Impact of a Stress Reduction, Meditation, and Mindfulness Program in Patients with Chronic Heart Failure: A Randomized Controlled Trial. / Impacto de um Programa de Redução do Estresse, Meditação e Mindfulness em Pacientes com Insuficiência Cardíaca Crônica: Um Ensaio Clínico Randomizado.

Heart Failure is a significant public health problem leading to a high burden of physical and psychological symptoms despite optimized therapy. To evaluate primarily the impact of a Stress Reduction, Meditation, and Mindfulness Program on stress reduction of patients with Heart Failure. A randomized and controlled clinical trial assessed the effect of a stress reduction program compared to conventional multidisciplinary care in two specialized centers in Brazil. The data collection period took place between April and October 2019. Thirty-eight patients were included and allocated to the intervention or control groups. The intervention took place over 8 weeks. The protocol assessed the scales of perceived stress, depression, quality of life, anxiety, mindfulness, quality of sleep, a 6-minute walk test, and biomarkers analyzed by a blinded team, considering a p-value <0.05 statistically significant. The intervention resulted in a significant reduction in perceived stress from 22.8 ± 4.3 to 14.3 ± 3.8 points in the perceived stress scale-14 items in the intervention group vs. 23.9 ± 4.3 to 25.8 ± 5.4 in the control group (p-value<0.001). A significant improvement in quality of life (p-value=0.013), mindfulness (p-value=0.041), quality of sleep (p-value<0.001), and the 6-minute walk test (p-value=0.004) was also observed in the group under intervention in comparison with the control. The Stress Reduction, Meditation, and Mindfulness Program effectively reduced perceived stress and improved clinical outcomes in patients with chronic Heart Failure.

A Insuficiência Cardíaca é um importante problema de saúde pública, que leva à alta carga de sintomas físicos e psicológicos, apesar da terapia otimizada. Avaliar primariamente o impacto de um Programa de Redução de Estresse, Meditação e Atenção plena na redução do estresse de pacientes com Insuficiência Cardíaca. Ensaio clínico randomizado e controlado que avaliou o impacto de um programa de redução de estresse comparado ao atendimento multidisciplinar convencional, em dois centros especializados no Brasil. O período de coleta de dados ocorreu entre abril e outubro de 2019. Um total de 38 pacientes foram alocados nos grupos de intervenção ou controle. A intervenção aconteceu ao longo de 8 semanas. O protocolo consistiu na avaliação das escalas de estresse percebido, depressão, qualidade de vida, ansiedade, atenção plena, qualidade do sono, teste de 6 minutos de caminhada e biomarcadores por um grupo cego, considerando um p-valor <0,05 como estatisticamente significativo. A intervenção resultou em redução significativa no estresse percebido de 22,8 ± 4,3 para 14,3 ± 3,8 pontos na escala de estresse percebido no grupo de intervenção vs. 23,9 ± 4,3 para 25,8 ± 5,4 no grupo controle (p-valor<0,001). Foi observada melhora significativa na qualidade de vida (p-valor=0,013), atenção plena (p-valor=0,041), qualidade do sono (p-valor<0,001) e no teste de 6 minutos de caminhada (p-valor=0,004) no grupo sob intervenção comparado com o controle. O Programa de Redução de Estresse, Meditação e Atenção plena reduziu efetivamente o estresse percebido e melhorou desfechos clínicos em pacientes com Insuficiência Cardíaca.

