Enhanced peri-operative care to improve outcomes for high-risk surgical patients in Brazil: a single-centre before-and-after cohort study.

Mortality and morbidity for high-risk surgical patients are often high, especially in low-resource settings. Enhanced peri-operative care has the potential to reduce preventable deaths but must be designed to meet local needs. This before-and-after cohort study aimed to assess the effectiveness of a postoperative 48-hour enhanced care pathway for high-risk surgical patients ('high-risk surgical bundle') who did not meet the criteria for elective admission to intensive care. The pathway comprised of six elements: risk identification and communication; adoption of a high-risk post-anaesthesia care unit discharge checklist; prompt nursing admission to ward; intensification of vital signs monitoring; troponin measurement; and prompt access to medical support if required. The primary outcome was in-hospital mortality. Data describing 1189 patients from two groups, before and after implementation of the pathway, were compared. The usual care group comprised a retrospective cohort of high-risk surgical patients between September 2015 and December 2016. The intervention group prospectively included high-risk surgical patients from February 2019 to March 2020. Unadjusted mortality rate was 10.5% (78/746) for the usual care and 6.3% (28/443) for the intervention group. After adjustment, the intervention effect remained significant (RR 0.46 (95%CI 0.30-0.72). The high-risk surgical bundle group received more rapid response team calls (24% vs. 12.6%; RR 0.63 [95%CI 0.49-0.80]) and surgical re-interventions (18.9 vs. 7.5%; RR 0.41 [95%CI 0.30-0.59]). These data suggest that a clinical pathway based on enhanced surveillance for high-risk surgical patients in a resource-constrained setting could reduce in-hospital mortality.

Evaluation of teratogenicity and genotoxicity induced by kramecyne (KACY).

Kramecyne (KACY), a polymer isolated from Krameria cytisoides Cav, has anti-inflammatory, anti-nociceptive, anti-arthritic and anti-ulcerogenic properties. As a part of standard preclinical safety tests, the present study sought to determine potential developmental toxicity (in female rats) and genotoxicity (in male mice) of KACY. Pregnant female rats were divided into six groups: the negative control (vehicle), the positive control (250 mg/kg of acetylsalicylic acid (ASA)), and four experimental groups (50, 250, 500 and 1000 mg/kg of KACY). To evaluate genotoxicity by in vivo micronuclei (MN) and sister chromatid exchange (SCE) tests, male mice were divided into five groups: the negative control (vehicle), the positive control (1.5 and 2.5 mg/kg of doxorubicin for MN and SCE, respectively), and three experimental groups (50, 500 and 1000 mg/kg of KACY). All treatments were administered by oral gavage. A slight maternal toxicity was evidenced by lower weight gain for rats receiving 500 and 1000 mg/kg of KACY, but no fetal malformations were found. However, there were less live fetuses/litter and greater post-implantation loss/litter at these two doses. Manifestations of developmental toxicity were limited to a higher rate of skeletal alterations. The MN tests did not evidence genotoxicity or cytotoxicity. KACY caused a slightly but significantly increased frequency of SCE. Although KACY-treated rats had skeletal alterations, these apparently were not caused by a mechanism of genotoxicity. Furthermore, the same administration in adult male mice did not produce genotoxicity. Hence, KACY herein proved to be safe for rats during the period of organogenesis.

Multimodal signalling in estrildid finches: song, dance and colour are associated with different ecological and life-history traits.

Sexual traits (e.g. visual ornaments, acoustic signals, courtship behaviour) are often displayed together as multimodal signals. Some hypotheses predict joint evolution of different sexual signals (e.g. to increase the efficiency of communication) or that different signals trade off with each other (e.g. due to limited resources). Alternatively, multiple signals may evolve independently for different functions, or to communicate different information (multiple message hypothesis). We evaluated these hypotheses with a comparative study in the family Estrildidae, one of the largest songbird radiations, and one that includes many model species for research in sexual selection and communication. We found little evidence for either joint evolution or trade-offs between song and colour ornamentation. Some negative correlations between dance repertoire and song traits may suggest a functional compromise, but generally courtship dance also evolved independently from other signals. Instead of correlated evolution, we found that song, dance and colour are each related to different socio-ecological traits. Song complexity evolved together with ecological generalism, song performance with investment in reproduction, dance with commonness and habitat type, whereas colour ornamentation was shown previously to correlate mostly with gregariousness. We conclude that multimodal signals evolve in response to various socio-ecological traits, suggesting the accumulation of distinct signalling functions.

