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To analyze nurses' motivation to learn, motivation to transfer, knowledge acquisition, and satisfaction with an e-Learning course about neonatal pain assessment.Quantitative, longitudinal, quasi-experimental study, conducted in a university affiliated hospital in São Paulo, Brazil, between April and October 2018.Upon consent, nurses received two questionnaires electronically ("Demographics Survey" and "Motivation to Learn Survey") and were granted access to the e- Learning environment. During the 10-module course, nurses completed a "Pre-Test Questionnaire" (in unit one), and the "Post-Test Questionnaire", "Satisfaction Evaluation Survey", and "Motivation to Transfer Knowledge Survey" at completion of the course. Data were analyzed using R, version 3.6.2.30 nurses were enrolled, the majority were female (93.33%), mean age 42.8 years (±7.6). The motivation to transfer knowledge (mean 4.09, ±0.53) was greater than the motivation to learn (mean 3.44, ±0, 33). There was significant increase in nurses' knowledge (p0.0001) when comparing Post- and Pre-Test scores. Participants' satisfaction was overall positive regarding tutoring, virtual environment, self-evaluation, contents and activities, visual communication/layout.e-Learning allows nurses to increase their knowledge, to access evidence-based information, while offering a space for critical thinking, clinical reasoning, and decision-making in nursing care, ultimately contributing to quality of care and patient safety.The e-Learning course contributed to participants' knowledge acquisition, resulting in a positive impact on nurses' motivation to implement new knowledge about neonatal pain assessment in their clinical practice. The course was considered to be in a suitable environment, easy to handle, interactive and dynamic.

Objective To identify the type and frequency of stressful and painful procedures, the use of pharmacological and non-pharmacological strategies; to identify relationships between demographic and clinical variables with frequency of procedures and pain management. Design A prospective longitudinal study was conducted in neonatal intensive care units (NICU) of two hospitals in the city of Belo Horizonte, Brazil. 140 newborns admitted to the NICU between June 2014 and January 2015 were included. Results A total of 21,291 procedures were documented, 18,131 (85.2%) stressful procedures and 3,160 (14.8%) invasive skin-breaking painful procedures. Each day of hospitalization increased by 10.9 the number of stressful procedures and by 2.2 the number of painful procedures. Furthermore, for each day of hospitalization, non-pharmacological strategies registered increased by 3.4% and pharmacological strategies, increased by 9.3%. Conclusion Neonates underwent a high number of stressful and painful procedures and with infrequent use of pharmacological and non-pharmacological strategies during the entire hospitalization.

This study aims to: (1) conduct a systematic review of YouTube videos showing newborn infants undergoing blood tests and (2) ascertain the use of recommended pain treatment strategies and infant pain during the filmed blood test. The pain was assessed using: (1) Neonatal Facial Coding System (NFCS) scores before, during and following the procedure; (2) Cry duration before and during the procedure. A total of 55 videos showing 63 procedures were included. Over half the babies cried and most babies scored the highest NFCS score of 4 at time of the poke as well as 15 s after the poke. YouTube videos of newborn infants undergoing blood sampling showed that recommended effective pain management interventions were rarely used and most infants were distressed during and following the procedure.

Objectives To analyze the relationship of ribosomal protein mutations and clonality of high-risk clones Acinetobacter baumannii. Methods Seventy-nine carbapenem-resistant A. baumannii were subjected to whole-genome sequencing (Illumina NextSeq), and codifying sequences of ribosomal proteins were extracted and screened for mutations. MALDI-TOF MS analysis (Bruker Biotyper) and Spectra data from MALDI-TOF was employed to generate a dendrogram based on principal component analysis (PCA) data. Clones were identified by Multilocus sequencing typing (MLST) based on WGS. Results Ribosomal RNA protein sequences extracted from the genomes identified mutations that were associated with clonal complexes, but most of them were silent. PCA did not cluster the isolates according to their clonality identified by MLST. Conclusions By comparing the nucleotide and amino acid sequences of diversified A. baumannii, and Bruker Biotyper profiles, we showed that silent mutations in ribosomal RNA nucleotides are associated with clonal complexes, but since most of the mutations were silent, MALDI-TOF MS raw data was not a useful tool for typing the high-risk clones of this species.