Impacto de um Programa de Redução do Estresse, Meditação e Mindfulness em Pacientes com Insuficiência Cardíaca Crônica: Um Ensaio Clínico Randomizado / Impact of a Stress Reduction, Meditation, and Mindfulness Program in Patients with Chronic Heart Failure: A Randomized Controlled Trial

Resumo Fundamento A Insuficiência Cardíaca é um importante problema de saúde pública, que leva à alta carga de sintomas físicos e psicológicos, apesar da terapia otimizada. Objetivo Avaliar primariamente o impacto de um Programa de Redução de Estresse, Meditação e Atenção plena na redução do estresse de pacientes com Insuficiência Cardíaca. Métodos Ensaio clínico randomizado e controlado que avaliou o impacto de um programa de redução de estresse comparado ao atendimento multidisciplinar convencional, em dois centros especializados no Brasil. O período de coleta de dados ocorreu entre abril e outubro de 2019. Um total de 38 pacientes foram alocados nos grupos de intervenção ou controle. A intervenção aconteceu ao longo de 8 semanas. O protocolo consistiu na avaliação das escalas de estresse percebido, depressão, qualidade de vida, ansiedade, atenção plena, qualidade do sono, teste de 6 minutos de caminhada e biomarcadores por um grupo cego, considerando um p-valor <0,05 como estatisticamente significativo. Resultados A intervenção resultou em redução significativa no estresse percebido de 22,8 ± 4,3 para 14,3 ± 3,8 pontos na escala de estresse percebido no grupo de intervenção vs. 23,9 ± 4,3 para 25,8 ± 5,4 no grupo controle (p-valor<0,001). Foi observada melhora significativa na qualidade de vida (p-valor=0,013), atenção plena (p-valor=0,041), qualidade do sono (p-valor<0,001) e no teste de 6 minutos de caminhada (p-valor=0,004) no grupo sob intervenção comparado com o controle. Conclusão O Programa de Redução de Estresse, Meditação e Atenção plena reduziu efetivamente o estresse percebido e melhorou desfechos clínicos em pacientes com Insuficiência Cardíaca.

Abstract Background Heart Failure is a significant public health problem leading to a high burden of physical and psychological symptoms despite optimized therapy. Objective To evaluate primarily the impact of a Stress Reduction, Meditation, and Mindfulness Program on stress reduction of patients with Heart Failure. Methods A randomized and controlled clinical trial assessed the effect of a stress reduction program compared to conventional multidisciplinary care in two specialized centers in Brazil. The data collection period took place between April and October 2019. Thirty-eight patients were included and allocated to the intervention or control groups. The intervention took place over 8 weeks. The protocol assessed the scales of perceived stress, depression, quality of life, anxiety, mindfulness, quality of sleep, a 6-minute walk test, and biomarkers analyzed by a blinded team, considering a p-value <0.05 statistically significant. Results The intervention resulted in a significant reduction in perceived stress from 22.8 ± 4.3 to 14.3 ± 3.8 points in the perceived stress scale-14 items in the intervention group vs. 23.9 ± 4.3 to 25.8 ± 5.4 in the control group (p-value<0.001). A significant improvement in quality of life (p-value=0.013), mindfulness (p-value=0.041), quality of sleep (p-value<0.001), and the 6-minute walk test (p-value=0.004) was also observed in the group under intervention in comparison with the control. Conclusion The Stress Reduction, Meditation, and Mindfulness Program effectively reduced perceived stress and improved clinical outcomes in patients with chronic Heart Failure.

Provenance of heavy and clay minerals in bottom sediments of Green Lake, an Amazonian fluvial lake in Brazil

Studies on provenance of minerals in Amazonian rivers focus mostly on suspended sediments, while processes that control bottom-sediment production and distribution are still little known. We determined the provenance of the bottom sediments of Green Lake, a micro-basin draining into the Tapajós River, in the eastern Brazilian Amazon. We used X-ray powder diffraction (XRD), Fourier-transform infrared spectroscopy (FTIR), scanning electron microscope (SEM) and, cathodoluminescence techniques to analyze clay, light and heavy minerals of 22 samples. The lake is L-shaped, with 5.5 m maximum depth, and predominance of mud over sand in the center. Quartz and feldspar were dominant in the light fraction, while zircon, tourmaline, kyanite, rutile, and staurolite were dominant in the heavy fraction. The clay fraction was dominated by kaolinite, with morphology and degree of crystallinity indicative of a detrital origin related to weathering. The Alter do Chão Formation (ACF) is suggested as the main source of sand sediments and heavy minerals, due to their mineralogical and percentage similarity. The provenance of kaolinite was mainly the ACF, with a minor contribution of the Amazon and Tapajós rivers. The primary origin of the heavy minerals in the ACF indicates the basement of the Amazonas Basin as source rock and this formation as a source of sediments for Green Lake through weathering and erosion processes under current tropical conditions. The presence of Aulacoseira granulata and Aulacoseira ambigua indicates the importance of current erosive processes on sediment production. (AU)

