Comparación entre la gravedad del paciente y la carga de trabajo de la enfermería antes y después de la ocurrencia de eventos adversos en ancianos con cuidados críticos

Indexación: Scopus.Objective: to compare the patient severity and the nursing workload before and after the occurrence of moderate and severe adverse events in elderly hospitalized at intensive care units. Method: comparative study developed at nine intensive therapy units of a University Hospital in São Paulo. The events were collected from the patient histories and classified as moderate and severe according to the World Health Organization. For the severity analysis, the Simplified Acute Physiologic Score II was used and, for the workload analysis, the Nursing Activities Score was applied 24 hours before and after the moderate and severe event. The t-test with 5% significance was used to compare the mean clinical severity and workload scores before and after the event. Results: the sample consisted of 315 elderly, 94 (29.8%) of whom were victims of moderate and severe events at the units. Among the 94 events, the clinical process and procedure type was predominant (40.0%). The installation and maintenance of therapeutic artifacts and catheters were the prevalent interventions that resulted in moderate (76.5%) physiopathological damage (66.0%). The mean workload score (75.19%) dropped 24 hours after the occurrence of the event (71.97%, p=0.008), and the severity, represented by the probability of death, increased from 22.0% to 29.0% after the event (p=0.045). Conclusion: in the patient safety context, the identification of the changes in clinical conditions and the nursing workload in elderly victims of events supports the prevention of these occurrences. © 2018, Universidade Federal de Santa Catarina. All rights reserved.Objetivo: comparar a gravidade do paciente e a carga de trabalho de enfermagem antes e após a ocorrência de evento adverso moderado e grave em idosos internados em unidades de terapia intensiva. Método: estudo comparativo, realizado em nove unidades de terapia intensiva de um Hospital Universitário de São Paulo. Os eventos foram coletados dos prontuários dos pacientes e classificados em moderados e graves segundo a Organização Mundial de Saúde. A análise da gravidade foi realizada segundo o Symplified Acute Phsiologic Score II e a carga de trabalho segundo o Nursing Activities Score, 24 horas antes e depois do evento moderado e grave. O teste t, com significância de 5%, foi utilizado para a comparação das médias da gravidade clínica e da carga de trabalho, antes e após o evento. Resultados: a amostra foi composta por 315 idosos, sendo que 94 (29,8%) sofreram eventos moderados e graves nas unidades. Dos 94 eventos, predominou o tipo processo clínico e procedimento (40,0%). A instalação e manutenção de artefatos terapêuticos e cateteres foram as intervenções prevalentes que resultaram em danos fisiopatológicos (66,0%), de grau moderado (76,5%). A média de pontuação da carga de trabalho (75,19%) diminuiu 24 horas após a ocorrência do evento (71,97%, p=0,008) e, a gravidade, representada pela probabilidade de morte, aumentou de 22,0% para 29,0% depois do evento (p=0,045). Conclusão: no contexto da segurança do paciente, a identificação das alterações nas condições clínicas e na carga de trabalho de enfermagem em idosos que sofrem eventos subsidiam a prevenção dessas ocorrências.Objetivo: comparar la gravedad del paciente y la carga de trabajo en enfermería antes y después de ocurrir un evento adverso moderado y grave en ancianos internados en unidades de terapia intensiva. Método: estudio comparativo realizado en nueve unidades de terapia intensiva de un Hospital Universitario de São Paulo. Los eventos fueron obtenidos a través de los prontuarios de los pacientes y clasificados en moderados y graves según la Organización Mundial de la Salud. El análisis sobre la gravedad fue realizado de acuerdo al Symplified Acute Physiologic Score II y la carga de trabajo se hizo conforme al Nursing Activities Score, 24 horas antes y después del evento moderado y grave. El test t, con una significancia del 5%, fue utilizado para la comparación de los promedios de la gravedad clínica y de la carga de trabajo antes y después del evento. Resultados: la muestra incluyó 315 ancianos, siendo que 94 (29,8%) sufrieron eventos moderados y graves en las unidades. De los 94 eventos, predominó el tipo de proceso clínico y el procedimiento (40,0%). La instalación y mantenimiento de artefactos terapéuticos y catéteres fueron las intervenciones prevalentes que resultaron en daños fisiopatológicos (66,0%) y de grado moderado (76,5%). El promedio de puntuación de la carga de trabajo (75,19%) disminuyó 24 horas después de ocurrido el evento (71,97%, p=0,008) y la gravedad, representada por la probabilidad de muerte, aumentó de 22,0% para 29,0% después del evento (p=0,045). Conclusion: en el contexto de seguridad del paciente, la identificación de las alteraciones en las condiciones clínicas y en la carga de trabajo de enfermería en los ancianos que sufren eventos subsidia la prevención de tales ocurrencias.http://ref.scielo.org/wcg6x

