A biofloc system avoids the adverse effects of diets with suboptimal protein levels on zootechnical performance, intestinal histomorphometry, and protein metabolism of Nile tilapia juvenile fed Spirulina biomass (Arthrospira platensis) as an alternative protein source.

This study aimed to evaluate the effect of the biofloc technology (BFT) system and the replacement of fish meal with Spirulina biomass on productive performance, intestinal histomorphometry, plasma biochemistry, and oxidative stress of Nile tilapia juveniles (Oreochromis niloticus) fed suboptimal levels of protein. Two factors were evaluated: production systems (clear water × BFT) and replacement of fish meal with Spirulina (0, 33, 66 e 100%). The design was in a 2 × 4 randomized factorial scheme with four replications, and the fish were evaluated for 48 days. Four isoproteic (28% crude protein) diets were formulated with gross energy values close to 4300 kcal kg-1. Nile tilapia juveniles (0.23 ± 0.01 g) were distributed in 16 circular tanks (70 L) at seven fish/tank. The diets were formulated with protein levels approximately 20% below that required for the species and life stage. No interaction was observed between the factors evaluated (production systems × Spirulina inclusion). Rearing the fish in the BFT system avoided the adverse effects of diets with suboptimal protein levels on performance, intestinal histomorphometry, and protein metabolism. Lower values lower lipid peroxidation and higher antioxidant capacity were observed in fish reared in the BFT system, showing evidence of improvements in antioxidant responses and lower levels of physiological oxidative stress. Spirulina completely replaced fish meal in the diets of Nile tilapia juveniles without adverse effects on intestinal morphometry, protein metabolism, and antioxidant response. Replacing 66% of fish meal with Spirulina improved the productive performance, regardless of the rearing system.

Cosmiatria: Uma análise do mercado brasileiro / Cosmiatry: An analysis of the Brazilian market

Introdução: O mercado de procedimento estéticos cresce exponencialmente no Brasil. Tal crescimento tem despertado o interesse de várias categorias profissionais. A decisão de praticar no setor deve considerar as oportunidades de mercado da localidade na qual se pretende atuar. Entretanto, a área carece de análises comparativas documentando prováveis diferenças regionais no país. O objetivo do estudo é descrever as diferenças de mercado em procedimentos estéticos entre os estados e regiões brasileiras. Um índice de potencial consumo de cosmiatria (IPCC) é calculado para tal análise comparativa. Método: Estudo transversal envolvendo prestadores de procedimentos estéticos não cirúrgicos no Brasil. Buscas no Google®-Google Maps® foram conduzidas usando termoschave e entrevistas telefônicas realizadas para obter informações sobre categorias profissionais, tipo de provedores e serviços oferecidos. Valores preditivos positivos foram obtidos para todas as estratégias de busca e usados para estimar o número total de provedores. O tamanho da população e a renda per capita foram considerados para o cálculo dos IPCCs para os estados brasileiros. Resultados: São Paulo, Minas Gerais e Rio de Janeiro apresentaram os maiores IPCCs, sendo 524, 210 e 180, respectivamente. Roraima teve um IPCC de 14, o mais baixo do país. A Região Sudeste apresentou, em média, o maior IPCC (242) entre todas as regiões brasileiras. Conclusão: Considerando o tamanho da população e a renda, a Região Sudeste apresenta as maiores oportunidades de mercado em procedimentos estéticos não cirúrgicos no Brasil. Nossos achados podem ser de interesse para profissionais de saúde e investidores que atuam ou pretendem atuar no setor.

Introduction: The aesthetic procedure market is growing exponentially in Brazil. This growth has aroused the interest of several professional categories. The decision to practice in the sector must consider the market opportunities in the location in which you intend to operate. However, the area lacks comparative analyses documenting probable regional differences in the country. The objective of the study is to describe market differences in aesthetic procedures between Brazilian states and regions. An index of potential cosmetic consumption (IPCC) is calculated for such a comparative analysis. Method: Cross-sectional study involving providers of nonsurgical aesthetic procedures in Brazil. Searches on Google Maps® were conducted using key terms, and telephone interviews were conducted to obtain information on professional categories, types of providers, and services offered. Positive predictive values were obtained for all search strategies and used to estimate the total number of providers. Population size and per capita income were considered to calculate the IPCCs for Brazilian states. Results: São Paulo, Minas Gerais, and Rio de Janeiro presented the highest IPCCs, being 524, 210, and 180, respectively. Roraima had an IPCC of 14, the lowest in the country. The Southeast Region presented, on average, the highest IPCC (242) among all Brazilian regions. Conclusion: Considering population size and income, the Southeast Region presents the greatest market opportunities for nonsurgical aesthetic procedures in Brazil. Our findings may be of interest to healthcare professionals and investors who work or intend to work in the sector.

