Demographic mapping and characterization of physical therapy care profile offered in Neonatal Intensive Care Units in the City of Rio de Janeiro, Brazil

Este estudio visa el mapeo y la caracterización del perfil de la asistencia fisioterapéutica ofrecida en unidades de cuidados intensivos (UCI) neonatales de los hospitales públicos y privados de Río de Janeiro (RJ), Brasil. Para eso, fueron realizadas entrevistas con los jefes a respecto de las rutinas de los servicios de fisioterapia de los hospitales de Río de Janeiro con UCI neonatales entre enero de 2013 y enero de 2015. Las preguntas abordaron a respecto de distribición de las horas de trabajo, organización y localización institucional, tiempo de experiencia en la área, tipos de técnicas fisioterapéuticas y recursos utilizados. Fueron incluidos 27 hospitales (17 públicos y 10 privados) de la seguiente forma: 6 hospitales en Zona Sul, 8 en Zona Norte, 8 en Zona Oeste y 5 en Centro y Zona Portuaria. El número total de fisioterapeutas integrantes de los equipos fue de 141, siendo que 59% de ellos eron expertos en cuidados intensivos neonatales. En lo que se refiere a los jefes entrevistados, 16 (59%) también eron expertos y 21 (79%) poseían más de cinco años de experiencia. Fueron citadas diversas técnicas fisioterapéuticas, como: fisioterapia motora, vibración torácica y reequilibrio tóraco-abdominal. A partir del exposto, se verificó que la asistencia fisioterapéutica neonatal de Río de Janeiro não está distribuída uniformemente en el territorio, estando más concentrada en las regiones Sul y Central. Además, falta padronización de las rutinas y carga horaria, siendo necesaria adecuación del perfil asistencial para atención ideal y integral del neonato.Este estudo visa ao mapeamento e a caracterização do perfil da assistência fisioterapêutica oferecida em unidades de terapia intensiva (UTI) neonatais dos hospitais públicos e privados do Rio de Janeiro (RJ). Para isso, foram realizadas entrevistas com os chefes sobre as rotinas dos serviços de fisioterapia dos hospitais do Rio de Janeiro com UTI neonatais entre janeiro de 2013 e janeiro de 2015. As perguntas abordaram distribuição das horas de trabalho, organização e localização institucional, tempo de experiência na área, tipos de técnicas fisioterapêuticas e recursos utilizados. Foram incluídos 27 hospitais (17 públicos e 10 privados) da seguinte forma: 6 hospitais na Zona Sul, 8 na Zona Norte, 8 na Zona Oeste e 5 no Centro e Zona Portuária. O número total de fisioterapeutas integrantes das equipes foi de 141, sendo que 59% deles eram especialistas em terapia intensiva neonatal. No que se refere aos chefes entrevistados, 16 (59%) também eram especialistas e 21 (79%) possuíam mais de cinco anos de experiência. Foram citadas diversas técnicas fisioterapêuticas, como: fisioterapia motora, vibração torácica e reequilíbrio tóraco-abdominal. A partir do exposto, verificou-se que a assistência fisioterapêutica neonatal do Rio de Janeiro não está distribuída uniformemente no território, estando mais concentrada nas regiões Sul e Central. Além disso, falta padronização das rotinas e carga horária, sendo necessária adequação do perfil assistencial para atenção ideal e integral do recém-nascido (RN).This study aims to map and characterize the profile of physical therapy care offered in intensive care units (ICU) of public and private hospitals in the city of Rio de Janeiro. To this end, a cross-sectional study was conducted by interviews with the heads/routine chiefs of physical therapy services of the hospitals in the city of Rio de Janeiro with neonatal ICU (NICU) from January 2013 to January 2015. The questions comprised the distribution of working hours, organization and institutional location, time of experience in the area, types of physical therapy techniques and resources used. Twenty seven hospitals (17 public and 10 private) were studied as follows: 6 hospitals in the South area of the city, 8 in the North, 8 in the West and 5 in the central area and port area. The total number of physical therapists of the teams was 141, and 59% of them were experts in neonatal intensive care. With regard to the heads/routine chiefs, 16 (59%) were specialists in neonatal intensive care and 21 (79%) had more than five years of experience. Various physical therapy techniques were cited as: motor physical therapy, chest vibration and thoracic-abdominal rebalance. According to the results, there was not a single standard regarding routines, protocols, professional organization and training, and techniques used. In addition, it was found that the physical therapy in ICUs was not held full-time, neither provided the three shifts care

Growth of Fungal Cells and the Production of Mycotoxins

Some filamentous fungi are able to grow in food and produce toxic metabolites. It occurs mainly in grains, cereals, oilseeds and some by-products. The growth of fungi in a particular food is governed largely by a series of physical and chemical parameters. The production of toxic metabolites is not confined to a single group of molds irrespective of whether they are grouped according to structure, ecology, or phylogenetic relationships. Mycotoxins can be carcinogenic and cause several harmful effects to both human and animal organisms, in addition to generating large economic losses. The major mycotoxins found in food are the aflatoxins, fumonisins, ochratoxins, patulin, zearalenone, and trichothecenes, generally stable at high temperatures and long storage periods. Considering the difficult prevention and control, international organizations for food safety establish safe levels of these toxins in food destined for both human and animal consumption. Good agricultural practices and control of temperature and moisture during storage are factors which contribute significantly to inhibit the production of mycotoxins. The use of some fungistatic products, such as essential oils and antioxidants, as well as physical, mechanical, chemical, or thermal processing, represents important methods to have the concentration of mycotoxins reduced in food

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.13Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Núcleos de Ensino da Unesp: artigos 2008

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq

Search for Scalar Diphoton Resonances in the Mass Range 65−60065-600 GeV with the ATLAS Detector in pppp Collision Data at s\sqrt{s} = 8 TeVTeV

A search for scalar particles decaying via narrow resonances into two photons in the mass range 65–600 GeV is performed using $20.3\text{}\text{}{\mathrm{fb}}^{-1}$ of $\sqrt{s}=8\text{}\text{}\mathrm{TeV}$ $pp$ collision data collected with the ATLAS detector at the Large Hadron Collider. The recently discovered Higgs boson is treated as a background. No significant evidence for an additional signal is observed. The results are presented as limits at the 95% confidence level on the production cross section of a scalar boson times branching ratio into two photons, in a fiducial volume where the reconstruction efficiency is approximately independent of the event topology. The upper limits set extend over a considerably wider mass range than previous searches