Microplastics and nanoplastics in haemodialysis waters: Emerging threats to be in our radar.

Microplastics are present in the environment, in drinking water, in human blood and there is evidence of nanoplastics in tap water. The objective of this work was to analyze the possibility of hemodialysis patients being contaminated by micro and nanoplastics (MNPs) during dialysis treatment. The motivation for this investigation is the fact that hemodialysis patients use about 300-600 L of drinking water per week, which may be contaminated by MNPs. A literature review, a field investigation in a London hospital and an estimation of MNPs intake in patients were carried out. The results showed potential points of risk of contamination of patients by MNPs in hemodialysis. It was also estimated that for a filtration efficiency of 99 % for MNPs, the amount of microplastics that can penetrate the kidneys of patients is 0.0021-3768 particles/week. The assessment concludes that hemodialysis patients are at high risk of MNP contamination.

Occupational accidents in native and planted forests in Brazil: 2007-2018.

BACKGROUND: Despite constant technological evolution, the forestry sector is still characterised as one with the highest risk of occupational accidents. There is no doubt that accidents penalise workers considerably, as well as the companies, insurers, and, consequently, the society, to which many of the costs are externalised, namely in cases where the worker is incapacitated and unable to work. OBJECTIVE: The aim of this work is to analyse data on occupational accidents in forestry operations in Brazil between 2007 and 2018 in both native and planted forests. METHODS: Data were made available by the Brazilian Statistical Directory of Accidents at Work. RESULTS: The results show that, although most accidents occurred in planted forests, mortality was higher in native forests. It was also found that, overall, the rate of serious accidents resulting in an incapacity to work and, consequently, sick leave is considerably high. CONCLUSIONS: These results highlight that integrating an occupational safety system into a forest management system is crucial for reducing work-related accidents in both native and planted forests. However, the success of this measure will only be effective if it is accompanied by a review of both the Brazilian labour policy and the Brazilian occupational safety management policy, to ensure compliance with legislation, mainly on the part of outsourced companies.

Zero-Risk Interpretation in the Level of Preventive Action Method Implementation for Health and Safety in Construction Sites.

Risk assessment is a legal obligation for all companies in most countries worldwide. It aims to control the quality of working conditions and avoid externalizing the consequences of accidents and resulting costs to society. This work discusses the need for an adequate interpretation of the zero-risk concept from a technical-preventive perspective to assess occupational risks in construction sites. A critical analysis of several risk assessment methodologies was carried out, focusing on the evaluation criteria of little or no-risk situations. The verification of the results was made through a case study. The perception of health and safety risks by workers is very different from that of the evaluators. Often, when workers identify a situation as low-risk or even zero-risk, the evaluator assesses the same context as maximum risk. Given the workers' and the evaluators' responses, the Preventive Action Method establishes a new parameter, the Environment Congruence. This parameter is based on the perception of the preventive environment and gives more importance to the evaluators' decision. When preventive action is optimal, the risk is low in all preventive observation settings. In conclusion, this study justifies the non-nullity of the risk and the difficulty of assessing zero-risk in construction sites. Therefore, evaluations with qualitative and quantitative non-risk approaches should be discarded.

SLEEP-GOAL: A multicenter success criteria outcome study on 302 obstructive sleep apnoea (OSA) patients

