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Edge computing is a paradigm that extends cloud computing with storage and processing capacity close to the edge of the network that can be materialized by using many fog nodes placed in multiple geographic locations. Fog nodes are likely to be vulnerable to tampering, so it is important to secure the functions they provide. A key building block of many distributed applications is an ordering service that keeps track of cause-effect dependencies among events and that allows events to be processed in an order that respects causality. In this paper we present the design and implementation of a secure event ordering service for fog nodes. Our service, named Omegae, leverages the availability of a Trusted Execution Environment (TEE) based on Intel SGX technology to offer fog clients guarantees regarding the order in which events are applied and served, even when fog nodes are compromised. We have also built OmegaKV, a key-value store that uses Omega e to offer causal consistency. Experimental results show that the ordering service can be secured without violating the latency constraints of time-sensitive edge applications, despite the overhead associated with using a TEE.

Background The development of vaccines to prevent COVID-19 breakouts came with highly positive results but some unexpected side effects. Rare side effects have been seen with the BNT162b2 SARS-CoV 2 vaccine. Case Presentation We present the case of a 45-year-old female patient who developed an acute kidney injury needing urgent hemodialysis one week after the second administration of the BNT162b2 SARS-CoV 2 vaccine. She developed a macular rash on her lower limbs and palms as well. A kidney biopsy was performed 10 days after vaccine inoculation, diagnosing acute interstitial nephritis and acute tubular necrosis with cellular casts. The patient was treated with three corticosteroid pulses followed by daily prednisolone. We witnessed clinical improvement 4 days after the initial corticosteroid treatment with progressive recovery of kidney function and hemodialysis withdrawal. After 2 weeks, the patient had recovered her kidney function. Immunophenotyping was performed, diagnosing a hypersensitivity to the vaccine and the polyethylene glycol excipient. Conclusion Patients may develop acute reactions to vaccines. In this case, symptoms seem to correlate significantly with its inoculation and, although this case had a favourable outcome, these side effects must be made aware for clinicians and patients.

Felty’s syndrome (rheumatoid arthritis with neutropenia and splenomegaly) is a rare condition with poor long-term prognosis, mainly as a result of severe infection risk. An effective treatment strategy has not been developed so far and current treatment options are based upon case reports, small series and clinical experience since no randomized clinical trials are available. The authors describe the case of a 53-year-old female patient with a 14-year history of rheumatoid arthritis presenting with fever, neutropenia and splenomegaly. Broad-spectrum antibiotics and granulocyte colony-stimulating factor were administered with good clinical outcome and low dose methotrexate for disease control was successfully initiated after discharge. We would like to highlight the importance of being aware of this syndrome in the differential diagnosis of long term rheumatoid arthritis patients presenting with febrile neutropenia.

OBJECTIVES Tacrolimus has a narrow therapeutic window, and lack of adherence to the therapeutic regimen is a main risk factor for acute graft rejection; hence, the prolonged-release formulation was created. A high intrapatient variability for tacrolimus trough levels has been associated with worse graft outcomes; therefore, we investigated the correlation between the tacrolimus variation coefficient and the development of biopsy-proven acute graft rejection in kidney transplant patients with typical maintenance immunosuppression versus the prolonged-release formulation. MATERIALS AND METHODS This was a single-center observational retrospective study that included all adult kidney transplants from deceased donors between January 2011 and December 2014 for which the transplant recipients were given maintenance therapy with tacrolimus prolonged-release formulation (Advagraf). The overall tacrolimus variation coefficient was calculated for the follow-up period from transplant until December 2019. Biopsy-proven acute graft rejection results were collected throughout follow-up. Statistical analysis was performed with SPSS software. RESULTS The study was composed of 147 patients with a mean follow-up time of 60.4 ± 15 months. The mean age of the patients was 47.5 ± 11.9 years and 67.3% were men. Of these 147 patients, 29 had at least 1 episode of acute graft rejection during follow-up. There was a significant correlation between patients with a higher tacrolimus variation coefficient and the presence of biopsy-proven acute graft rejection. Receiver operating characteristic curves were used to determine an intrapatient variability cutoff point of 28.3% for tacrolimus. Younger patients were also more likely than older patients to develop acute graft rejection in our sample. CONCLUSIONS High intrapatient variability of tacrolimus trough levels is a risk factor for acute graft rejection in kidney transplant patients.

