Availability of pediatric and neonatal intensive care units in the city of São Paulo

OBJECTIVE: To describe the health care service provided in pediatric intensive care units in the city of São Paulo, by identifying and describing the units and analyzing their geographic distribution. METHODS: A descriptive cross-sectional study was carried out during a two-year period (August 2000 to July 2002). Data were collected through questionnaires answered by medical directors of each pediatric and neonatal intensive care unit. RESULTS: São Paulo is served by 107 pediatric and neonatal intensive care units, of which 85 (79.4%) completed and returned the questionnaire. We found a very unequal distribution of units as there were more units in places with the least pediatric population. Regarding to pediatric intensive care units specialization, 7% were pediatric, 41.2% were neonatal and 51.7% were mixed (pediatric and neonatal). Regarding hospital funds, 15.3% were associated with philanthropic institutions, 37.6% were private and 47% were public. A total of 1,067 beds were identified, of which 969 were active. The ratio bed/patient aged 0-14 was 1/2,728, varying from 1/604 at health districts - I to 1/6,812 at health districts - III. The units reported an average of 11.7 beds (2 to 60). The neonatal intensive care unit had a median of 16.9 beds per unit and pediatric intensive care units a median of 8.5 beds/unit. CONCLUSION: In São Paulo, we found an uneven distribution of pediatric and neonatal intensive care units among the health districts. There was also an uneven distribution between public and private units, and neonatal and pediatric ones. The current report is the first step in the effort to improve the quality of medical assistance in pediatric and neonatal intensive care units in São Paulo.OBJETIVO: Caracterizar a assistência de saúde prestada em tratamento intensivo pediátrico e neonatal no município de São Paulo através da identificação, descrição e distribuição geográfica das unidades. MÉTODOS: Estudo descritivo, tipo transversal, onde foram estudadas as unidades de terapia intensiva pediátrica e neonatal do município de São Paulo, no período de agosto de 2000 a julho de 2002. A coleta dos dados foi realizada por meio de questionário preenchido pelo coordenador médico de cada unidade. RESULTADOS: Foram listadas 107 unidades de terapia intensiva pediátricas e neonatais no município de São Paulo. Oitenta e cinco (79,4%) unidades forneceram os dados, constituindo a população de estudo. Observou-se maior número de unidades de terapia intensiva em Núcleos Regionais de Saúde com menor população pediátrica. Quanto à faixa etária, 7% eram exclusivamente pediátricas, 41,2% neonatais, e 51,7% mistas. Em relação ao mantenedor: 47% eram públicas, 37,6% privadas, e 15,3% filantrópicas. Identificamos 1.067 leitos, estando 969 em atividade. A razão leito/paciente de 0 a 14 anos foi de 1:2.728, variando de 1:604 (Núcleo Regional de Saúde - I) a 1:6.812 (Núcleo Regional de Saúde - III). O número de leitos por unidade variou de 2 a 60, com média de 11,7 (unidades de terapia intensiva neonatais: 16,9; mistas: 8,5). CONCLUSÃO: No município de São Paulo, observou-se uma distribuição desproporcional das unidades de terapia intensiva pediátrica e neonatal entre os cinco Núcleos Regionais de Saúde. Houve também uma distribuição desproporcional entre unidades de terapia intensiva públicas e privadas e entre neonatais e pediátricas. Esse estudo foi o primeiro esforço na busca por melhor qualidade na assistência intensiva pediátrica e neonatal no município de São Paulo.Universidade de São Paulo Faculdade de MedicinaUniversidade Federal de São Paulo (UNIFESP) Departamento de PediatriaUniversidade de São Paulo Hospital Universitário Unidade de Terapia Intensiva PediátricaUNIFESP, Depto. de PediatriaSciEL

Molecular Oxygen Lignin Depolymerization: An Insight into the Stability of Phenolic Monomers

This is the peer reviewed version of the following article: Y. Mathieu, J. D. Vidal, L. Arribas Martínez, N. Abad Fernández, S. Iborra, A. Corma, ChemSusChem 2020, 13, 4743, which has been published in final form at https://doi.org/10.1002/cssc.202001295. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.[EN] During oxidative depolymn. of lignin in aq. alk. medium using mol. oxygen as oxidant, the highly functionalized primary phenolic monomers are not stable products, owing to various not fully identified secondary reaction mechanisms. However, better understanding of the mechanisms responsible for the instability of the main part of the products of interest derived from lignin is of much interest. Evaluation of their individual reactivities under oxidative conditions should significantly help to find a better way to valorize the lignin polymer and to maximize the yields of target value-added products. Consequently, the main objective of this study is to assess the individual stabilities of some selected ligninbased phenolic compds., such as vanillin, vanillic acid, and acetovanillone, together with some other pure chem. compds. such as phenol and anisole to give an insight into the mechanisms responsible for the simultaneous formation and repolymn. of those products and the influence of the oxidn. conditions. Various complementary strategies of stabilization are proposed, discussed, and applied for the oxidative depolymn. reactions of a tech. lignin extd. from pinewood with a high content of b-O-4 interconnecting bonds to try to obtain enhanced yields of value-added products.The authors thank Tecnicas Reunidas for material and financial support. We also acknowledge the Spanish Ministry of Science, Innovation, and Universities for funding through the "Severo Ochoa" Excellence Program (SEV 2016-0683) and the LIGNO-PRIZED project from the Spanish Centre for the Development of Industrial Technology (CDTI) in the framework of the Strategic Program of National Business Research Consortia (CIEN-2016). Special and kindly thanks are also given to Dr. Dalgi Sunith Barbosa Trillos and Dr. Jakob Mottweiler for their priceless help during the elaboration of the present work.Mathieu, Y.; Vidal, JD.; Arribas Martínez, L.; Abad Fernández, N.; Iborra Chornet, S.; Corma Canós, A. (2020). Molecular Oxygen Lignin Depolymerization: An Insight into the Stability of Phenolic Monomers. ChemSusChem. 13(17):4743-4758. https://doi.org/10.1002/cssc.202001295S474347581317BP. energy outlook2019 https://www.bp.com/content/dam/bp/business-sites/en/global/corporate/pdfs/energy-economics/energy-outlook/bp-energy-outlook-2019.pdf.J. Bluestein J. 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Lung volume calculated from electrical impedance tomography in ICU patients at different PEEP levels

