Mapping of processes and risks in the digital transformation in metrology of ionizing radiation, a case study in X-rays air kerma calibration

For the new metrological challenges of an increasingly digitized world, several countries are developing applications and infrastructure for Digital Calibration Certificates – DCC, researching the comparability of real and virtual measurements. Objective: to map the processes and risks related to the digital transformation of X-rays air kerma calibration. The Failure Mode and Effect Analysis - FMEA was used to quantify risks and is widely used in the aviation and automotive industry due to its reliability. The results presented a conceptual model for calibrating ionizing radiation quantities in the framework of new technologies and calibration 4.0 and comparing processes and risks. The conceptual model of calibration 4.0 comprises three main parts: a transmitter, the 4.0 communication network, and a receiver. Intelligent devices with configurations enable calibration data transfers by radio-frequency messaging in all these parts. Comparing risks in contemporary and calibration 4.0 processes, a slight reduction in the total risk can be observed. But new risks are unique to the 4.0 model, all with maximum severity, and how to mitigate them is still unknown. It is also possible to estimate that artificial intelligence and automation can significantly reduce measurement risks, identification, and error in the analysis and use of calibration certificates

A avaliação da evolução dos gastos públicos em serviços hospitalares com pacientes desnutridos no Brasil entre 2008 e 2018 e a necessidade de sua abordagem precoce

Introdução: A desnutrição pode ser definida como uma condição clínica decorrente de uma deficiência ou excesso, relativo ou absoluto, de um ou mais nutrientes essenciais. Segundo a Organização das Nações Unidas, o Brasil está entre os 51 países mais suscetíveis a esse mal. Alguns efeitos dessa enfermidade são hospitalização e convalescência prolongadas além do aumento da morbidade e da mortalidade. Assim, uma população desnutrida representa também maiores gastos em saúde para o país, por isso é relevante analisar os gastos públicos dessa doença no Brasil. Objetivo: Apresentar e discutir os gastos públicos em serviços hospitalares com pacientes desnutridos entre janeiro 2008 e dezembro 2018 no Brasil a partir de uma perspectiva orçamentária. Material e método: Foi realizado um estudo epidemiológico a respeito dos custos entre 2008 e 2018 com os pacientes desnutridos utilizando-se dados do DataSUS e estes foram trabalhados em planilhas do Excel. Resultados: No total, os gastos do sistema único de saúde em serviços hospitalares com a desnutrição no Brasil entre jan/2008 e dez/2018 foi de R$267.192.725,89. O Sudeste foi a região que despendeu maior verba e utilizou ao total R$ 113.088.032,62(42%), seguida pela região Nordeste que utilizou R$81.639.805,29 (30,5$ 15.142.032,06 (5%). Em relação ao sexo, o consumo foi equilibrado, os homens gastaram 55% e as mulheres 45%. Além disso, a faixa etária acima de 60 anos foi a que teve o custeio mais elevado: R$128.9374.470, totalizando 48$ 3.895.971,11, cerca de 1,4%. Durante o período analisado, percebe-se que com o passar dos anos os gastos diminuíram de R$22.627.376,39, em 2008, para R$ 21.626.874,62 em 2018. A mediana dos valores gastos por ano, durante o período analisado, pelos serviços hospitalares foi de R$24.990.010, e a média foi de R$ 24.290.250. Conclusão: No Brasil, percebe-se que a desnutrição hospitalar é muito comum e está associada a grandes gastos aos cofres públicos. A região Sudeste e Nordeste foram as que mais gastaram, isso nos mostra que pode existir uma relação direta entre o número de habitantes de uma região com o número de pacientes desnutridos e, consequentemente, com um maior gasto com a doença. Ambas ocupam, respectivamente, a primeira e a segunda macrorregião mais habitada no Brasil. Aliado a isso, o Nordeste é a segunda região com o menor Índice de Desenvolvimento Humano. Ademais, a literatura mostra que há um aumento de 60,5% nos custos de internação dos pacientes com desnutrição clínica e, considerando a ocorrência de complicações e tempo de internação, esses custos apresentaram aumento de até 308,9% quando comparados com a internação de pacientes bem nutridos. Isso pode explicar o porquê de a população idosa ser a mais dispendiosa em relação ao gasto com a desnutrição, mas são necessários mais estudos para comprovar tal hipótese. Por fim, a avaliação nutricional, detecção e intervenção precoce do status nutricional, além de confluir em melhor prognóstico, é uma medida financeiramente efetiva, com a expectativa de redução dos custos no âmbito hospitalar

Evolução dos gastos públicos em serviços hospitalares em pacientes internados por câncer de mama em Goiás no Sistema Único de Saúde entre o período de 2008 a 2018

