The Downs-Thompson paradox in multimodal networks

Users of the transportation networks generally choose their routes in an independent and uncoordinated way in order to minimize their own perceived costs. This non-cooperative behaviour can lead to a suboptimal utilization of the network and, in some situations, increasing the network capacity can make the subutilization even worse. Such phenomenon is described in literature as traffic or network paradoxes. This paper provides a review on two famous network paradoxes, and also introduces a new one

Homocysteine plasma levels as a marker of clinical severity in septic patients

OBJECTIVE: Homocysteine and sepsis are both associated with inflammation and endothelial activation. Therefore this study was aimed to evaluate if the plasma homocystein level is related with the septic patient clinical severity. METHODS: Severe sepsis or septic shock patients, with less than 48 hours from organ dysfunction start, were admitted to this prospective observational study. Homocysteine levels were determined by the time of study admission and then on the Days 3, 7 and 14. The homocysteine association with the Sequential Organ Failure Assessment (SOFA) score was evaluated using the Sperman test, and its association with mortality using the Mann-Whitney test. A p<0.05 value was considered statistically significant. RESULTS: Twenty one patients were enrolled, and 60 blood samples were collected to measure total homocysteine [median 6.92 (5.27 - 9.74 μmol/L)]. The Sperman correlation test showed no association between homocysteine and SOFA ( r=0.15 and p=0.26). Also no correlation was found for the homocysteine level by the study admission time and the difference between the Day 3 SOFA score versus by study admission (deltaSOFA) (r=0.04 and p=0.87). Homocysteine variation between the Day 3 and the study admission (deltaHmc) and SOFA score variation in the same period were not correlated (r=-0.11 and p=0.66). Homocysteine by the study admission was not correlated with death in intensive care unit rate (p= 0.46) or in-hospital death rate (p = 0.13). This was also true for deltaHmc (p=0.12 and p=0.99, respectively). CONCLUSION: Baseline homocysteine levels and its variations within the first dysfunction days were not related with septic patients' worsened organ function parameters or mortality.OBJETIVO: Homocisteína e a sepse estão ambos associados à inflamação e ativação endotelial. O objetivo desse estudo foi verificar se o nível plasmático de homocisteína está relacionado à gravidade do quadro séptico. MÉTODOS: Estudo clínico, prospectivo e observacional, incluindo pacientes com sepse grave ou choque séptico com menos de 48 horas de instalação da disfunção orgânica. Os níveis de homocisteína foram determinados no dia da inclusão no estudo e nos dias 3, 7, 14. A associação entre homocisteína com o escore Sequential Organ Failure Assessment (SOFA) foi avaliada pelo teste de Sperman e com mortalidade pelo teste de Mann-Whitney. Os resultados foram considerados significativos se p<0,05. RESULTADOS: Foram incluídos 21 pacientes e feitas 60 coletas para avaliação da homocisteina total (mediana de 6,92 (5,27 - 9,74 μmol/l). O teste de correlação Spearman não mostrou associação entre homocisteina e SOFA (r = -0,15 e p = 0,26). Também não foi encontrada correlação da medida de homocisteína na data de admissão do estudo e a diferença do SOFA obtido no 3º dia e o SOFA da admissão (deltaSOFA) (r = 0,04 e p = 0,87). A variação da homocisteína do 3º dia e a admissão no estudo (deltaHmc) e a variação do SOFA no mesmo período não estavam correlacionadas (r = -0,11 e p = 0,66). A homocisteina da admissão não se correlacionou com mortalidade na UTI (p=0,46) ou com a mortalidade hospitalar.(p=0,13). Mesmo quando foi utilizado o deltaHmc não houve correlação (p=012 e p=0,99, respectivamente). CONCLUSÃO: O nível basal de homocisteína ou sua variação nos primeiros dias da disfunção não estiveram relacionadas com a piora dos parâmetros funcionais dos sistemas orgânicos ou mortalidade nos pacientes sépticos.Universidade Federal de São Paulo (UNIFESP) Setor de Terapia Intensiva da Disciplina de Anestesiologia, Dor e Terapia IntensivaUniversidade Federal de São Paulo (UNIFESP)UNIFESP, Setor de Terapia Intensiva da Disciplina de Anestesiologia, Dor e Terapia IntensivaUNIFESPSciEL

Photobiomodulatory effect of low-intensity laser radiation on multicellular spheroids

