In vitro bioassays for monitoring drinking water quality of tap water, domestic filtration and bottled water.

BACKGROUND: Location-specific patterns of regulated and non-regulated disinfection byproducts (DBPs) were detected in tap water samples of the Barcelona Metropolitan Area. However, it remains unclear if the detected DBPs together with undetected DPBs and organic micropollutants can lead to mixture effects in drinking water. OBJECTIVE: To evaluate the neurotoxicity, oxidative stress response and cytotoxicity of 42 tap water samples, 6 treated with activated carbon filters, 5 with reverse osmosis and 9 bottled waters. To compare the measured effects of the extracts with the mixture effects predicted from the detected concentrations and the relative effect potencies of the detected DBPs using the mixture model of concentration addition. METHODS: Mixtures of organic chemicals in water samples were enriched by solid phase extraction and tested for cytotoxicity and neurite outgrowth inhibition in the neuronal cell line SH-SY5Y and for cytotoxicity and oxidative stress response in the AREc32 assay. RESULTS: Unenriched water did not trigger neurotoxicity or cytotoxicity. After up to 500-fold enrichment, few extracts showed cytotoxicity. Disinfected water showed low neurotoxicity at 20- to 300-fold enrichment and oxidative stress response at 8- to 140-fold enrichment. Non-regulated non-volatile DBPs, particularly (brominated) haloacetonitriles dominated the predicted mixture effects of the detected chemicals and predicted effects agreed with the measured effects. By hierarchical clustering we identified strong geographical patterns in the types of DPBs and their association with effects. Activated carbon filters did not show a consistent reduction of effects but domestic reverse osmosis filters decreased the effect to that of bottled water. IMPACT STATEMENT: Bioassays are an important complement to chemical analysis of disinfection by-products (DBPs) in drinking water. Comparison of the measured oxidative stress response and mixture effects predicted from the detected chemicals and their relative effect potencies allowed the identification of the forcing agents for the mixture effects, which differed by location but were mainly non-regulated DBPs. This study demonstrates the relevance of non-regulated DBPs from a toxicological perspective. In vitro bioassays, in particular reporter gene assays for oxidative stress response that integrate different reactive toxicity pathways including genotoxicity, may therefore serve as sum parameters for drinking water quality assessment.

Care for potential brain-dead organ donors in an adult emergency room: a convergent care perspective / Asistencia a potenciales donantes de órganos en muerte encefálica en un servicio de urgencias de adultos: una perspectiva de asistencia convergente / Assistência ao potencial doador de órgãos em morte encefálica em pronto-socorro adulto: perspectiva convergente-assistencial

ABSTRACT Objective: to investigate situations that interfere with health professionals' performance, in the identification and maintenance of potential brain-dead donors in an Adult Emergency Care Unit, and to indicate actions, from the health team's perception, that can promote care for these patients. Method: this is a qualitative, convergent care research, carried out with health professionals from an adult emergency unit, a large public teaching hospital located in southern Brazil. Data were collected between February 2020 and January 2021 through structured participant observation, semi-structured interview and convergence group. Data analysis was performed according to the stages of gathering, synthesis, theorization and transfer. Results: based on data analysis, the difficulties in caring for brain-dead persons, lack of information, inadequate structure and difficulties in the work process were identified as situations that interfere with health professionals' performance in relation to brain-dead potential donors. Actions were signaled to promote care for these people through continuing education activities on the subject, dissemination of information, construction of technologies/protocols, organization of infrastructure and the work process with support for professionals who assist these people. Conclusion: it was evidenced that professional education, the organization of the donation process and systematized actions to improve the work are fundamental factors for the effective care for brain-dead potential organ donors.