Introdução: O Brasil tem acompanhado as altas taxas de incidência e mortalidade de câncer (CA) de mama dos países desenvolvidos, mas as ações fundamentais à prevenção, ao diagnóstico e ao controle da doença não têm acompanhado o mesmo crescimento. Em 2018, nosso país ocupou a primeira posição no ranking de neoplasias primárias do sexo feminino. Estima-se que um em cada três casos pode ser curado se for descoberto logo no início, ou seja, é de grande importância governamental investir em medidas preventivas. Dessa forma, é relevância em realizar estudos com o intuito de analisar os gastos públicos com essa enfermidade é indiscutível. Objetivos: Apresentar os gastos públicos em serviços hospitalares em pacientes internados por câncer de mama entre 2008 e 2018 no estado de Goiás (GO) a partir de uma perspectiva orçamentária. MÉTODOS: Trata-se de um estudo epidemiológico em relação aos gastos públicos com internações devido ao câncer de mama no período de jan/2008 a dez/2018.O estudo foi realizado através de informações da base de dados no DataSus e trabalhados na planilha do Excel. Resultados: No total, os gastos do SUS em serviços hospitalares por CA de mama em GO no período de jan/2008 a dez/2018 foi de R$20.136.194,35.Em relação à faixa etária, os pacientes que mais gastaram foram os que tinham entre 40 e 49 anos, gastando R$ 5.874.317, 29% do total. A faixa etária que menos gastou foi entre 5 a 9 anos, gastando apenas R$430,00, cerca de 0,0021$ 773.511,97 ,em 2008, para R$ 3.354.994,05 ,em 2018, um aumento total de 433%.Conclusões: No Brasil, a incidência de câncer de mama tem aumentado progressivamente nas últimas décadas. Aliado a isso, a descoberta e utilização de novos medicamentos, equipamentos, tratamentos e terapias são fatores que têm elevado cada vez mais os custos na abordagem destes pacientes. Outro fator importante são os custos associados ao tratamento em estágios mais avançados da doença, o qual é muito mais oneroso do que o feito em estágios iniciais. No Brasil, embora tenha ocorrido avanços consideráveis em relação à prevenção e estratégias de diagnóstico precoce, ainda existe uma grande parcela de casos detectados nos estágios mais avançados. Portanto, investir em diagnóstico precoce, além de aumentar a sobrevida dos pacientes, poderá trazer muitas economias ao SUS. Nesse âmbito, a realização de mais pesquisas pode evidenciar causas e condições que favoreçam o entendimento da atual situação, e medidas que visem melhorá-la. De forma que o acesso aos serviços de mais avançada tecnologia possa continuar sendo garantido ao usuário do SUS, ao mesmo tempo em que a viabilidade financeira aos cofres públicos seja mantida

Effect of Powdered Shells of the Snail Megalobulimus lopesi

Topical administration of powdered shells of the land snail Megalobulimus lopesi was evaluated in Wistar rats for their healing activity in an excision wound model. The animals were distributed into three groups—G1 (control): no therapeutic intervention; G2 (vehicle controls): Lanette cream once daily; G3 (experimental animals): treated with powdered shells. Variables investigated were: wound area contraction, angiogenic activity, morphometric data, leukocytic inflammatory infiltrate, and total leukocyte count in peripheral blood. Thermogravimetric analysis and quantification and characterization of powdered shell proteins were also performed. Wound area on days 3, 7, and 14 was smaller in G3, besides presenting wound closure on day 21 for all these animals. Topical administration of the powdered shells also led to an increased number of vessels at the wound site, higher leukocyte counts in peripheral blood, and increased leukocytic inflammatory infiltrate. The results lend support to the southern Brazilian folk use of M. lopesi powdered shells, as shown by the enhanced secondary-intention healing achieved with their topical administration to wounds in rats. Topical administration caused inflammatory response modulation, crucial to accelerating the healing process, the chronification of which increases the risks of wound contamination by opportunistic pathogens

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

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

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Reduction of cardiac imaging tests during the COVID-19 pandemic: The case of Italy. Findings from the IAEA Non-invasive Cardiology Protocol Survey on COVID-19 (INCAPS COVID)

Background: In early 2020, COVID-19 massively hit Italy, earlier and harder than any other European country. This caused a series of strict containment measures, aimed at blocking the spread of the pandemic. Healthcare delivery was also affected when resources were diverted towards care of COVID-19 patients, including intensive care wards. Aim of the study: The aim is assessing the impact of COVID-19 on cardiac imaging in Italy, compare to the Rest of Europe (RoE) and the World (RoW). Methods: A global survey was conducted in May–June 2020 worldwide, through a questionnaire distributed online. The survey covered three periods: March and April 2020, and March 2019. Data from 52 Italian centres, a subset of the 909 participating centres from 108 countries, were analyzed. Results: In Italy, volumes decreased by 67% in March 2020, compared to March 2019, as opposed to a significantly lower decrease (p &lt; 0.001) in RoE and RoW (41% and 40%, respectively). A further decrease from March 2020 to April 2020 summed up to 76% for the North, 77% for the Centre and 86% for the South. When compared to the RoE and RoW, this further decrease from March 2020 to April 2020 in Italy was significantly less (p = 0.005), most likely reflecting the earlier effects of the containment measures in Italy, taken earlier than anywhere else in the West. Conclusions: The COVID-19 pandemic massively hit Italy and caused a disruption of healthcare services, including cardiac imaging studies. This raises concern about the medium- and long-term consequences for the high number of patients who were denied timely diagnoses and the subsequent lifesaving therapies and procedures