@#Objective: To demonstrate SLEEP-GOAL as a more holistic and comprehensive success criterion for Obstructive Sleep Apnoea (OSA) treatment. Methods: A prospective 7-country clinical trial of 302 OSA patients, who met the selection criteria, and underwent nose, palate and/or tongue surgery. Pre- and post-operative data were recorded and analysed based on both the Sher criteria (apnoea hypopnea index, AHI reduction 50% and <20) and the SLEEP-GOAL. Results: There were 229 males and 73 females, mean age of 42.4±17.3 years, mean BMI 27.9±4.2. The mean VAS score improved from 7.7±1.4 to 2.5±1.7 (p<0.05), mean Epworth score (ESS) improved from 12.2±4.6 to 4.9±2.8 (p<0.05), mean body mass index (BMI) decreased from 27.9±4.2 to 26.1±3.7 (p>0.05), gross weight decreased from 81.9±14.3kg to 76.6±13.3kg. The mean AHI decreased 33.4±18.9 to 14.6±11.0 (p<0.05), mean lowest oxygen saturation (LSAT) improved 79.4±9.2% to 86.9±5.9% (p<0.05), and mean duration of oxygen <90% decreased from 32.6±8.9 minutes to 7.3±2.1 minutes (p<0.05). The overall success rate (302 patients) based on the Sher criteria was 66.2%. Crosstabulation of respective major/minor criteria fulfilment, based on fulfilment of two major and two minor or better, the success rate (based on SLEEP-GOAL) was 69.8%. Based solely on the Sher criteria, 63 patients who had significant blood pressure reduction, 29 patients who had BMI reduction and 66 patients who had clinically significant decrease in duration of oxygen <90% would have been misclassified as “failures”. Conclusion: AHI as a single parameter is unreliable. Assessing true success outcomes of OSA treatment, requires comprehensive and holistic parameters, reflecting true end-organ injury/function; the SLEEP-GOAL meets these requirements

Coupled virus - bacteria interactions and ecosystem function in an engineered microbial system.

Viruses are thought to control bacterial abundance, affect community composition and influence ecosystem function in natural environments. Yet their dynamics have seldom been studied in engineered systems, or indeed in any system, for long periods of time. We measured virus abundance in a full-scale activated sludge plant every week for two years. Total bacteria and ammonia oxidising bacteria (AOB) abundances, bacterial community profiles, and a suite of environmental and operational parameters were also monitored. Mixed liquor virus abundance fluctuated over an order of magnitude (3.18 × 108-3.41 × 109 virus's mL-1) and that variation was statistically significantly associated with total bacterial and AOB abundance, community composition, and effluent concentrations of COD and NH4+- N and thus system function. This suggests viruses play a far more important role in the dynamics of activated sludge systems than previously realised and could be one of the key factors controlling bacterial abundance, community structure and functional stability and may cause reactors to fail. These findings are based on statistical associations, not mechanistic models. Nevertheless, viral associations with abiotic factors, such as pH, make physical sense, giving credence to these findings and highlighting the role that physical factors play in virus ecology. Further work is needed to identify and quantify specific bacteriophage and their hosts to enable us to develop mechanistic models of the ecology of viruses in wastewater treatment systems. However, since we have shown that viruses can be related to effluent quality and virus quantification is simple and cheap, practitioners would probably benefit from quantifying viruses now.

Assessing preschoolers interactive behaviour: A validation study of the "Coding System for Mother-Child Interaction".

BACKGROUND: The preschool years are a period of great developmental achievements, which impact critically on a child's interactive skills. Having valid and reliable measures to assess interactive behaviour at this stage is therefore crucial. The aim of this study was to describe the adaptation and validation of the child coding of the Coding System for Mother-Child Interactions and discuss its applications and implications in future research and practice. METHODS: Two hundred twenty Portuguese preschoolers and their mothers were videotaped during a structured task. Child and mother interactive behaviours were coded based on the task. Maternal reports on the child's temperament and emotional and behaviour problems were also collected, along with family psychosocial information. RESULTS: Interrater agreement was confirmed. The use of child Cooperation, Enthusiasm, and Negativity as subscales was supported by their correlations across tasks. Moreover, these subscales were correlated with each other, which supports the use of a global child interactive behaviour score. Convergent validity with a measure of emotional and behavioural problems (Child Behaviour Checklist 1 ½-5) was established, as well as divergent validity with a measure of temperament (Children's Behaviour Questionnaire-Short Form). Regarding associations with family variables, child interactive behaviour was only associated with maternal behaviour. CONCLUSIONS: Findings suggest that this coding system is a valid and reliable measure for assessing child interactive behaviour in preschool age children. It therefore represents an important alternative to this area of research and practice, with reduced costs and with more flexible training requirements. Attention should be given in future research to expanding this work to clinical populations and different age groups.

