A novel method for identification of patients at risk of deterioration using FACS

Facial displays are used by health professionals to assess the wellbeing of patients at risk of deterioration. Surprisingly, there is not a single early warning system based on the assessment of facial expressions. There is ample literature that supports the study of face expressions by means of anatomical based score systems, such as FACS (1). Preliminary studies suggested that outreach nurses identified mostly sadness and fear in patients at risk of deterioration (2). As part of a pilot study on analysing facial expressions in critical illness, this research has compared Action Units (AU in FACS terminology) from patients at risk of deterioration against AU inferred from 20 facial images of patients deemed to die

What faces reveal : a novel method to identify patients at risk of deterioration using facial expressions

Objectives: To identify facial expressions occurring in patients at risk of deterioration in hospital wards. Design: Prospective observational feasibility study. Setting: General ward patients in a London Community Hospital, United Kingdom. Patients: Thirty-four patients at risk of clinical deterioration. Interventions: A 5-minute video (25 frames/s; 7,500 images) was recorded, encrypted, and subsequently analyzed for action units by a trained facial action coding system psychologist blinded to outcome. Measurements and Main Results: Action units of the upper face, head position, eyes position, lips and jaw position, and lower face were analyzed in conjunction with clinical measures collected within the National Early Warning Score. The most frequently detected action units were action unit 43 (73%) for upper face, action unit 51 (11.7%) for head position, action unit 62 (5.8%) for eyes position, action unit 25 (44.1%) for lips and jaw, and action unit 15 (67.6%) for lower face. The presence of certain combined face displays was increased in patients requiring admission to intensive care, namely, action units 43 + 15 + 25 (face display 1, p < 0.013), action units 43 + 15 + 51/52 (face display 2, p < 0.003), and action units 43 + 15 + 51 + 25 (face display 3, p < 0.002). Having face display 1, face display 2, and face display 3 increased the risk of being admitted to intensive care eight-fold, 18-fold, and as a sure event, respectively. A logistic regression model with face display 1, face display 2, face display 3, and National Early Warning Score as independent covariates described admission to intensive care with an average concordance statistic (C-index) of 0.71 (p = 0.009). Conclusions: Patterned facial expressions can be identified in deteriorating general ward patients. This tool may potentially augment risk prediction of current scoring systems

História oral como técnica para o arquivista na construção do arranjo documental

Arquivologia como área de conhecimento contemporâneo, possui muitos desafios no seu campo de trabalho. A realidade de muitas instituições é possuir um grande volume documental e não possuir estrutura física, acondicionadas de maneira errônea e sem organização. Sobre a questão da organização dos documentos, o arranjo documental entra como primeiro passo para organização da massa documental, passo esse fundamental para o desenvolvimento de outras atividades como, por exemplo, a classificação e a descrição. Este artigo buscou mostrar a interface de duas áreas de conhecimento: a Arquivologia e História. Trabalhar a interlocução dessas duas áreas de conhecimento é importante, pois a historia oferece contribuição para o desenvolvimento do trabalho do arquivista. Apresentou, de forma geral, como o arquivista poderá usar a técnica da história oral para a construção da memória institucional, que define o arranjo documental. Caracterizou-se como uma pesquisa documental, utilizando textos referentes a temática. Destacou-se, por meio deste estudo, que as lacunas documentais existentes nas instituições dificultam o trabalho do arquivista, uma vez que, os documentos existentes muitas vezes não respondem nossas perguntas como profissionais. Para suprir a necessidade de informação quanto a construção de um arranjo consistente temos a história oral como uma das técnicas advindas da História, como coadjuvante no levantamento de informações de funcionários e ex-funcionários para reconstruir a historia administrativa e a memória institucional. Essa interlocução mostra que a Arquivologia utiliza métodos da Historia, especificamente na gestão documental.Archival and contemporary knowledge area, has many challenges in their field of work. The reality is that many institutions have a large volume document and has no physical structure, put in the wrong way and without organization. On the question of the organization of documents, documentary score enters as a first step to organizing mass documentary, this fundamental step for the development of other activities, eg, classification and description. This paper aims to show the interface of two areas of knowledge: Archival and History. Working the dialogue between these two fields of knowledge is important because the history provides contribution to the development of the work of the archivist. Showed, in general, as the archivist can use the technique of oral history to build institutional memory, which defines the document arrangement. Characterized as desk research, using texts on the subject. Stood out through this study that the documentary gaps in institutions hinder the work of the archivist, since existing documents often do not respond our questions as professionals. To meet the need for information regarding the construction of a consistent arrangement have oral history as one of stemming techniques of history as an aid in gathering information from employees and former employees to rebuild the administrative history and memory institucional. That dialogue shows that Archival uses the methods of history, specifically in the document management.Arquivologia como área de conhecimento contemporâneo, possui muitos desafios no seu campo de trabalho. A realidade de muitas instituições é possuir um grande volume documental e não possuir estrutura física, acondicionadas de maneira errônea e sem organização. Sobre a questão da organização dos documentos, o arranjo documental entra como primeiro passo para organização da massa documental, passo esse fundamental para o desenvolvimento de outras atividades como, por exemplo, a classificação e a descrição. Este artigo buscou mostrar a interface de duas áreas de conhecimento: a Arquivologia e História. Trabalhar a interlocução dessas duas áreas de conhecimento é importante, pois a historia oferece contribuição para o desenvolvimento do trabalho do arquivista. Apresentou, de forma geral, como o arquivista poderá usar a técnica da história oral para a construção da memória institucional, que define o arranjo documental. Caracterizou-se como uma pesquisa documental, utilizando textos referentes a temática. Destacou-se, por meio deste estudo, que as lacunas documentais existentes nas instituições dificultam o trabalho do arquivista, uma vez que, os documentos existentes muitas vezes não respondem nossas perguntas como profissionais. Para suprir a necessidade de informação quanto a construção de um arranjo consistente temos a história oral como uma das técnicas advindas da História, como coadjuvante no levantamento de informações de funcionários e ex-funcionários para reconstruir a historia administrativa e a memória institucional. Essa interlocução mostra que a Arquivologia utiliza métodos da Historia, especificamente na gestão documental

