Predicting post-discharge complications in cardiothoracic surgery: A clinical decision support system to optimize remote patient monitoring resources.

Cardiac surgery patients are highly prone to severe complications post-discharge. Close follow-up through remote patient monitoring can help detect adverse outcomes earlier or prevent them, closing the gap between hospital and home care. However, equipment is limited due to economic and human resource constraints. This issue raises the need for efficient risk estimation to provide clinicians with insights into the potential benefit of remote monitoring for each patient. Standard models, such as the EuroSCORE, predict the mortality risk before the surgery. While these are used and validated in real settings, the models lack information collected during or following the surgery, determinant to predict adverse outcomes occurring further in the future. This paper proposes a Clinical Decision Support System based on Machine Learning to estimate the risk of severe complications within 90 days following cardiothoracic surgery discharge, an innovative objective underexplored in the literature. Health records from a cardiothoracic surgery department regarding 5 045 patients (60.8% male) collected throughout ten years were used to train predictive models. Clinicians' insights contributed to improving data preparation and extending traditional pipeline optimization techniques, addressing medical Artificial Intelligence requirements. Two separate test sets were used to evaluate the generalizability, one derived from a patient-grouped 70/30 split and another including all surgeries from the last available year. The achieved Area Under the Receiver Operating Characteristic curve on these test sets was 69.5% and 65.3%, respectively. Also, additional testing was implemented to simulate a real-world use case considering the weekly distribution of remote patient monitoring resources post-discharge. Compared to the random resource allocation, the selection of patients with respect to the outputs of the proposed model was proven beneficial, as it led to a higher number of high-risk patients receiving remote monitoring equipment.

In silico and in vitro elastase inhibition assessment assays of rosmarinic acid natural product from Rosmarinus officinalis Linn.

The use of various herbs and their compounds has been a strategy widely used in the fight against various human diseases. For example, rosmarinic acid, a bioactive phenolic compound commonly found in Rosemary plants (Rosmarinus officinalis Labiatae), has multiple therapeutic benefits in different diseases, such as cancer. Therefore, the study aimed to evaluate in silico and in vitro the inhibition potential of the enzyme Elastase from the porcine pancreas by rosmarinic acid isolated from the plant species R. officinalis Linn. Through Molecular Docking, the mechanism of action was investigated. In addition, rosmarinic acid presented a range of 5-60 µg/mL and significantly inhibited Elastase. At 60 µg/mL, there was an inhibition of 55% on the enzymatic activity. The results demonstrate the inhibition of Elastase by rosmarinic acid, which can lead to the development of new enzyme inhibitors that can be an inspiration for developing various drugs, including anticancer drugs.

Experiência de psicólogas(os) brasileiras(os) com atendimento psicológico online durante a primeira onda da pandemia de covid-19 / Brazilian psychologists' experience with online psychotherapy during the first wave of the covid-19 pandemic / Experiencia de los psicólogos brasileños con la atención psicológica en línea durante la primera ola de la pandemia de la covid-19

Com a emergência da pandemia de Covid-19, as(os) psicólogas(os) passaram a oferecer atendimento online para pacientes que até então eram atendidos de forma presencial. Na maior parte dos casos, essa mudança se deu de forma improvisada e sem capacitação prévia. Nesse contexto, este estudo, de caráter descritivo-exploratório, quanti-qualitativo e com delineamento transversal, buscou compreender a experiência das(os) psicólogas(os) na transição das intervenções da modalidade presencial para o atendimento remoto durante a pandemia de Covid-19 no Brasil, identificando dificuldades e lacunas percebidas nas orientações disponibilizadas pelo Conselho Federal de Psicologia. Participaram da pesquisa 385 psicólogas(os). Utilizou-se um questionário online para a coleta dos dados, distribuído por meio de uma plataforma digital entre maio e novembro de 2020. O estudo também foi divulgado em grupos da categoria profissional da psicologia em diversas redes sociais. Os dados quantitativos foram analisados por meio de análise estatística descritiva, e as respostas para as questões abertas por meio de análise temática reflexiva. Os achados foram organizados em três categorias temáticas: (a) lacunas percebidas nas orientações quanto à escolha da plataforma digital; (b) lacunas quanto ao preenchimento do cadastro no site E-Psi ; e (c) falta de treinamento adequado para realizar a transição para o formato online. Entre os principais resultados, destacaram-se a insegurança gerada pela falta de preparo prévio das(os) profissionais e a resistência de alguns clientes a aceitar a transposição dos atendimentos do modelo presencial para o online. Espera-se que o mapeamento das principais dificuldades enfrentadas pela categoria contribua para qualificar o debate sobre a efetividade das orientações disponibilizadas para as(os) psicólogas(os).(AU)