Dissemination of carbapenem-resistant Acinetobacter baumannii (CRAB) is mainly driven by the spread of clonal lineages. High frequencies of CRAB are reported in South America, and clonal complexes CC1, CC15, CC79 and CC25 are predominant. A total of 79 non-redundant CRAB recovered from 26 Brazilian hospitals were selected for antimicrobial susceptibility testing by microdilution and whole-genome sequencing (WGS). Multilocus sequence typing (MLST), acquired antimicrobial resistance genes and phylogeny based on high-quality SNPs were extracted from WGS data. XDR (86.1%), MDR (12.7%) and one PDR isolate from CC15 (1.3%) were identified. Colistin resistance was more frequent in CC25 isolates (P0.01). Prevalence of CC79 (n = 22; 27.8%) CC1 (n = 21; 26.6%), CC15 (n = 21; 26.6%) and CC25 (n = 12; 15.2%) was observed. Regarding carbapenem-hydrolysing class D β-lactamases (CHDLs), bla

A provincial-wide online survey was conducted to: 1) ascertain frequency of use of breastfeeding (BF), skin-to-skin care (SSC) and sucrose for pain reduction during heel lance and venipuncture in maternal newborn units and neonatal intensive care units (NICUs), and 2) to identify barriers to using these strategies for pain reduction. An invitation and link to an electronic survey were emailed to nurse managers of 91 maternal newborn units and NICUs in Ontario, Canada, and 40 completed surveys were submitted (44%). Results showed variable but infrequent use of pain reduction strategies. Barriers were coded as health care provider (HCP), infant, parent and organizational factors. Most barriers related to BF and SSC and included: preference to perform blood sampling without parents; parental preference to not be involved during blood sampling; unit cultures; out of date policies; insufficient time, knowledge and education; and staff being uncomfortable performing blood sampling with infants BF or held SSC.

Safe application of the anaerobic sequencing biofilm batch reactor (ASBBR) still depends on deeper insight into its behavior when faced with common operational problems in wastewater treatments such as tolerance to abrupt variations in influent concentration, so called shock loads. To this end the current work shows the effect of organic shock loads on the performance of an ASBBR, with a useful volume of 5L, containing 0.5-cm polyurethane cubes and operating at 30 degrees C with mechanical stirring of 500 rpm. In the assays 2L of two types of synthetic wastewater were treated in 8-h cycles. Synthetic wastewater I was based on sucrose-amide-cellulose with concentration of 500 mg COD/L and synthetic wastewater II was based on volatile acids with concentration ranging from 500 to 2000 mg COD/L. Organic shock loads of 2-4 times the operation concentration were applied during one and two cycles. System efficiency was monitored before and after application of the perturbation. When operating with concentrations from 500 to 1000 mg COD/L and shock loads of 2-4 times the influent concentration during one or two cycles the system was able to regain stability after one cycle and the values of organic matter, total and intermediate volatile acids, bicarbonate alkalinity and pH were similar to those prior to the perturbations. At a concentration of 2000 mg COD/L the reactor appeared to be robust, regaining removal efficiencies similar to those prior to perturbation at shock loads twice the operation concentration lasting one cycle and stability was recovered after two cycles. However, for shock loads twice the operation concentration during two cycles and shock loads four times the operation concentration during one or two cycles filtered sample removal efficiency decreased to levels different from those prior to perturbation, on an average of 90-80%, approximately, yet the system managed to attain stability within two cycles after shock application. Therefore, this investigation envisions the potential of full scale application of this type of bioreactor which showed robustness to organic shock loads, despite discontinuous operation and the short times available for treating total wastewater volume.