o tempo para fazer o procedimento cirúrgico, o tratamento implementado e com as comorbidades. Materiais e métodos: Realizado um estudo retrospectivo, observacional e analítico por meio da avaliação de prontuários de trinta pacientes admitidos com joelho flutuante em um hospital de trauma durante o período de outubro de 2016 a julho de 2017.  Resultados: Dos 30 pacientes avaliados, foi observado que 25 (83%) dos pacientes eram do gênero masculino e 5 (17%) dos pacientes eram do gênero feminino. A faixa etária mais acometida foi entre 21 e 30 anos (36%). O acometimento do membro dominante ocorreu em 17 (57%) dos pacientes avaliados. Dezenove (63%) pacientes acometidos foram classificados como Fraser Tipo I. Dezoito (60%) pacientes tiveram fratura exposta, sendo 16 (53%) em tíbia e 8 (26%) em fêmur. O tratamento mais utilizado como urgência foi o de controle de danos com fixador externo em fêmur e tíbia (25 pacientes ou 83%). Sete pacientes utilizaram placa no fêmur e fixador externo na tíbia como tratamento definitivo. Dos 30 pacientes estudados, 14 (46%) tiveram complicações infecciosas, sendo 9 (30%) superficiais e 5 (16%) profundas. Observamos trombose venosa profunda em 17% dos pacientes (p=0,409).  Conclusão: Apesar do uso da profilaxia antitrombótica medicamentosa, houve uma grande incidência de TVP no membro acometido em pacientes com joelho flutuante na população estudada. As fraturas classificadas como Fraser I, pacientes do sexo masculino e o membro não dominante levaram ao aumento da probabilidade do surgimento de TVP. Nível de Evidência: Nível

Salmonellosis in Calves by Serovar Dublin in Paraná State, Brazil - Clinicopathological Aspects

Background: Calf diarrhea remains one of the main diseases affecting the cattle industry. Persistence of this significant problem is associated with the complexity of factors that may be involved (infectious, environmental). An accurate diagnosis is essential for confirming the cause and helping clinicians and cattle producers to apply appropriate strategies in a timely manner. This report describes the histological changes according to the degree of salmonellosis severity, which is a contagious infectious disease caused by Salmonella enterica subsp. enterica, a Gram-negative bacterium, in two beef calves in northern Paraná State, southern Brazil. Cases: Two 90-day-old crossbred Angus and Nellore calves from a beef farm in northern Paraná State were referred to a Veterinary Hospital. Animal 1- developed acute clinical signs (enteritis, ataxia, and muscle rigidity) and died the day after the signs began. Gross findings included heavy and non-collapsed lungs, pulmonary oedema, hepatomegaly, enteritis, and severe diffuse typhlitis. Microscopic analysis revealed severe diffuse necrotic enteritis, typhlitis, severe diffuse interstitial pneumonia, moderate centrilobular hepatic necrosis, mild multifocal nephritis, and severe spleen and lymph node necrosis. Paratyphoid nodules were evidenced on the liver, spleen, and mesenteric lymph nodes. Animal 2- presented apathy, green fibrinous diarrhea, and died three days after the onset of clinical signs. The macroscopic examination showed moderate diffuse enteritis and hepatosplenomegaly. At the microscopic examination, many paratyphoid nodules were observed on the liver, spleen, kidneys, and Peyer's patches, which were associated with intralesional and intravascular bacilli. Additional findings included severe diffuse fibrinous necrotic enteritis with intralesional bacilli, diffuse interstitial pneumonia, multifocal splenic necrosis, lymphoid depletion, and moderate multifocal to coalescent lymphocytic nephritis. Histological Gram staining was performed on selected samples, revealing intralesional Gram-negative bacilli in the liver and intestine. Thus, liver and intestine fragments were used for the microbiological examination. Microbiological culture, isolation and biochemical tests identified the genus Salmonella spp. Then, the colonies were subjected to serological tests for serovar identification, according to ISO/TR 6579-3, which determined the serovar Dublin. After identifying the disease etiological agent, the outbreak was controlled by appropriate antibiotic therapy combined with the correction of sanitary measures.Discussion: Enteritis is a frequent disease in calves, posing a diagnostic challenge in identifying the etiological agent. In the present case, the histological, microbiological, and serological results confirmed a disseminated Salmonella spp. infection. The microscopic findings, such as interstitial pneumonia, fibrinous necrotic enteritis markedly in ileum and paratyphoid nodules in various organs, are the most common aspects of the disease. However, fibrinous cholecystitis, which is considered pathognomonic for salmonellosis, was not observed in this study. Therefore, the absence of such a lesion should not exclude the disease in sick animals. A microscopic injury score was used to determine lesion severity by assigning values from 1 to 4, wherein: 1 = no apparent lesions, 2 = mild lesions, 3 = moderate lesions, and 4 = severe lesions. Both calves were scored as 4. Multiple predisposing factors for the condition were identified in this farm such as different age animals in the same paddock and no specific paddock for sick animals, given that the infectious agent remains in feces, saliva, and nasal discharge. The serovar Dublin induces several clinical signs such as septicemic, respiratory, and enteric manifestations, making a clinical diagnosis a challenge. Keywords: dysbiosis, calf diarrhea, infection, paratyphoid nodules, septicemia.Descritores: disbiose, diarreia neonatal, infecção, nódulos paratifoides, septicemia.Título:  Salmonelose em bezerros pelo sorovar Dublin no estado do Paraná, Brasil - aspectos clínico-patológicos