With the emergence of the COVID-19 pandemic, psychologists began to offer online consultations to their patients, who were previously seen in person. In most cases, this change happened in an improvised way and with no prior training required. In this context, this study, of a descriptive-exploratory, quanti-qualitative character with cross-sectional design, aimed to understand the experience of psychologists in the transition from in-person to remote modality during the COVID-19 pandemic in Brazil, identifying difficulties and gaps regarding the guidelines provided by the Federal Council of Psychology. A total of 385 psychologists participated in the research. An online questionnaire was used for data collection, distributed via a digital platform between May and November 2020. The study was also shared in professional Psychology groups on several social networks. The quantitative data were analyzed by descriptive statistical analysis, and the answers to the open questions by reflective thematic analysis. The findings were organized into three thematic categories: (a) gaps perceived in the guidance regarding the choice of the digital platform; (b) gaps regarding the completion of the registration on the E-Psi website; and (c) lack of adequate training to make the transition to the online format. Among the main results were the insecurity generated by the lack of previous preparation of the professionals and the resistance of some clients to accept the transposition of the face-to-face services to the online model. It is expected that the mapping of the main difficulties faced by the category will contribute to qualify the debate about the effectiveness of the orientations made available to psychologists.(AU)

Con la emergencia de la pandemia de Covid-19, las(os) psicólogas(os) comenzaron a ofrecer atención psicológica en línea a pacientes que hasta entonces eran atendidos de forma presencial. Este cambio se producía a menudo de forma improvisada y sin la formación previa necesaria. Este estudio descriptivo, exploratorio, cuanticualitativo, con enfoque transversal, tuvo como objetivo comprender la experiencia de estos profesionales en la transición del trabajo presencial al remoto durante la pandemia de Covid-19 en Brasil, identificando dificultades y lagunas percibidas en las directrices del Consejo Federal de Psicología. Participaron en la investigación 385 psicólogos(as). Para la recogida de datos se utilizó un cuestionario en línea distribuido por plataforma digital entre mayo y noviembre de 2020. El estudio también se difundió en grupos de la categoría profesional de la Psicología en diversas redes sociales. Los datos cuantitativos se analizaron mediante análisis estadístico descriptivo, y las respuestas a las preguntas abiertas mediante análisis temático reflexivo. Los resultados se organizaron en tres categorías temáticas: (a) lagunas percibidas en la orientación sobre la elección de la plataforma digital; (b) lagunas relativas a la realización de la inscripción en el sitio web E-Psi ; y (c) falta de formación adecuada para realizar la transición al formato en línea. Entre los principales resultados, destacaron la inseguridad generada por la falta de preparación previa de los profesionales y la resistencia de algunos clientes a aceptar la transición de los servicios del modelo presencial al modelo en línea. Se espera que el estudio de las principales dificultades a las que se enfrenta la categoría contribuya a matizar el debate sobre la eficacia de las orientaciones puestas a disposición de los(as) psicólogos(as).(AU)

Tratamento de feridas complexas com prótese de PVC e enxerto parcial de pele autólogo: Protocolo acelerado e de baixo custo de cicatrização por terceira intenção / Treatment of complex wounds with PVC prosthesis and autologous partial skin graft: Accelerated and low-cost third-intention healing protocol

Introdução: Feridas complexas são lesões tegumentares graves, de difícil resolução com curativos convencionais. O objetivo deste estudo foi descrever uma técnica de cicatrização de feridas por terceira intenção, reprodutível e de baixo custo, aplicável a feridas complexas, utilizando uma prótese de policloreto de vinila (PVC) colocada temporariamente na área da lesão para promover proteção e estimular sua "granulação", seguida de enxerto autólogo de pele de espessura parcial. Método: De forma consecutiva, foram selecionados 20 pacientes com feridas complexas, decorrentes de causas externas, divididos em 2 grupos: A - pacientes que foram submetidos à técnica de cobertura com prótese de PVC, seguida de enxerto; e B - pacientes submetidos aos cuidados da equipe de curativo, com trocas diárias até granulação da ferida, padrão da nossa instituição. Os pacientes foram avaliados quanto ao tempo de internação; custos; em relação à dor local; à presença de complicações; ao tempo até a alta médica; e à satisfação do paciente. Resultados: O tempo de internamento e seus custos, assim como o tempo até a alta médica, foram menores no grupo A (p<0,05). Todavia, não houve diferença estatisticamente significativa em relação à dor local entre as técnicas A e B. Conclusão: A técnica utilizando prótese de PVC e enxerto possui boa eficácia para o tratamento de feridas complexas, sendo reprodutível e de baixo custo.