National survey regarding obstetricians' perspective of obstetric emergencies in Brazil.

INTRODUCTION: The maternal mortality rate in developing countries, such as Brazil, has significantly increased since 2020. Obstetric Emergencies (OE) account for 72.5% of these deaths. A national survey was conducted in Brazil to evaluate how gynecologists and obstetricians deal with OE and identify the main difficulties regarding theoretical/practical knowledge and structural resources. METHODS: An electronic questionnaire assessing resource availability, health teams, institutional protocols, and provision of OE training courses was completed by Brazilian obstetricians. RESULTS: More than 90 % of the questionnaire respondents reported treating a pregnant and/or puerperal patient with severe morbidity and that their health network has human resources, trained professionals, and structural resources required for this type of care. However, few respondents participate in continuing education programs (36 %) or specific training for the medical team (61.41 %). The implementation rates of obstetric risk identification protocols (33.09 %), a rapid response team (46.54 %), and boxes and emergency cart assembly teams (71.68 %) were determined. CONCLUSION: A high Maternal Mortality Ratio (MMR) may be related to disorganized healthcare systems, low implementation of risk classification protocols for the care of severe maternal and fetal conditions, and lack of access to continued/specific training programs. The Brazilian MMR is multifactorial. According to obstetricians, Brazilian health services include care teams, essential medications, obstetric centers, and clinical analysis laboratories, though they lack systematized processes and permanent professional training for qualified care of OE.

National survey regarding obstetricians' perspective of obstetric emergencies in Brazil

Abstract Introduction The maternal mortality rate in developing countries, such as Brazil, has significantly increased since 2020. Obstetric Emergencies (OE) account for 72.5% of these deaths. A national survey was conducted in Brazil to evaluate how gynecologists and obstetricians deal with OE and identify the main difficulties regarding theoretical/practical knowledge and structural resources. Methods An electronic questionnaire assessing resource availability, health teams, institutional protocols, and provision of OE training courses was completed by Brazilian obstetricians. Results More than 90 % of the questionnaire respondents reported treating a pregnant and/or puerperal patient with severe morbidity and that their health network has human resources, trained professionals, and structural resources required for this type of care. However, few respondents participate in continuing education programs (36 %) or specific training for the medical team (61.41 %). The implementation rates of obstetric risk identification protocols (33.09 %), a rapid response team (46.54 %), and boxes and emergency cart assembly teams (71.68 %) were determined. Conclusion A high Maternal Mortality Ratio (MMR) may be related to disorganized healthcare systems, low implementation of risk classification protocols for the care of severe maternal and fetal conditions, and lack of access to continued/specific training programs. The Brazilian MMR is multifactorial. According to obstetricians, Brazilian health services include care teams, essential medications, obstetric centers, and clinical analysis laboratories, though they lack systematized processes and permanent professional training for qualified care of OE.

Designing spiking neural networks for robust and reconfigurable computation.

Networks of spiking neurons constitute analog systems capable of effective and resilient computing. Recent work has shown that networks of symmetrically connected inhibitory neurons may implement basic computations such that they are resilient to system disruption. For instance, if the functionality of one neuron is lost (e.g., the neuron, along with its connections, is removed), the system may be robustly reconfigured by adapting only one global system parameter. How to effectively adapt network parameters to robustly perform a given computation is still unclear. Here, we present an analytical approach to derive such parameters. Specifically, we analyze k-winners-takes-all (k-WTA) computations, basic computational tasks of identifying the k largest signals from a total of N input signals from which one can construct any computation. We identify and characterize different dynamical regimes and provide analytical expressions for the transitions between different numbers k of winners as a function of both input and network parameters. Our results thereby provide analytical insights about the dynamics underlying k-winner-takes-all functionality as well as an effective way of designing spiking neural network computing systems implementing disruption-resilient dynamics.

