Transverse coloplasty pouch and colonic J-pouch for rectal cancer: a comparative study

OBJECTIVES: The introduction of the colonic J-pouch has markedly improved the functional outcome of restorative rectal cancer surgery. However colonic J-pouch surgery can be problematic and may present some late evacuatory problems. To overcome these limitations a novel pouch has been proposed: the transverse coloplasty pouch. The purpose of our study was to compare the functional outcomes of these two different types of pouches--the transverse coloplasty pouch (TCP) and the colonic J-pouch (CJP)--during the first 12 months postoperatively. PATIENTS AND METHODS: A prospective randomized trial was conducted in which a total of 30 patients with mid and low rectal cancer were submitted either to a transverse coloplasty pouch or a colonic J-pouch. Clinical defaecatory function was assessed and anorectal physiological assessment was carried out, pre-operatively and at 3, 6 and 12 months postoperatively, by means of a standard clinical questionnaire and by anorectal manometry. RESULTS: No statistically significant differences were found between the two groups regarding bowel function. The postoperative frequency of daily bowel movements was lower in the TCP group in all the phases of the study (3.9 vs. 4.1 at 3 months; 3.1 vs. 3.4 at 6 months; 2.1 vs. 2.8 at 12 months), the same occurring with fragmentation (33% vs. 40% at 3 months; 26.6%vs. 33.3% at 6 months; 7.1%vs. 14.3% at 12 months). Less urgency was also seen in the TCP group during the first 6 months (20%vs. 26.7%), with identical values at 12 months (14.3% vs. 14.3%). No significant differences were also found concerning incontinence grading and scoring, with TCP patients having less nocturnal leaks. At one year two CJP patients (14.3%) needed the use of enemas to evacuate the pouch and provoke defaecation, a problem never seen in TCP patients. The anorectal manometry data was similar in both types of pouches. The local complication rates were also identical in the two groups (20%); more anastomotic leaks were seen in TCP patients (13.2% vs. 6.6%), without reaching a statistical significance. CONCLUSION: The transverse coloplasty pouch has similar functional results but fewer evacuation problems than the J-Pouch, making it a safe and reliable alternative to the colonic J-pouch

Discovery of a Luminous Quasar in the Nearby Universe

In the course of the Pico dos Dias survey (PDS), we identified the stellar like object PDS456 at coordinates alpha = 17h 28m 19.796s, delta = -14deg 15' 55.87'' (epoch 2000), with a relatively nearby (z = 0.184) and bright (B = 14.69) quasar. Its position at Galactic coordinates l_II = 10.4deg, b_II = +11.2deg, near the bulge of the Galaxy, may explain why it was not detected before. The optical spectrum of PDS456 is typical of a luminous quasar, showing a broad (FWHM ~ 4000 km/s) H_\beta line, very intense FeII lines and a weak [OIII]\lambda5007 line. PDS456 is associated to the infrared source IRAS 17254-1413 with a 60 \mum infrared luminosity L_{60} = 3.8 x 10^{45} erg/s. The relatively flat slopes in the infrared (\alpha(25,60) = -0.33 and \alpha(12,25) = -0.78) and a flat power index in the optical (F_{\nu} \propto \nu^{-0.72}) may indicate a low dust content. A good match between the position of PDS456 and the position of the X-ray source RXS J172819.3-141600 implies an X-ray luminosity L_x = 2.8 x 10^{44} erg/s. The good correlation between the strength of the emission lines in the optical and the X-ray luminosity, as well as the steep optical to X-ray index estimated (\alpha_{ox} = -1.64) suggest that PDS456 is radio quiet. A radio survey previously performed in this region yields an upper limit for radio power at ~ 5 GHz of ~ 2.6 x 10^{30} erg/s/Hz. We estimate the Galactic reddening in this line-of-sight to be A_B \simeq 2.0, implying an absolute magnitude M_B = -26.7 (using H_0 = 75 km s^{-1} Mpc^{-1} and q_0 = 0). In the optical, PDS456 is therefore 1.3 times more luminous than 3C 273 and the most luminous quasar in the nearby (z \leq 0.3) Universe.Comment: 12 pages, LaTeX (aasms4.sty) + 3 figures; accepted for publication in the Astrophysical Journal Letter

Avaliação do sedimento em áreas de produção de peixes em tanques redes no Reservatório de Furnas (MG).