Introduction: Complex wounds are serious tegumentary injuries that are difficult to resolve with conventional dressings. This study aimed to describe a third-intention wound healing technique, reproducible and low cost, applicable to complex wounds, using polyvinyl chloride (PVC) prosthesis temporarily placed in the injured area to promote the protection and stimulate its "granulation," followed by autologous partial-thickness skin grafting. Method: Consecutively, 20 patients with complex wounds resulting from external causes were selected and divided into 2 groups: A - patients who underwent the coverage technique with PVC prosthesis, followed by grafting, and B - patients submitted to the care of the dressing team, with daily changes until wound granulation, standard in our institution. Patients were evaluated regarding length of stay; costs; local pain; complications; the time until medical discharge; and patient satisfaction. Results: The length of hospital stay, its costs, and the time until medical discharge were shorter in group A (p<0.05). However, there was no statistically significant difference in local pain between techniques A and B. Conclusion: The technique using PVC prosthesis and graft has good efficacy for treating complex wounds, being reproducible and inexpensive.

Assessment of Harbour Porpoise Bycatch along the Portuguese and Galician Coast: Insights from Strandings over Two Decades.

The Iberian harbour porpoise population is small and fisheries bycatch has been described as one of its most important threats. Data on harbour porpoise strandings collected by the Portuguese and Galician stranding networks between 2000 and 2020 are indicative of a recent mortality increase in the western Iberian coast (particularly in northern Portugal). Overall, in Portugal and Galicia, individuals stranded due to confirmed fishery interaction represented 46.98% of all analysed porpoises, and individuals stranded due to probable fishery interaction represented another 10.99% of all analysed porpoises. Considering the Portuguese annual abundance estimates available between 2011 and 2015, it was possible to calculate that an annual average of 207 individuals was removed from the population in Portuguese waters alone, which largely surpasses the potential biological removal (PBR) estimates (22 porpoises, CI: 12-43) for the same period. These results are conservative and bycatch values from strandings are likely underestimated. A structured action plan accounting for new activities at sea is needed to limit the Iberian porpoise population decline. Meanwhile, there is an urgent need for a fishing effort reorganization to directly decrease porpoise mortality.

Assessment of the environmental acceptability of potential artificial reef materials using two ecotoxicity tests: Luminescent bacteria and sea urchin embryogenesis.

Ecotoxicological analysis of construction products is a relatively unexplored area at international level. Aquatic toxicity tests on construction products has been recommended recently for freshwater environment. However, the biological effects of alternative materials on marine ecosystem are still not considered. In this study, the main aim was to assess the environmental impact of alternative mortars proposed as artificial reefs (ARs) materials. The ARs specimens were developed by 3D printing, based on cement and geopolymer mortars using recycled sands of glass and seashells. For this purpose, a leaching test and two different toxicity bioassays, luminosity reduction of marine bacteria Vibrio fischeri (Microtox®) and the success of embryo-larval development of sea-urchin Paracentrotus lividus, were conducted. From the leaching results it should be noted that the mobility of all trace elements considered in both, raw materials and mortars, meet the inert landfill limits, except As, Mo, Se or Sb in the leachates geopolymer mortars. However, the results obtained from the both bioassays show low environmental acceptability for those mortars containing shell sand, probably due to the degradation of the organic matter adhered to the shells. On the other hand, cement mortars obtain better results than geopolymer mortars, regardless of the aggregate used, showing certain consistency with the leaching behaviour, since they present the lowest mobility of trace chemical elements. Therefore, the results supporting the environmental acceptability of its potential use as alternative materials in the production of ARs.

Resilience Perception of a Mining Town in Eastern Amazonia: A Case Study of Canaã Dos Carajás, Brazil.

The ability of communities to react to risks and disturbances is for their balance, development, and sustainability. The concept of resilience provides a way to think about policies and actions for future changes in socioeconomic and ecological-environmental systems. This paper analyzes, in the context of mining, the perception of the resilience of Canaã dos Carajás population in Pará State, Brazilian Amazon. The methodology involved face-to-face interviews based on a structured questionnaire conducted on a sample of 140 residents stratified from 11 social actors in the Canaã community. This approach allowed the evaluation of resilience perception using 26 interview statements derived from six resilience theories. Our multivariate analysis found that the level of residents' perception of resilience was reasonable (with an average score of 3.04 ± 0.22 using a Likert scale, with a Cronbach's alpha of 0.788). The interviewees pointed out one positive and five negative factors that influenced the level of resilience in Canaã. According to residents' perceptions, the resilience of Canaã dos Carajás was moderate but could have been improved with more economic diversification, more infrastructure, and less inequality in access to services and participation in decision-making. The considered most relevant themes were problems caused by mining in the municipality, quality of life issues, difficulties dealing with change after the arrival of mining, and economic problems. This study contributes to the literature because it used theories as a conceptual orientation for the development of a resilience scale to measure resilience at the community level in the context of large-scale mining.

