Virtual reality interactive simulator for training healthcare professionals in the use of ionising radiations

The application of ionizing radiation in medicine requires a rigorous attention to procedures in order to minimize the risks to the healthcare professional and to the patient. Risk minimization involves the training of the professional and the adequacy of the facilities. Virtual Reality (VR) is an already consolidated tool for training procedures, including those of the health sciences. In this context, an interactive VR simulator representing a radiotherapy room (bunker) for training healthcare professionals and the inspectors of such facilities was developed. This VR model allows the user to perform the normal activities on the operation and the inspection procedures of the facility. The model was based on the blueprints of a real radiotherapy clinic. The virtual model of the radiotherapy bunker, developed at the Institute of Nuclear Engineering, was presented to experts of the General Coordination of Medical and Industrial Facilities of CNEN and is in the process of receiving small modifications to the specific needs for its adequateness, as a training tool, in a training course, sponsored by the International Atomic Energy Agency (IAEA), for inspectors of radiotherapy installations. This work shows the possibility of using Virtual Reality in the development of training tools for professionals working in radioactive installations

Qualidade e Consumo do Leite Bovino do Vale do Ribeira

Preocupados con el perfil del consumo de leche en la región de Vale do Ribeira/PR el proyecto pertenecienteal programa “Universidade Sem Fronteras” de la SETI/PR en sociedad con el PROLAC – ProjetoLeite, Alimento de Criança, decidió mejorar la calidad de leche bovina y analizar el perfil del consumode leche y derivados de la población de la región. Para alcanzar los objetivos fueron realizadas visitas en39 propiedades rurales, evidenciando los problemas higiénico-sanitarios siendo estos corregidos. Resultoen la mejora de 33% en la producción de leche y considerables mejorías en la calidad de leche. También,como herramienta de la acción, fueron dadas conferencias en escuelas municipales y estatales de primariay secundaria, para el análisis del perfil de la consumición de leche de los alumnos de la región. Todos losalumnos de Adrianópolis (100%) con hasta 10 años dicen injerir 2 vasos de la leche por día, mientras que30.3% de los alumnos de Bocaiúva do Sul con esta venda del etária consumen cantidad inferior recomendadapara los nutricionistas. Importantes cantidad de individuos (40.89% en Adrianópolis y 21.3% en Bocaiúvadel Sul) consume derivados de origen casera y artesanal, sin garantías higiénicas y sanitarias. El consumode leche es inferior al recomendado por el “National Institute of Heath” (Instituto Nacional de la Salud),para los niños de hasta 12 años, siendo aproximadamente 4 y 5 vasos de leche por día. Hace necesaria lacontinuación del trabajo para concientizar el producto rural de la importancia para mejorar la calidad deleche producida y estimular el consumo de leche y derivados de la derivación de estas características.Worried about the profile of milk consumption in the region of the Vale do Ribeira/PR, the pertaining Projectof the Program Universidade sem Fronteiras from SETI/PR, in partnership with the PROLAC – Projeto Leite,Alimento de Criança, targeted to improve the quality of bovine milk and to analyze the profile of the milkconsumption and derivatives of the population of the Region. To reach the objectives, visits in 39 countryproperties had been carried through, evidencing hygienical-sanitary problems,wich were solved. This redisposultedin the improvement of 33% in the production of milk and considerable improvements in the qualityof this milk. Also, as action tools, lectures in municipal and state elementary and high schools been given,to an analysis of the profile of milk consumption of the pupils from the region. All the pupils of Adrianópolis(100%) under 10 years old reported that they ingested 2 cupsoper day, while 30.3% of the children fromBocaiúva do Sul uder that age consumed an inferior amount i relation to the recommended nutritionists.Some important parcel of individuals (40.89% in Adrianópolis and 21.3% in Bocaiúva do Sul) consumesdairy products from homemade and artisanal origin, without hygienical-sanitary guarantees. The daily milkconsumption is inferior to what is recommended byf the National Institute of Health for children up to 12years old, that is approximately 4-5 cups of milk per day. The continuation of that work becomes necessaryto the agricultural producer’s awareness of the importance in improving the productive quality of milk andstimulating the consumption of milk and dairy products which come from those properties.Preocupados com o perfil de consumo de leite na região do Vale do Ribeira/PR, o Projeto pertencente aoPrograma Universidade Sem Fronteiras da SETI/PR em parceria com o PROLAC - Projeto Leite, Alimentode Criança, objetivou melhorar a qualidade do leite bovino e analisar o perfil do consumo de leite e derivadosda população dessa Região. Para alcançar os objetivos foram realizadas visitas em 39 propriedadesrurais, constatando problemas higiênico-sanitários e corrigindo-os. Isso resultou na melhora de 33% naprodução de leite e consideráveis melhorias na qualidade. Também, como ferramentas de ação, foramministradas palestras em escolas municipais e estaduais de nível fundamental e médio, para análise doperfil do consumo de leite dos alunos da região. Todos os alunos de Adrianópolis (100%) com até 10 anosrelatam ingerir 2 copos leite/dia, enquanto 30,3% dos alunos de Bocaiúva de Sul, com esta faixa etária,consomem quantidade inferior à recomendada por nutricionistas. Importante parcela de indivíduos (40,89%em Adrianópolis e 21,3% em Bocaiúva do Sul) consome derivados de origem caseira e artesanal, semgarantias higiênico-sanitárias. O consumo de leite diário é inferior ao recomendado pelo National Instituteof Health para crianças de até 12 anos, que é de aproximadamente 4 a 5 copos leite/dia. Faz-se necessáriauma intensa ação extensionista para conscientizar o produtor da importância de melhorar a qualidadeprodutiva e estimular o consumo de leite e derivados oriundos dessas propriedades