GHI separation models: validation for 1-min data and impact analysis for low-latitude photovoltaic system simulation

As simulações de sistemas fotovoltaicos (FV) demandam informações de qualidade a respeito dos dados de entrada e seleção dos modelos aplicados no processo de simulação. Um dos grupos de modelos existentes nas ferramentas de simulação diz respeito a separação da irradiância global horizontal para obtenção da irradiância direta (DNI) e difusa (DHI). Nos últimos anos, esses modelos passaram a ser avaliados em resoluções temporais sub-horárias, com destaque para 1-min. Neste trabalho 19 modelos de separação de GHI foram avaliados com base nos dados medidos de DNI e DHI de Araripina (Brasil), uma análise sobre o impacto dos mesmos na simulação de sistemas fotovoltaicos foi realizada. Com base nas gerações obtidas a partir da DNI e DHI modelados e medidos, observou-se que a seleção dos modelos para sistemas fixos de baixa inclinação não apresentam forte impacto no PR e na geração. Já para os sistemas FV de elevada inclinação ou com rastreamento, a escolha do modelo de separação possui impacto não desprezível nos resultados obtidos, podendo variar o PR em até 0,94% e sobrestimar a geração em até 6,45%, valor quase 3 vezes superior ao melhor modelo (nMBE de 2,25%), Yang4. Os melhores modelos avaliados para a localidade correspondem aos modelos Yang4, Starke3 e Engerer2, ambos apresentaram melhor desempenho quanto a DNI/DHI e a geração.The simulations of photovoltaic systems demand high quality information regarding the input data and the selection of the models applied in the simulation process. One of the existing groups of models in software is related to the separation of global horizontal irradiance. In recent years, these models have been evaluated with sub-hourly temporal resolutions, especially 1-min. In this work 19 GHI separation models were evaluated based on DNI and DHI data from Araripina (Brazil), an analysis on their impact on the simulation of photovoltaic systems was performed. Based on the generation obtained from the modeled and measured DNI and DHI, it was observed that the selection of the models for fixed lowslope systems do not have much impact on Performance Ratio and generation. On the other hand, for highslope PV systems or tracking systems, the choice of the separation model has a greater impact on the results obtained, the PR value can vary by up to 0.94% and overestimate the generation by up to 6.45%, a value almost 3 times higher than the best model (nMBE of 2.25%), Yang4. The best models evaluated for the semiarid location correspond to Yang4, Starke3 and Engerer2, which presented the best performance regarding DNI/DHI statistics, as well as in terms of generation.Asociación Argentina de Energías Renovables y Medio Ambiente (ASADES

Validação prática de modelos de infravermelho próximo para tomate: sólidos solúveis e acidez