Quantitative FTA using Monte Carlo analyses in a pharmaceutical plant.

The evaluation of faults in a multipurpose pharmaceutical pilot plant used for production of polymer particles was performed, integrating traditional Fault Tree Analyses (FTA) and Monte Carlo procedures and employing tools of the quality risk management methodology for production of medicines. The plant was divided into four basic processes: (i) receipt and sampling of materials; (ii) treatment of purified water; (iii) reaction; and (iv) lyophilization and purification. For each process, the most critical failure was selected, and the FTA was built. Selection of basic events considered the most important effects on the final quality of the medicine. Then, the FTA was reduced to basic events using Boolean algebra. The quantitative assessment was made by assigning failure rate values for each event. The reliability data of the failure rates were based on the literature that deals with similar processes. The frequencies for each fault were determined through Monte Carlo simulations, considering that fault probability distributions followed the exponential distribution. When failure rate (ʎ) data are available, the quality management can establish a prediction of plant behavior over a period. This scenario is consistent and coherent with practices of pharmaceutical sites, since occurrence of high rates of failure must be corrected immediately in order to preserve the safety of the operation.

Sitio web sobre medios diagnósticos para el estudio del segmento anterior ocular en Oftalmología / Website on diagnostic procedures for the study of the anterior ocular segment in Ophthalmology

Fundamento: las nuevas plataformas de las tecnologías de la información y las comunicaciones constituyen una vía adecuada para el diagnóstico de enfermedades del segmento anterior ocular, en Oftalmología. Objetivo: diseñar un sitio web sobre medios diagnósticos para el análisis del segmento anterior ocular utilizando las nuevas plataformas tecnológicas. Métodos: se realizó una investigación de desarrollo tecnológico en el Hospital General Docente "Abel Santamaría Cuadrado" de Pinar del Río, de septiembre 2014 a octubre 2015. Se utilizaron métodos teóricos: inducción-deducción y análisis-síntesis que permitieron concretar la revisión de la bibliografía en diferentes sitios disponibles en Internet; y como empírico se aplicó un cuestionario para valorar el producto a partir de los criterios de los usuarios y de expertos. Resultados: la confección del sitio web se desarrolló utilizando el lenguaje de marcado de hipertexto (HTML) mediante Wordpress 4.2.4. y para procesar sus elementos se emplearon los programas Adobe Photoshop 8.0 y Microsoft Office 2013. Contiene textos e imágenes, actividades interactivas de autoevaluación y refiere sitios oficiales sobre el tema para su consulta. Conclusiones: el sitio web constituye un compendio de los principales medios diagnósticos para las subespecialidades de Córnea y Cirugía Refractiva y ofrece información útil y actualizada para especialistas en formación y egresados. Fue valorado como muy adecuado, tanto por los usuarios como por los expertos.

Background: the new platforms of information and communication technologies are an adequate way to diagnose diseases of the anterior ocular segment, in Ophthalmology. Objective: to design a website on diagnostic Procedures for the analysis of the anterior ocular segment using the new technological platforms. Methods: a technological development research was carried out in the "Abel Santamaría Cuadrado" General Teaching Hospital in Pinar del Río, from September 2014 to October 2015. Theoretical methods were used: induction-deduction and analysis-synthesis, which allowed finalizing the review of the bibliography in different sites available on the Internet; and as empirical ones a questionnaire was applied to evaluate the product based on the criteria of the users and experts. Results: the preparation of the website was developed using the hypertext markup language (HTML) using Wordpress 4.2.4. To process its elements, the Adobe Photoshop 8.0 and Microsoft Office 2013 programs were used. It contains texts, images and videos, interactive self-evaluation activities and refers official sites on the subject for consultation. Conclusions: the website constitutes a compendium of the main diagnostic procedures for the subspecialties of Cornea and Refractive Surgery and offers useful and updated information for training specialists and graduates. It was rated as very suitable, both by users and experts.

Assessment of IrisPlex-based multiplex for eye and skin color prediction with application to a Portuguese population.

