Identification by cluster analysis of patients with asthma and nasal symptoms using the MASK-air® mHealth app

peer reviewedBackground: The self-reporting of asthma frequently leads to patient misidentification in epidemiological studies. Strategies combining the triangulation of data sources may help to improve the identification of people with asthma. We aimed to combine information from the self-reporting of asthma, medication use and symptoms to identify asthma patterns in the users of an mHealth app. Methods: We studied MASK-air® users who reported their daily asthma symptoms (assessed by a 0-100 visual analogue scale – “VAS Asthma”) at least three times (either in three different months or in any period). K-means cluster analysis methods were applied to identify asthma patterns based on: (i) whether the user self-reported asthma; (ii) whether the user reported asthma medication use and (iii) VAS asthma. Clusters were compared by the number of medications used, VAS asthma levels and Control of Asthma and Allergic Rhinitis Test (CARAT) levels. Findings: We assessed a total of 8,075 MASK-air® users. The main clustering approach resulted in the identification of seven groups. These groups were interpreted as probable: (i) severe/uncontrolled asthma despite treatment (11.9-16.1% of MASK-air® users); (ii) treated and partly-controlled asthma (6.3-9.7%); (iii) treated and controlled asthma (4.6-5.5%); (iv) untreated uncontrolled asthma (18.2-20.5%); (v) untreated partly-controlled asthma (10.1-10.7%); (vi) untreated controlled asthma (6.7-8.5%) and (vii) no evidence of asthma (33.0-40.2%). This classification was validated in a study of 192 patients enrolled by physicians. Interpretation: We identified seven profiles based on the probability of having asthma and on its level of control. mHealth tools are hypothesis-generating and complement classical epidemiological approaches in identifying patients with asthma. © 2022 Sociedade Portuguesa de Pneumologi

Clinical and patient-reported trajectories at end-of-life in older patients with advanced CKD

Background We explore longitudinal trajectories of clinical indicators, patient-reported outcomes, and hospitalizations, in the years preceding death in a population of older patients with advanced chronic kidney disease (CKD). Methods The EQUAL study is a European observational prospective cohort study with an incident eGFR Results We included 661 decedents with a median time to death of 2.0 years (IQR 0.9-3.2). During the years preceding death, eGFR, Subjective Global Assessment score, and blood pressure declined, with accelerations seen at 6 months preceding death. Serum hemoglobin, hematocrit, cholesterol, calcium, albumin, and sodium values declined slowly during follow-up, with accelerations observed between 6 and 12 months preceding death. Physical and mental quality of life declined linearly throughout follow-up. The number of reported symptoms was stable up to 2 years prior to death, with an acceleration observed at 1 year prior to death. The rate of hospitalization was stable at around one hospitalization per person year, increasing exponentially at 6 months preceding death. Conclusions We identified clinically relevant physiological accelerations in patient trajectories that began similar to 6 to 12 months prior to death, which are likely multifactorial in nature, but correlate with a surge in hospitalizations. Further research should focus on how to effectively use this knowledge to inform patient and family expectations, to benefit the planning of (end-of-life) care, and to establish clinical alert systems.Clinical epidemiolog