Tomatoes are the most commonly used and consumed vegetables, being acceptable for fresh consumption as well as for industrialization. Despite the wide acceptance of tomatoes, the consumer presents quality as a requirement for the acquisition of the fruit, which is measured through parameters such as soluble solids (SS) and titratable acidity (TA). A chemical analysis technique, non-destructive and non-invasive and with fast response, is an absorption spectroscopy in the near infrared region that has been widely used in several industries, from agricultural to petrochemicals. Demanding large-scale production, the quality of tomatoes demanded by consumers and as it is a non-destructive and non-invasive technique of near infrared spectroscopy (NIR), it is still necessary to test models under commercial conditions, ensuring a near infrared model for tomatoes making sorting easy. An external and practical validation of the near infrared models for fresh tomatoes was carried out, comparing them with the destructive methods and checking the accuracy of the models in qualifying the fruit in terms of soluble solids and acidity. This paper presents project models obtained from 2018 to 2019, built from the Model Builder and The Unscrambler programs and selected from parameters such as calibration coefficient, cross validation coefficient, average error of the calibration set, and cross validation and calculation of the residual calibration deviation. The results obtained through the prediction of the model for the soluble solid attributes and titratable acidity, of the table tomato with greater production variability. The model for SS of table tomato has potential for commercial use, either in determining the harvest point, or quantifying the vegetable’s quality. For AT or portable NIR, it did not produce an applicable model due to the wavelength limitation.O tomate é a hortaliça mais produzida e consumida, tendo aceitabilidade tanto para o consumo in natura quanto para a industrialização. Apesar da ampla aceitação dos tomates, o consumidor apresenta como exigência para aquisição do fruto a qualidade, mensurada através de parâmetros como sólidos solúveis (SS) e acidez titulável (AT). Uma técnica de análise química, não destrutiva e não invasiva e de resposta rápida, é a de espectroscopia de absorção na região do infravermelho próximo que tem sido bastante utilizada em várias indústrias, desde agrícola a petroquímica. Considerando a produção em alta escala, a qualidade do tomate exigida pelos consumidores e por se tratar de uma técnica não destrutiva e não invasiva da espectroscopia no infravermelho próximo (Near Infrared Spectroscopy – NIR), faz-se necessário modelos testados em condições comerciais garantindo um modelo de infravermelho próximo para tomate facilitando a classificação. Realizou-se a validação de forma externa e prática dos modelos de infravermelho próximo para tomate in natura, comparando com os métodos destrutivos e conferindo a acurácia dos modelos na qualificação do fruto quanto aos teores de sólidos solúveis e acidez. O presente trabalho apresenta modelos do projeto executado de 2018 a 2019, construídos através dos aplicativos Model Builder e The Unscrambler e selecionados a partir de parâmetros como coeficiente de calibração, coeficiente da validação cruzada, erro médio do conjunto de calibração, e da validação cruzada e cálculo do desvio do resíduo de calibração. Os resultados foram obtidos através da previsão do modelo para os atributos sólidos solúveis (SS) e acidez titulável (AT), do tomate de mesa com maior variabilidade de produção. O modelo para SS apresenta potencialidade para uso comercial, seja na determinação de ponto de colheita, seja na quantificação de qualidade do vegetal. Já para AT, o NIR portátil não produziu um modelo aplicável pela limitação do comprimento de onda