DNA phenotyping research is one of the most emergent areas of forensic genetics. Predictions of externally visible characteristics are possible through analysis of single nucleotide polymorphisms. These tools can provide police with "intelligence" in cases where there are no obvious suspects and unknown biological samples found at the crime scene do not result in any criminal DNA database hits. IrisPlex, an eye color prediction assay, revealed high prediction rates for blue and brown eye color in European populations. However, this is less predictive in some non-European populations, probably due to admixing. When compared to other European countries, Portugal has a relatively admixed population, resulting from a genetic influx derived from its proximity to and historical relations with numerous African territories. The aim of this work was to evaluate the utility of IrisPlex in the Portuguese population. Furthermore, the possibility of supplementing this multiplex with additional markers to also achieve skin color prediction within this population was evaluated. For that, IrisPlex was augmented with additional SNP loci. Eye and skin color prediction was estimated using the multinomial logistic regression and binomial logistic regression models, respectively. The results demonstrated eye color prediction accuracies of the IrisPlex system of 90 and 60% for brown and blue eye color, respectively, and 77% for intermediate eye color, after allele frequency adjustment. With regard to skin color, it was possible to achieve a prediction accuracy of 93%. In the future, phenotypic determination multiplexes must include additional loci to permit skin color prediction as presented in this study as this can be an advantageous tool for forensic investigation.

The challenges for solid waste management in accordance with Agenda 21: a Brazilian case review.

This paper aims to evaluate the suitability of the Brazilian solid waste policy (BSWP) with global Agenda 21 and the challenges of implementing the BSWP in municipalities. For this, a review of the principles that guided the creation of this policy was performed to demonstrate that international pressures were important in determining its effectiveness. The contradictory relationship between the satisfactory legal framework that established the Brazilian waste management policy and its weakened implementation in the municipalities is also examined . To illustrate the difficulties faced at the local level, a case study involving municipalities that compose the state of Espírito Santowe was undertaken. In this state, the municipalities signed terms of environmental commitment with supervisory agencies who undertook, within a pre-established schedule, to implement a set of actions to shape the proper management of solid waste, adapted to the requirements of national policy and the guidelines of Agenda 21. Finally, the various difficulties in meeting the requirements are discussed. It is necessary and urgent that Brazil finds a way to coordinate the mechanisms of an innovative and well formulated legal instrument to ensure the successful implementation of solid waste management at the local level to achieve the environmental, economic and social objectives.

A evaluación de latencia y duración de la analgesia de una dosis individual de morfina peridural para el manejo del paciente con dolor crónico oncológico agudizado / Assessment of latent period and duration of an epidural morphine single dose analgesia in patients with severe oncological chronic pain

Objetivo: Establecer la dosis del sulfato de morfina peridural para el manejo del dolor oncológico crónico agudizado, duración analgésica, tiempo de latencia y efectos colaterales. Material y métodos: Se estudiaron 30 pacientes de ambos sexos, de 30 a 70 años de edad, con diagnóstico de dolor oncológico crónico agudizado con EVA de 7 o mayor se dividieron en 3 Grupos cada uno de 10 pacientes, a los cuales se les administró morfina peridural dosis única: Grupo 1: 30 mcg/kg, Grupo 2: 50 mcg/kg, Grupo 3: 75 mcg/kg. Se valoró el tiempo de latencia y duración de la dosis a los 5ï, 10ï, 15ï, 20ï, 40ï, 60ï, 2, 3, 4, 5, 6 y posteriormente cada 2 horas hasta que el paciente presentara nuevamente el dolor. La valoración de la analgesia se realizó por medio de la Escala Visual Análoga (EVA). Se registraron los parámetros hemodinámicos (presión arterial, frecuencia cardiaca, frecuencia respiratoria). Resultados: Se estudiaron 30 pacientes, 18 pacientes del sexo femenino y 12 pacientes del sexo masculino, con un promedio de edad de 58.3 años. Encontramos durante la fase de estudio adecuado control del dolor de acuerdo a la calificación del EVA al disminuir los valores basales de 8.4 a 3.8 en el Grupo 1, de 8.4 a 3.9 en el Grupo 2, y de 8.3 a 3.4 en el Grupo 3. La latencia para el Grupo 1 fue de 14ñ 1.5 min con una duración de 417ñ29.8, Grupo 2 de15.1ñ6.1 min con una duración de 459ñ6.1, y el Grupo 3 de 9.5ñ1.0 con una duración de 648ñ120.1. Los efectos colaterales más evidentes fueron náusea, vómito, y prurito, siendo más frecuentes en el Grupo 3. Discusión: Consideramos que la dosis para el manejo del dolor oncológico crónico agudizado, con bolo inicial único de morfina por vía peridural es de 50 mcg/kg, encontrando una analgesia aceptable, con una duración adecuada y menos efectos colaterales.