Punching shear strength of flat slab edge column connections with outward eccentricity of loading

Thirteen tests were carried out to investigate the effect of outwards eccentricity on the punching resistance of flat slab edge column connections. The slabs measured 2350 x 1700 mm (92.5 x 66.9 in.) on plan and were 180 mm (7.1 in.) thick. One end of the slab was supported on a 300 mm (11.8 in.) square column with a boot at its base for imposition of eccentricity. The other end was supported on a fixed roller support that extended across the full slab width of 1700 mm (66.9 in.). Four point loads were applied to the unsupported slab edges. The tested variables were eccentricity and the areas of flexural, shear, and torsion reinforcement. Presented test results include reinforcement strains, displacements, rotations, crack patterns, failure modes, and ultimate loads. The ACI 318 design procedure for punching shear at edge columns with outwards eccentricity is shown to be overly conservative unless the interaction between punching shear and unbalanced moment is reduced as permitted by the code. The EC2 design procedure is unsatisfactory and a modification is proposed

A FORMAÇÃO DO ENFERMEIRO PARA A ASSISTÊNCIA DE PORTADORES DE NECESSIDADES ESPECIAIS, COM PARALISIA CEREBRAL, SUBMETIDOS À INTERNAÇÃO DOMICILIAR

This is an end of course work that has as its subject nurse training in the home care of special needs patients, particularly, of patients with cerebral paralysis. Its aim is to sensitize the nurse to the peculiarities of Attention Services at home and for patients with cerebral palsy. To direct the course of this work, we present as a study the problem of the identification of the main necessities of the patients with cerebral palsy in Attention Services at home. The general objective of this research will be to describe the training process of specialist nurses in home care and the specific objectives will be: To identify the main requirements of patients with special needs and cerebral palsy, and to describe how nurses are prepared for this type of care of patients and their family. It was opted to carry out a bibliographical research, contemplating a qualitative focus, of explorative nature, descriptive and explanatory, resulting in the following thematic categories: The perception of the importance of "being a nurse in home care" and the relevance of the knowledge of the needs of patients with cerebral palsy and their family, in regards to home internment. From its development, it was possible to perceive that the academic focus given to this type of service and to this type of patient is limited, and that a specific specialization for the peculiarities of the service of home care and the peculiarities of a patient with cerebral palsy is still restricted. We conclude that greater assessment and study of the service of home care, as well as the patient with cerebral palsy, is necessary. As much during study as after graduation because this is a service in expansion and the patient needs complete care. We hope that this study contributes to a greater interest in the subject, facilitating the assistance of patients in home care, particularly those with special needs.Este es un trabajo de finalización de curso, que tiene como tema la formación de enfermeras en la atención domiciliaria con una necesidad especial, más concretamente, para el cliente con parálisis cerebral; quiere aumentar la sensibilización, especialmente a la enfermera acerca de las peculiaridades del Servicio de Atención a domicilio y al paciente con parálisis cerebral. Para dirigir el progreso de este trabajo, se presenta como problema el estudio de la identificación de las principales necesidades presentadas por el cliente con parálisis cerebral en el servicio de cuidados en el hogar. El objetivo general de esta investigación es describir el proceso de formación de la enfermera especialista en cuidados en el hogar y los objetivos específicos: identificar las principales necesidades de la atención al cliente con necesidades especiales, con parálisis cerebral; describir cómo las enfermeras están preparadas para este tipo de asistencia a estos clientes y de su familia. Nuestra opción es realizar una búsqueda bibliográfica, se contempla un enfoque cualitativo, el carácter exploratorio, descriptivo y explicativo, por lo que en las siguientes categorías temáticas: La percepción de la importancia de "ser calificadas enfermeras en la atención a domicilio" y la importancia del conocimiento de las necesidades del cliente y de la familia del neuropata, frente al episodio de hospitalización en domicilio. A partir de su desarrollo, es posible percibir que el enfoque académico dispensado a este tipo de servicio y a ese tipo de cliente es limitada, y que está todavía limitada una especialización especifica tanto para las peculiaridades del servicio de atención domiciliaria, como las peculiaridades de un paciente neuropata. Llegamos a la conclusión de que necesitamos una mayor valoración y estudio del servicio de atención domiciliaria, así como a los clientes con parálisis cerebral, tanto durante como en la postgraduación, por el hecho de que este es un servicio en expansión y el cliente es un usuario que necesita toda la atención. Esperamos que este estudio contribuya a un mayor interés en el tema, facilitar la asistencia de los clientes sometidos a atención domiciliaria, especialmente los que tienen necesidades especiales.Trata-se de um trabalho de conclusão de curso, que tem como tema a formação do enfermeiro no atendimento domiciliar ao portador de necessidade especial, mais especificamente, ao cliente com paralisia cerebral, pretende sensibilizar, em especial ao enfermeiro quanto às peculiaridades do serviço de atendimento domiciliar e do paciente com paralisia cerebral. Para direcionar o andamento deste trabalho, apresentamos como problema de estudo a identificação das principais necessidades apresentadas pelo cliente com paralisia cerebral no serviço de atendimento domiciliar. O objetivo geral desta pesquisa foi descrever o processo de formação do enfermeiro especialista em atendimento domiciliar e os objetivos específicos: identificar as principais necessidades assistenciais do cliente portador de necessidades especiais com paralisia cerebral; descrever como o enfermeiro é preparado para essa assistência a esses clientes e sua família. Optou-se por realizar uma pesquisa bibliográfica, contemplando-se uma abordagem qualitativa, de natureza exploratória, descritiva e explicativa, resultando nas seguintes categorias temáticas: A percepção da importância do “ser enfermeiro capacitado em home care” e A relevância do conhecimento das necessidades do cliente e da família do neuropata, frente ao episodio de internação domiciliar. A partir do seu desenvolvimento, foi possível perceber que a abordagem acadêmica dispensada a esse tipo de serviço e a esse tipo de cliente é restrita, e que ainda é restrita também uma especialização especifica, tanto para as peculiaridades do serviço de atendimento domiciliar, como às peculiaridades de um paciente neuropata. Concluímos que é necessário maior valorização e estudo quanto ao serviço de atendimento domiciliar, assim como também ao cliente com paralisia cerebral, tanto no intra como na pós-graduação, pelo fato de que este é um serviço em expansão e esse cliente é um usuário em potencial, por ser um cliente que necessita de atenção integral. Desejamos que este estudo contribua de forma a impulsionar um maior interesse sobre o tema, facilitando a assistência de clientes submetidos à internação domiciliar, em especial àqueles que possuem necessidades especiais