Evaluation of progenies from the fifth reciprocal recurrent selection cycle in maize.

The objective of this study was to evaluate the performance of 119 full sib progenies of the fifth cycle of reciprocal recurrent selection (RRS) derived from of Universidade Federal de Lavras maize breeding program. The experiment was carried out in an 11 x 11 triple lattice design at two locations (Lavras, Lambari). The plots consisted of two rows of 3 m, with four plants per 1 m and 0.60 meters of spacing between lines. The grain yield was obtained as kg/plot through weighing of husked ears. The contrast between progenies and controls was not significant, indicating there were no significant differences among the average grain yields of the progenies and controls. When considering the joint analysis, heritability was 64.2%; however, this estimate did not differ from the values estimated for each location separately. Estimates of genetic and phenotypic variance among progenies ranged from 0.21 to 0.28 and 0.30 to 0.47, respectively. Estimates of selection gain, for 10% selection intensity, indicated gains of 16% in the joint analysis of the two locations. The progenies of the fifth cycle of RRS had high average grain yield, associated with high variability. In comparison to the average grain yields exhibited by the controls, it was concluded that the progenies have the potential to be commercially exploited.

Similar preferences for ornamentation in opposite- and same-sex choice experiments.

Selection due to social interactions comprises competition over matings (sexual selection stricto sensu) plus other forms of social competition and cooperation. Sexual selection explains sex differences in ornamentation and in various other phenotypes, but does not easily explain cases where those phenotypes are similar in males and females. Understanding such similarities requires knowing how phenotypes influence nonsexual social interactions as well, which can be very important in gregarious animals, but whose role for phenotypic evolution has been overlooked. For example, 'mate choice' experiments often found preferences for ornamentation, but have not assessed whether those are strictly sexual or are general social preferences. Using choice experiments with a gregarious and mutually ornamented finch, the common waxbill (Estrilda astrild), we show that preferences for ornamentation in the opposite-sex also extend to same-sex interactions. Waxbills discriminated between opposite- and same-sex individuals, but most preferences for colour traits were similar when interacting with either sex. Similar preferences in sexual and nonsexual associations may be widespread in nature, either as social adaptations or as by-product of mate preferences. In either case, such preferences may set the stage for the evolution of mutual ornamentation and of various other similarities between the sexes.

Progesterone (PR), oestrogen (ER-α and ER-ß) and oxytocin (OTR) gene expression in the oviduct and uterus of pregnant and non-pregnant bitches.

The aim was to assess hormone receptor gene expression in the oviduct and uterus during canine pregnancy. Nineteen pregnant bitches divided into four groups were ovariohysterectomized (OVH) at either day 8, 12, 21 or 60 of pregnancy, and five non-pregnant females underwent OVH 12 days after the pre-ovulatory Luteinizant Hormone (LH) surge and served as controls. RT-qPCR for progesterone (PR), oestrogen (ER-α and ER-ß) and oxytocin (OTR) receptors was performed on the oviduct and uterine tissue. The mRNA PR expression in the uterus during early stages of pregnancy and the luteal phase was higher than at other times. The mRNA ER-ß expression in the oviduct during early pregnancy was less than in non-pregnant bitches. In the uterus, the mRNA ER-ß expression was higher in the initial stages of pregnancy. The ER-α expression was higher in the oviduct and uterus in advanced stages of pregnancy. The mRNA OTR expression in the oviduct was lower than in the uterus in control group. The expression of this receptor in oviduct and the uterus was higher in the final stages of pregnancy, when compared with other phases. These data suggested that the serum progesterone concentrations probably exert a direct control on the PR and ER (α and ß) expression and indirectly on OTR expression in the bitch oviduct and uterus.

Preliminary evaluation of a non-invasive device for monitoring intracranial pressure waveforms in dogs.

