The simple and the simpler in pneumonia diagnosis

In the absence of a perfect 'gold standard' for diagnosing pneumonia, comparing diagnostic performance between techniques remains controversial. El Solh and coworkers present a study evaluating use of quantitative endotracheal aspirate culture to enhance diagnostic accuracy in pneumonia patients admitted from nursing homes. We discuss the use of quantitative cultures and thresholds to differentiate between colonization and infection in pneumonia patients; we also consider the inaccuracy of diagnostic studies, which compromises the reproducibility of these data in clinical practice

Towards zero rate in healthcare-associated infections : one size shall not fi t all...

ICU patients are identifi ed as targets for quality of care and patient safety improvement strategies. Critically ill patients are at high risk for complications due to the complex and invasive nature of critical care. Several reports in the literature describe initiatives aiming to zero the healthcare-associated infection rate. We discuss the results of a study assessing a systematic team approach with very aggressive interventions surrounding the Institute for Healthcare Improvement Central Line-associated Blood Stream Infection bundle, which obtained a successful reduction of the rates. In addition, we discuss why some healthcare-associated infections are not fully preventable and the diff erent reasons for this, the identifi cation of which would be a cornerstone of quality improvement and safety promotion initiatives in critically ill patients

C-reactiveprotein in community-acquiredsepsis : youcanteach new tricks to an old dog

Severe sepsis is a major challenge for clinicians caring for acutely ill patients. For many years, several biomarkers have been tested and proposed to improve the ability not only to diagnose but also to anticipate clinical response to antibiotics. Despite the availability of many sophisticated and novel biomarkers, current evidence demonstrates that C-reactive protein (CRP), a well-known and relatively inexpensive biomarker, is useful in the clinical setting. The sequential evaluation of plasma CRP concentrations in patients with severe sepsis and the interpretation of its patterns may allow assessments of individual prognosis and response to treatment

Aplicação de um método de diagnóstico das tecnologias da indústria 4.0 com indicadores de sustentabilidade em laboratórios de teste de motores : um estudo de caso

Orientador: Prof. Dr. Marcelo Gechele CletoDissertação (mestrado) - Universidade Federal do Paraná, Setor de Tecnologia, Programa de Pós-Graduação em Engenharia de Produção. Defesa : Curitiba, 26/02/2019Inclui referências: p.84-89Área de concentração: Tecnologia e InovaçãoResumo: Durante o desenvolvimento de novos motores ou componentes de motores, bem como auditorias de motores de uma linha de produção, uma das atividades chave é o teste em laboratório ou em bancada. Seja qual for o tipo de teste, de desempenho, durabilidade, ruído ou emissões, as atividades de teste utilizam várias horas para ajustes de calibração e verificação dos requisitos de engenharia. Tais horas compreendem um custo elevado dentro de um projeto ou processo produtivo e também utilizam continuamente recursos naturais, tais como água, ar, energia, entre outros, além dos impactos econômicos e sociais dentro da organização. Um melhor uso desses recursos é importante para que empresas desenvolvam motores e veículos automotivos de uma maneira mais sustentável, garantindo competitividade no mercado. As tecnologias da Indústria 4.0 utilizadas com foco em indicadores de sustentabilidade podem desempenhar um papel importante em melhorias no processo de teste de motores, entretanto, ainda existe pouco material acadêmico publicado vinculando todos esses assuntos. Esse trabalho tem como objetivo aplicar e adaptar um método de diagnóstico disponível na literatura para laboratórios de teste de motores, identificando quais tecnologias da Indústria 4.0 podem ser utilizadas para melhorar indicadores de sustentabilidade. Dessa maneira é possível mapear o processo do caso estudado, identificar as aplicações da Indústria 4.0 e potenciais de melhoria, além de propor ações, visando melhorar indicadores de sustentabilidade em pilares econômicos, sociais e ambientais como, por exemplo, tempos de ciclo, produtividade, utilização dos recursos naturais, energia, entre outros. O uso de um modelo de diagnóstico auxiliou em identificar as tecnologias da indústria 4.0 com indicadores de sustentabilidade em um processo produtivo e ajudou a identificar oportunidades em um laboratório de teste de motores. Antes da aplicação do modelo de diagnóstico não era possível vincular as tecnologias normalmente direcionadas ao termo Indústria 4.0 com um laboratório de teste de motores e ainda apresentar como os indicadores de sustentabilidade podem ser afetados. Ao observar o estudo de caso foi verificado que soluções como o uso de sistemas integrados com ferramentas de sistemas supervisórios (SCADA), Realidade Aumentada e Big Data, são as tecnologias com maior potencial de aplicação no laboratório, com impactos diretos nos indicadores ambientais, sociais e econômicos. Palavras-chave: Indústria 4.0, Teste de Motores, Motor, Teste, Emissões, Sustentabilidade.Abstract: During the development of new engines or engine components, as well as engine audits of a production line, one of the key activities is laboratory or bench testing. Regardless of the type of test, performance, durability, noise or emissions, the test activities use several hours for calibration adjustments and verification of engineering requirements. These hours comprise a high cost within a project or process, as well as the continuous use of natural resources, such as water, air, energy, among others, in addition to the economic and social impacts within the organization. Optimizing the use of these resources is of the most importance for companies to develop engines and automotive vehicles in a sustainable way and be compatible in the market. Industry 4.0 technologies with sustainability indicators can be used to focus on improvements in the engine test process, however, there is little published academic material linking all of these issues. This work has the objective to apply and adapt a diagnose method, in order to identify which technologies of Industry 4.0 can be used in an engine test laboratory based on sustainability indicators. Thus, it is possible to map the process of the case study, identify Industry 4.0 applications and improvements potential, as well as propose actions for improvement of sustainability indicators in economic, social and environmental pillars, such as cycle times, productivity, use of natural resources, energy, among others. The use of a diagnostic method helped identify the industry's 4.0 technologies with sustainability indicators in a productive process and helped identify opportunities in an engine test laboratory. Prior to the application of the diagnostic model it was not possible to link the technologies normally linked to the term Industry 4.0 with an engine test laboratory and to show how the sustainability indicators can be affected. Observing the case study, it was verified that solutions such as the use of integrated systems with tools of supervisory systems (SCADA), Augmented Reality and Big Data, are the technologies with the greatest potential of application in the laboratory, with direct impacts on the environmental, social indicators and economic. Key-words: Industry 4.0. Engine Testing. Bench Testing. Emissions Testing, Sustainability