Do the oxidative stress biomarkers predict COVID-19 outcome? An in-hospital cohort study.

In SARSCoV-2 infections, excessive activation of the immune system dramatically elevates reactive oxygen species levels, harms cell structures, and directly increases disease severity and mortality. We aimed to evaluate whether plasma oxidative stress biomarker levels could predict mortality in adults admitted with Coronavirus Disease 2019 (COVID-19), considering potential confounders. We conducted a cohort study of 115 adults (62.1 ± 17.6 years, 65 males) admitted to a Brazilian public hospital for severely symptomatic COVID-19. Serum levels of α-tocopherol, glutathione, superoxide dismutase, 8-hydroxy-2'-deoxyguanosine, malondialdehyde, and advanced oxidation protein products were quantified at COVID-19 diagnosis using real-time polymerase chain reaction. Serum levels of α-tocopherol, glutathione, superoxide dismutase, and advanced oxidation protein products differed significantly between survivors and non-survivors. Serum glutathione levels below 327.2 µmol/mL were associated with a significant risk of death in COVID-19 patients, even after accounting for other factors (adjusted hazard ratio = 3.12 [95% CI: 1.83-5.33]).

Environmental Biofilms from an Urban Community in Salvador, Brazil, Shelter Previously Uncharacterized Saprophytic Leptospira.

Biofilms are complex microecosystems with valuable ecological roles that can shelter a variety of microorganisms. Spirochetes from the genus Leptospira have been observed to form biofilms in vitro, in rural environments, and in the kidneys of reservoir rats. The genus Leptospira is composed of pathogenic and non-pathogenic species, and the description of new species is ongoing due to the advent of whole genome sequencing. Leptospires have increasingly been isolated from water and soil samples. To investigate the presence of Leptospira in environmental biofilms, we collected three distinct samples of biofilms formed in an urban setting with poor sanitation: Pau da Lima, in Salvador, Bahia, Brazil. All biofilm samples were negative for the presence of pathogenic leptospires via conventional PCR, but cultures containing saprophytic Leptospira were identified. Whole genomes were generated and analyzed for twenty isolates obtained from these biofilms. For species identification, we used digital DNA-DNA hybridization (dDDH) and average nucleotide identity (ANI) analysis. The obtained isolates were classified into seven presumptive species from the saprophytic S1 clade. ANI and dDDH analysis suggest that three of those seven species were new. Classical phenotypic tests confirmed the novel isolated bacteria as saprophytic Leptospira. The isolates presented typical morphology and ultrastructure according to scanning electron microscopy and formed biofilms under in vitro conditions. Our data indicate that a diversity of saprophytic Leptospira species survive in the Brazilian poorly sanitized urban environment, in a biofilm lifestyle. We believe our results contribute to a better understanding of Leptospira biology and ecology, considering biofilms as natural environmental reservoirs for leptospires.

COMPLEMENTARY AND ALTERNATIVE MEDICINE USE IN BRAZILIAN PATIENTS WITH INFLAMMATORY BOWEL DISEASE.