Improving an interior-point approach for large block-angular problems by hybrid preconditioners

The computational time required by interior-point methods is often domi- nated by the solution of linear systems of equations. An efficient spec ialized interior-point algorithm for primal block-angular proble ms has been used to solve these systems by combining Cholesky factorizations for the block con- straints and a conjugate gradient based on a power series precon ditioner for the linking constraints. In some problems this power series prec onditioner re- sulted to be inefficient on the last interior-point iterations, wh en the systems became ill-conditioned. In this work this approach is combi ned with a split- ting preconditioner based on LU factorization, which is main ly appropriate for the last interior-point iterations. Computational result s are provided for three classes of problems: multicommodity flows (oriented and no noriented), minimum-distance controlled tabular adjustment for statistic al data protec- tion, and the minimum congestion problem. The results show that , in most cases, the hybrid preconditioner improves the performance an d robustness of the interior-point solver. In particular, for some block-ang ular problems the solution time is reduced by a factor of 10.Peer ReviewedPreprin

Organic-Rich facies in the Sinemurian and Pliensbachian of the Lusitanian Basin, Portugal : Total organic carbon distribution and relation to transgressive-regressive facies cycles

The upper Sinemurian to Pliensbachian series of the Lusitanian Basin (Portugal) correspond to marly limestone sediments rich in benthic and nektonic macrofauna. This sedimentary record includes several intervals of organicrich facies, which are particularly well developed in the western sectors of the basin. They correspond to grey and dark marls locally showing strong lamination (black shale type) and are recognized as one of the most important potential oil source rocks. This study shows the vertical and lateral distribution of these organic-rich intervals, supported by over 550 total organic carbon (TOC) determinations. The results presented reveal two important intervals, with several black shale occurrences, in the Oxynotum(?)-Raricostatum (Polvoeira Member of Água de Madeiros Formation) and at the top of the Ibex-upper part of Margaritatus zones (top of the Vale das Fontes Formation), showing in the distal (western) sectors up to 22% and 15% TOC, respectively. TOC values decrease progressively towards the proximal sectors, the youngest organic-rich interval being the most expressive at the basin scale. This lateral TOC distribution, the facies stacking patterns and the decrease observed in benthic macrofauna confirm that these intervals are related to 2nd-order transgressive phases. 2nd-order regressive phases, developed during the uppermost Raricostatum and Spinatum zones respectively, show lower TOC values. TOC distribution combined with other stratigraphic and sedimentological parameters enabled seven facies maps to be created for the time interval studied. At the regional scale, this study shows for the first time the good similarity between the upper Sinemurian-Pliensbachian sedimentary successions of the Lusitanian and Basque- Cantabrian basins

The VMC survey III : Mass-loss rates and luminosities of LMC AGB stars

Context. Asymptotic giant branch (AGB) stars are major contributors to both the chemical enrichment of the interstellar medium and the integrated light of galaxies. Despite its importance, the AGB is one of the least understood phases of stellar evolution. The main difficulties associated with detailed modelling of the AGB are related to the mass-loss process and the 3rd dredge-up efficiency Aims. We provide direct measures of mass-loss rates and luminosities for a complete sample of AGB stars in the Large Magellanic Cloud, disentangling the C- and O-rich stellar populations. Methods. Dust radiative transfer models are presented for all 374 AGB stars candidates in one of the fields observed by the new VISTA survey of the Magellanic Clouds (VMC). Mass-loss rates, luminosities and a classification of C-and O-rich stars are derived by fitting the models to the spectral energy distribution (SED) obtained by combining VMC data with existing optical, near-, and mid-infrared photometry. Results. The classification technique is reliable at a level of - at worst -75% and significantly better for the reddest dusty stars. We classified none of the stars with a relevant mass-loss rate as O-rich, and we can exclude the presence of more than one dusty O-rich star at a similar to 94% level. The bolometric luminosity function we obtained is fully consistent with most of the literature data on the LMC and with the prediction of theoretical models, with a peak of the C-star distribution at M-bol similar or equal to -4.8 mag and no stars brighter than the classical AGB tip, at M-bol = -7.1 mag. Conclusions. This exploratory study shows that our method provides reliable mass-loss rates, luminosities and chemical classifications for all AGB stars. These results offer already important constraints to AGB evolutionary models. Most of our conclusions, especially for the rarer dust-enshrouded extreme AGB stars, are however strongly limited by the relatively small area covered by our study. Forthcoming VMC observations will easily remove this limitation.Peer reviewe