Background Borderline changes suspicious for acute T-cell–mediated rejection (BC) are frequently seen on biopsy specimens, but their clinical significance and clinical management are still controversial. Our goal was to compare clinical outcomes of kidney transplant recipients with biopsy-proven BC vs acute T-cell–mediated rejection (aTCMR) and the influence of treating BC on graft outcomes. Methods A retrospective cohort study was performed in all kidney transplant recipients with biopsy-proven BC and aTCMR between January 2012 and December 2018, according to Banff 2017 criteria; patients with concomitant antibody-mediated rejection were excluded. Results We included 85 patients, 30 with BC (35.3%) and 55 with aTCMR (64.7%). There was no difference between groups regarding demographics, HLA matching and sensitization, immunosuppression, or time of transplant. Treatment with steroids was started in 15 patients with BC (50%) and in all patients with aTCMR, with 4 of the latter additionally receiving thymoglobulin (7.2%). At 1 year post biopsy, overall graft survival was 71%, and despite presenting better estimated glomerular filtration rate (eGFR) at biopsy (33.3 ± 23.4 vs 19.9 ± 13.2 mL/min/1.73 m2, P = .008), patients in the BC group presented the same graft survival as the aTCMR group according to Kaplan-Meyer survival curves. When analyzing the BC group (n = 30) and comparing the patients who were treated (n = 15) vs a conservative approach (n = 15), graft survival at 1 year was 87% for treated patients and 73% for nontreated patients (P = .651), with no difference in eGFR for patients with functioning graft. However, at longer follow-up, survival curves showed a trend for better graft survival in treated patients (70.2 ± 9.2 vs 38.4 ± 8.4 months, P = .087). Conclusion Our study showed that patients with BC did not present better graft survival or graft function at 1 year after biopsy or at follow-up compared with the aTCMR group, despite better eGFR at diagnosis. We found a trend for better graft survival in patients with BC treated with steroids compared with a conservative approach. These results reinforce the importance of borderline changes in graft outcomes and that the decision to treat can influence long-term outcomes.

The usage of non-traditional data in credit scoring, from microfinance institutions, is very useful when trying to address the problem, very common in emerging markets, of the lack of a verifiable customers’ credit history. In this context, this paper relies on data acquired from smartphones in a loan classification problem. We conduct a set of experiments concerning feature selection, strategies to deal with imbalanced datasets and algorithm choice, to define a baseline model. This model is, then, compared to others adding network features to the original ones. For that comparison, we generate a network that links a given user to its phone book contacts which are users of a given mobile application, taking into account the ethics and privacy concerns involved, and use some feature extraction techniques, such as the introduction of centrality measures and the definition of node embeddings, in order to capture certain aspects of the network’s topology. Several node embedding algorithms are tested, but only Node2Vec proves to be significantly better than the baseline model, applying Friedman’s post hoc tests. This node embedding algorithm outperforms all the other, representing a relative improvement, in comparison with the baseline model, of 5.74% on the mean accuracy, 7.13% on the area under the Receiver Operating Characteristic curve and 30.83% on the Kolmogorov–Smirnov statistic scores. This method, therefore, proves to be very promising when trying to discriminate between “good” and “bad” customers, in credit scoring classification problems.

The largest bottleneck to the development of convolutional neural network (CNN) models in the computational pathology domain is the collection and curation of diverse training datasets. Training CNNs requires large cohorts of image data, and model generalizability is dependent on training data heterogeneity. Including data from multiple centers enhances the generalizability of CNN based models, but this is hindered by the logistical challenges of sharing medical data. In this paper we explore the feasibility of training our recently developed cloud-based segmentation tool (Histo-Cloud) using federated learning. We show that a federated trained model to segment interstitial fibrosis and tubular atrophy (IFTA) using datasets from three institutions is comparable to a model trained by pooling the data on one server when tested on a fourth (holdout) institution’s data. Further, training a model to segment glomeruli for a federated dataset (split by staining) demonstrates similar performance.