BACKGROUND: The conventional treatment of inflammatory bowel disease (IBD) is based on drug therapy, but different studies have shown a progressive increase in the use of complementary and alternative medicine (CAM). The most used CAM comprises of acupuncture, traditional Chinese medicine, Ayurvedic medicine, homeopathy, and herbal medicine, as well as more modern practices, including aromatherapy and reflexology. Data from CAM use in Brazil has previously been scarce and there are no studies among Brazilian patients with IBD. OBJECTIVE: The aim of the study was to evaluate the frequency of, and factors associated with the use of CAM among IBD patients in Brazil, in addition to estimating the satisfaction with CAM use. METHODS: A cross-sectional study was performed in adult IBD outpatients from two Southeastern Brazilian referral centers, with a total a sample of 227 individuals. A semi-structured questionnaire was used containing CAM products - tea, probiotics, omega 3 or glutamine, homeopathy, and herbal therapy, and factors associated with CAM use and patient satisfaction. We used descriptive statistics, association tests (P<0.05) and logistic regression for statistical analyses. RESULTS: In total, 126 patients with Crohn's disease and 101 with ulcerative colitis were included. The mean age was 41.19±14.49 years and 57.27% were female. The time since diagnosis was 10.58±7.5 years, and most patients were in clinical remission. Twenty-nine patients (12.8%) reported having used CAM for IBD treatment, such as tea (5.29%), probiotics (5.29%), omega-3 or glutamine (1.76%), homeopathy (0.88%), and herbal therapies (0.44%). Despite the low frequency, patients were satisfied (>50%). There was no difference between CAM use in Crohn's disease as compared to ulcerative colitis patients (P=0.1171). The factors associated with the use of CAM were regular or poor quality of life (odds ratio 2.084; 95% confidence interval 1.147-3.786, P=0.0159) and a shorter time since diagnosis (odds ratio 0.956; 95% confidence interval 0.918-0.995; P=0.0260). CONCLUSION: The prevalence of CAM use was low, but satisfactory among Brazilian IBD patients. The application of CAM has been associated with poor quality of life and shorter disease duration compared to patients with no use of CAM.

Uso de medicina complementar e alternativa em pacientes brasileiros com doença inflamatória intestinal / Complementary and alternative medicine use in brazilian patients with inflammatory bowel disease

ABSTRACT Background: The conventional treatment of inflammatory bowel disease (IBD) is based on drug therapy, but different studies have shown a progressive increase in the use of complementary and alternative medicine (CAM). The most used CAM comprises of acupuncture, traditional Chinese medicine, Ayurvedic medicine, homeopathy, and herbal medicine, as well as more modern practices, including aromatherapy and reflexology. Data from CAM use in Brazil has previously been scarce and there are no studies among Brazilian patients with IBD. Objective: The aim of the study was to evaluate the frequency of, and factors associated with the use of CAM among IBD patients in Brazil, in addition to estimating the satisfaction with CAM use. Methods: A cross-sectional study was performed in adult IBD outpatients from two Southeastern Brazilian referral centers, with a total a sample of 227 individuals. A semi-structured questionnaire was used containing CAM products - tea, probiotics, omega 3 or glutamine, homeopathy, and herbal therapy, and factors associated with CAM use and patient satisfaction. We used descriptive statistics, association tests (P<0.05) and logistic regression for statistical analyses. Results: In total, 126 patients with Crohn's disease and 101 with ulcerative colitis were included. The mean age was 41.19±14.49 years and 57.27% were female. The time since diagnosis was 10.58±7.5 years, and most patients were in clinical remission. Twenty-nine patients (12.8%) reported having used CAM for IBD treatment, such as tea (5.29%), probiotics (5.29%), omega-3 or glutamine (1.76%), homeopathy (0.88%), and herbal therapies (0.44%). Despite the low frequency, patients were satisfied (>50%). There was no difference between CAM use in Crohn's disease as compared to ulcerative colitis patients (P=0.1171). The factors associated with the use of CAM were regular or poor quality of life (odds ratio 2.084; 95% confidence interval 1.147-3.786, P=0.0159) and a shorter time since diagnosis (odds ratio 0.956; 95% confidence interval 0.918-0.995; P=0.0260). Conclusion: The prevalence of CAM use was low, but satisfactory among Brazilian IBD patients. The application of CAM has been associated with poor quality of life and shorter disease duration compared to patients with no use of CAM.