Main technical differences in the processing of broilers: a comparison between slaughterhouses in Brazil and UK

Rapid technological advances in chicken processing in plants around the world have meant that different techniques are being employed regarding the slaughter’s flow process. This paper aimed to compare and contrast systems and practices in two large slaughterhouses—one in UK and the other in Brazil. Annotated observations were made during inspection visits to chicken slaughterhouses in the two countries between 2014 and 2016. Whilst there were similarities in the two systems, there are also clear differences. The Brazilian case is evidently adapted for a more tropical condition, rather than the temperate one in UK. The handling practices of birds used during transportation, waiting, stunning as well as pre-cooling differ in techniques employed and consequently likely their efficiencies. In UK, the practices are more geared towards water and energy saving. The difference in market conditions and the length of the respective supply chains also determine the type of primary packaging used in final products. Both countries adhere to similar rulings applied to slaughterhouses. However, in the Brazilian case, it tended to comply with mainly external market demands. In conclusion, managers in the Brazilian poultry system could consider looking into adopting some of the practices used in UK, such as cage/crate dimension which reduce bird’s lesions and bruises; the use of stunning by modified atmosphere and pre-cooling for resource efficiency reasons and improvement in animal welfare. Finally, when distances between sites of production and consumption are great such as in Brazil, the use of modified atmosphere technology could be also further explored to ensure better quality of the final product

Organic-Rich facies in the Sinemurian and Pliensbachian of the Lusitanian Basin, Portugal: Total organic carbon distribution and relation to transgressive-regressive facies cycles

The upper Sinemurian to Pliensbachian series of the Lusitanian Basin (Portugal) correspond to marly limestone sediments rich in benthic and nektonic macrofauna. This sedimentary record includes several intervals of organicrich facies, which are particularly well developed in the western sectors of the basin. They correspond to grey and dark marls locally showing strong lamination (black shale type) and are recognized as one of the most important potential oil source rocks. This study shows the vertical and lateral distribution of these organic-rich intervals, supported by over 550 total organic carbon (TOC) determinations. The results presented reveal two important intervals, with several black shale occurrences, in the Oxynotum(?)–Raricostatum (Polvoeira Member of Água de Madeiros Formation) and at the top of the Ibex-upper part of Margaritatus zones (top of the Vale das Fontes Formation), showing in the distal (western) sectors up to 22% and 15% TOC, respectively. TOC values decrease progressively towards the proximal sectors, the youngest organic-rich interval being the most expressive at the basin scale. This lateral TOC distribution, the facies stacking patterns and the decrease observed in benthic macrofauna confirm that these intervals are related to 2nd-order transgressive phases. 2nd-order regressive phases, developed during the uppermost Raricostatum and Spinatum zones respectively, show lower TOC values. TOC distribution combined with other stratigraphic and sedimentological parameters enabled seven facies maps to be created for the time interval studied. At the regional scale, this study shows for the first time the good similarity between the upper Sinemurian-Pliensbachian sedimentary successions of the Lusitanian and Basque- Cantabrian basins

Kinetics of TNF-alpha and IFN-gamma mRNA expression in islets and spleen of NOD mice

Insulin-dependent diabetes mellitus is caused by autoimmune destruction of pancreatic ß cells. Non-obese diabetic (NOD) mice spontaneously develop diabetes similar to the human disease. Cytokines produced by islet-infiltrating mononuclear cells may be directly cytotoxic and can be involved in islet destruction coordinated by CD4+ and CD8+ cells. We utilized a semiquantitative RT-PCR assay to analyze in vitro the mRNA expression of TNF-alpha and IFN-gamma cytokine genes in isolated islets (N = 100) and spleen cells (5 x 10(5) cells) from female NOD mice during the development of diabetes and from female CBA-j mice as a related control strain that does not develop diabetes. Cytokine mRNAs were measured at 2, 4, 8, 14 and 28 weeks of age from the onset of insulitis to the development of overt diabetes. An increase in IFN-gamma expression in islets was observed for females aged 28 weeks (149 ± 29 arbitrary units (AU), P<0.05, Student t-test) with advanced destructive insulitis when compared with CBA-j mice, while TNF-alpha was expressed in both NOD and CBA-j female islets at the same level at all ages studied. In contrast, TNF-alpha in spleen was expressed at higher levels in NOD females at 14 weeks (99 ± 8 AU, P<0.05) and 28 weeks (144 ± 17 AU, P<0.05) of age when compared to CBA-j mice. The data suggest that IFN-gamma and TNF-alpha expression in pancreatic islets of female NOD mice is associated with ß cell destruction and overt diabetes.1347135