Palate surgery for obstructive sleep apnea: a 17-year meta-analysis.

OBJECTIVES: Systematic review of palate surgery for the treatment of OSA. METHODS: Independent searches to identify publications relevant to OSA treatment and upper airway palate surgery. All relevant studies published between January 2001 and February 2018 were included. Inclusion criteria were adult patients, documented airway evaluation methods and absent hypopharyngeal collapse. Outcomes included success rates of treatment, AHI, Epworth scale, QOL and snoring VAS. RESULTS: Fifty-nine papers with a total of 2715 patients, UPPP accounted for 16.7% of all the procedures. Evident differentiation progressing from 2001 to 2018, from 2001 to 2010, the percentage of UPPP procedures were 25.67%, from 2011 to 2018, there were only 12.6% of UPPP procedures. The average follow up was 8.18 months. Meta-analysis on the AHI change for all procedures, showed the fixed effect AHI per follow-up (FU) month change was 1.45 (95% CI 1.33, 1.8), p < 0.001; while for ESS, the fixed effect AHI per FU month change was 0.61 (95% CI 0.56, 0.66), p < 0.001. The mean decrease in AHI was from 35.66 to 13.91 (p < 0.001). The mean decrease in ESS was from 11.65 to 5.08 (p < 0.001). The mean AHI change was 19.9 (p < 0.001). The mean ESS change was 5.8 (p < 0.001). The overall pooled success rate was 67.5%. Meta-analysis of the procedures, showed that the respective mean AHI reduction was 24.7 for the anterior palatoplasty (p = 0.015), 19.8 for the lateral/expansion pharyngoplasty (p = 0.046), and 17.2 for the uvulopalatopharyngoplasty (p = 0.360). CONCLUSIONS: Better understanding of the upper airway and objective airway evaluation diagnostic techniques and innovative palate surgeries have improved success rates of OSA surgery.

Impact of antibiotic therapy in severe community-acquired pneumonia: Data from the Infauci study.

Antibiotic therapy (AT) is the cornerstone of the management of severe community-acquired pneumonia (CAP). However, the best treatment strategy is far from being established. To evaluate the impact of different aspects of AT on the outcome of critically ill patients with CAP, we performed a post hoc analysis of all CAP patients enrolled in a prospective, observational, multicentre study. Of the 502 patients included, 76% received combination therapy, mainly a ß-lactam with a macrolide (80%). AT was inappropriate in 16% of all microbiologically documented CAP (n=177). Hospital and 6months mortality were 34% and 35%. In adjusted multivariate logistic regression analysis, combination AT with a macrolide was independently associated with a reduction in hospital (OR 0.17, 95%CI 0.06-0.51) and 6months (OR 0.21, 95%CI 0.07-0.57) mortality. Prolonged AT (>7days) was associated with a longer ICU (14 vs. 7days; p<0.001) and hospital length of stay (LOS) (25 vs. 17days; p<0.001). Combination AT with a macrolide may be the most suitable AT strategy to improve both short and long term outcome of severe CAP patients. AT >7days had no survival benefit and was associated with a longer LOS.

Incidence and prevalence of upper-limb work related musculoskeletal disorders: A systematic review.

BACKGROUND: Musculoskeletal disorders are one of the most common work-related diseases. Frequently this association is thought to have a temporal cause-effect relation. The absence of accessible diagnostic criteria and ethological cause-effect demonstration are probably important reasons for the lack of good evidence data on these pathologies. OBJECTIVE: For these reasons, the authors aim to present a systematic review on prevalence and incidence of the upper limb WRMSD. METHODS: The survey was conducted for papers published between January 1st, 2000 and July 2012, according to the PRISMA statement (2009) guidelines. RESULTS: From the 2016 papers obtained, 94 met the qualitative selection criteria. From these 27 address upper-limb WRMSD, and 17 present data on prevalence or incidence on upper-limb musculoskeletal diseases, six of them with a control group. Annual incidence ranges from 0.08 to 6.3, and prevalence from 0.14 to 14.9. Rotator cuff syndrome among shoe industry workers, present the highest incidence, and cubital, radial or ulnar nerve entrapment, the highest prevalence among a miscellaneous group of workers. CONCLUSIONS: More studies are needed to clarify the relation between work and WRMSD's, especially prospective investigations from different economic sectors and work activities, but with similar, reproducible and comparable methodologies.