Resumo: A aquicultura tem apresentado um crescimento nos últimos anos consolidando-se como um setor de grande importância econômica. Diante deste crescimento, surge à necessidade de desenvolvimento de processos de monitoramento ambiental que assegurem uma correta interpretação dos possíveis impactos e a melhor forma de diminuí-los. O presente trabalho teve por objetivo avaliar a concentração de metais potencialmente tóxicos e de carbono e nitrogênio, em sedimentos coletados na área de influência direta de piscicultura em tanques rede no reservatório de Furnas. A área de coleta é composta por 4 braços do rio Grande todos no município de Guapé (MG). Em 3 dos 4 braços existem piscicultura em tanques rede e um foi utilizado como controle. Foram realizadas 3 coletas de sedimento em maio, agosto e outubro de 2013, utilizando-se draga de Ekman-Birge. No laboratório, as amostras foram secas, moídas e digeridas para a determinação elementar de Cu (cobre), Pb (chumbo) e Zn (zinco) por Espectrometria de Absorção Atômica com Chama (F-AAS). Os resultados encontrados nas três coletadas variaram de 11,6 a 36,9 mg.L-1 para o Cu, de 95,2 a 184,8 mg.L-1 para o Pb e de 12,7 a 86,3 mg.L-1 para o Zn. O carbono (C) e o nitrogênio (N) total foram determinados por combustão a seco, com resultados que variam de 0,71 a 2,34 % para o C e de 0,097 a 0,224 % para o N. Abstract: Aquaculture has growing in the last decades establishing as sector of great economic importance. The growing of the sector, inputs a necessity to develop environmental monitoring processes to ensuring a correct interpretation of the possible impacts and how the best way to reduce them. This study aimed to evaluate the concentration of potentially toxic metals and carbon and nitrogen in sediments, collected in the area of direct influence of fish farming in tanks, located in Furnas reservoir. The sampling area consists of 4 arms of the rio Grande in the city of Guape (MG). In arms 2 to 4 there are fish farming in net tanks and arm 1 was used as control. Three samples were taken in all sampling sites, during May, August and October 2013, using Ekman-Birge dredge. At the laboratory, samples were dried, ground and digested for elemental determination of Cu (copper), Pb (lead) and Zn (zinc) Spectrometry Flame Atomic Absorption (F-AAS). The results in the three collected ranged from 11.6 to 36.9 mg.L -1 of Cu, 95.2 to 184.8 mg.L -1 for Pb and 12.7 to 86.3 mg.L -1 for Zn. The carbon (C) and nitrogen (N) were determined by the total dry combustion with results ranging from 0.71 to 2.34% for C and 0.097 to 0.224% for

Nucleation of the electroactive γ phase and enhancement of the optical transparency in low filler content poly(vinylidene)/clay nanocomposites

Poly(vinylidene fluoride), PVDF, based nanocomposites with different clays structures have been processed by solvent casting and melt crystallisation. Depending on the melting temperature of the polymer, the nanocomposite recrystalises in the electroactive or non electroactive β-phase of the polymer. This fact is related to the thermal behaviour of the clay. For montmorillonite clay, the full crystallisation of the electroactiveγ-phase occurs for clay contents lower than 0.5 wt%, allowing the nanocomposites to maintain the mechanical properties of the polymer matrix. The electroactivity of the material has been proven by measuring the piezoelectric d33 response of the material. The obtained value of d33 is -7 pC/N, lower than in β-PVDF obtained by mechanical stretching, but still among the largest coefficients obtained for polymers. Further, the optical transmittance in the visible range is strongly enhanced with respect to the transmittance of the pure polymer. Finally, it is demonstrated that the nucleation of the β-phase can be also obtained in other clays, such as in kaolinite and laponite.Fundação para a Ciência e a Tecnologia (FCT) - NANO/NMed-SD/0156/2007, PTDC/CTM/69316/2006, PTDC/CTM-NAN/112574/2009, SFRH/BD/62507/2009.FEDER funds through the "Programa Operacional Factores de Competitividade – COMPETECOST Action MP1003, the ‘European Scientific Network for Artificial Muscles’ (ESNAM)