Histopathology of valves in infective endocarditis, diagnostic criteria and treatment considerations.

BACKGROUND: Infective endocarditis (IE) is a severe disease. Pathogen isolation is fundamental so as to treat effectively and reduce morbidity and mortality. Blood and valve culture and histopathology (HP) are routinely employed for this purpose. Valve HP is the gold standard for diagnosis. OBJECTIVES: To determine the sensitivity and specificity of clinical criteria for IE (the modified Duke and the St Thomas' minor modifications, STH) of blood and valve culture compared to valve HP, and to evaluate antibiotic treatment duration. METHODS: Prospective case series of patients, from 2006 to 2014 with surgically treated IE. Statistical analysis was done by the R software. RESULTS: There were 136 clinically definite episodes of IE in 133 patients. Mean age ± SD was 43 ± 15.6 years and IE was left sided in 81.6 %. HP was definite in 96 valves examined, which were used as gold standard. Sensitivity of blood culture was 61 % (CI 0.51, 0.71) and of valve culture 15 % (CI 0.07, 0.26). The modified Duke criteria were 65 % (CI 0.55, 0.75) sensitive and 33 % specific, while the STH's sensitivity was 72 % (CI 0.61, 0.80) with similar specificity. In multivariate analysis and logistic regression, the only variable with statistical significance was duration of antibiotic therapy postoperatively. CONCLUSIONS: Valve HP had high sensitivity and valve culture low sensitivity in the diagnosis of IE. The STH's criteria were more sensitive than the modified Duke criteria. Valve HP should guide duration of postoperative antibiotic treatment.

Predição da performance de carvão ativado granular para remoção de herbicidas com ensaios em coluna de escala reduzida / Prediction of granular activated carbon performance in removing herbicides with rapid small-scale column tests

RESUMO: Na região de Ribeirão Preto está localizado um dos polos produtores da cana-de-açúcar, com vasta área cultivada e uso intensivo de herbicidas, tais como o diuron e a hexazinona, os quais possuem elevado potencial de contaminação em águas superficiais e subterrâneas. Diversas tecnologias podem ser utilizadas para remover esses microcontaminantes da água, em função de, neste caso, não ser eficiente a técnica de tratamento em ciclo completo (ou convencional). Neste trabalho, estudou-se o desempenho do carvão ativado granular na remoção destes herbicidas. A água de estudo foi preparada em laboratório e fortificada com diuron e hexazinona. Foi construída e operada uma instalação piloto com colunas de adsorção em carvão ativado granular, cujos resultados obtidos mostraram que a difusividade intrapartícula predominante entre o carvão e os herbicidas diuron e hexazinona pode ser considerada constante, em relação ao tamanho do grão de carvão ativado. Eles também possibilitaram a validação do método de ensaios rápidos em coluna de carvão ativado em escala reduzida, com vista à predição do tempo para ruptura de um filtro de carvão ativado granular em escala real.