RESUMEN Objetivo: investigar situaciones que interfieren en la actuación de los profesionales de la salud, en la identificación y mantenimiento de potenciales donantes en muerte encefálica en una unidad de emergencia de adultos y señalar acciones, en la percepción del equipo de salud, que puedan promover el cuidado de estos pacientes. Método: Investigación cualitativa, de asistencia convergente, realizada con profesionales de la salud de una unidad de emergencia de adultos, de un gran hospital público de enseñanza ubicado en el sur de Brasil. Los datos fueron recolectados entre febrero de 2020 y enero de 2021 a través de observación participante estructurada, entrevista semiestructurada y grupo de convergencia. El análisis de los datos se realizó según las etapas: aprehensión, síntesis, teorización y transferencia. Resultados: con base en el análisis de los datos, las dificultades en la asistencia a la persona con muerte encefálica, falta de información, estructura inadecuada y dificultades en el proceso de trabajo fueron identificadas como situaciones que interfieren en la actuación de los profesionales de la salud en relación al potencial donante en cerebro muerte. Se señalaron acciones para promover la asistencia a estas personas a través de actividades de educación continua en el tema, difusión de información, construcción de tecnologías/protocolos, organización de la infraestructura y del proceso de trabajo con apoyo a los profesionales que asisten a estas personas. Conclusión: se evidenció que la educación profesional, la organización del proceso de donación y acciones sistematizadas para mejorar el trabajo son factores fundamentales para la asistencia eficaz al potencial donante de órganos en muerte encefálica.

RESUMO Objetivo: investigar situações que interferem na atuação dos profissionais da saúde, na identificação e manutenção do potencial doador em morte encefálica em uma unidade de pronto-socorro adulto e sinalizar ações, na percepção da equipe de saúde, que possam promover a assistência a esses pacientes. Método: pesquisa qualitativa, convergente-assistencial, realizada com profissionais de saúde de uma unidade de pronto-socorro adulto, de um hospital-escola público e de grande porte localizado no Sul do Brasil. Os dados foram coletados entre fevereiro de 2020 e janeiro de 2021 por meio de observação estruturada participante, entrevista semiestruturada e grupo de convergência. A análise dos dados foi realizada de acordo com as etapas: apreensão, síntese, teorização e transferência. Resultados: a partir da análise dos dados identificaram-se como situações que interferem na atuação dos profissionais da saúde frente ao potencial doador em morte encefálica as dificuldades na assistência à pessoa em morte encefálica, a falta de informação, estrutura inadequada e as dificuldades no processo de trabalho. Houve sinalização de ações para promover a assistência a essas pessoas por meio de atividades de educação permanente sobre o tema, divulgação de informações, construção de tecnologias/protocolos, organização da infraestrutura e do processo de trabalho com suporte aos profissionais que atendem essas pessoas. Conclusão: evidenciou-se que a educação profissional, a organização do processo de doação e ações sistematizadas para aperfeiçoamento do trabalho são fatores fundamentais para a efetiva assistência ao potencial doador de órgãos em morte encefálica.

Identification of New CTX Analogues in Fish from the Madeira and Selvagens Archipelagos by Neuro-2a CBA and LC-HRMS.

Ciguatera Poisoning (CP) is caused by consumption of fish or invertebrates contaminated with ciguatoxins (CTXs). Presently CP is a public concern in some temperate regions, such as Macaronesia (North-Eastern Atlantic Ocean). Toxicity analysis was performed to characterize the fish species that can accumulate CTXs and improve understanding of the ciguatera risk in this area. For that, seventeen fish specimens comprising nine species were captured from coastal waters inMadeira and Selvagens Archipelagos. Toxicity was analysed by screening CTX-like toxicity with the neuroblastoma cell-based assay (neuro-2a CBA). Afterwards, the four most toxic samples were analysed with liquid chromatography-high resolution mass spectrometry (LC-HRMS). Thirteen fish specimens presented CTX-like toxicity in their liver, but only four of these in their muscle. The liver of one specimen of Muraena augusti presented the highest CTX-like toxicity (0.270 ± 0.121 µg of CTX1B equiv·kg-1). Moreover, CTX analogues were detected with LC-HRMS, for M. augusti and Gymnothorax unicolor. The presence of three CTX analogues was identified: C-CTX1, which had been previously described in the area; dihydro-CTX2, which is reported in the area for the first time; a putative new CTX m/z 1127.6023 ([M+NH4]+) named as putative C-CTX-1109, and gambieric acid A.

