Occupational hazards for nursing professionals related to the reuse and single use of the dialyzer

Objective: To compare the reports of occupational events recorded by nursing professionals during the periods of reuse and single use of the dialyzer. Method: Retrospective longitudinal study with electronic medical records from nursing technicians of a hemodialysis service. Data were analyzed descriptively and Rate ratio. Results: During the reuse of the dialyzer, there were seven events from five professionals reporting musculoskeletal disorders, ocular allergies and dermatosis. During single use, two professionals reported low back pain. The rate ratio of medication use was 6.7 days for every 1000 professionals during the reuse period and 1.52 days in the single use period (RR=4.4; 95% CI 2.182-9.805). Anti-inflammatory drugs were the most prescribed, and sick leaves were similar in both periods. Conclusion: Dialyzer reuse was associated with musculoskeletal disorders, ocular irritation, dermatosis and increased use of medications by professionals. Sick leaves were similar on the periods of dialyzer reuse and single use

Chemical composition, antinociceptive, anti-inflammatory and redox properties in vitro of the essential oil from Remirea maritima Aubl. (Cyperaceae)

Methods: The essential oil from the roots and rhizomes of RMO were obtained by hydrodistillation using a Clevenger apparatus, and analyzed by gas chromatography/mass spectrometry (GC/MS). Here, we evaluated free radical scavenging activities and antioxidant potential of RMO using in vitro assays for scavenging activity against hydroxyl radicals, hydrogen peroxide, superoxide radicals, and nitric oxide. The total reactive antioxidant potential (TRAP) and total antioxidant reactivity (TAR) indexes and in vitro lipoperoxidation were also evaluated. The ability of RMO to prevent lipid peroxidation was measured by quantifying thiobarbituric acid-reactive substances (TBARS). NO radical generated at physiological pH was found to be inhibited by RMO, that showed scavenging effect upon SNP-induced NO production at all concentrations. Antinociceptive and anti-inflammatory properties were evaluated by acetic acid writhing reflex, Formalin-induced nociception and Carrageenan-induced edema test. - Results: The majors compounds identified was remirol (43.2%), cyperene (13.8%), iso-evodionol (5.8%), cyperotundone (5.7%), caryophyllene oxide (4.9%), and rotundene (4.6%). At the TRAP assay, RMO concentration of 1 mg.mL−1 showed anti-oxidant effects and at concentration of 1 and 10 ng.mL−1 RMO showed pro-oxidant effect. RMO at 1 mg.mL−1 also showed significant anti-oxidant capacity in TAR measurement. Concentrations of RMO from 1 ng.mL−1 to 100 μg.mL−1 enhanced the AAPH-induced lipoperoxidation. RMO reduced deoxyribose oxidative damage, induced by the Fenton reaction induction system, at concentrations from 1 ng.mL−1 to 100 μg.mL−1. We observed that RMO caused a significant increase in rate of adrenaline auto-oxidation. On the other hand RMO did not present any scavenging effect in H2O2 formation in vitro. The results of this study revealed that RMO has both peripheral and central analgesic properties. The RMO, all doses, orally (p.o.) administered significantly inhibited (p < 0.05, p < 0.01 and p < 0.001) the acetic acid-induced writhings and two phases of formalin-induced nociception in mice. - Conclusion: The RMO demonstrated antioxidant and analgesic profile which may be related to the composition of the oil

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

TRY plant trait database – enhanced coverage and open access

Plant traits - the morphological, anatomical, physiological, biochemical and phenological characteristics of plants - determine how plants respond to environmental factors, affect other trophic levels, and influence ecosystem properties and their benefits and detriments to people. Plant trait data thus represent the basis for a vast area of research spanning from evolutionary biology, community and functional ecology, to biodiversity conservation, ecosystem and landscape management, restoration, biogeography and earth system modelling. Since its foundation in 2007, the TRY database of plant traits has grown continuously. It now provides unprecedented data coverage under an open access data policy and is the main plant trait database used by the research community worldwide. Increasingly, the TRY database also supports new frontiers of trait‐based plant research, including the identification of data gaps and the subsequent mobilization or measurement of new data. To support this development, in this article we evaluate the extent of the trait data compiled in TRY and analyse emerging patterns of data coverage and representativeness. Best species coverage is achieved for categorical traits - almost complete coverage for ‘plant growth form’. However, most traits relevant for ecology and vegetation modelling are characterized by continuous intraspecific variation and trait–environmental relationships. These traits have to be measured on individual plants in their respective environment. Despite unprecedented data coverage, we observe a humbling lack of completeness and representativeness of these continuous traits in many aspects. We, therefore, conclude that reducing data gaps and biases in the TRY database remains a key challenge and requires a coordinated approach to data mobilization and trait measurements. This can only be achieved in collaboration with other initiatives