application of lean methodologies

Poster presentationHealthcare acquired infections (HAI) are an important cause of morbidity and mortality. Hand hygiene (HH) is one of the most effective measures for preventing HAI. However, stirring healthcare workers to comply with HH remains a challenge. Two common barriers often found are forgetfulness and the lack of time. We hypothesize that the perception of lack of time and forgetfulness stems from the pressure of too much tasks in a short period of time. Therefore, it is rational to search for efficiency and minimize waste. This study aims at exploring the use of LEAN methodologies to improve nurses’ work processes in an ICU ward. A design science research approach was used. A questionnaire was applied to the nurses followed by an observational study of an 8-hour work shift to identify nurses’ activities, processes of care, and to describe HH compliance. Next, a value stream map (VSM) was designed and the analysis performed with the nurses, which helped to identify points of possible improvement in the process of care. After this, weekly LEAN workshops were held with the objective of improving workflow efficiency. From the initial observational study, we found that a nurse may take on average 16% of their work time using the information system, and the overall rate of HH was 63%. The full compliance to HH would amount to 13% of a nurse’s workload. Three processes were identified as the most relevant HH compliance drivers: the reorganization of essential supplies, the optimal provision of medicines and monitoring equipment automatic data collection. The participant nurses defined as objectives to reduce the supplies’ delivering time and establish a stock management system. To achieve it the reorganization of the storage with the ABC method, with the nurses deciding the layout of the storage space, was essential. The use of LEAN methods permitted to detect and address improvement opportunities with significant benefits. Moreover, nurses’ participation in the process enriched the experience, helping to design a customized intervention and heightened their sense of teamwork.publishersversionpublishe

Health-related quality of life and utilities in gastric premalignant conditions and malignant lesions: a multicentre study in a high prevalence country

BACKGROUND AND AIMS: A recent review of economic studies relating to gastric cancer revealed that authors use different tests to estimate utilities in patients with and without gastric cancer. Our aim was to determine the utilities of gastric premalignant conditions and adenocarcinoma with a single standardized health measure instrument. METHODS: Cross-sectional nationwide study of patients undergoing upper endoscopy (n=1,434) using the EQ-5D-5L quality of life (QoL) questionnaire. RESULTS: According to EQ-5D-5L, utilities in individuals without gastric lesions were 0.78 (95% confidence interval: 0.76-0.80), with gastric premalignant conditions 0.79 (0.77-0.81), previously treated for gastric cancer 0.77 (0.73-0.81) and with present cancer 0.68 (0.55-0.81). Self-reported QoL according to the visual analogue scale (VAS) for the same groups were 0.67 (0.66-0.69), 0.67 (0.66-0.69), 0.62 (0.59-0.65) and 0.62 (0.54-0.70) respectively. Utilities were consistently lower in women versus men (no lesions 0.71 vs. 0.78; premalignant conditions 0.70 vs. 0.82; treated for cancer 0.72 vs. 0.78 and present cancer 0.66 vs. 0.70). CONCLUSION: The health-related QoL utilities of patients with premalignant conditions are similar to those without gastric diseases whereas patients with present cancer show decreased utilities. Moreover, women had consistently lower utilities than men. These results confirm that the use of a single standardized instrument such as the EQ-5D-5L for all stages of the gastric carcinogenesis cascade is feasible and that it captures differences between conditions and gender dissimilarities, being relevant information for authors pretending to conduct further cost-utility analysis

BEfree: A new psychological program for binge eating that integrates psychoeducation, mindfulness, and compassion

Background Binge eating disorder (BED) is associated with several psychological and medical problems, such as obesity. Approximately 30% of individuals seeking weight loss treatments present binge eating symptomatology. Moreover, current treatments for BED lack efficacy at follow‐up assessments. Developing mindfulness and self‐compassion seem to be beneficial in treating BED, although there is still room for improvement, which may include integrating these different but complimentary approaches. BEfree is the first program integrating psychoeducation‐, mindfulness‐, and compassion‐based components for treating women with binge eating and obesity. Objective To test the acceptability and efficacy up to 6‐month postintervention of a psychological program based on psychoeducation, mindfulness, and self‐compassion for obese or overweight women with BED. Design A controlled longitudinal design was followed in order to compare results between BEfree (n = 19) and waiting list group (WL; n = 17) from preintervention to postintervention. Results from BEfree were compared from preintervention to 3‐ and 6‐month follow‐up. Results BEfree was effective in eliminating BED; in diminishing eating psychopathology, depression, shame and self‐criticism, body‐image psychological inflexibility, and body‐image cognitive fusion; and in improving obesity‐related quality of life and self‐compassion when compared to a WL control group. Results were maintained at 3‐ and 6‐month follow‐up. Finally, participants rated BEfree helpful for dealing with impulses and negative internal experiences. Conclusions These results seem to suggest the efficacy of BEfree and the benefit of integrating different components such as psychoeducation, mindfulness, and self‐compassion when treating BED in obese or overweight women. Key Practitioner Message The current study provides evidence of the acceptability of a psychoeducation, mindfulness, and compassion program for binge eating in obesity (BEfree); Developing mindfulness and self‐compassionate skills is an effective way of diminishing binge eating, eating psychopathology and depression, and increasing quality of life in women with obesity; Integrating psychoeducation, mindfulness, and compassion seem to be effective in diminishing binge eating, with results maintained up to 6‐month postintervention