Da solidão à cooperação: estratégias de enfrentamento de trabalhadores de enfermagem de terapia intensiva / From loneliness to cooperation: coping strategies of intensive care nursing workers / De la soledad a la cooperación: estrategias de afrontamiento de los trabajadores de enfermería de cuidados intensivos

RESUMO Objetivo: conhecer as estratégias de enfrentamento desenvolvidas pelos trabalhadores de enfermagem de Unidades de Terapia Intensiva para a manutenção da saúde mental. Método: estudo qualitativo descritivo, com trabalhadores de enfermagem de três Centros de Cuidados Intensivos de um estado do sul do Brasil. Dados coletados entre junho de 2019 e julho de 2021 por meio de entrevista semiestruturadas e submetidos à análise temática de conteúdo. Resultados: desvelaram-se estratégias de enfrentamento individuais baseadas em situações geradoras de sofrimento. Evidenciou-se a solidão do trabalho, resultado dos descompassos entre os espaços terapêuticos oferecidos pela instituição e as demandas dos trabalhadores. Por fim, identificou-se a possibilidade de ressignificação da solidão em cooperação por meio das estratégias coletivas como caminho para enfrentamento do sofrimento no trabalho e como fator protetor de maior eficácia. Conclusão: podem-se promover ações coletivas de enfrentamento e atividades que fortaleçam a união e cooperação das equipes de enfermagem em terapia intensiva.

ABSTRACT Objective: to know the coping strategies developed by intensive care unit nurse practioners to maintain mental health. Method: qualitative descriptive study, with nursing workers from three Intensive Care Centers in a southern state of Brazil. Data collected between June 2019 and July 2021 through semi-structured interviews and submitted to thematic content analysis. Results: individual coping strategies based on situations that generate suffering were unveiled. The loneliness of work was evidenced because of the mismatches between the therapeutic spaces offered by the institution and the demands of the workers. Finally, the possibility of re-signifying loneliness in cooperation through collective strategies was identified as a path to face suffering at work and as a protective factor of greater effectiveness. Conclusion: collective coping actions and activities that strengthen the union and cooperation of intensive care nursing teams can be promoted.

RESUMEN Objetivo: conocer las estrategias de afrontamiento desarrolladas por los trabajadores de enfermería de las Unidades de Cuidados Intensivos para el mantenimiento de la salud mental. Método: estudio cualitativo descriptivo, con trabajadores de enfermería de tres Centros de Cuidados Intensivos de un estado del sur de Brasil. Datos recogidos entre junio de 2019 y julio de 2021 mediante entrevistas semiestructuradas y sometidos a análisis de contenido temático. Resultados: se desarrollaron estrategias de afrontamiento individuales basadas en situaciones de riesgo de soborno. Se evidenció la solidez del trabajo, resultado de los desajustes entre los espacios terapéuticos ofrecidos por la institución y las demandas de los trabajadores. Por último, se identificó la posibilidad de resignificar la solidaridad en la cooperación mediante las estrategias colectivas como camino para enfrentar el sufrimiento en el trabajo y como factor protector de mayor eficacia. Conclusión: se pueden promover acciones colectivas de afrontamiento y actividades que fortalezcan la unión y cooperación de los equipos de enfermería en cuidados intensivos.

Toxic effects of bisphenol A diglycidyl ether and derivatives in human placental cells.