Covid-19 Dynamic Monitoring and Real-Time Spatio-Temporal Forecasting

Background: Periodically, humanity is often faced with new and emerging viruses that can be a significant global threat. It has already been over a century post—the Spanish Flu pandemic, and we are witnessing a new type of coronavirus, the SARS-CoV-2, which is responsible for Covid-19. It emerged from the city of Wuhan (China) in December 2019, and within a few months, the virus propagated itself globally now resulting more than 50 million cases with over 1 million deaths. The high infection rates coupled with dynamic population movement demands for tools, especially within a Brazilian context, that will support health managers to develop policies for controlling and combating the new virus. / Methods: In this work, we propose a tool for real-time spatio-temporal analysis using a machine learning approach. The COVID-SGIS system brings together routinely collected health data on Covid-19 distributed across public health systems in Brazil, as well as taking to under consideration the geographic and time-dependent features of Covid-19 so as to make spatio-temporal predictions. The data are sub-divided by federative unit and municipality. In our case study, we made spatio-temporal predictions of the distribution of cases and deaths in Brazil and in each federative unit. Four regression methods were investigated: linear regression, support vector machines (polynomial kernels and RBF), multilayer perceptrons, and random forests. We use the percentage RMSE and the correlation coefficient as quality metrics. / Results: For qualitative evaluation, we made spatio-temporal predictions for the period from 25 to 27 May 2020. Considering qualitatively and quantitatively the case of the State of Pernambuco and Brazil as a whole, linear regression presented the best prediction results (thematic maps with good data distribution, correlation coefficient >0.99 and RMSE (%) <4% for Pernambuco and around 5% for Brazil) with low training time: [0.00; 0.04 ms], CI 95%. / Conclusion: Spatio-temporal analysis provided a broader assessment of those in the regions where the accumulated confirmed cases of Covid-19 were concentrated. It was possible to differentiate in the thematic maps the regions with the highest concentration of cases from the regions with low concentration and regions in the transition range. This approach is fundamental to support health managers and epidemiologists to elaborate policies and plans to control the Covid-19 pandemics

COVID-SGIS: A Smart Tool for Dynamic Monitoring and Temporal Forecasting of Covid-19