ABSTRACT: Ribeirão Preto has one of the producer poles of sugarcane, with a vast sugarcane plantation area and intensive use of herbicides, especially diuron and hexazinone, which have high potential of contaminating surface waters and groundwater. Several technologies can be used to remove these micro-contaminants from water, since the conventional treatment in complete cycle is not an efficient technique for this case. In the present study, the performance of the granular activated carbon in removing these herbicides was evaluated. The water sample was prepared in a laboratory and supplemented with diuron and hexazinone. A pilot granular activated carbon column was built and operated, and the results showed that the prevailing intra-particle diffusivity between carbon and diuron and hexazinone herbicides could be considered constant, with regard to the size of the activated carbon grain. The results obtained also enabled the validation of the rapid small-scale column test method to predict the full scale breakthrough time of a granular activated carbon filter.

Pacemaker endocarditis caused by Propionibacterium acnes in an adult patient with Ebstein's anomaly: a report of a rare case.

We report a rare case of a Brazilian adult woman with Ebstein's Anomaly who presented with pacemaker endocarditis caused by Propionibacterium acnes. Ebstein's Anomaly is a rare congenital malformation of the heart. Infective endocarditis is defined as an infection of heart valves, of the mural endocardium, of a septal defect, or of a cardiac electronic implantable device. Propionibacterium acnes is a skin commensal bacterium, that is usually considered as a contaminant, but can, on rare occasions, cause serious infections including endocarditis of prosthetic valves, native valves and cardiac electronic implantable devices. Diagnosis was made after nearly two years of investigation by identification of the organism by the MALDI-TOF technique and transoesophageal echocardiogram. The patient was successfully treated with daptomycin and device removal. She remains free of endocarditis after 32 months of follow-up.

Methane emission of Santa Inês sheep fed cottonseed by-products containing different levels of gossypol.

The aim of this study was to evaluate the methane (CH4) emission of Santa Inês sheep fed cottonseed by-products, verifying if the gossypol content of these feedstuffs affects CH4 emission. Twelve late-lactating Santa Inês sheep (44.8 ± 7.5 kg body weight (BW)) were allocated in metabolic cages for an experimental period of 19 days, 14 days for adaptation and 5 days for measuring CH4 emission and dry matter intake (DMI). The animals were divided into four treatments, established in accordance with the cottonseed by-product used in concentrate formulation: Control (CON - no cottonseed by-product), Whole cottonseed (WCS), Cottonseed cake (CSC), and Cottonseed meal (CSM). The free gossypol level of the concentrates were 0, 1,276, 350, and 190 ppm for CON, WCS, CSC, and CSM, respectively. Also, the animals received Cynodon dactylon cv. Coast Cross hay, water, and mineral salt ad libitum. The ether extract content of the diets was balanced between treatments by including soybean oil in concentrates. The technique used to measure the CH4 emission was the sulfur hexafluoride (SF6) tracer technique, and the gas samples collected were quantified by analysis in gas chromatography system. The CH4 emission was evaluated considering the daily emission (g CH4/day); DMI (g CH4/kg DMI); and BW (g CH4/kg BW). No statistical difference was found (P > 0.05) between treatments for DMI and CH4 parameters. In the regression analysis, no significant relation (P > 0.05) between gossypol content and CH4 emission was observed. These results suggest that gossypol does not affect rumen methanogenesis.

Removal of diclofenac by conventional drinking water treatment processes and granular activated carbon filtration.

This study was carried out to evaluate the efficiency of conventional drinking water treatment processes with and without pre-oxidation with chlorine and chlorine dioxide and the use of granular activated carbon (GAC) filtration for the removal of diclofenac (DCF). Water treatment was performed using the Jar test with filters on a lab scale, employing nonchlorinated artesian well water prepared with aquatic humic substances to yield 20HU true color, kaolin turbidity of 70 NTU and 1mgL(-1) DCF. For the quantification of DCF in water samples, solid phase extraction and HPLC-DAD methods were developed and validated. There was no removal of DCF in coagulation with aluminum sulfate (3.47mgAlL(-1) and pH=6.5), flocculation, sedimentation and sand filtration. In the treatment with pre-oxidation and disinfection, DCF was partially removed, but the concentration of dissolved organic carbon (DOC) was unchanged and byproducts of DCF were observed. Chlorine dioxide was more effective than chorine in oxidizing DCF. In conclusion, the identification of DCF and DOC in finished water indicated the incomplete elimination of DCF through conventional treatments. Nevertheless, conventional drinking water treatment followed by GAC filtration was effective in removing DCF (⩾99.7%). In the oxidation with chlorine, three byproducts were tentatively identified, corresponding to a hydroxylation, aromatic substitution of one hydrogen by chlorine and a decarboxylation/hydroxylation. Oxidation with chlorine dioxide resulted in only one byproduct (hydroxylation).