RESUMO Contexto: O tratamento convencional da doença inflamatória intestinal (DII) é baseado na terapia medicamentosa, mas diferentes estudos têm mostrado aumento progressivo do uso de medicina complementar e alternativa (MCA) na abordagem dos pacientes. As modalidades de MCA mais usadas compreendem: acupuntura, medicina tradicional chinesa, medicina ayurvédica, homeopatia e fitoterapia, bem como práticas mais modernas, como aromaterapia e reflexologia. Os dados do uso de MCA no Brasil são escassos e não há estudos entre pacientes brasileiros com DII. Objetivo: O objetivo do estudo foi avaliar a frequência e os fatores associados com o uso de MCA entre pacientes com DII, além de estimar a satisfação com o uso de MCA. Métodos: Foi realizado estudo transversal em pacientes adultos ambulatoriais com DII oriundos de dois centros de referência no sudeste do Brasil, com amostra de 227 indivíduos. Foi aplicado questionário semiestruturado contendo produtos como - chá, probióticos, ômega 3 ou glutamina, homeopatia e fitoterapia, além de fatores associados ao uso de MCA e a satisfação do paciente. Utilizamos estatística descritiva, testes de associação (P<0,05) e regressão logística para análise estatística. Resultados: No total, 126 pacientes com doença de Crohn e 101 com retocolite ulcerativa foram incluídos. A média de idade foi 41,19±14,49 anos e 57,27% eram do sexo feminino. O tempo desde o diagnóstico foi de 10,58±7,5 anos, e a maioria dos pacientes estava em remissão clínica. Vinte e nove pacientes (12,8%) relataram ter usado MCA para o tratamento de DII, como chá (5,29%), probióticos (5,29%), ômega-3 ou glutamina (1,76%), homeopatia (0,88%) e fitoterápicos (0,44%). Apesar da baixa frequência, os pacientes ficaram satisfeitos com o uso (>50%). Não houve diferença entre o uso de MCA entre os pacientes com doença de Crohn em comparação com pacientes com retocolite ulcerativa (P=0,1171). Os fatores associados com o uso de MCA foram qualidade de vida regular ou ruim (Odds ratio 2,084; intervalo de confiança de 95% 1,147-3,786, P=0,0159) e menor tempo desde o diagnóstico (Odds ratio 0,956; intervalo de confiança de 95% 0,918-0,995; P=0,0260). Conclusão: A prevalência do uso de MCA foi baixa, mas satisfatória entre os pacientes com DII. O uso de MCA tem sido associada a baixa qualidade de vida e menor duração da doença.

Vitamin D deficiency predicts 30-day hospital mortality of adults with COVID-19.

BACKGROUND & AIMS: Several studies have shown conflicting results for the relationship between vitamin D deficiency and COVID-19 outcomes. Here, we aimed to evaluate whether plasma 25(OH)D levels predict mortality in adults admitted with COVID-19, considering potential confounders. METHODS: We conducted a retrospective cohort study that included 115 adults (age 62.1 ± 17.6 years, 65 males) admitted to a Brazilian public hospital for severely symptomatic COVID-19. Subjects were classified into two groups according to their plasma levels of 25(OH)D: sufficiency (≥50 nmol/L) and the deficiency (<50 nmol/L). The diagnosis of COVID-19 was performed using real-time polymerase chain reaction (qPCR). In addition, direct competitive chemiluminescence immunoassay assessed serum 25(OH)D levels. RESULTS: The all-cause 30-day mortality was 13.8% (95% CI: 6.5%-21%) in the group of patients with sufficient plasma 25(OH)D levels and 32.1% (95% CI: 14.8%-49.4%) among those with deficient plasma 25(OH)D levels. Cox regression showed that plasma 25(OH)D levels remained a significant predictor of mortality even after adjusting for the covariates sex, age, length of the delay between symptom onset and hospitalization, and disease severity (HR = 0.98, 95% CI: 0.96-1.00; p = 0.02). CONCLUSION: Vitamin D deficiency predicts higher mortality risk in adults with COVID-19.

Retraction notice to "Use of ivermectin in the treatment of Covid-19: A pilot trial" [Toxicol. Rep. 8 (2021) 505-510].

[This retracts the article DOI: 10.1016/j.toxrep.2021.03.003.].

The New Omics Era into Systems Approaches: What Is the Importance of Separation Techniques?

Omics sciences have been facing challenges in different fields, especially in life sciences. One of these challenges involves assessing biology into systems interpretation. With the advance of genomics, molecular biology has been projected into the realm of systems biology. In a different direction, systems approaches are making definitive strides toward scientific understanding and biotechnological applications. Separation techniques provided meaningful progress in the omics era, conducting the classical molecular biology to contemporary systems biology. In this introductory chapter, the relevance of these techniques to the development of different omics sciences, within the systems biology context, will be discussed.

Stochastic facilitation in heteroclinic communication channels.