OBJECTIVES: The objective of this study was to compare waveforms obtained with a new device for the non-invasive monitoring of intracranial pressure (ICP) in dogs with and without neurological disease. MATERIALS AND METHODS: This prospective study was conducted on both neurologically normal dogs and dogs with neurological diseases. First, non-invasive ICP waveforms were recorded in normal dogs using the Braincare® BcMM 2000 monitor while the dogs were under general anaesthesia induced for procedures unrelated to this study. The dogs were positioned in lateral recumbency, and the sensor was placed over the skin of the parietal region. Secondly, non-invasive ICP waveforms were monitored in dogs with brain and spinal disease until waveforms with characteristic peaks were acquired. All the recorded signals were amplified, filtered and digitalized, by the device, and then transferred to a computer for analysis. RESULTS: Normal pulse waveforms indicating normal brain complacency were observed in eight neurologically normal dogs. In six dogs with brain disease, abnormal pulse waveforms were observed suggesting increased ICP and decreased brain complacency. Four dogs with spinal disease undergoing myelography, had normal waveforms before contrast medium injection and abnormal pulse waveforms during contrast medium injection, indicating a potential increase in ICP. CLINICAL SIGNIFICANCE: Based on these preliminary observations, this method was capable of detecting abnormal pulse waveforms that suggested increased ICP.

Characterization of Contemporary Conventional, Bulk-fill, and Self-adhesive Resin Composite Materials.

OBJECTIVE: To evaluate the physical and biological properties of different types of flowable resin composites and their bonding ability to dentin, comparing the performance of self-adhesive and bulk-fill materials with a conventional control. METHODS AND MATERIALS: Four flowable resin composites were tested: two self-adhesive (Y-flow [SA_YF]; and Dyad Flow [SA_DF]); one bulk-fill (Filtek Bulk Fill Flow [BF]); and one conventional composite (Opallis Flow [OF]). The microshear bond strength (µSBS) to dentin (bovine samples) was investigated at 24 hours and 6 months of storage. The materials were also characterized by degree of conversion, cross-link density, water contact angle, color stability, and cell viability (ISO 10993-5/2009) analyses. Data were analyzed using Analysis of Variance and Tukey tests (α=0.05). RESULTS: The µSBS values were higher for control specimens at 24 hours, whereas the resin-dentin bonds were similarly distributed among the groups after aging. Adhesive failure was the most frequent pattern observed at both time intervals. SA_YF was the only material that increased the bond strength over time. Degree of conversion increased in the following order: SA_YF (28.6±1.4%) < BF (49.7±0.8%) < OF (60.0±2.0%) = SA_DF (63.6±2.3%). Cross-link density was similar among all materials. The self-adhesive composites were more hydrophilic than the other types, with BF showing the lowest water contact angle and the greatest color alteration. All resin composites had a biocompatible behavior. CONCLUSION: Chemical composition appeared to be an influential factor affecting the physico-mechanical and biological behavior of the materials tested.

The contribution of structural-, psittacofulvin- and melanin-based colouration to sexual dichromatism in Australasian parrots.

Colour ornamentation in animals is exceptionally diverse, but some colours may provide better signals of individual quality or more efficient visual stimuli and, thus, be more often used as sexual signals. This may depend on physiological costs, which depend on the mechanism of colour production (e.g. exogenously acquired colouration in passerine birds appears to be most sexually dichromatic). We studied sexual dichromatism in a sample of 27 Australasian parrot species with pigment- (melanin and psittacofulvin) and structural-based colouration, to test whether some of these types of colouration are more prominent in sexual ornamentation. Unlike passerines, in which long wavelength colouration (yellow to red) usually involves exogenous and costly carotenoid pigments, yellow to red colouration in parrots is based on endogenously synthesized psittacofulvin pigments. This allows us to assess whether costly exogenous pigments are necessary for these plumage colours to have a prominent role in sexual signalling. Structural blue colouration showed the largest and most consistent sexual dichromatism, both in area and perceptually relevant chromatic differences, indicating that it is often ornamental in parrots. By contrast, we found little evidence for consistent sexual dichromatism in melanin-based colouration. Unlike passerines, yellow to red colouration was not strongly sexually dichromatic: although the area of colouration was generally larger in males, colour differences between the sexes were on average imperceptible to parrots. This is consistent with the idea that the prominent yellow to red sexual dichromatism in passerines is related to the use of carotenoid pigments, rather than resulting from sensory bias for these colours.