Tratamento de água de reservatórios por dupla filtração, oxidação e adsorção em carvão ativado granular / Double filtration, oxidation and granular activated carbon adsorption for treating lake water

Este trabalho teve como objetivo avaliar o tratamento de água bruta proveniente de um reservatório de água, utilizando instalação piloto de dupla filtração (DF), composta por filtro ascendente de pedregulho (FAP) e filtro rápido descendente de areia (FRD), seguida de uma unidade de pós-tratamento com carvão ativado granular (CAG). Adicionalmente, foi verificado o efeito da pré e interoxidação (entre o FAP e o FRD) na eficiência global do tratamento e na formação de subprodutos orgânicos halogenados (SOH). Em função dos resultados obtidos, foi observado que a pré-oxidação melhorou a qualidade do efluente do FAP e a interoxidação favoreceu que resultassem valores menores de turbidez e cor no efluente do FRD. O processo de tratamento por adsorção em carvão ativado granular, utilizado como pós-tratamento, mostrou-se eficiente para assegurar a qualidade dos efluentes finais nos ensaios realizados, especialmente, em relação à remoção de matéria orgânica, cianobactérias e cor. As concentrações máximas de SOH encontrados nos efluentes do FRD e do FCAG não ultrapassaram os valores limites da Portaria nº 2.914/2011 do Ministério da Saúde.

This study evaluated the treatment of raw lake water using a double filtration (DF) pilot plant consisting of an up-flow gravel filter (UGF) in series with a down-flow sand filter (DSF) and followed by a post-treatment granular activated carbon (GAC) unit. Additionally, the study examines the effect of pre and inter-oxidation (between UGF and DSF) on overall efficiency in the treatment and the formation of halogenated organic byproducts (HOB). According to the results obtained, it was observed that the pre-oxidation improved the quality of the UGF effluent and the inter-oxidation favored lower values of turbidity and color in the DSF effluent. Also, the treatment process by adsorption on granular activated carbon, used as a post-treatment, was efficient to ensure the quality of final effluent in the tests, especially regarding the removal of organic matter, cyanobacteria, and color. The maximum concentrations of HOB found in the effluents from the DSF and GAC did not exceed the limits of the Brazilian drinking water standards (Portaria nº 2.914/2011).

Análise e modelação matemática da interação entre partículas na filtração direta utilizando a teoria coloidal / Mathematical modeling and analysis of the particle interactions in the direct filtration using the colloidal theory

Este trabalho utilizou a teoria coloidal para descrever o comportamento físico pelo balanço de forças e balanço de energia de complexos coloidais na água bruta e daqueles formados durante a filtração direta em escoamento ascendente. Nele são descritos os perfis de energia de interação entre as superfícies dos colóides para três geometrias: esférica, plana e cilíndrica; e quatro arranjos de interação entre as superfícies: dois cilindros, dois planos, duas esferas e uma esfera e um plano. Duas situações foram analisadas, antes e após a desestabilização eletrostática pela ação de sulfato de alumínio em águas de estudo contendo caulinita, utilizando-se a modelação e análise pela teoria DLVO (das iniciais de Derjarguin-Landau-Verwey-Overbeek) modificada, ou XDLVO, que inclui à abordagem tradicional das forças da dupla camada elétrica (DCE), forças de atração de superfície ou London-van der Waals (LvdW), forças estéricas, força hidrofóbica e forças de outras origens no cálculo do balanço de forças, a saber: repulsão molecular, denominada repulsão de Born, e a força oriunda das funções químicas ácido e Base (AB) de Lewis.