Biological neural systems encode and transmit information as patterns of activity tracing complex trajectories in high-dimensional state spaces, inspiring alternative paradigms of information processing. Heteroclinic networks, naturally emerging in artificial neural systems, are networks of saddles in state space that provide a transparent approach to generate complex trajectories via controlled switches among interconnected saddles. External signals induce specific switching sequences, thus dynamically encoding inputs as trajectories. Recent works have focused either on computational aspects of heteroclinic networks, i.e., Heteroclinic Computing, or their stochastic properties under noise. Yet, how well such systems may transmit information remains an open question. Here, we investigate the information transmission properties of heteroclinic networks, studying them as communication channels. Choosing a tractable but representative system exhibiting a heteroclinic network, we investigate the mutual information rate (MIR) between input signals and the resulting sequences of states as the level of noise varies. Intriguingly, MIR does not decrease monotonically with increasing noise. Intermediate noise levels indeed maximize the information transmission capacity by promoting an increased yet controlled exploration of the underlying network of states. Complementing standard stochastic resonance, these results highlight the constructive effect of stochastic facilitation (i.e., noise-enhanced information transfer) on heteroclinic communication channels and possibly on more general dynamical systems exhibiting complex trajectories in state space.

Comparison Between Short Text Messages and Phone Calls to Reduce No-Show Rates in Outpatient Medical Appointments: A Randomized Trial.

The objective of this study was to evaluate the impact of telephone calls and short text messages (SMS) on no-show rates regarding scheduled appointments with a general practitioner. In a prospective, intervention-controlled, and randomized study, we divided 306 patients into 3 groups: telephone call, SMS, and no intervention. We compared no-show rates, as well as variables that influenced it. The lowest percentage of no-show (9.5%) occurred in the telephone call group, while the SMS group presented at 21% and the no-intervention group at 22.8% (P = .025). Telephone calls proved to be a superior strategy to text messaging.

Use of ivermectin in the treatment of Covid-19: A pilot trial.

OBJECTIVES: In this randomized open-label trial pilot study we assessed the antiviral effects and safety of various doses of ivermectin in patients with mild clinical symptoms of COVID-19. METHODS: Patients were randomly assigned to receive standard of care (SOC) treatment at hospital admission; SOC plus ivermectin 100 mcg/kg; SOC plus ivermectin 200 mcg/kg; or SOC plus ivermectin 400 mcg/kg. The primary assessed endpoint was the proportion of patients who achieved two consecutive negative SARS-CoV-2 RT PCR tests within 7 days of the start of the dosing period. This study was registered at ClinicalTrials.gov (NCT04431466). RESULTS: A total of 32 patients were enrolled and randomized to treatment. SOC treatment together with ivermectin did not result in any serious adverse events. All patients exhibited a reduction in SARS-CoV-2 viral load within 7 days; however, those who received ivermectin had a more consistent decrease as compared to the SOC alone group, characterized by a shorter time for obtaining two consecutive negative SARS-CoV-2 RT PCR tests. CONCLUSIONS: Ivermectin is safe in patients with SARS-CoV-2, reducing symptomatology and the SARS-CoV-2 viral load. This antiviral effect appears to depend on the dose used, and if confirmed in future studies, it suggests that ivermectin may be a useful adjuvant to the SOC treatment in patients with mild COVID-19 symptoms.

Decoding complex state space trajectories for neural computing.

In biological neural circuits as well as in bio-inspired information processing systems, trajectories in high-dimensional state-space encode the solutions to computational tasks performed by complex dynamical systems. Due to the high state-space dimensionality and the number of possible encoding trajectories rapidly growing with input signal dimension, decoding these trajectories constitutes a major challenge on its own, in particular, as exponentially growing (space or time) requirements for decoding would render the original computational paradigm inefficient. Here, we suggest an approach to overcome this problem. We propose an efficient decoding scheme for trajectories emerging in spiking neural circuits that exhibit linear scaling with input signal dimensionality. We focus on the dynamics near a sequence of unstable saddle states that naturally emerge in a range of physical systems and provide a novel paradigm for analog computing, for instance, in the form of heteroclinic computing. Identifying simple measures of coordinated activity (synchrony) that are commonly applicable to all trajectories representing the same percept, we design robust readouts whose sizes and time requirements increase only linearly with the system size. These results move the conceptual boundary so far hindering the implementation of heteroclinic computing in hardware and may also catalyze efficient decoding strategies in spiking neural networks in general.