Background: The global burden of the new coronavirus SARS-CoV-2 is increasing at an unprecedented rate. The current spread of Covid-19 in Brazil is problematic causing a huge public health burden to its population and national health-care service. To evaluate strategies for alleviating such problems, it is necessary to forecast the number of cases and deaths in order to aid the stakeholders in the process of making decisions against the disease. We propose a novel system for real-time forecast of the cumulative cases of Covid-19 in Brazil. / Methods: We developed the novel COVID-SGIS application for the real-time surveillance, forecast and spatial visualization of Covid-19 for Brazil. This system captures routinely reported Covid-19 information from 27 federative units from the Brazil.io database. It utilizes all Covid-19 confirmed case data that have been notified through the National Notification System, from March to May 2020. Time series ARIMA models were integrated for the forecast of cumulative number of Covid-19 cases and deaths. These include 6-days forecasts as graphical outputs for each federative unit in Brazil, separately, with its corresponding 95% CI for statistical significance. In addition, a worst and best scenarios are presented. / Results: The following federative units (out of 27) were flagged by our ARIMA models showing statistically significant increasing temporal patterns of Covid-19 cases during the specified day-to-day period: Bahia, Maranhão, Piauí, Rio Grande do Norte, Amapá, Rondônia, where their day-to-day forecasts were within the 95% CI limits. Equally, the same findings were observed for Espírito Santo, Minas Gerais, Paraná, and Santa Catarina. The overall percentage error between the forecasted values and the actual values varied between 2.56 and 6.50%. For the days when the forecasts fell outside the forecast interval, the percentage errors in relation to the worst case scenario were below 5%. / Conclusion: The proposed method for dynamic forecasting may be used to guide social policies and plan direct interventions in a cost-effective, concise, and robust manner. This novel tools can play an important role for guiding the course of action against the Covid-19 pandemic for Brazil and country neighbors in South America

QUANTITATIVE REAL-TIME PCR (Q-PCR) FOR SPUTUM SMEAR DIAGNOSIS OF PULMONARY TUBERCULOSIS AMONG PEOPLE WITH HIV/AIDS

Objective: To assess quantitative real-time polymerase chain reaction (q-PCR) for the sputum smear diagnosis of pulmonary tuberculosis (PTB) in patients living with HIV/AIDS with a clinical suspicion of PTB. Method: This is a prospective study to assess the accuracy of a diagnostic test, conducted on 140 sputum specimens from 140 patients living with HIV/AIDS with a clinical suspicion of PTB, attended at two referral hospitals for people living with HIV/AIDS in the city of Recife, Pernambuco, Brazil. A Löwenstein-Jensen medium culture and 7H9 broth were used as gold standard. Results: Of the 140 sputum samples, 47 (33.6%) were positive with the gold standard. q-PCR was positive in 42 (30%) of the 140 patients. Only one (0.71%) did not correspond to the culture. The sensitivity, specificity and accuracy of the q-PCR were 87.2%, 98.9% and 95% respectively. In 39 (93%) of the 42 q-PCR positive cases, the CT (threshold cycle) was equal to or less than 37. Conclusion: q-PCR performed on sputum smears from patients living with HIV/AIDS demonstrated satisfactory sensitivity, specificity and accuracy, and may therefore be recommended as a method for diagnosing PTB

Quantitative effects of tobacco smoking exposure on the maternal-fetal circulation

<p>Abstract</p> <p>Background</p> <p>Despite the existence of various published studies regarding the effects of tobacco smoking on pregnancy, and especially in regards to placental blood flow and vascular resistance, some points still require clarification. In addition, the amount of damage due to tobacco smoking exposure that occurs has not been quantified by objective means. In this study, we looked for a possible association between flow resistance indices of several arteries and the levels of urinary cotinine and the concentration of carbon monoxide in the exhaled air (COex) of both smoking and non-smoking pregnant women. We also looked for a relationship between those findings and fetal growth and birth weight.</p> <p>Methods</p> <p>In a prospective design, thirty pregnant smokers and thirty-four pregnant non-smokers were studied. The volunteers signed consent forms, completed a self-applied questionnaire and were subjected to Doppler velocimetry. Tobacco smoking exposure was quantified by subject provided information and confirmed by the measurement of urinary cotinine levels and by the concentration of carbon monoxide in the exhaled air (COex). The weight of newborns was evaluated immediately after birth.</p> <p>Results</p> <p>Comparing smoking to non-smoking pregnant women, a significant increase in the resistance index was observed in the uterine arteries (P = 0.001) and umbilical artery (P = 0.001), and a decrease in the middle cerebral artery (P = 0.450). These findings were associated with progressively higher concentrations of COex and urinary cotinine. A decrease in the birth weight was also detected (P < 0.001) in association with a progressive increase in the tobacco exposure of the pregnant woman.</p> <p>Conclusions</p> <p>In pregnant women who smoke, higher arterial resistance indices and lower birth weights were observed, and these findings were associated with increasing levels of tobacco smoking exposure. The values were significantly different when compared to those found in non-smoking pregnant women. This study contributes to the findings that smoking damage during pregnancy is dose-dependent, as demonstrated by the objective methods for measuring tobacco smoking exposure.</p