Do temporal changes in facial expressions help identify patients at risk of deterioration in hospital wards? A post hoc analysis of the Visual Early Warning Score study

Objectives: To determine whether time-series analysis and Shannon information entropy of facial expressions predict acute clinical deterioration in patients on general hospital wards. Design: Post hoc analysis of a prospective observational feasibility study (Visual Early Warning Score study). Setting: General ward patients in a community hospital. Patients: Thirty-four patients at risk of clinical deterioration. Interventions: A 3-minute video (153,000 frames) for each of the patients enrolled into the Visual Early Warning Score study database was analyzed by a trained psychologist for facial expressions measured as action units using the Facial Action Coding System. Measurements and Main Results: Three-thousand six-hundred eighty-eight action unit were analyzed over the 34 3-minute study periods. The action unit time variables considered were onset, apex, offset, and total time duration. A generalized linear regression model and time-series analyses were performed. Shannon information entropy (Hn) and diversity (Dn) were calculated from the frequency and repertoire of facial expressions. Patients subsequently admitted to critical care displayed a reduced frequency rate (95% CI moving average of the mean: 9.5–10.9 vs 26.1–28.9 in those not admitted), a higher Shannon information entropy (0.30 ± 0.06 vs 0.26 ± 0.05; p = 0.019) and diversity index (1.36 ± 0.08 vs 1.30 ± 0.07; p = 0.020) and a prolonged action unit reaction time (23.5 vs 9.4 s) compared with patients not admitted to ICU. The number of action unit identified per window within the time-series analysis predicted admission to critical care with an area under the curve of 0.88. The area under the curve for National Early Warning Score alone, Hn alone, National Early Warning Score plus Hn, and National Early Warning Score plus Hn plus Dn were 0.53, 0.75, 0.76, and 0.81, respectively. Conclusions: Patients who will be admitted to intensive care have a decrease in the number of facial expressions per unit of time and an increase in their diversity

Newest diabetes related technologies for pediatric type 1 diabetes and its impact on routine care : a narrative synthesis of the literature

Purpose of Review This review aims to address the actual state of the most advanced diabetes devices, as follows: continuous subcutaneous insulin infusions (CSII), continuous glucose monitoring systems (CGM), hybrid-closed loop (HCL) systems, and “Do-it-yourself” Artifcial Pancreas Systems (DIYAPS) in children, adolescents, and young adults. This review has also the objective to assess the use of telemedicine for diabetes care across three diferent areas: education, social media, and daily care. Recent Findings Recent advances in diabetes technology after integration of CSII with CGM have increased the popularity of this treatment modality in pediatric age and shifted the standard diabetes management in many countries. We found an impressive transition from the use of CSII and/or CGM only to integrative devices with automated delivery systems. Although much has changed over the past 5 years, including a pandemic period that precipitated a broader use of telemedicine in diabetes care, some advances in technology may still be an additional burden of care for providers, patients, and caregivers. The extent of a higher rate of “auto-mode” use in diabetes devices while using the HCL/DIYAPS is essential to reduce the burden of diabetes treatment. Summary More studies including higher-risk populations are needed, and eforts should be taken to ensure proper access to cost-efective advanced technology on diabetes care