Early mobilization practices of mechanically ventilated patients : a 1-day point-prevalence study in southern Brazil

OBJECTIVES: To assess early mobilization practices of mechanically ventilated patients in southern Brazilian intensive care units (ICUs) and to identify barriers associated with early mobilization and possible complications. METHODS: A prospective, observational, multicenter, 1-day point-prevalence study was conducted across 11 ICUs and included all mechanically ventilated adult patients. Hospital and ICU characteristics and patients’ demographic data, the highest level of mobilization achieved in the 24 hours prior to the survey and related barriers, and complications that occurred during mobilization were collected in the hospital and the ICU. RESULTS: A total of 140 patients were included with a mean age of 57±17 years. The median and interquartile range was 7 (3-17) days for the length of ICU stay to the day of the survey and 7 (3-16) days for the duration of mechanical ventilation (MV). The 8-level mobilization scale was classified into two categories: 126 patients (90%) remained in bed (level 1–3) and 14 (10%) were mobilized out of bed (level 4–8). Among patients with an endotracheal tube, tracheostomy, and noninvasive ventilation, 2%, 23%, and 50% were mobilized out of bed, respectively (po0.001 for differences among the three groups). Weakness (20%), cardiovascular instability (19%), and sedation (18%) were the most commonly observed barriers to achieving a higher level of mobilization. No complications were reported. CONCLUSIONS: In southern Brazilian ICUs, the prevalence of patient mobilization was low, with only 10% of all mechanically ventilated patients and only 2% of patients with an endotracheal tube mobilized out of bed as part of routine care

High-intensity strength training in an older population: a preliminary study

BACKGROUND: Osteoarthritis is the most common joint disease worldwide, and it occurs mainly later in life. Many factors are associated with osteoarthritis development, including decline in muscle strength. Muscle strengthening exercises have been recognized as important approaches to osteoarthritis conservative management of the knee; however, issues related to its applicability in terms of intensity are still elusive. OBJECTIVE: Studies using high-intensity exercises have shown inconsistent results, thus the purpose of this study was to analyze the response to high-intensity strength training for muscle strength and physical function in an older healthy population, as well as their attitudes towards the strength training. METHODS: This study employed a within-subject, repeated measure, in an experimental design to assess the response to strength training for physical mobility and strength in a cohort of 10 healthy older subjects at baseline and after six weeks of intervention. RESULTS: The statistical analysis demonstrated that knee extensor isokinetic peak torque significantly improved (p < 0.05) after intervention, whereas knee flexors only showed a trend for improvement (p = 0.066). Repetition maximum tests had significant improvements for all exercises performed. There was no change in physical mobility after intervention (p = 0.163). CONCLUSION: The results of this study demonstrate that high-intensity strength training was safe and has potential value in healthy older people

Is red blood cell distribution width a marker of severity in patients discharged from the ICU?

We have read the study about the association between high red blood cell distribution width and higher ward mortality after intensive care unit discharge. The study increases the evidence that RDW may be a marker of severity for patients discharged from the ICU. However, in this letter, we comment on issues that need further discussion

Corticosteroids for severe influenza pneumonia : a critical appraisal

Influenza pneumonia is associated with high number of severe cases requiring hospital and intensive care unit (ICU) admissions with high mortality. Systemic steroids are proposed as a valid therapeutic option even though its effects are still controversial. Heterogeneity of published data regarding study design, population demographics, severity of illness, dosing, type and timing of corticosteroids administered constitute an important limitation for drawing robust conclusions. However, it is reasonable to admit that, as it was not found any advantage of corticosteroid therapy in so diverse conditions, such beneficial effects do not exist at all. Its administration is likely to increase overall mortality and such trend is consistent regardless of the quality as well as the sample size of studies. Moreover it was shown that corticosteroids might be associated with higher incidence of hospital-acquired pneumonia and longer duration of mechanical ventilation and ICU stay. Finally, it is reasonable to conclude that corticosteroids failed to demonstrate any beneficial effects in the treatment of patients with severe influenza infection. Thus its current use in severe influenza pneumonia should be restricted to very selected cases and in the setting of clinical trials

A perspectiva sócio-cultural dos EUA na década de 1970 pelo filme Os Embalos de Sábado à Noite

Em sua conjuntura social, política e cultural, os anos 1970 revelaram aspectos bastante peculiares, até então não apresentados na década anterior. A Era disco soube ilustrar muito bem esse momento de transição, entre uma sociedade marcada por resquícios do engajamento político e outra impregnada pela cultura do consumo. O presente artigo trata dessa fase de desdobramentos, onde a razão social coletiva perde força dando margem a um novo momento de experimentação, especialmente focado na realidade norte-americana. A abordagem dessa perspectiva é realizada através da análise fílmica de Embalos de sábado à noite, que acaba por reafirmar o intuito da discussão