Introduction: Central venous stenosis can be the main obstacle to the creation of an autologous vascular access in the upper limbs. The Hemodialysis Reliable Outflow graft was developed to provide an upper limb vascular access option to such patients, avoiding alternative, less advantageous options, such as lower limb vascular accesses or central venous catheters. Its advantages include catheter avoidance and, in case of lower limbs accesses, reduction of the ischemic risk and iliac vein thrombosis, potentially compromising a future kidney transplant. Patients and methods: Revision of the clinical files of the four patients who were placed a Hemodialysis Reliable Outflow device in our Center, including demographic variables, implantation technique characteristics, surgical complications, episodes of infection and thrombosis of the access, and need to place a transitory central venous catheter to undergo hemodialysis treatment. Results: Four Hemodialysis Reliable Outflow grafts were placed, which resulted in a significant improvement in the dialysis efficacy in all patients, with a median raise in the Kt/V of 36.7%. Two cases needed thrombectomy, one of which was unsuccessful. The actual time of patency varies between 3 and 28 months. Conclusion: Our experience with the Hemodialysis Reliable Outflow device showed that it was a safe option for patients with central venous stenosis and was associated with good clinical and analytic outcomes.

Introduction:Angiosarcomas are rare tumors, comprising less than 1% of all sarcomas. However, they portend a poor prognosis, as they tend to metastasize early, being of uttermost importance a prompt diagnosis and treatment.Case description:We present the case of a 55-year-old female with history of kidney transplantation, immunosuppressed with tacrolimus, prednisolone, and mofetil mycophenolate. Fifteen years after the transplant, she developed an ulcerated lesion on the site of a nonfunctioning arteriovenous graft, which was excised. Histology was compatible with a high grade angiosarcoma that invaded the margins, and immunosuppression was switched to everolimus. Staging imaging exams revealed lymph node, muscle, and lung metastases. Shortly after, nodular lesions appeared compatible with local recurrence of the disease, and the patient showed severe deterioration of her clinical condition, being proposed for palliative chemotherapy. However, the disease showed an explosive progression and the patient died before starting the treatment.Conclusion:This case emphasizes the importance of including inspection of the vascular access (functioning or not) in regular post-transplant consultation and value any alterations in the attempt of a timely diagnosis. Although rare, angiosarcoma is an important entity that should be considered in the differential diagnosis of soft tissue masses arising from a vascular access, especially in immunocompromised patients. Aggressive treatment should be offered whenever possible.

Background and Aims Kidney retransplantation confers a robust survival benefit over dialysis in selected patients and recent data has shown second graft outcomes similar to those of a first graft. However, the management of these patients is challenging, particularly due to allosensitization and an increased risk of acute rejection, which are related with poorer graft survival. The recognition of risk factors to acute rejection, dependent on the first and second graft, might help us to personalize standard care and achieve similar graft survival rates to patients with a first transplant. Our aim was to identify risk factors to second graft acute rejection, and the impact of acute rejection in graft failure. Method We performed a retrospective, longitudinal study including all patients submitted to a second kidney transplant between January 2008 and December 2019, excluding patients with more than 2 grafts or multi-organ transplant. Demographic, clinical and histocompatibility data from the donor and receptor were collected from our unit database. Delayed graft function was defined as the need of dialysis in the first week post-transplant. All acute rejection episodes were biopsy proven, according to Banff 2017 criteria. Follow-up was defined at 1st June 2020 for functioning grafts or at graft failure, with a mean time of 94±42 months. Results We included 109 patients of which 70 males (64%), mostly Caucasian (97%), with a mean age of 43±12 years at second kidney transplant. The main causes of end stage renal disease were glomerular disease (37%), undetermined cause (34%), and urological pathology (15%). First kidney transplant was performed before the year 2010 in 95 patients (87%). The median time of first graft survival was 75 months (IQR 58.5-91.4) and the main causes of first graft loss were chronic allograft nephropathy (N=62, 70.5%) and 11 patients (12.5%) presented primary disfunction due to surgical/vascular complications. During follow-up, 20 patients (18%) presented biopsy proven acute rejection: 3 patients borderline changes, 10 patients T cell mediated and 7 patients antibody mediated, the majority during the first-year post-transplant (N=17, 85%). The risk factors for second graft rejection are summarized in table 1. First year graft survival of the second transplant was 90% and survival at follow up was 72.5% (N=79). Acute rejection was an important risk factor for graft loss (OR 6.548 (95%CI[2.292 - 18.703]), p Conclusion Worst outcomes in first kidney transplant, such as acute rejection, primary dysfunction and lower graft survival were related with an increased risk of acute rejection in second graft outcomes, and consequently a higher risk of graft failure.