Institutionalization and indiscriminate social behavior: Differential-susceptibility versus diathesis-stress models for the 5-HTTLPR and BDNF genotypes.

Institutionalization adversely impacts children's emotional functioning, proving related to attachment disorders, perhaps most notably that involving indiscriminate behavior, the subject of this report. In seeking to extend work in this area, this research on gene X environment (GXE) interplay investigated whether the serotonin transporter (5-HTTLPR) and val66met Brain-Derived Neurotrophic Factor (BDNF) polymorphisms moderated the effect of institutional care on indiscriminate behavior in preschoolers. Eighty-five institutionalized and 135 home-reared Portuguese children were assessed using Disturbances of Attachment Interview (DAI). GXE results indicated that s/s homozygotes of the 5-HTTLPR gene displayed significantly higher levels of indiscriminate behavior than all other children if institutionalized, something not true of such children when family reared. These findings proved consistent with the diathesis-stress rather than differential-susceptibility model of person×environment interaction. BDNF proved unrelated to indiscriminate behavior. Results are discussed in relation to previous work on this subject of indiscriminate behavior, institutionalization and GXE interaction.

Long-term functional changes in an estuarine fish assemblage.

The functional diversity of the fish assemblages of the Mondego estuary was studied for a discontinuous 30-year period (1988-2012). During this time, hydrological changes occurred due to man-induced alterations and weather extremes. These changes led to alterations in the structure and function of the fish community. Species richness and functional richness decreased over time and the fish community started to explore new micro-habitats and food resources. Before severe hydrological changes, the community was dominated by pelagic, detritivorous and species with wider salinity ranges. After, the community became dominated by demersal, benthic, piscivorous and marine species. During a drought, omnivorous became increasingly important, reflecting greater possibilities of using available feeding resources. We have also found an increase in sub-tropical species throughout the years, which might be related to gradual temperature increases at a global scale. This study also confirmed estuaries as extremely important for restocking several commercial species.

Avaliação da qualidade de águas purificadas utilizadas em farmácias de manipulação / Assessing the quality of purified water used in compounding pharmacies

The Brazilian Food, Drug and Sanitary Agency (ANVISA) published a Resolution (RDC 67) in 2007, repealing RDC 33 of 2000, which established a legally required monthly analysis of a number of microbiological and physicochemical variables in the purified water used in compounded pharmaceutical preparations, which were not specified in the preceding RDC. In view of the amendment, the aim of this study was to assess the quality of purified water used in compounding pharmacies in the region of Araraquara (SP, Brazil) and review the impact of the most recent regulation (RDC 67 of 2007) on this quality. In the study, 744 samples of purified water were collected from 30 pharmacies in the course of four years (2008 to 2011). The variables recorded were: presence of total coliforms and fecal coliforms/E. coli, pH, color, turbidity, total dissolved solids, fluoride and residual free chlorine. The methods used were pharmacopeial standards for water analysis, published by the Brazilian National Health Foundation (FUNASA) and the American Public Health Association (APHA). Among the samples, 78.90% were in compliance with the required standards. No sample contravened the rules for color and fecal coliforms/E. coli. However, 0.54%, 7.80%, 10.75%, 0.54% and 4.56% of the samples were unacceptable in terms of turbidity, fluorides, pH, free residual chlorine and total coliforms respectively. There was a variation in the number of irregular samples by comparing the years of 2008 and 2009 (20.26% and 26.71%, respectively) and the years of 2010 and 2011 (18.33% and 19.91%, respectively). Four years after the RDC n°. 67 of 2007, manipulation pharmacies are still adjusting to the rules, and it is important that ANVISA and others agencies continue monitoring to ensure the quality of purified water...