Alcohol to control dark beetle in poultry litter

Brazil is the third largest producer of chicken meat in the world, resulting in the production of a large amount of waste called chicken litter. This residue generates favorable conditions for the development of the beetle Alphitobius diaperinus (Panzer) (Coleoptera: Tenebrionidae), known as cascudinho, which is considered the main pest of poultry farming, affecting poultry production worldwide. Its control is considered difficult, and pyrethroid and organophosphorous substances are commonly used, although they are not efficient. In the search for alternative insect control, several natural insecticidal and insecticidal methods have been tested. However, in the entomological practice, substances with high vapor pressure in order to produce toxic gases are used for insect fixation. Thus, in October 2015, ethyl alcohol PA was tested with the aim of controlling A. diaperinus in chicken litter. The experimental units were represented by cut plastic pet bottles, where 100g of were poultry litter added, with 20 adult insects and 135 larvae each. The treatments were constituted by the application of alcohol in the volume of 1, 2.5, 5, 7.5 and 10 mL and its with dilution water (1:1) with equal volume applied. Two environments were simulated, one open (screens to contain the insects) and one closed (sample container closed with the portion previously cut). The plots were maintained at 28.5 ± 2° C and 51.0 ± 2% of relative humidity, with six replicates per treatment. The amount of 2.5 mL (2.5% v/p) alcohol generated 100% mortality in adults and larvae in the closed samples, requiring twice the volume in the open system. For the alcohol-water dilution (1:1) the 100% control was obtained with twice the amount reported previously in relation to the respective treatments.O Brasil é o maior exportador e o terceiro maior produtor mundial de carne de frango, sendo a atividade geradora de grande quantidade de resíduo chamado de cama de frango. Este resíduo gera condições favoráveis para o desenvolvimento do besouro Alphitobius diaperinus (Panzer) (Coleoptera: Tenebrionidae), conhecido como cascudinho, sendo esse considerado a principal praga da avicultura, e afeta a produção avícola em todo o mundo. Seu controle é considerado difícil, sendo comumente empregadas substâncias piretróides e organofosforadas, apesar de não eficientes. Na busca pelo controle alternativo do inseto, vários métodos aditivos e inseticidas naturais vêm sendo testados. Contudo, na prática entomológica, substâncias com elevada pressão de vapor a fim de se produzir gases tóxicos são utilizadas para fixação dos insetos. Assim, em outubro de 2015, avaliou-se o álcool etílico PA para o controle de A. diaperinus em cama de frango. As unidades experimentais foram representadas por garrafas plásticas tipo “pet” cortadas, onde foram colocadas 100g de cama de frango, acrescidos de 20 insetos adultos e 135 larvas, cada uma. Os tratamentos foram constituídos pela aplicação de álcool no volume de 1, 2,5, 5, 7,5 e 10 mL e sua diluição com água (1:1) sendo aplicado igual volume. Simularam-se dois ambientes, sendo um aberto (com telas contendo os insetos) e um fechado (recipiente amostral fechado com a porção previamente cortada da garrafa “pet”). Nas parcelas foram mantidas a temperatura de 28,5 ± 2 ºC e UR de 51,0 ± 2%, feito seis repetições por tratamento. A quantidade de 2,5 mL (2,5% v/p) de álcool gerou 100% de mortalidade de adultos e larvas nas amostras fechadas, sendo necessário o dobro do volume no sistema aberto. Para a diluição álcool-água (1:1) o controle de 100% foi obtido com o dobro das quantidades relatadas anteriormente em relação aos respectivos tratamentos

Modelagem para o dimensionamento de microtubos em irrigação localizada Modeling for the design of microtubes in trickle irrigation

Com o intuito de oferecer embasamento técnico-científico para o desenvolvimento de uma irrigação de baixo custo e alto nível tecnológico, este trabalho teve como objetivo desenvolver uma equação para dimensionamento de microtubos em que a perda de carga localizada, a perda de carga ao longo do tubo e a energia de velocidade, estão representados na equação. O presente trabalho foi conduzido no Departamento de Engenharia Rural da ESALQ/USP, onde foi estabelecida, com base nos resultados dos ensaios dos microtubos, a relação entre pressão, comprimento, vazão e diâmetro para três diferentes modelos matemáticos de representação do fenômeno de perda de energia no microtubo. Dentre os modelos propostos, o que considerou a perda de carga localizada nesse fenômeno, com o coeficiente K da equação de perda carga localizada em função do Número de Reynolds (RN) foi o que melhor representou o fenômeno de perda de energia no microtubo. Foi testado, também, um modelo que não considera a perda de carga localizada e um outro que ressalta a perda de carga localizada com o coeficiente de perda de carga localizada (K) constante. A perda de carga localizada é um importante fator que deve ser considerado no dimensionamento do microtubo. Além disso, em situações de baixo NR o coeficiente de perda de carga localizada (K) não é um valor constante e, sim, uma função do NR.<br>The objective of this work was to develop an equation for the design of microtubes where the friction head loss in the microtube wall, the localized head loss and the velocity are explicit in the equation. The aim of this work was to offer a technical base for the development of a high irrigation technology with low cost. The work was carried out at the Rural Engineering Department of the ESALQ/USP. Based on the results of microtube tests the relation between pressure, length, flow and diameter for three different models of microtube head loss were established. The best representation of the microtube head loss was given by the model which considered the localized head loss with the coefficient K of the localized head loss equation depending on the Reynolds Number (RN). The other models tested were the model without localized head loss and the one considering the localized head loss with a constant K. The localized head loss is an important parameter which should be considered in the design of microtubes. Besides this, the coefficient of the localized head loss (K) is not a constant value but is a function of RN