Photobiomodulatory effects of low-intensity laser radiation (LILR) in cells cultured in standard, two-dimensional conditions are well established. Conversely, the characteristics of this effect in three-dimensional (3D) cultures, which are currently recommended due to the greater similarity with cellular behavior in vivo, have not yet been widely investigated. The objective of this work was to analyze the biomodulator effect of LILR, on the wavelength (λ) of 685 nm, on the constitution process and on the viability of cells cultured as multicellular spheroid (MSs). For this, agarose molds containing microwells were seeded (2x105 cell/ml) with osteogenic precursor cells (OPCs - MC3T3-E1) and kept under ideal culture conditions. The molds were irradiated for five consecutive days with doses of 0.5, 1.0 and 1.5 J/cm², the first irradiation being performed immediately after sowing. The process of constitution of MSs was analyzed and the cultures were submitted to the cell viability test. The results demonstrated that the LILR at λ 685 nm exerted a dose-dependent biomodulatory effect on cell metabolism and on the process of constituting the MSs of OPCs. These results demonstrate the potential of photobiomodulation to contribute to the process of constituting MSs, which can be explored in the strategies of multicellular spheroids therapy used in regenerative medicine and bioprinting.Os efeitos biomoduladores da radiação laser de baixa intensidade (RLBI) em células cultivadas em condição bidimensional padrão já estão bem estabelecidos. Em contrapartida, as características desse efeito em cultivos tridimensionais (3D), atualmente recomendados devido à maior similaridade com o comportamento celular in vivo, ainda não foram amplamente investigados. O objetivo deste trabalho foi analisar o efeito biomodulador da RLBI, no comprimento de onda (λ) de 685 nm, no processo de constituição e na viabilidade de células cultivadas como esferoides multicelulares (EMs). Para tal, moldes de agarose contendo micropoços foram semeados (2x105 células/ml) com células precursoras osteogênicas (CPOs - MC3T3-E1) e mantidas sob condições ideais de cultivo. Os moldes foram irradiados por cinco dias consecutivos com doses de 0.5, 1.0 e 1.5 J/cm², sendo a primeira irradiação realizada imediatamente após a semeadura. Foram analisadas o processo de constituição dos EMs e os cultivos foram submetidas ao ensaio de viabilidade celular. Os resultados demonstraram que a RLBI no λ 685 nm exerceu um efeito biomodulador dose-dependente sobre o metabolismo celular e sobre o processo de constituição dos EMs de CPOs. Estes resultados evidenciam a potencialidade da fotobiomodulação em contribuir com o processo de constituição dos EMs, podendo ser explorado nas estratégias de terapia celular utilizadas em medicina regenerativa e bioimpressão.

Sexualidade e gênero na escola: construindo atividades formativas na rede pública de ensino através do PIBID.

O Programa Institucional de Bolsas de Iniciação à Docência (PIBID) vem se configurando como uma importante polí­tica pública para o fortalecimento da formação inicial e permanente de professores, articulando universidade e escola básica. Neste contexto o presente trabalho vem explicitar as ações formativas construí­das e vividas no ano de 2014, em um subprojeto PIBID vinculado ao curso de Licenciatura em Ciências Biológicas da Universidade Federal de São Carlos campus Sorocaba, em parceria com a E. E. Professor Benedicto Leme Vieira Neto localizada na cidade de Salto de Pirapora - SP. A partir de uma pesquisa sociocultural deu-se iní­cio às atividades junto aos educandos do ensino médio, com o intuito de compreender as contradições e problemáticas vividas pela comunidade escolar. A partir dessa investigação e da demanda identificada pela escola – gravidez na adolescência – ocorreram desdobramentos para a abordagem de assuntos referentes às construções de sexualidade e gênero, com base nos procedimentos dos Momentos Pedagógicos. O processo de elaboração e desenvolvimento das ações formativas envolvendo docentes do ensino superior e básico, bem como licenciandas em processo de formação inicial constitui o foco dos resultados apresentados e discutidos

Nasal polyposis : more than a chronic inflammatory disorder : a disease of mechanical dysfunction : the São Paulo position

Introduction The importance of our study lies in the fact that we have demonstrated the occurrence of mechanical dysfunction within polypoid tissues, which promotes the development of polyps in the nasal cavity. Objective To change the paradigm of nasal polyposis (NP). In this new conception, the chronic nasal inflammatory process that occurs in response to allergies, to pollution, to changes in the epithelial barrier, or to other factors is merely the trigger of the development of the disease in individuals with a genetic predisposition to an abnormal tissue remodeling process, which leads to a derangement of the mechanical properties of the nasal mucosa and, consequently, allows it to grow unchecked. Data Synthesis We propose a fundamentally new approach to intervening in the pathological process of NP, addressing biomechanical properties, fluid dynamics, and the concept of surface tension. Conclusion The incorporation of biomechanical knowledge into our understanding of NP provides a new perspective to help elucidate the physiology and the pathology of nasal polyps, and new avenues for the treatment and cure of NP

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

Recent advances in lanthanide spectroscopy in Brazil

This review discusses recent advances in lanthanide spectroscopy involving luminescence applications Q2 carried out in Brazil. The revised topics include glasses, sol–gel, light-emitting diodes, nanoparticles, metal–organic frameworks, coordination polymers, thin films, energy transfer processes, upconversion and development of new theoretical tools. The important role played by Prof. Oscar L. Malta on this subject is evidenced by his many contributions to the broad range of investigations reported here and this review is dedicated to him, on the occasion of his 60th birthday

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030