Purpose: To study and compare the relationship between end-expiratory lung volume (EELV) and changes in end-expiratory lung impedance (EELI) measured with electrical impedance tomography (EIT) at the basal part of the lung at different PEEP levels in a mixed ICU population. Methods: End-expiratory lung volume, EELI and tidal impedance variation were determined at four PEEP levels (15-10-5-0 cm H2O) in 25 ventilated ICU patients. The tidal impedance variation and tidal volume at 5 cm H2O PEEP were used to calculate change in impedance per ml; this ratio was then used to calculate change in lung volume from change in EELI. To evaluate repeatability, EELV was measured in quadruplicate in five additional patients. Results: There was a significant but relatively low correlation (r = 0.79; R2= 0.62) and moderate agreement (bias 194 ml, SD 323 ml) between ΔEELV and change in lung volume calculated from the ΔEELI. The ratio of tidal impedance variation and tidal volume differed between patients and also varied at different PEEP levels. Good agreement was found between repeated EELV measurements and washin/washout of a simulated nitrogen washout technique. Conclusion: During a PEEP trial, the assumption of a linear relationship between change in global tidal impedance and tidal volume cannot be used to calculate EELV when impedance is measured at only one thoracic level just above the diaphragm

Understanding the mechanisms of cooperative physico-chemical treatment and mechanical disintegration of biomass as a route for enhancing enzyme saccharification

A novel chemico-kinetic disintegration model has been applied to study the cooperative relationship between physico-chemical treatment and supplementary wet-state milling of biomass, as an efficient process route to achieve high enzyme accessibility. Wheat straw, Miscanthus and short-rotation willow were studied as three contrasting biomass species, which were subjected to controlled hydrothermal pretreatment using a microwave reactor, followed by controlled wet-state ball-milling. Comparative particle disintegration behaviour and related enzyme digestibilities have been interpreted on the basis of model parameters and with evaluation of textural and chemical differences in tissue structures, aided by the application of specific material characterisation techniques. Supplementary milling led to a 1.3×, 1.6× and 3× enhancement in glucose saccharification yield after 24 h for straw, Miscanthus and willow, respectively, following a standardised 10-min hydrothermal treatment, with corresponding milling energy savings of 98, 97 and 91% predicted from the model, compared to the unmilled case. The results confirm the viability of pretreatment combined with supplementary wet-milling as an efficient process route. The results will be valuable in understanding the key parameters for process design and optimisation and also the key phenotypical parameters for feedstock breeding and selection for highest saccharification yield

Regional age structure, human capital and innovation - is demographic ageing increasing regional disparities?

Demographic change is expected to affect labour markets in very different ways on a regional scale. The objective of this paper is to explore the spatio-temporal patterns of recent distributional changes in the workers age structure, innovation output and skill composition for German regions by conducting an Exploratory Space-Time Data Analysis (ESTDA). Beside commonly used tools, we apply newly developed approaches which allow investigating the space-time dynamics of the spatial distributions. We include an analysis of the joint distributional dynamics of the patenting variable with the remaining interest variables. Overall, we find strong clustering tendencies for the demographic variables and innovation that constitute a great divide across German regions. The detected clusters partly evolve over time and suggest a demographic polarization trend among regions that may further reinforce the observed innovation divide in the future

Executive Summary of the Second International Guidelines for the Diagnosis and Management of Pediatric Acute Respiratory Distress Syndrome (PALICC-2)

OBJECTIVES: We sought to update our 2015 work in the Second Pediatric Acute Lung Injury Consensus Conference (PALICC-2) guidelines for the diagnosis and management of pediatric acute respiratory distress syndrome (PARDS), considering new evidence and topic areas that were not previously addressed. DESIGN: International consensus conference series involving 52 multidisciplinary international content experts in PARDS and four methodology experts from 15 countries, using consensus conference methodology, and implementation science. SETTING: Not applicable. PATIENTS: Patients with or at risk for PARDS. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Eleven subgroups conducted systematic or scoping reviews addressing 11 topic areas: 1) definition, incidence, and epidemiology; 2) pathobiology, severity, and risk stratification; 3) ventilatory support; 4) pulmonary-specific ancillary treatment; 5) nonpulmonary treatment; 6) monitoring; 7) noninvasive respiratory support; 8) extracorporeal support; 9) morbidity and long-term outcomes; 10) clinical informatics and data science; and 11) resource-limited settings. The search included MEDLINE, EMBASE, and CINAHL Complete (EBSCOhost) and was updated in March 2022. Grading of Recommendations, Assessment, Development, and Evaluation methodology was used to summarize evidence and develop the recommendations, which were discussed and voted on by all PALICC-2 experts. There were 146 recommendations and statements, including: 34 recommendations for clinical practice; 112 consensus-based statements with 18 on PARDS definition, 55 on good practice, seven on policy, and 32 on research. All recommendations and statements had agreement greater than 80%. CONCLUSIONS: PALICC-2 recommendations and consensus-based statements should facilitate the implementation and adherence to the best clinical practice in patients with PARDS. These results will also inform the development of future programs of research that are crucially needed to provide stronger evidence to guide the pediatric critical care teams managing these patients.</p