Serum biomarkers associated with SARS-CoV-2 severity

Immunity with SARS-CoV-2 infection during the acute phase is not sufficiently well understood to differentiate mild from severe cases and identify prognostic markers. We evaluated the immune response profile using a total of 71 biomarkers in sera from patients with SARS-CoV-2 infection, confirmed by RT-PCR and controls. We correlated biological marker levels with negative control (C) asymptomatic (A), nonhospitalized (mild cases-M), and hospitalized (severe cases-S) groups. Among angiogenesis markers, we identified biomarkers that were more frequently elevated in severe cases when compared to the other groups (C, A, and M). Among cardiovascular diseases, there were biomarkers with differences between the groups, with D-dimer, GDF-15, and sICAM-1 higher in the S group. The levels of the biomarkers Myoglobin and P-Selectin were lower among patients in group M compared to those in groups S and A. Important differences in cytokines and chemokines according to the clinical course were identified. Severe cases presented altered levels when compared to group C. This study helps to characterize biological markers related to angiogenesis, growth factors, heart disease, and cytokine/chemokine production in individuals infected with SARS-CoV-2, offering prognostic signatures and a basis for understanding the biological factors in disease severity

Multicenter study of the natural history and therapeutic responses of patients with chikungunya, focusing on acute and chronic musculoskeletal manifestations - a study protocol from the clinical and applied research in Chikungunya (REPLICK network)

BACKGROUND: Chikungunya is associated with high morbidity and the natural history of symptomatic infection has been divided into three phases (acute, post-acute, and chronic) according to the duration of musculoskeletal symptoms. Although this classification has been designed to help guide therapeutic decisions, it does not encompass the complexity of the clinical expression of the disease and does not assist in the evaluation of the prognosis of severity nor chronic disease. Thus, the current challenge is to identify and diagnose musculoskeletal disorders and to provide the optimal treatment in order to prevent perpetuation or progression to a potentially destructive disease course. METHODS: The study is the first product of the Clinical and Applied Research Network in Chikungunya (REPLICK). This is a prospective, outpatient department-based, multicenter cohort study in Brazil. Four work packages were defined: i. Clinical research; ii) Translational Science - comprising immunology and virology streams; iii) Epidemiology and Economics; iv) Therapeutic Response and clinical trials design. Scheduled appointments on days 21 (D21) ± 7 after enrollment, D90 ± 15, D120 ± 30, D180 ± 30; D360 ± 30; D720 ± 60, and D1080 ± 60 days. On these visits a panel of blood tests are collected in addition to the clinical report forms to obtain data on socio-demographic, medical history, physical examination and questionnaires devoted to the evaluation of musculoskeletal manifestations and overall health are performed. Participants are asked to consent for their specimens to be maintained in a biobank. Aliquots of blood, serum, saliva, PAXgene, and when clinically indicated to be examined, synovial fluid, are stored at -80° C. The study protocol was submitted and approved to the National IRB and local IRB at each study site. DISCUSSION: Standardized and harmonized patient cohorts are needed to provide better estimates of chronic arthralgia development, the clinical spectra of acute and chronic disease and investigation of associated risk factors. This study is the largest evaluation of the long-term sequelae of individuals infected with CHIKV in the Brazilian population focusing on musculoskeletal manifestations, mental health, quality of life, and chronic pain. This information will both define disease burden and costs associated with CHIKV infection, and better inform therapeutic guidelines

Biological Function and Molecular Mapping of M Antigen in Yeast Phase of Histoplasma capsulatum

Histoplasmosis, due to the intracellular fungus Histoplasma capsulatum, can be diagnosed by demonstrating the presence of antibodies specific to the immunodominant M antigen. However, the role of this protein in the pathogenesis of histoplasmosis has not been elucidated. We sought to structurally and immunologically characterize the protein, determine yeast cell surface expression, and confirm catalase activity. A 3D-rendering of the M antigen by homology modeling revealed that the structures and domains closely resemble characterized fungal catalases. We generated monoclonal antibodies (mAbs) to the protein and determined that the M antigen is present on the yeast cell surface and in cell wall/cell membrane preparations. Similarly, we found that the majority of catalase activity was in extracts containing fungal surface antigens and that the M antigen is not significantly secreted by live yeast cells. The mAbs also identified unique epitopes on the M antigen. The localization of the M antigen to the cell surface of H. capsulatum yeast and the characterization of the protein's major epitopes have important implications since it demonstrates that although the protein may participate in protecting the fungus against oxidative stress it is also accessible to host immune cells and antibody