Loudness of birdsong is related to the body size, syntax and phonology of passerine species.

Songs of passerines are generally complex, long-range acoustic signals, and are highly diverse across species. This diversity must nevertheless be shaped by the capabilities of the avian vocal physiology. For example, within species, loudness has been shown to trade-off with aspects of song complexity. Here, I ask if such trade-offs with loudness influenced the evolutionary diversification of song among passerines. Comparing perceived song loudness across > 140 European and North American species showed that loudness is positively related to body size and to singing with simple trilled syntax, and negatively related to aspects of syllable complexity. Syntax and syllable phonology together explained more variation than body size did, indicating that the acoustic design of songs is an important factor determining loudness. These results show for the first time that loudness covaries with, and possibly limits, song complexity across species, suggesting that a trade-off with loudness shaped the evolutionary diversification of passerine song.

The dual function of barred plumage in birds: camouflage and communication.

A commonly held principle in visual ecology is that communication compromises camouflage: while visual signals are often conspicuous, camouflage provides concealment. However, some traits may have evolved for communication and camouflage simultaneously, thereby overcoming this functional compromise. Visual patterns generally provide camouflage, but it was suggested that a particular type of visual pattern ­ avian barred plumage ­ could also be a signal of individual quality. Here, we test if the evolution of sexual dimorphism in barred plumage, as well as differences between juvenile and adult plumage, indicate camouflage and/or signalling functions across the class Aves. We found a higher frequency of female- rather than male-biased sexual dimorphism in barred plumage, indicating that camouflage is its most common function. But we also found that, compared to other pigmentation patterns, barred plumage is more frequently biased towards males and its expression more frequently restricted to adulthood, suggesting that barred plumage often evolves or is maintained as a sexual communication signal. This illustrates how visual traits can accommodate the apparently incompatible functions of camouflage and communication, which has implications for our understanding of avian visual ecology and sexual ornamentation.

Factors associated with length of stay and readmission in acute psychiatric inpatient services in Portugal.

Assessing the factors that influence duration and number of hospitalizations may support mental health services planning and delivery. This study examines the factors associated with length of stay and readmission in Portuguese psychiatric inpatient services during 2002, 2007 and 2012. Data from all admissions were extracted from clinical files. Logistic regression models estimated the association between length of stay (<17 vs ≥17 days) and number of admissions per year (1 vs >1 admission) with sociodemographic, clinical, and contextual factors. Older age, a diagnosis of psychosis, and compulsory admission were associated with higher odds of longer length of stay. Being married, secondary education, suicide attempt, a diagnosis of substance use and "other mental disorders", being admitted in 2012, and two of the psychiatric inpatient services associated with lower odds of longer length of stay. Being retired (or others), a diagnosis of psychosis, compulsory admission, and psychiatric service were associated with increased odds of readmission. Older age, and secondary and higher education were associated with lower odds of readmission. The findings indicate that multiple factors influence length of stay and readmission. Identifying these factors provides useful evidence for clinicians and policy makers to design more targeted and cost-effective interventions.

Alpha-thalassemia (3.7 kb deletion) in a population from the Brazilian Amazon region: Santarém, Pará State.

The ethnic composition of the Brazilian population favors high frequencies of the -alpha3.7 deletion, responsible for alpha-thalassemia, because this mutation is very common in African populations. In spite of its importance, this hemoglobinopathy has been poorly investigated in Brazil, especially at the molecular level. We investigated the prevalence of the -alpha3.7 mutation in 220 individuals attended at the Municipal Hospital of Santarém, in the state of Pará. These patients were distributed into three different groups: i) 103 individuals with anemia who had microcytosis and hypochromia, ii) 11 individuals without anemia who had microcytosis and hypochromia, and iii) 106 individuals with no hematological alterations. We examined the usefulness of investigating alpha-thalassemia carrier status for microcytosis. Among the 103 patients with anemia, 20 (19.4%) were heterozygotes (-alpha3.7/alphaalpha) and one (1.0%) was a homozygote (-alpha3.7/-alpha3.7). Among the 11 patients without anemia, one heterozygote (-alpha3.7/alphaalpha) was identified; in the third group, composed of normal individuals (106 samples), deletion -alpha3.7 was found in seven samples (6.6%), all of which were heterozygotes (-alpha/alphaalpha).These frequencies are within the expected range, given available data on the distribution of this hemoglobin disorder in human populations and the ethnic composition of the population of Santarém. We found that alpha-thalassemia is a common cause of microcytosis, given that a high proportion (19.2%) of the microcytic population carried alpha-globin gene deletions.