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure &lt;= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Bem de família dado em caução de aluguel comercial é impenhorável (Superior Tribunal de Justiça; REsp 1.789.505/SP; Rel. Min. Marco Buzzi)

Jurisprudência comentada do Recurso Especial nº 1.789.505/S

Notificação de incidentes relacionados à assistência à saúde em um hospital de ensino

Objective: Analyzing incidents related to health care in a teaching hospital. Method: A quantitative research carried out based on notifications of incidents carried out between 2016 and 2018. The data were processed in STATA version 12. Results: The incidence of adverse events was 3.82 per 100 patient-days. The adult hospitalization units were the main notifiers, 57.20%; adult patients, 52.75%; females, 52.9%; blacks, 80.01%; singles, 47.62%; with low or no schooling, 50.91%, were the main ones. The nurses were the main notifiers, 80.38%. Phlebitis, 27.05%; surgeries, 19.20%; and falls, 17.27%, were the most reported incidents, whose damage was classified as mild in 91.52%, but there were three deaths in the period. Conclusion: The analysis of incidents allows us to highlight the importance of notifications for the planning and implementation of measures that can contribute to the strengthening of the patient safety culture.Objetivo: Analizar los incidentes relacionados con la atención médica en un hospital docente. Método: Investigación cuantitativa, realizada con base en las notificaciones de incidencias realizadas entre 2016 y 2018. Los datos se procesaron en la versión 12 del programa STATA. Resultados: La incidencia de eventos adversos fue de 3,82 por cada 100 pacientes-día. Las unidades de hospitalización para adultos fueron los lugares con mayor incidencia de incidentes, 57,20%; pacientes adultos, 52,75%; mujeres, 52,9%; negros, 80,01%; solteros, 47,62%; con escolarización baja o nula, el 50,91%, fueron los principales. Las enfermeras fueron los principales notificadores, 80,38%. Flebitis, 27,05%; cirugías, 19,20%; y las caídas, el 17,27%, fueron los incidentes más reportados, cuyos daños fueron clasificados como leves en el 91,52%, pero hubo 03 muertes en el período. Conclusión: El análisis de los incidentes permite destacar la importancia de las notificaciones para la planificación e implementación de medidas que puedan contribuir al fortalecimiento de la cultura de seguridad del paciente.Objetivo: Analisar os incidentes relacionados à assistência à saúde em um hospital de ensino. Método: Pesquisa quantitativa, realizada a partir das notificações de incidentes realizadas entre 2016 e 2018. Os dados foram processados no programa STATA versão 12. Resultados: A incidência de eventos adversos foi 3,82 por 100 pacientes-dia. As unidades de internação para adultos foram os locais com maior ocorrência de incidentes, 57,20%; os pacientes adultos, 52,75%; do sexo feminino, 52,9%; negros, 80,01%; solteiros, 47,62%; com baixa ou nenhuma escolaridade, 50,91%, foram os principais atingidos. Os enfermeiros foram os principais notificadores, 80,38%. As flebites, 27,05%; cirurgias, 19,20%; e quedas, 17,27%, foram os incidentes mais notificados, cujos danos foram classificados como leves em 91,52%, mas houve 03 óbitos no período. Conclusão: A análise dos incidentes permite destacar a importância das notificações para o planejamento e implementação de medidas que possam contribuir para o fortalecimento da cultura de segurança do paciente

Riscos ocupacionais para profissionais de enfermagem relacionados ao reúso e uso único do dialisador

RESUMO Objetivo: Comparar as ocorrências ocupacionais registradas pelos profissionais de Enfermagem durante a utilização do dialisador reutilizado e de uso único. Método: Estudo longitudinal, retrospectivo, realizado com prontuários de técnicos de Enfermagem de um serviço de hemodiálise. Os dados foram analisados descritivamente e calculados pela Razão de Densidade de Incidência. Resultados: Durante a reutilização do dialisador, foram registradas sete notificações de cinco profissionais relacionadas a distúrbios osteomusculares, a alergias oculares e à dermatose. Durante o uso único, dois profissionais registraram dor lombar. A taxa de exposição ao uso de medicamentos foi de 6,7 dias para cada 1.000 profissionais no período de reutilização do dialisador e de 1,52 dias no período de uso único (RDI=4,4; IC 95%: 2.182-9.805). Os anti-inflamatórios foram os mais prescritos, e os afastamentos do trabalho foram semelhantes nos dois períodos. Conclusão: O reúso do dialisador esteve associado a distúrbios osteomusculares, irritação ocular, dermatoses e maior uso de medicamentos pelos profissionais. Os afastamentos do trabalho foram semelhantes durante o uso do dialisador reutilizado e de uso único