Immunohistochemical and Biochemical Characterization of Mucin in Pseudomyxoma Peritonei: A Case Study

We previously reported the presence of MUC2, MUC5AC and, for the first time, MUC5B in a 58-year-old male with pseudomyxoma peritonei (PMP). This is a report on the biochemical and immunohistochemical characterization of mucin in a 50-year-old female with the same rare illness. A right oophorectomy and appendicectomy and a resection of the involved omentum were performed. Approximately a litre of crude material in the sol and gel phases was obtained from the patient during laparotomy. This was briefly homogenized in 6 M guanidinium hydrochloride and proteolytic inhibitors and purified by density gradient centrifugation in caesium chloride. At laparotomy it was noted that the patient had appendiceal and ovarian masses as well as extensive mucinous deposits in the omentum and peritoneum. A mucinous adenocarcinoma of the appendix and ovary was confirmed on histology. The cells expressed both sulphated and non-sulphated acidic mucins. The presence of MUC2, MUC5AC, MUC5B and a-1-acid glycoprotein was shown by Western blotting and MUC4 by immunohistochemical staining. MUC1 and MUC6 were not detectable in the tissue. The study confirms that MUC2, MUC5AC and MUC5B are produced in the mucus of patients with PMP. The expression of MUC4 in this disease has not been previously reported

Oviposition behavior of Haemagogus leucocelaenus (Diptera: culicidae), a vector of wild yellow fever in Brazil

Haemagogus leucocelaenus, which is considered a major vector of wild yellow fever, exhibits acrodendrophilic habits and mainly deposits its eggs in treeholes and bamboo internodes. The selection of nursery sites is essential in the life history and reproductive success of mosquitoes. The present work investigated the preferred oviposition height and period of Hg. leucocelaenus in an Atlantic forest area in Rio de Janeiro. Sampling was performed using oviposition traps that were placed on plant material at 0, 2, 4, 6, and 8 m above the ground, from August 2015 to July 2016. Eggs were more abundant during October and May, and the height of traps placement had no significant effect on the eggs number indicating that Hg. leucocelaenus explores different levels of forest habitats, a behavior that may favor the transmission of pathogens among arboreal animals including primates and humans. The findings of the present study are discussed from an ecological and epidemiological point of view

IMPACTS CAUSED BY THE INADEQUATE DEPOSITION OF THE RESIDUE OF THE RIO GRANDE DO NORTE AGROINDUSTRIES

The current consumer market is eager for products with great practicality and quick preparation. Among these, in recent years, a great emphasis has been given to the use of fruit pulps for the preparation of juice and other derived products. This work consists of a balance sheet of the industries making juice from fruit pulps of the state of Rio Grande do Norte (Brazil), with respect to the disposal of waste and the impact associated with the activities developed by them. The work was developed through a bibliographic research and the survey of data in 12 agroindustries of fruits processing in the state of Rio Grande do Norte, by applying a standard questionnaire. The results demonstrate a critical level with the improper disposal of waste in inappropriate places and low rates of preventive practices or the reuse of these. The management of liquid effluents is not treated with the degree of importance that is required and the exposure of emissions to the atmosphere is practically done in a grossly way, without any treatment. The paper explores such results and suggests an alternative proposal for the recycling of the wastes of those industries as food and as a food of animal origin.IMPACTOS CAUSADOS PELA DISPOSIÇÃO INADEQUADA DE RESÍDUOS EM AGROINDÚSTRIAS DO RIO GRANDE DO NORTE. O atual mercado consumidor é ávido por produtos com grande praticidade e rápido preparo. Dentre esses, nos últimos anos, dado um grande destaque ao uso de polpas de frutas para o preparo de sucos e outros derivados. Este trabalho consiste de um balanço da situação das indústrias de beneficiamento de polpas de frutas do estado Rio Grande do Norte (Brasil), com relação à disposição final de resíduos e o impacto associado pelas atividades desenvolvidas por estas. O trabalho foi desenvolvido através de uma pesquisa bibliográfica e levantamento de dados em 12 agroindústrias de processamento de frutas do estado do Rio Grande do Norte, mediante a aplicação de um questionário padrão. Os resultados demonstram um nível de criticidade com a disposição inadequada de resíduos em locais inapropriados e baixos índices de práticas preventivas ou de reuso desses. O gerenciamento dos efluentes líquidos não é tratado com o grau de importância que se requer e a exposição de emissões para a atmosfera praticamente é feito de forma bruta, sem nenhum tratamento. O trabalho explora tais resultados e sugere uma proposta de alternativas para o reaproveitamento dos resíduos dessas indústrias como alimentação humana e como um alimento de origem animal