BADGE (bisphenol A diglycidyl ether) is a synthesis product of bisphenol A (BPA), which, like other plasticizers, can cross the human placenta and reach the foetus. However, compared to BPA, there is almost no toxicological information. This work investigates the toxicity, endocrine and lipid disruption potential of BADGE and its hydrolysed and chlorinated derivatives (BADGE·H2O and BADGE·2HCl) in human placental JEG-3 cells. The analysis of culture medium by HPLC-ESI(+)-QqQ evidenced a good bioavailability of BADGE·2HCl and BADGE·H2O, but low stability of BADGE. Regardless, BADGE·2HCl and BADGE showed higher cytotoxicity than BADGE·H2O, which was the only compound that significantly inhibited CYP19 activity (IC50 49 ±â€¯5 µM). JEG-3 cells lipidome analyzed by FIA-ESI(+/-)-Orbitrap was significantly altered by exposure to BADGE·2HCl and BADGE at concentrations at the low µM range. BADGE·2HCl lead to a strong decrease of diacyl- and triacyl-glycerides (DGs,TGs) together with some membrane lipids, while BADGE lead to an accumulation of TGs. The results evidence the ability of BADGE and derivatives to affect placental lipid handling and to modulate placental CYP19 activity (BADGE·H2O) and highlights the need to monitor human exposure to these compounds, at least as intensely as BPA is monitored.

Percepções e experiências de trabalhadores de enfermagem sobre o cuidado ao paciente em morte encefálica / Las percepciones y experiencias de los trabajadores de enfermería sobre el cuidado del paciente en muerte encefálica / Perceptions and experiences of nursing workers about patient care in brain death

Objetivo conhecer as percepções e experiências dos trabalhadores de enfermagem atuantes em terapia intensiva acerca do cuidado de pacientes com suspeita ou diagnóstico de morte encefálica. Método pesquisa de abordagem qualitativa, de caráter exploratório-descritivo, realizada com 19 profissionais de enfermagem de um Hospital Universitário no interior do estado do Rio Grande do Sul, Brasil, por meio de entrevista semiestruturada e questionário sociodemográfico. Resultados o cuidado com paciente em morte encefálica está permeado por problemáticas relativas ao desgaste emocional e por complexidade. Além disso, destacam-se as dificuldades na abordagem da família do potencial doador, bem como a falta de qualificação e preparo requeridos para o cuidado. Conclusão o cuidado de enfermagem para com o paciente em morte encefálica está permeado por inúmeras dificuldades e enfrentamentos, resultando na necessidade de qualificação profissional e apoio psicológico para os trabalhadores.

Objetivo conocer las percepciones y experiencias de los trabajadores de enfermería en cuidados intensivos sobre el cuidado de los pacientes con diagnóstico conocido o sospechoso de la muerte encefálica. Método estudio cualitativo, exploratorio-descriptivo, realizado con 19 profesionales de enfermería de un Hospital Universitario en el interior del estado de Rio Grande do Sul, Brasil, por medio de entrevistas y cuestionario sociodemográfico. Resultados el cuidado con el paciente en muerte encefálica está permeado por problemas relacionados con el estrés emocional y la complejidad. Además, se destacan las dificultades para abordar la familia del posible donante, así como la falta de calificación y preparación necesarias para el cuidado. Conclusión la atención de enfermería en el paciente en muerte encefálica está permeada por numerosas dificultades y enfrentamiento, resultando en la necesidad de cualificación profesional y de apoyo psicológico para los trabajadores.

Objective to know the perceptions and experiences of nurse practitioners working in intensive care about the care of patients with known or suspected diagnosis of brain death. Method qualitative, exploratory-descriptive study, performed with 19 nursing professionals from a University Hospital in the countryside of the state of Rio Grande do Sul, Brazil, by means of interviews and sociodemographic questionnaire. Results the care with the patient in brain death is permeated by problems relating to the emotional distress and complexity. Furthermore, the difficulties to approach the potential donor's family stand out, as well as the lack of qualification and training required for the care. Conclusion the nursing care with the patient in brain death is permeated by numerous difficulties and coping, resulting in the need for professional qualification and psychological support for workers.