Mitochondria-rough-ER contacts in the liver regulate systemic lipid homeostasis

Contacts between organelles create microdomains that play major roles in regulating key intracellular activities and signaling pathways, but whether they also regulate systemic functions remains unknown. Here, we report the ultrastructural organization and dynamics of the inter-organellar contact established by sheets of curved rough endoplasmic reticulum closely wrapped around the mitochondria (wrappER). To elucidate the in vivo function of this contact, mouse liver fractions enriched in wrappER-associated mitochondria are analyzed by transcriptomics, proteomics, and lipidomics. The biochemical signature of the wrappER points to a role in the biogenesis of very-low-density lipoproteins (VLDL). Altering wrappER-mitochondria contacts curtails VLDL secretion and increases hepatic fatty acids, lipid droplets, and neutral lipid content. Conversely, acute liver-specific ablation of Mttp, the most upstream regulator of VLDL biogenesis, recapitulates this hepatic dyslipidemia phenotype and promotes remodeling of the wrappER-mitochondria contact. The discovery that liver wrappER-mitochondria contacts participate in VLDL biology suggests an involvement of inter-organelle contacts in systemic lipid homeostasis.Fil: Anastasia, Irene. Laval University; Canadá. Brain Research Center; CanadáFil: Ilacqua, Nicolò. Laval University; Canadá. Brain Research Center; CanadáFil: Raimondi, Andrea. San Raffaele Scientific Institute; ItaliaFil: Lemieux, Philippe. Brain Research Center; CanadáFil: Ghandehari-Alavijeh, Rana. Brain Research Center; CanadáFil: Faure, Guilhem. Broad Institute of MIT and Harvard; Estados Unidos. National Center For Biotechnology Information; Estados UnidosFil: Mekhedov, Sergei L.. National Center For Biotechnology Information ; Estados UnidosFil: Williams, Kevin J.. University of California at Los Angeles. School of Medicine; Estados UnidosFil: Caicci, Federico. Università di Padova; ItaliaFil: Valle, Giorgio. Università di Padova; ItaliaFil: Giacomello, Marta. Università di Padova; ItaliaFil: Quiroga, Ariel Dario. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Rosario. Instituto de Fisiología Experimental. Universidad Nacional de Rosario. Facultad de Ciencias Bioquímicas y Farmacéuticas. Instituto de Fisiología Experimental; Argentina. University of Alberta; CanadáFil: Lehner, Richard. University of Alberta; CanadáFil: Miksis, Michael J.. Northwestern University; Estados UnidosFil: Toth, Katalin. University of Ottawa; CanadáFil: de Aguiar Vallim, Thomas Q.. University of California at Los Angeles. School of Medicine; Estados UnidosFil: Koonin, Eugene V.. National Center For Biotechnology Information ; Estados UnidosFil: Scorrano, Luca. Università di Padova; ItaliaFil: Pellegrini, Luca. Laval University; Canad

Innovations for Sustainability: Pathways to an efficient and post-pandemic future

3rd Report prepared by The World in 2050 initiativ

Type-Specific HPV Prevalence in Cervical Cancer and High-Grade Lesions in Latin America and the Caribbean: Systematic Review and Meta-Analysis

BACKGROUND: Cervical cancer is a major public health problem in Latin America and the Caribbean (LA&C), showing some of the highest incidence and mortality rates worldwide. Information on HPV type distribution in high-grade cervical lesions (HSIL) and invasive cervical cancer (ICC) is crucial to predict the future impact of HPV16/18 vaccines and screening programmes, and to establish an appropriate post-vaccinal virologic surveillance. The aim was to assess the prevalence of HPV types in HSIL and ICC in studies in LA&C. METHODS AND FINDINGS: We performed a systematic review, following the MOOSE guidelines for systematic reviews of observational studies, and the PRISMA statement for reporting systematic reviews and meta-analyses. Inclusion criteria were at least ten cases of HSIL/ICC, and HPV-type elicitation. The search, without language restrictions, was performed in MEDLINE, Cochrane Library, EMBASE, LILACS from inception date to December 2009, proceedings, reference lists and consulting experts. A meta-analysis was performed using arc-sine transformations to stabilize the variance of simple proportions. Seventy-nine studies from 18 countries were identified, including 2446 cases of HSIL and 5540 of ICC. Overall, 46.5% of HSIL cases harbored HPV 16 and 8.9% HPV18; in ICC, 53.2% of cases harbored HPV 16 and 13.2% HPV 18. The next five most common types, in decreasing frequency, were HPV 31, 58, 33, 45, and 52. Study's limitations comprise the cross-sectional design of most included studies and their inherent risk of bias, the lack of representativeness, and variations in the HPV type-specific sensitivity of different PCR protocols. CONCLUSIONS: This study is the broadest summary of HPV type distribution in HSIL and ICC in LA&C to date. These data are essential for local decision makers regarding HPV screening and vaccination policies. Continued HPV surveillance would be useful, to assess the potential for changing type-specific HPV prevalence in the post-vaccination era in Latin America