A RDC n° 67 de 2007, que revogou a RDC nº 33 de 2000, regulamentou análises mensais que avaliam parâmetros microbiológicos e físico-químicos em águas purificadas utilizadas em preparações magistrais, antes não especificados pela RDC n° 33 de 2000. Diante dessas alterações, o objetivo do trabalho foi avaliar a qualidade de águas utilizadas em farmácias de manipulação em Araraquara e região e verificar o impacto da legislação mais recente (RDC nº 67 de 2007) nessa qualidade. Foram analisadas 744 amostras de água purificada em 30 farmácias no decorrer de quatro anos (2008 a 2011). Os parâmetros avaliados foram: presença de coliformes totais e coliformes termotolerantes/E.coli, pH, cor, turbidez, sólidos totais dissolvidos, fluoreto e cloro residual livre. Os métodos utilizados seguiram padrões de farmacopeias, da FUNASA e da APHA. Dentre as amostras analisadas 78,90% estavam em conformidade com os padrões estabelecidos. Não foram encontradas amostras irregulares quanto aos parâmetros cor e coliformes termotolerantes/E. coli. No entanto, 0,54%, 7,80%, 10,75%, 0,54% e 4,56% das amostras estavam irregulares para turbidez, fluoretos, pH, cloro residual livre e coliformes totais, respectivamente. Foi observada uma variação do número de amostras irregulares ao compararmos os anos de 2008 e 2009 (20,26% e 26,71% respectivamente) com os anos de 2010 e 2011 (18,33% e 19,91% respectivamente). Quatro anos após a RDC n° 67 de 2007, as farmácias de manipulação ainda estão se adequando às normas e é importante que a ANVISA e outros órgãos continuem a fiscalização para garantir a qualidade da água purificada...

Impact of infection on admission and of the process of care on mortality of patients admitted to the Intensive Care Unit: the INFAUCI study.

A prospective, cohort, clinical, observational study was performed in 14 Intensive Care Units (ICUs) to evaluate the contemporary epidemiology, morbi-mortality and determinants of outcome of the population with an infection on admission. All 3766 patients admitted during a consecutive 12-month period were screened. Their median age was 63 [26-83], 61.1% were male and 69.8% had significant comorbidities. On admission to the ICU 1652 patients (43.9%) had an infection, which was community acquired in 68.2% (one-fifth with healthcare-associated criteria) and ward-acquired in the others. Roughly half presented to the ICU with septic shock. As much as 488 patients with community-acquired infections were deemed stable enough to be first admitted to the ward, but had similar mortality to unstable patients directly admitted to the ICU (35.9% vs. 35.1%, p 0.78). Only 48.3% of this infected population had microbiological documentation and almost one-quarter received inappropriate initial antibiotic therapy. This, along with comorbidities, was a main determinant of mortality. Overall, infected patients on admission had higher mortality both in the ICU (28.0% vs. 19.9%, p <0.001) and in the hospital (38.2% vs. 27.5%, p <0.001) and even after being discharged to the ward (14.2% vs. 9.6%, p <0.001). Also, patients not infected on admission who acquired an infection in the ICU, had an increased risk of dying in the hospital (odds ratio 1.41 [1.12-1.83]). Consequently, infection, regardless of its place of acquisition, was associated with increased mortality. Improving the process of care, especially first-line antibiotic appropriateness, and preventing ICU-acquired infections, may lead to better outcomes.

Agreement between amoA gene-specific quantitative PCR and fluorescence in situ hybridization in the measurement of ammonia-oxidizing bacteria in activated sludge.

