Gastrosquise no Brasil em um Contexto Global

Introduction: global disparity in outcomes of gastroschisis is visible. Survival rates in high-income countries have improved since 1960, and are currently around 100%, due to progress in pediatric surgery and neonatal intensive care. However, in low- and middle-income countries mortality rates can reach all cases. Objective: this study aims to map the existing literature on gastroschisis in Brazil within a global context. Methods: scoping Review. PubMed, Scielo Brazil, Biblioteca Virtual em Saúde (BVS) and Google Scholar, were searched from January 2000 to May 2020. Results: eight studies met the inclusion criteria. The consolidated data of 912 patients were: Mean maternal age of 20.7 years, antenatal diagnosis rate of 80.2%, cesarean section rate of 77.7%. Mean of hospital stay of 40.8 days. Mean mortality rate of 25.3 %. Risk factors associated with death were: prematurity, low birth weight, low APGAR score, reinterventions, sepsis, birth-to-surgery interval greater than 4 hours, fewer prenatal visits, delayed prenatal diagnosis. Conclusion: studies on gastroschisis in Brazil were scarce, most of carried out in southeast of country. This study suggests that there are regional contrasts on gastroschisis outcomes in Brazil. The worst results are in regions with low economic resources, a similar situation found in international literature. This review should be validated with future studies to investigate the situation of pregnant women with fetuses with gastroschisis, especially in low-resource regions, in Brazil.Introdução: a disparidade global nos resultados da gastrosquise é visível. Taxas de sobrevivência em países de alta renda melhoraram desde 1960 e atualmente estão em torno de 100%, devido ao progresso da cirurgia pediátrica e da terapia intensiva neonatal. No entanto, em países de media e baixa renda, as taxas de mortalidade continual elevadas. Objetivo: este estudo tem como objetivo mapear a literatura existente sobre gastrosquise no Brasil e discutir as evidências disponíveis em um contexto global. Método: revisão de escopo. Foram pesquisados o PubMed, o Scielo Brasil, a Biblioteca Virtual em Saúde (BVS) e o Google Scholar no período de janeiro de 2000 a maio de 2020. Resultados: oito estudos preencheram os critérios de inclusão e os dados encontrados de 912 pacientes foram: idade materna média de 20.7 anos, média do diagnóstico antenatal de 80.2%, taxa média de cesarianas de 77.7%, tempo de permanência hospitalar médio de 40.8 dias e taxa média de mortalidade 25.3%. Os fatores de risco associados ao óbito encontrados foram a prematuridade, baixo peso ao nascer, APGAR baixo, reintervenções cirúrgicas, sepse, intervalo nascimento-cirurgia maior que 4 horas, poucas consultas do pré-natal e diagnóstico antenatal tardio. Conclusão: estudos sobre gastrosquise no Brasil são escassos, a maioria realizada no Sudeste do país. Os piores desfechos estão em regiões com poucos recursos econômicos, situação semelhante à encontrada na literatura internacional. Esta revisão deve ser validada com estudos futuros que investiguem a situação de gestantes portadoras de fetos com gastrosquise, especialmente em regiões de poucos recursos, no Brasil

Cateterismo venoso periférico: compreensão e avaliação das práticas de enfermagem

Objective: to understand the nursing practices related to peripheral venipuncture and to analyze the incidence of complications in patients with venous catheters. Method: mixed design, involving: case study, sectional study, cohort study and focus group. The sample consisted of nurses and patients from a medical clinic in Portugal. Thematic analysis and descriptive statistics were performed. Results: stressors capable of influencing nursing practices were identified, including: the decisions of the medical team, the age and characteristics of the venous network of the patient, the availability of other catheters in the institution, the low level of knowledge of nurses regarding the care of patients in the insertion, maintenance and removal of the peripherally inserted central venous catheter. The following complications and their respective incidences were documented in patients with peripheral venous catheters: phlebitis (22.2%), obstruction (27.7%), fluid exiting through insertion site (36.1%), infiltration (38.8%) and accidental catheter removal (47.2%). Catheter obstruction with an incidence of 22.2% was only observed in those who used the peripherally inserted central venous catheter. The following benefits were observed with the use of the peripherally inserted central venous catheter: safe administration of drugs; pain reduction, number of venous punctures and complications. Conclusions: the peripherally inserted central venous catheter is presented as a valid and viable alternative that can improve the quality of nursing care and the safety and well-being of patients.Objetivo: compreender as práticas de enfermagem relacionadas com o cateterismo venoso periférico e analisar a incidência de complicações durante a permanência do cateter venoso no paciente. Método: delineamento misto, envolvendo: estudo de caso, estudo seccional, estudo de coorte e grupo focal. A amostra foi constituída por enfermeiros e pacientes de um serviço de clínica médica de Portugal. Efetuada análise temática e estatística descritiva. Resultados: identificou-se estressores capazes de influenciar as práticas de enfermagem, sendo eles: as decisões da equipe médica, a idade e as características da rede venosa do paciente, a disponibilização de outros cateteres pela instituição e o baixo nível de conhecimento dos enfermeiros sobre os cuidados aos pacientes na inserção, manutenção e remoção do cateter venoso central de inserção periférica. Nos pacientes portadores de cateter venoso periférico, documentou-se as seguintes complicações e suas respectivas incidências: flebite (22,2%), obstrução (27,7%), saída de fluido pela inserção (36,1%), infiltração (38,8%) e remoção acidental do cateter (47,2%). Naqueles que usaram o cateter venoso central de inserção periférica, identificou-se apenas a obstrução desse cateter, com incidência de 22,2%. Verificou-se os seguintes benefícios com a utilização do cateter venoso central de inserção periférica: administração segura de medicamentos e redução da dor, do número de punções venosas e de complicações. Conclusão: o cateter venoso central de inserção periférica apresenta-se como alternativa válida e viável para melhorar a qualidade da assistência de enfermagem, a segurança e o bem-estar dos pacientes