Triage and flow management in sepsis.

BACKGROUND: Sepsis is a major public health problem, with a growing incidence and mortality rates still close to 30% in severe cases. The speed and adequacy of the treatment administered in the first hours of sepsis, particularly access to intensive care, are important to reduce mortality. This study compared the triage strategies and intensive care rationing between septic patients and patients with other indications of intensive care. This study included all patients with signs for intensive care, enrolled in the intensive care management system of a Brazilian tertiary public emergency hospital, from January 1, 2010, to December 31, 2016. The intensivist periodically evaluated the requests, prioritizing them according to a semi-quantitative scale. Demographic data, Charlson Comorbidity Index (CCI), Sequential Organ Failure Assessment (SOFA), and quick SOFA (qSOFA), as well as surgical interventions, were used as possible confounding factors in the construction of incremental logistic regression models for prioritization and admission to intensive care outcomes. RESULTS: The study analyzed 9195 ICU requests; septic patients accounted for 1076 cases (11.7%), 293 (27.2%) of which were regarded as priority 1. Priority 1 septic patients were more frequently hospitalized in the ICU than nonseptic patients (52.2% vs. 34.9%, p <  0.01). Septic patients waited longer for the vacancy, with a median delay time of 43.9 h (interquartile range 18.2-108.0), whereas nonseptic patients waited 32.5 h (interquartile range 11.5-75.8)-p <  0.01. Overall mortality was significantly higher in the septic group than in the group of patients with other indications for intensive care (72.3% vs. 39.8%, p <  0.01). This trend became more evident after the multivariate analysis, and the mortality odds ratio was almost three times higher in septic patients (2.7, 2.3-3.1). CONCLUSION: Septic patients had a lower priority for ICU admission and longer waiting times for an ICU vacancy than patients with other critical conditions. Overall, this implied a 2.7-fold increased risk of mortality in septic patients.

Carbon biofixation and lipid composition of an acidophilic microalga cultivated on treated wastewater supplied with different CO2 levels.

This study evaluated productivity, CO2 biofixation, and lipid content in biomass of the acidophilic microalga Chlamydomonas acidophila LAFIC-004 cultivated with five different carbon dioxide concentrations. The influence of carbon dioxide concentration on nutrient removal and pH was also investigated. Treated wastewater (secondary effluent) was used as culture medium. Five experimental setups were tested: T-0% - injection of atmospheric air (0.038% CO2), T-5% (5% CO2), T-10% (10% CO2), T-15% (15% CO2) and T-20% (20% CO2). The T-5% and T-10% experiments showed the highest values of productivity and CO2 biofixation, and maximum biomass dry weight was 0.48 ± 0.02 and 0.51 ± 0.03 g L-1, respectively. This acidophilic microalga proved to be suitable for carbon biofixation and removal of nutrients from secondary effluent of wastewater treatment plants with high CO2 concentration. All assays were performed without pH control. This microalga species presented high lipid content. However, fatty acid methyl esters (FAME) are not suitable for biodiesel use.

Construindo cenários de simulação: pérolas e armadilhas / Developing simulation scenarios: pearls and pitfalls