Looking Ahead: Health Impact Assessment of Front-of-Pack Nutrition Labelling Schema as a Public Health Measure

This study aimed to describe the underlying process, used methods and major recommendations emerging from a comprehensive and prospective health impact assessment of the endorsement of a front-of-pack nutrition labelling (FOP-NL) system by the Portuguese health authorities. A mixed-methods approach was used to gather information on the impact of four FOP-NL schemes on consumers' selection of food products according to the perception of their nutritional quality, combining a systematic literature review, focus groups (FG), in-depth individual interviews, and an open-label crossover randomized controlled study. The relevance of FOP-NL as a public health promotion policy has emerged as a consensual idea among either FGs' participants (i.e., consumers and experts), or interviewed stakeholders. Although all of the evaluated FOP-NLs result better than no system on promoting the choice of the healthiest product, the effectiveness of easy-to-interpret FOP-NL among vulnerable groups raised concerns related to the need of integrating specific nutritional information to promote a better self-management of chronic diseases, and related to the level of literacy of consumers, which could impair the usage of FOP-NL. Educational campaigns addressing skills to use FOP-NL is recommended. Furthermore, a monitoring strategy should be considered to evaluate the long-term effectiveness of this policy in promoting healthier food choices, and in reducing diet-related non-communicable diseases burden

Temporal shoreline series analysis using GNSS

In recent decades, Boa Viagem beach located in the city of Recife-PE and Piedade in Jaboatão dos Guararapes-PE (Brazil) has seen urbanization near the coastline causing changes in social, economic and morphological aspects, where coastal erosion problems are observed. This study uses GNSS (global navigation satellite system) shoreline monitoring approach, which is quicker, and provides continuously updatable data at cm-level accuracy to analyze and determine temporal positional shifts of the shoreline as well as annual average rates through EPR (end point rate). To achieve this, kinematic GNSS survey data for the years 2007, 2009, 2010 and 2012 were used. The results show sectorial trends over the years, with the highest annual retreat rate of 8.16 m /year occurring during the period 2007-2009. Variety of different patterns over the shoreline were also observed. These findings could be essential for decision making in coastal environments

Improvements in Compassion and Fears of Compassion throughout the COVID-19 Pandemic: A Multinational Study

During large-scale disasters, social support, caring behaviours, and compassion are shown to protect against poor mental health outcomes. This multi-national study aimed to assess the fluctuations in compassion over time during the COVID-19 pandemic. Respondents (Time 1 n = 4156, Time 2 n = 980, Time 3 n = 825) from 23 countries completed online self-report questionnaires measuring the flows of compassion (i.e., Compassionate Engagement and Action Scales) and fears of compassion toward self and others and from others (i.e., Fears of Compassion Scales) and mental health at three time-points during a 10-month period. The results for the flows of compassion showed that self-compassion increased at Time 3. Compassion for others increased at Time 2 and 3 for the general population, but in contrast, it decreased in health professionals, possibly linked to burnout. Compassion from others did not change in Time 2, but it did increase significantly in Time 3. For fears of compassion, fears of self-compassion reduced over time, fears of compassion for others showed more variation, reducing for the general public but increasing for health professionals, whilst fears of compassion from others did not change over time. Health professionals, those with compassion training, older adults, and women showed greater flows of compassion and lower fears of compassion compared with the general population, those without compassion training, younger adults, and men. These findings highlight that, in a period of shared suffering, people from multiple countries and nationalities show a cumulative improvement in compassion and reduction in fears of compassion, suggesting that, when there is intense suffering, people become more compassionate to self and others and less afraid of, and resistant to, compassion