Microbial abundance is central to most investigations in microbial ecology, and its accurate measurement is a challenging task that has been significantly facilitated by the advent of molecular techniques over the last 20 years. Fluorescence in situ hybridization (FISH) is considered the gold standard of quantification techniques; however, it is expensive and offers low sample throughput, both of which limit its wider application. Quantitative PCR (qPCR) is an alternative that offers significantly higher throughput, and it is used extensively in molecular biology. The accuracy of qPCR can be compromised by biases in the DNA extraction and amplification steps. In this study, we compared the accuracy of these two established quantification techniques to measure the abundance of a key functional group in biological wastewater treatment systems, the ammonia-oxidizing bacteria (AOB), in samples from a time-series experiment monitoring a set of laboratory-scale reactors and a full-scale plant. For the qPCR analysis, we tested two different sets of AOB-specific primers, one targeting the 16SrRNA gene and one targeting the ammonia monooxygenase (amoA) gene. We found that there was a positive linear logarithmic relationship between FISH and the amoA gene-specific qPCR, where the data obtained from both techniques was equivalent at the order of magnitude level. The 16S rRNA gene-specific qPCR assay consistently underestimated AOB numbers.

Chemical sensing by differential thermal analysis with a digitally controlled fiber optic interferometer.

In this work the implementation of an optical fiber interferometric system for differential thermal analysis enabling the identification of chemical species is described. The system is based on a white light Mach-Zehnder configuration using pseudo-heterodyne demodulation to interrogate two identical fiber Bragg gratings (FBG) in a differential scheme. System performance is compared using either standard hardware or low cost virtual instrumentation for operation control and signal processing. The operation with the virtual system enabled temperature measurements with a ±0.023 °C resolution nearly matching the performance of the standard hardware. The system ability to discriminate chemical species by differential thermal analysis was demonstrated. Mixed samples of acetone and methanol could be successfully identified, indicating the suitability of the system for high precision measurements using low cost instrumentation.

Fatty acid composition of selected macrophytes.

The content of total lipids and the fatty acid (FA) profile were determined for eight macroalgae (Cystoseira abies-marina, Fucus spiralis, Chaetomorpha pachynema, Codium elisabethae, Porphyra sp., Osmundea pinnatifida, Pterocladiella capillacea and Sphaeroccoccus coronopifolius). Total lipids were extracted using a solvent mixture of methanol/chloroform (2/1, v/v) and further derivatised to FA methyl esters (FAME). The analyses of FAME samples were performed by gas chromatography coupled to a flame ionisation detector. The total lipid content ranged from 0.06 to 3.54 g (per 100 g). The most abundant saturated FA were palmitic (C16:0) and myristic (C14:0), while oleic (C18:1 n-9) was the dominant monounsaturated acid. All seaweeds contained linoleic FA (C18:2 n-6). The α-linolenic (C18:3 n-3) and eicosapentaenoic (20:5 n-3) acids were present only in Porphyra sp. (3.34% ± 0.13) and C. pachynema (0.47% ± 0.12), respectively. The n-6/n-3 and h/H ratios were low, suggesting a high nutritional value of the algae studied.

Morphological characteristics of the rat thymus duringperinatal protein deprivation and early refeeding: a qualitative and quantitative study

Protein malnutrition is particularly deleterious in young individuals. An immunodeficient state is a well‑known functional consequence but alterations in thymic morphology remain unknown. Our aim is to analyze morphological characteristics of the rat thymus in a perinatal undernutrition and renutrition model – we hypothesize these morphological alterations are reversible with early refeeding. Ninety-day-old Wistar rats were allowed to mate and divided into three groups: nourished (N – normal 20% protein diet), undernourished (UN – pre- and postnatal 5% protein diet until post-natal day 60 – PND 60) and renourished (RN – as UN but normal diet from PND 21 to 60). The thymi of 10 pups/group were submitted to macroscopic, histology, morphometry and scanning electron microscopy analyses. Body weight was highest in N and lowest in UN animals as expected but the thymic/body weight ratio remained similar in N and UN; this ratio was significantly higher in the RN group. UN thymi had a prevalence of type I collagen fibers, atrophic lobules and absence of a clear corticomedullary boundary. Thymic cortical component was decreased in UN. Apoptotic thymocytes were more frequently visualized in the UN thymi. N and RN thymi exhibited very similar morphology. Perinatal protein malnutrition induces drastic morphological alterations in rat thymi but these could be largely reversed with early renutrition. Functional studies are needed to assess if organ function mimics morphology in its recovery.