OBJETIVOS: Por meio de uma revisão da literatura, este artigo visa organizar diretrizes concisas de elaboração de cenários para utilização em treinamentos simulados, discutindo aspectos práticos da aplicação dessa metodologia na área da saúde. MÉTODOS: As buscas foram feitas nas bases de dados PubMed, Web of Science e LILACS, incluindo artigos nos idiomas inglês, espanhol e português, publicados entre agosto de 1997 e julho de 2017. Os descritores incluíram os termos scenario-based training, scenario-based simulation, scenario preparation, script development, simulation scenario e case-based teaching, e equivalentes em português e espanhol. Os descritores foram baseados nos termos utilizados em artigos, pois ainda não foram indexados descritores específicos nas bases de dados ou nos Descritores em Ciências da Saúde. A pesquisa foi limitada aos artigos de revisão, diretrizes práticas, comentários, editoriais e cartas ao editor. Somente foram incluídos artigos que tratassem da metodologia de construção de cenários de simulação. RESULTADOS: Foram acessados 1.128 artigos e eleitos os 20 que preencheram os critérios de inclusão. A maioria dos estudos tratava de situações clínicas específicas, não discutindo a metodologia de construção dos cenários. A análise dos 20 estudos possibilitou a elaboração de diretrizes para construção de cenários, as quais foram didaticamente divididas em três seções: construindo um cenário em oito passos, pérolas na construção de cenários de simulação e armadilhas no desenvolvimento de cenários. CONCLUSÕES: A construção de cenários de simulação deve ser planejada e estruturada de acordo com s objetivos de aprendizagem propostos, os quais devem ser claros e sinérgicos com o restante do conteúdo curricular. Além disso, é fundamental a adequação do grau de fidelidade do cenário aos objetivos de aprendizagem, visto que cenários excessivamente produzidos são caros e podem produzir fascinação excessiva, dispersando a atenção do estudante. Por outro lado, cenários de baixa fidelidade podem dificultar a imersão dos participantes na atividade. Como em todo projeto, devem-se investir recursos em planejamento de modo a facilitar a sua execução e, consequentemente, aumentar a sua efetividade.

AIMS: By means of a literature review, this article aims to organize concise guidelines for the construction of scenarios for simulated training, discussing practical aspects of the application of this methodology in the health area. METHODS: Search were made in PubMed, Web of Science and LILACS databases, including articles in English, Spanish and Portuguese, published between August 1997 and July 2017. The descriptors used were "scenario-based training", "scenario-based simulation", "scenario preparation", "script development", "simulation scenario", and "case-based teaching", and their equivalents in Portuguese and Spanish. The search was delimited for review articles, practical guidelines, comments, editorials and letters to the editor. The descriptors were identified directly from articles, since they were not yet included in the subject indexes of databases or in the Medical Subject Headings. Only articles dealing with the methodology of simulation scenario construction were included. RESULTS: From 1,128 studies assessed, we selected 20 that met the inclusion criteria. Most of studies dealt with specific clinical situations, not discussing the methodology of scenario construction. The analysis of the 20 studies made it possible to develop guidelines for scenario construction, which were divided into three sections: building a scenario in eight steps, pearls in the construction of simulation scenarios and pitfalls in the development of scenarios. CONCLUSIONS: Construction of simulation scenarios should be planned and structured according to the proposed learning objectives, which should be clear and synergistic with the curricular content. In addition, it is fundamental to adjust the degree of fidelity of the scenario to the learning objectives, because excessively produced scenarios are expensive and can produce excessive fascination, dispersing the attention of the student. On the other hand, low fidelity scenarios can make it difficult for participants to immerse themselves in the activity. Like any project, resources must be invested in planning to facilitate its execution and, consequently, to increase its effectiveness.

Analysis of the Environmental Management System based on ISO 14001 on the American continent.

The American continent is in broad economic and industrial development. Consequently, a more detailed discussion of the impacts generated by such development is needed. Moreover, there is an increase in the number of ISO 14001 certificates issued to this continent. Given the above, no studies were found that bridge the gap to identify the influence of different factors on ISO 14001 in the Americas. Thus, this article has as its main aim to check which economic, environmental and cultural factors have influence on ISO 14001 Certification in the American Continent. The data were collected in the ISO Survey, World Bank, United Nations Development Programme and International Energy Agency. Among the countries of that continent, thirteen were analyzed and only two did not show the economic factors as the influence factor in the multiple regression models fitted with Brazil and the United State. In these models, all presented environmental factors as influencing factors. Only in Brazil the index HDI presented as cultural factor in multiple regression model fitted. The economic factors: Gross Domestic Product and exports of goods and services and environmental: Carbon Dioxide (CO2) and fossil fuel consumption were the most influential in ISO 14001 certification. Venezuela, Uruguay, Colombia and the United States were countries that had factors dependent on each other, featuring the environmental marketing. Briefly, this study brings up several implications: to the academy, with the proposal of new concepts and guidance on the factors that assist in ISO 14001 certification in the American Continent. Additionally, taking into account the industry, the factors serve as efficiency parameters for the implementation of ISO 14001 standard, and for the Government to improve through factors that do not fit in multiple regression models.