An improved classifier for mortality prediction in adult critical care admissions

Introduction: Over the last 25 years there has been significant work carried out in producing risk prediction models for patients admitted to critical care units. The most recent of these models is the Intensive Care National Audit and Research Centre (ICNARC) model developed in 2007 (1) which uses data from 231,930 admissions to 163 critical care units to develop and validate a UK based model outperforming other approaches (with an average c index of 0.863). Aims: This research aims to present an artificial neural network based model for critical care admissions that improves over the ICNARC model in terms of the discrimination across the data set used in this study. Results: Figure 1 shows a comparison between the receiver operator characteristics (ROC) curve for our artificial neural network (ANN) model and the ICNARC model presented in (1). This figure shows the ROC curve and point-wise confidence intervals for the true positive values of both our model (in blue) and the ICNARC model (in red). In comparison, our artificial neural network classification model produces an average c value of 0.8983 in 10 fold cross validation of our data compared to a c value of 0.8306 for the ICNARC model using the same data set (consisting of 642 patients admitted to North Middlesex Hospital critical care unit over a 28 month period. Data excludes 432 patients where data was incomplete). Conclusion: Our classification model provides a percentage risk score that outperforms the ICNARC model. This classification model does suffer from some of same issues surrounding the ICNARC model – for instance, the influence of some of the parameters within both models can be unclear to clinicians trying to predict the survival of individual patients. However, further work is ongoing to improve the transparency of this mode

Multiplicação vegetativa da espécie Eugenia involucrata, nativa da Mata Atlântica

The objective of this work was to evaluate air layering, cutting, and grafting, with different indolebutyric acid (IBA) rates, for the vegetative propagation of Eugenia involucrata. Air layering was carried out for two consecutive years with five different IBA rates. Cutting was tested for woody and herbaceous cuttings, using four IBA rates, in three seasons. The grafting methods – cleft graft and splice graft – were tested in two seasons. For the air layering, cutting, and grafting trials the experimental designs were randomized complete blocks, completely randomized in a 3x4 factorial arrangement, and completely randomized, respectively. Plants were evaluated for rooting, survival percentage, and shoot development. In air layering, low rooting rates of 0 to 50% were observed, the use of IBA showed no consistent results, and no resulting propagules survived after being transplanted. The cutting technique showed low survival, rooting, and leaf retention rates, with no consistent effect of IBA rates. Grafting showed 35 to 50% graft fixation, with no significant difference between the splice and cleft grafting techniques. The air layering and cutting techniques are not efficient for the propagation of E. involucrata, as they do not favor the survival and rooting of seedlings. Grafting, by both techniques, is the most efficient method for E. involucrata propagation.O objetivo deste trabalho foi avaliar a alporquia, a estaquia e a enxertia, com diferentes doses de ácido indolbutírico (AIB), para a propagação vegetativa de Eugenia involucrata. A alporquia foi realizada por dois anos consecutivos, com cinco diferentes doses de AIB. A estaquia foi testada com estacas lenhosas e herbáceas, quatro doses de AIB, em três estações do ano. Os métodos de enxertia – garfagem em fenda cheia e inglês simples – foram avaliados em duas estações do ano. Para os ensaios de alporquia, estaquia e enxertia, os delineamentos experimentais foram em blocos ao acaso, inteiramente casualizado em arranjo fatorial 3x4 e inteiramente casualizado, respectivamente. As plantas foram avaliadas quanto ao enraizamento, à percentagem de sobrevivência e ao desenvolvimento da parte aérea. Na alporquia, foram observadas baixas taxas de enraizamento foram observadas na alporquia de 0 a 50%, o uso de AIB não apresentou resultados consistentes e nenhum propágulo resultante sobreviveu após o transplante. A técnica de estaquia mostrou baixas taxas de sobrevivência, enraizamento e retenção foliar, sem efeito consistente das doses de AIB. A enxertia mostrou de 35 a 50% de fixação do enxerto, sem diferença significativa entre as técnicas de enxerto de emenda e de fenda. As técnicas de alporquia e estaquia não são eficientes para a propagação de E. involucrata, pois não favorecem a sobrevivência e o enraizamento das mudas. A enxertia, por ambos os métodos, é a técnica mais eficiente para a propagação de E. involucrata