Impactos ambientais do manejo agroecológico da caatinga no Rio Grande do Norte.

O objetivo deste trabalho foi avaliar os impactos ambientais do manejo agroecológico da caatinga, em unidades de produção familiar no Rio Grande do Norte, pelo método Ambitec de produção animal - dimensão ambiental, desenvolvido pela Embrapa Meio Ambiente. Foram avaliadas sete unidades de produção familiar, em quatro projetos de assentamentos de reforma agrária do Município de Apodi, RN. Os dados para o levantamento foram obtidos por meio de questionários aplicados aos representantes das unidades produtivas familiares, que atribuíram, a cada variável estudada, um valor que representou a alteração proporcionada pela implementação da tecnologia. Após a inserção dos coeficientes de alteração de cada variável dos indicadores por unidade de produção, o coeficiente de impacto foi automaticamente calculado por meio da planilha Ambitec. O manejo agroecológico da caatinga resultou num impacto ambiental positivo, e suas maiores contribuições foram relacionadas aos efeitos positivos dos seguintes indicadores: capacidade produtiva do solo, uso de insumos materiais, qualidade do produto e diminuição da emissão de poluentes à atmosfera. Dois indicadores geraram efeitos negativos: o uso de energia e o uso de recursos naturais. Pela superioridade dos benefícios gerados, o manejo agroecológico da caatinga é uma inovação tecnológica geradora de impactos ambientais positivos

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

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 <= 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

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

Análise biocinética do iodo-131 e dosimetria citogenética em pacientes, após administração do radionuclídeo para o tratamento de câncer de tireóide

Pacientes apresentando câncer de tireoide, são submetidos à administração oral de iodo -131 para a eliminação de tecido tireoidiano remanescente, após a realização de tireoidectomia subtotal. A atividade média administrada para este tratamento é de 3,7 GBq (dose para ablação), ocorrendo significante irradiação dos tecidos do corpo. Contudo, existem poucas informações conclusivas na literatura especializada a respeito da dose absorvida por estes pacientes. A partir dessas informações foi dado inicio a um estudo de acompanhamento do comportamento metabólico do radioiodo no organismo de quatro pacientes, através das medidas de sua atividade no corpo inteiro, na tireoide e nas amostras de urina e sangue. Foi realizada também a estimativa da dose absorvida pelos pacientes devido à contribuição da radiação gama do radionuclídeo, através da análise de aberrações cromossômica radioinduzidas em linfócitos. Os resultados deste acompanhamento sugerem que grande parte do tecido tireoidiano remanescente é eliminado até o dia após a dose para ablação e, a partir de então, o iodo-131 encontra-se distribuído de maneira quase que uniforme pelo corpo dos pacientes. A retenção do idodo-131 no corpo, após os dez primeiros dias pode ser representada matematicamente pela soma de dois termos exponenciais: o primeiro, com uma meia-vida biológica aproximadamente igual a 3 dias (meia-vida efetiva = 2,3 dias) e o segundo, com uma meia-vida biológica aproximadamente igual a 26 dias (meia-vida efetiva = 6,2 dias). A dose absorvida estimada através da dosimetria citogenética a partir da média das frequências observadas em 3 pacientes, após a administração da dose para a ablação, variou entre, aproximadamente, 0,3 e 0,4 Gy