Ictiofauna De Riachos Da Bacia Do Baixo Rio Iguaçu, Estado Do Paraná, Brasil

The drainages of the Iguaçu River basin, as well as the main channel of the river, have peculiar characteristics resulting from geomorphological processes in this area, including the formation of the Iguaçu River Falls. This slope in the lower portion of the basin is a biogeographical barrier to many organisms. In this study was inventoried the fish fauna of streams of the lower Iguaçu River basin, evaluating possible differences in the species composition upstream and downstream of this biogeographical barrier. Sampling were conducted between 2004 and 2013, in five streams, three upstream and two downstream of the Iguaçu River Falls, using electrofishing. The nMDS analysis was run to investigate possible groupings of similar fauna between the streams sampled. The scores of this test were tested as to the significance of groupings with the Hotelling T2 test. The indicator value method (IndVal) was used to detect the distribution of species among the groups of the streams upstream and downstream of the Iguaçu River Falls. We collected 18,908 individuals of six orders, 11 families, and 40 species. Siluriformes and Characiformes had the highest species richness; Cyprinodontiformes presented the highest abundance. Considering the species recorded, 21 are considered natives to the Iguaçu River basin, including 15 endemic, wich were found only in streams upstream of the falls. Additional 18 species were verified only in the streams downstream of such barrier. Four species were common to both stretches. The axis 1 of the nMDS separated two groups: streams upstream (S1, S2 and S3) and streams downstream of the Iguaçu River Falls (S4 and S5). The indicator species analysis also indicated a distinction between the groups of streams, that were significantly different (Hotelling’s T2 = 234.36, p &lt; 0.0001). The number of endemic species in the streams upstream of the Falls (15 spp.) evidences a significant effect of isolation promoted by the Iguaçu River Falls, and confirms the role of this barrier in the vicariant processes and endemism typical of this basin. These results emphasize the importance of conserving these ecosystems, once the extinction of species in this region means the irreversible loss of them. © 2016, Universidade Estadual de Campinas UNICAMP. All rights reserved.16311

Nutritional characteristics of meat from lambs fed diets containing mulberry hay

The objective of this study was to evaluate the nutritional characteristics of meat from lambs fed diets containing 0%, 12.5% and 25.0% (dry matter (DM)) mulberry hay as a substitute for the concentrate. Twenty-four feedlot Île-de-France lambs with an average age of 60 days and bodyweight (BW) of 15 kg were fed in individual stalls and slaughtered at 32 kg BW, at approximately 130 days old. The chemical composition of the experimental diets contained, respectively, 584.4, 569.4 and 571.8 g DM/kg; 188.8, 185.1 and 184 g crude protein (CP)/kg and 29.9, 29.5 and 25.5 Mcal/kg DM for the mulberry hay inclusion levels of 0%, 12.5% and 25.0%, with a dietary forage to concentrate ratio of 50 : 50. The chemical composition of the meat was 757.9 g moisture/kg DM, 208.6 g CP/kg DM, 22.9 g crude fat/kg DM and 10.5 g ash/kg DM. Cholesterol concentration (36.07 mg/100 g) in the meat was not influenced by mulberry hay inclusion of the diet. An increase was observed in the concentrations of saturated pentadecanoic, heptadecanoic and arachidic acids; monounaturated heptadecenoic acid; and polyunsaturated α-linolenic, ɣ-linolenic and eicosapentaenoic acids. Nervonic and conjugated linoleic acid (CLA) concentrations responded quadratically, representing 3.7 g/kg and 5.9 g/kg of the meat when mulberry hay was included at 16.98% and 12.56%. Omega-3 acid concentrations increased, while the omega-3 : omega-6 ratio decreased in the meat of mulberry hay-fed animals. Inclusion of mulberry hay in lamb diets increases the amount of desirable fatty acids in their meat, whose nutritional characteristics are improved.Keywords: Chemical composition, fatty acids, feedlot, sheep mea