In vivo approach of calcium deficient hydroxyapatite filler as bone induction factor.

Tissue engineering combine biomaterials, cells and biologically active molecules having as a goal create functional tissues; many of the compositions are blends of a polymeric matrix with ceramic fillers, however, reduction of mechanical resistance can be a drawback on ceramic-polymer systems. In this manuscript, we investigate the potential of calcium-deficient hydroxyapatite (CDHA) whiskers, a needle shape bioceramic, to enhance mechanical and osteoconduction properties on the polymeric matrix. For this purpose, PCL scaffolds incorporating CDHA whiskers were produced by combining solvent casting and particulate leaching techniques to develop a composite scaffold that possess mechanical and biological properties which is useful for bone tissue engineering regeneration. We produced CDHA whiskers using alkaline hydrolysis of α-tricalcium phosphate and characterized by XRD, XRF and SEM. PCL/CDHA scaffolds were fabricated with a final porosity of ~70%, quantified by SEM images. Mechanical properties were evaluated by compression test. As an initial test, PCL/CDHA scaffolds were immersed in simulated body fluid to quantify apatite deposition. In vitro and in vivo studies were performed to assess cytotoxicity and bioactivity. CDHA whiskers exhibited a needle-like morphology and a Ca/P ratio equal to calcium deficient hydroxyapatite. The composite scaffolds contained interconnected pores 177 to 350 µm in size and homogeneous ceramic distribution. The addition of CDHA whiskers influences the mechanical results: higher elastic modulus and compressive strength was observed on PCL/CDHA samples. In vitro results demonstrated biocompatibility on PCL and PCL/CDHA films. In vivo data demonstrated cellular infiltration from the surrounding tissue with new bone formation that suggests bioactive potential of CDHA whiskers. Our goal was to produce a scaffold with a potential induction factor and a favorable morphology, which was proved according to this study's findings.

Changes in socioeconomic position among individuals with mental disorders during the economic recession in Portugal: a follow-up of the National Mental Health Survey.

AIMS: Portugal was one of the European countries most affected by the period of economic recession initiated in 2008. Social inequalities are likely to widen during such periods and disproportionately affect people with mental disorders. The present study aims to compare self-reported changes in indicators of socioeconomic position during the economic recession in Portugal among people with and without mental disorders in the beginning of this period. Three dimensions were assessed, namely employment situation, experiences of financial hardship and subjective social status. METHODS: Data from the World Mental Health Survey Initiative Portugal (2008/2009) and from the National Mental Health Survey Follow-up (2015/2016) were used (n = 911). Multinomial and logistic recession models were performed to examine the association between the presence of any 12-month mood or anxiety mental disorder in 2008/2009 and indicators of socioeconomic position in 2015/2016. All analyses were adjusted for gender, age, presence of any physical disorder and education at the baseline. RESULTS: Participants that had any mental disorder in the beginning of the economic recession reported 2.20 (95% CI 1.31-3.71; P < 0.01) higher odds of financial hardship related to daily life in 2015/2016, when compared with those without any mental disorder, after adjusting for age, gender, education and presence of any physical disorder. The results may also suggest a pattern of increased socioeconomic disadvantage among people with prior mental disorder, despite not reaching statistical significance. CONCLUSIONS: The results of this study suggest that the economic recession may have contributed to wider social inequalities between people with and without mental disorders. Policies to support these individuals, such as access to treatment and alleviation of financial hardship, should be a priority in times of economic downturn.

Impact of economic crises on mental health care: a systematic review.