Extraction of the Muon Signals Recorded with the Surface Detector of the Pierre Auger Observatory Using Recurrent Neural Networks

We present a method based on the use of Recurrent Neural Networks to extract the muon component from the time traces registered with water-Cherenkov detector (WCD) stations of the Surface Detector of the Pierre Auger Observatory. The design of the WCDs does not allow to separate the contribution of muons to the time traces obtained from the WCDs from those of photons, electrons and positrons for all events. Separating the muon and electromagnetic components is crucial for the determination of the nature of the primary cosmic rays and properties of the hadronic interactions at ultra-high energies. We trained a neural network to extract the muon and the electromagnetic components from the WCD traces using a large set of simulated air showers, with around 450 000 simulated events. For training and evaluating the performance of the neural network, simulated events with energies between 1018.5, eV and 1020 eV and zenith angles below 60 degrees were used. We also study the performance of this method on experimental data of the Pierre Auger Observatory and show that our predicted muon lateral distributions agree with the parameterizations obtained by the AGASA collaboration

A search for ultra-high-energy photons at the Pierre Auger Observatory exploiting air-shower universality

The Pierre Auger Observatory is the most sensitive detector to primary photons with energies above ∼0.2 EeV. It measures extensive air showers using a hybrid technique that combines a fluorescence detector (FD) with a ground array of particle detectors (SD). The signatures of a photon-induced air shower are a larger atmospheric depth at the shower maximum (X$_{max}$) and a steeper lateral distribution function, along with a lower number of muons with respect to the bulk of hadron-induced background. Using observables measured by the FD and SD, three photon searches in different energy bands are performed. In particular, between threshold energies of 1-10 EeV, a new analysis technique has been developed by combining the FD-based measurement of X$_{max}$ with the SD signal through a parameter related to its muon content, derived from the universality of the air showers. This technique has led to a better photon/hadron separation and, consequently, to a higher search sensitivity, resulting in a tighter upper limit than before. The outcome of this new analysis is presented here, along with previous results in the energy ranges below 1 EeV and above 10 EeV. From the data collected by the Pierre Auger Observatory in about 15 years of operation, the most stringent constraints on the fraction of photons in the cosmic flux are set over almost three decades in energy

Study on multi-ELVES in the Pierre Auger Observatory

Since 2013, the four sites of the Fluorescence Detector (FD) of the Pierre Auger Observatory record ELVES with a dedicated trigger. These UV light emissions are correlated to distant lightning strikes. The length of recorded traces has been increased from 100 μs (2013), to 300 μs (2014-16), to 900 μs (2017-present), to progressively extend the observation of the light emission towards the vertical of the causative lightning and beyond. A large fraction of the observed events shows double ELVES within the time window, and, in some cases, even more complex structures are observed. The nature of the multi-ELVES is not completely understood but may be related to the different types of lightning in which they are originated. For example, it is known that Narrow Bipolar Events can produce double ELVES, and Energetic In-cloud Pulses, occurring between the main negative and upper positive charge layer of clouds, can induce double and even quadruple ELVES in the ionosphere. This report shows the seasonal and daily dependence of the time gap, amplitude ratio, and correlation between the pulse widths of the peaks in a sample of 1000+ multi-ELVES events recorded during the period 2014-20. The events have been compared with data from other satellite and ground-based sensing devices to study the correlation of their properties with lightning observables such as altitude and polarity

Studies of the mass composition of cosmic rays and proton-proton interaction cross-sections at ultra-high energies with the Pierre Auger Observatory

In this work, we present an estimate of the cosmic-ray mass composition from the distributions of the depth of the shower maximum (Xmax) measured by the fluorescence detector of the Pierre Auger Observatory. We discuss the sensitivity of the mass composition measurements to the uncertainties in the properties of the hadronic interactions, particularly in the predictions of the particle interaction cross-sections. For this purpose, we adjust the fractions of cosmic-ray mass groups to fit the data with Xmax distributions from air shower simulations. We modify the proton-proton cross-sections at ultra-high energies, and the corresponding air shower simulations with rescaled nucleus-air cross-sections are obtained via Glauber theory. We compare the energy-dependent composition of ultra-high-energy cosmic rays obtained for the different extrapolations of the proton-proton cross-sections from low-energy accelerator data