This work used the colloidal theory to describe forces and energy interactions of colloidal complexes in the water and those formed during filtration run in direct filtration. Many interactions of particle energy profiles between colloidal surfaces for three geometries are presented here in: spherical, plate and cylindrical; and four surface interactions arrangements: two cylinders, two spheres, two plates and a sphere and a plate. Two different situations were analyzed, before and after electrostatic destabilization by action of the alum sulfate as coagulant in water studies samples prepared with kaolin. In the case were used mathematical modeling by extended DLVO theory (from the names: Derjarguin-Landau-Verwey-Overbeek) or XDLVO, which include traditional approach of the electric double layer (EDL), surfaces attraction forces or London-van der Waals (LvdW), esteric forces and hydrophobic forces, additionally considering another forces in colloidal system, like molecular repulsion or Born Repulsion and Acid-Base (AB) chemical function forces from Lewis.

Influence of the apparent molecular size of aquatic humic substances on colour removal by coagulation and filtration.

This study aims to verify the influence of the apparent molecular size of aquatic humic substances (AHSs) on the effectiveness of coagulation with aluminium sulphate and ferric chloride. Coagulation-filtration tests using the jar test and bench-scale sand filters were carried out with water samples having a true colour of approximately 100 Hazen units and prepared with AHSs of different molecular sizes. Stability diagrams are presented showing regions of > or = 90% and > or = 95% apparent colour removal delineated for each water sample using plots of total metal ion concentration (Al3+ and Fe3+) versus coagulation pH. To achieve the same degree of colour removal, the water samples with smaller apparent molecular sizes and a higher percentage of fulvic acids required higher dosages of both aluminium sulphate and ferric chloride.

Pré-oxidação e adsorção em carvão ativado granular para remoção dos herbicidas Diuron e Hexazinona de água subterrânea / Preoxidation and adsorption in granular activated carbon for the removal of Diuron and Hexazinone from groundwater

O cultivo da cana-de-açúcar exige a utilização de herbicidas, destacando-se o Diuron e a Hexazinona. Alguns dos poços de abastecimento de Ribeirão Preto (SP) construídos no Aquífero Guarani estão situados em pontos de recarga, e a presença de solo de textura arenosa nessas áreas aumenta a vulnerabilidade da água subterrânea à contaminação por herbicidas. Neste trabalho foram monitorados alguns poços localizados na área de recarga e estudou-se a remoção de Diuron e Hexazinona por meio da adsorção em carvão ativado granular (CAG) e da pré-oxidação com cloro e dióxido de cloro em uma instalação piloto de escoamento contínuo. Verificou-se que o tempo de saturação do CAG no ensaio com a pré-oxidação foi inferior ao obtido no ensaio sem a pré-oxidação com ambos os oxidantes, possivelmente pela formação de subprodutos que competiram com a adsorção dos herbicidas.

The cultivation of sugarcane demands the use of herbicides such as Diuron and Hexazinone. Some supply wells from Ribeirão Preto, SP, Brazil, built in the Guarani Aquifer are located in recharge points, and the presence of sandy Quartzarenic Neosol in these areas increases the vulnerability of the groundwater to contamination from herbicides This paper reports the water quality monitored in some wells located in the recharge area and the removal of Diuron and Hexazinone by means of adsorption in granular activated carbon (GAC), preceded or not by preoxidation with chlorine and chlorine dioxide in a pilot plant. The results indicated that Diuron was more strongly adsorbed than Hexazinone and that the saturation time of the GAC in the test with preoxidation was shorter than in the test without preoxidation, which may have occurred mainly due to the formation of by-products that competed with the adsorption of the herbicides.