AIMS: Unmet needs for mental health treatment are large and widespread, and periods of economic crisis may increase the need for care and the treatment gap, with serious consequences for individuals and society. The aim of this systematic review was to summarise the empirical evidence on the association between periods of economic crisis and the use of mental health care. METHODS: Following the PRISMA statement, MEDLINE, Embase, Scopus, Open Grey and Cochrane Database were searched for relevant publications, published between 1990 and 2018, from inception to June 2018. Search terms included (1) economic crisis, (2) use of mental health services and (3) mental health problems. Study selection, data extraction and the assessment of study quality were performed in duplicate. RESULTS: Seventeen studies from different countries met the inclusion criteria. The results from the included articles suggest that periods of economic crisis might be linked to an increase of general help sought for mental health problems, with conflicting results regarding the changes in the use of specialised psychiatric care. The evidence on the use of mental health care specifically due to suicide behaviour is mixed. The results also suggest that economic crises might be associated with a higher use of prescription drugs and an increase in hospital admissions for mental disorders. CONCLUSIONS: Research on the impact of economic crises on the use of mental health care is scarce, and methodologies of the included papers are prone to substantial bias. More empirical and long-term studies on this topic are needed, in order to adapt mental health care systems to the specific needs of the population in times of economic crisis.

Duffy blood group genotypes among African-Brazilian communities of the Amazon region.

Duffy blood group genotype was studied in 95 unrelated subjects from four African-Brazilian communities of the Amazon region: Trombetas, Pitimandeua, Curiaú, and Mazagão Velho. Genotyping was performed using an allele-specific primer polymerase chain reaction technique for determining the three major alleles at FY blood group, and as expected, FY*O allele was the most common one, with frequencies ranging from 56.4% in Mazagão Velho to 72.2% in Pitimandeua, whereas the FY*O/FY*O genotype was found with frequencies between 32.3% in Mazagão Velho and 58.8% in Curiaú. Genotype and allele distributions in the four Amazonian communities are consistent with a predominantly African origin with some degree of local differentiation and admixture with people of Caucasian ancestry and/or Amerindians. These results reveal that the impact of the FY*O/FY*O genotype on the transmission and endemicity of the vivax malaria deserves to be investigated in full detail in an attempt to identify the contribution of host biological factors and explain the non-homogeneous prevalence of malaria in the region expressed by its different levels of exposure.

Investigation of the antifungal potential of linalool against clinical isolates of fluconazole resistant Trichophyton rubrum.

The aim of this study was to investigate the activity of the monoterpene linalool against clinical isolates of Trichophyton rubrum. Initially, a sensitivity assay for commercial antifungals with solid disks in diffusion medium was performed. Minimum inhibitory concentration (MIC) of linalool and ketoconazole (positive control) were determined by microdilution in RPMI 1640 medium (CLSI M38-A2). We then evaluated the action of linalool and ketoconazole at different concentrations (1/2MIC, MIC and 2×MIC) on mycelial growth (radial mycelial growth), conidia production and conidia germination using a hemacytometer. The effects on cell membrane (release of intracellular material) were also investigated. Finally, changes in fungal morphology as induced by the test drugs were analyzed. Based on the sensitivity tests, the fungal strains showed resistance to 5-fluorocytosine and fluconazole. The linalool MIC values ranged from 256µg/mL to 512µg/mL, whereas ketoconazole showed values of 4µg/mL to 8µg/mL. For the LM 305 strain, the test drugs showed the following MIC values: linalool 256µg/mL and ketoconazole 8µg/mL. The mycelial growth of T. rubrum LM 305 was inhibited by linalool (2×MIC) and ketoconazole (1/2MIC, MIC, 2×MIC), in 7 days of treatment (P<0.05). The test-drugs also inhibited conidial germination and conidiogenesis (P<0.05). Linalool also caused leakage of intracellular material (P<0.05). Finally, we verified the effectiveness of linalool and ketoconazole to induce micro-morphological changes, forming abnormal, wide, short and crooked hyphae. Based on these results, we conclude that linalool presents as an antifungal agent with anti-Trichophyton rubrum potential, an important dermatophytosis agent.