Doar ou não doar: a visão de familiares frente à doação de órgãos / Donate or not to donate: the view of the family before the organ donation / Donar o no donar: la visión de los familiares ante la donación de órganos

O presente estudo objetiva compreender as motivações que influenciam as famílias na decisão para a doação ou não de órgãos de um familiar adulto. Trata-se de estudo qualitativo, descritivo-exploratório, na modalidade estudo de caso, realizado com três famílias de pacientes diagnosticados com morte encefálica (ME) internados em um hospital público do interior do RS. A produção de dados se deu por meio de entrevista semiestruturada, de setembro a dezembro de 2013, os quais foram submetidos à análise de conteúdo. Pode-se evidenciar que famílias têm motivos para aceitar ou negar a doação de órgãos. O principal motivo para a não doação se deve ao respeito à vontade do potencial doador ou ao desconhecimento sobre o que o potencial doador gostaria que fosse feito nessa situação. Os motivos para aceitar a doação estão relacionados à intenção de ajudar pessoas que precisam e fazer o que o familiar havia lhes pedido. Destaca-se a necessidade de mais estudos relacionados ao processo vivenciado pelas famílias, em torno da morte encefálica e do processo de decisão, para que seja possível compreender com mais profundidade as situações vividas por seus membros durante esse processo.

The present study aims to understand the motivations that influence families in the decision to donate or not the organs of adult relatives. This isa qualitative, descriptive-exploratory study in the case report modality, carried out with three families of patients diagnosed with brain death (BD)hospitalized in a public hospital in the countryside of the state of Rio Grande do Sul. The production of data was done through semi-structured interviews from September to December 2013 and these were submitted to content analysis. It was found that families have reasons to acceptand decline the request for organ donation. The main reason for families choosing not to donate was the respect of the will of the potential donorand the lack of knowledge of what the potential donor would like to be done in this situation. The reasons for accepting the donation are relatedto the intention to help people who need organs and to do what the family member asked them to do. It is worth noting that more studies relatedto the process experienced by families, about brain death and the decision process, are needed to make it possible to understand in greater depththe situations experienced by family members during this process.

Este estudio tiene como objetivo comprender los motivos que influyen en la toma de decisión para la donación de órganos de un familiar adulto. Se trata de un estudio de caso cualitativo, exploratorio y descriptivo, realizado con tres familias de pacientes con diagnóstico de muerte encefálica (ME) ingresados en un hospital público del estado de Rio Grande do Sul. La recogida de datos se realizó a través de entrevistas semiestructuradas, de septiembre a diciembre de 2013. Los datos fueron sometidos al análisis de contenido. Es evidente que las familias tienenmotivos para aceptar o negar la donación de órganos. El motivo principal para rechazar la donación tiene que con ver el respeto a la voluntad del donante o por no saber cuál era su voluntad. Las razones para aceptar la donación se relacionan con la intención de ayudar a las personasy con cumplir con el deseo del familiar donante. Se destaca la necesidad de más estudios relacionados con el proceso que viven las familiasde las personas con muerte cerebral y el proceso de toma de decisión para comprender mejor las situaciones que atraviesan los miembros durante este proceso.

An integrated strategy for rapid and accurate determination of free and cell-bound microcystins and related peptides in natural blooms by liquid chromatography-electrospray-high resolution mass spectrometry and matrix-assisted laser desorption/ionization time-of-flight/time-of-flight mass spectrometry using both positive and negative ionization modes.

An integrated high resolution mass spectrometry (HRMS) strategy has been developed for rapid and accurate determination of free and cell-bound microcystins (MCs) and related peptides in water blooms. The natural samples (water and algae) were filtered for independent analysis of aqueous and sestonic fractions. These fractions were analyzed by MALDI-TOF/TOF-MS and ESI-Orbitrap-HCD-MS. MALDI, ESI and the study of fragmentation sequences have been provided crucial structural information. The potential of combined positive and negative ionization modes, full scan and fragmentation acquisition modes (TOF/TOF and HCD) by HRMS and high resolution and accurate mass was investigated in order to allow unequivocal determination of MCs. Besides, a reliable quantitation has been possible by HRMS. This composition helped to decrease the probability of false positives and negatives, as alternative to commonly used LC-ESI-MS/MS methods. The analysis was non-target, therefore covered the possibility to analyze all MC analogs concurrently without any pre-selection of target MC. Furthermore, archived data was subjected to retrospective "post-targeted" analysis and a screening of other potential toxins and related peptides as anabaenopeptins in the samples was done. Finally, the MS protocol and identification tools suggested were applied to the analysis of characteristic water blooms from Spanish reservoirs.