Background and Aims A growing number of end-stage renal disease patients waiting for a kidney transplant (KT) are older than 50 years old. Consequently, many kidney transplant recipients will be in need of dialysis or re-transplantation at an older age. For young patients, re-transplantation offers an advantage over dialysis but in the elderly these benefits are not well established. For selected older recipients, with rigorous cardiovascular and neoplastic evaluation, immunosenescence might actually provide an advantage in graft outcomes. Our aim was to compare major clinical outcomes between patients older and younger than 60 years old at re-transplantation, and between first and second KT for recipients older than 60 years old. Method We performed a retrospective, longitudinal study, that included all patients submitted to a second KT between January 2008 and December 2019, excluding patients with more than 2 grafts or multi-organ transplant. We defined two groups according to recipient’s age at re-transplant, older and younger than 60 years-old, and compared major clinical outcomes such as biopsy proven acute rejection, death-censored graft survival and patients’ survival. Afterwards, we selected KT patients older than 60 years, and compared the same outcomes for patients with first and second KT. Follow-up time was defined at 1st June 2020 for functioning grafts or at graft failure (including death with a functioning graft). Results We included 109 patients with a second KT, 13 (12%) older than 60-years-old (group 1), with a mean age of 62.85 ± 2.9 years, and 96 (88%) younger than 60-years-old (group 2), with a mean age of 40.4 ± 10.6 years. Group 1 recipients were all male (100% vs 59.4%; p=0.004) and had higher body mass index (25±2.8 vs 22.5±3.6 kg/m2, p=0.016). Recipients from the group 1, waited less time for their second KT (37.7±21.8 vs 64.8±58.8 months; p=0.003), but had older donors (59.5±13.5 vs 45.9±11.5 years old; p Conclusion In carefully selected patients, advanced age should not be a contraindication to kidney re-transplantation. Immunosenescense might lead to lower acute rejection rates and older donors might be used with less restrictions. In our study, major clinical outcomes were comparable to their younger counterparts with a second graft and to older patients with a first graft.

Objective: to build assistive technology, in video format, for deaf and hearing people about sexual health and condom use. Methods: methodological study consisting of the stages of pre-production, production and post-production. In pre-production we built the script, storyboard and scenes, following the principles of Lev Semenovich Vygotsky’s Theory of Learning. In production there was the development of the animation and recording of the scenes by the Libras interpreter. In post-production the final editing of the video took place. Results: the video “Condom: learn to use correctly”,lasting nine minutes and 25 seconds discusses the sexual and reproductive system of man and woman; mode of action, benefits and care with the use of condoms.Given the scarcity of educational materials on the subject, accessibility resources were used to build a video for deaf and hearing people. Conclusion: the construction of the video as an assistive technology directed to the deaf was successfully accomplished. Objetivo: construir tecnologia assistiva, no formato de vídeo, para surdos e ouvintes sobre saúde sexual e o uso do preservativo. Métodos: estudo metodológico constituído das etapas de pré-produção, produção e pós-produção. Na pré-produção construiu-se roteiro, storybord e cenas, seguindo os princípios da Teoria da Aprendizagem de Lev Semenovich Vygotsky. Na produção houve o desenvolvimento da animação e gravação das cenas pelo intérprete de Libras. Na pós-produção ocorreu a edição final do vídeo. Resultados: o vídeo “Preservativo: aprenda a usar corretamente”, com duração de nove minutos e 25 segundos discorre sobre o sistema sexual e reprodutivo do homem e da mulher; modo de ação, benefícios e cuidados com o uso do preservativo. Diante da escassez de materiais educativos sobre o tema, empregaram-se recursos de acessibilidade para construir um vídeo para surdos e ouvintes. Conclusão: a construção do vídeo como tecnologia assistiva dirigida aos surdos foi realizada com êxito.

Background and Aims As kidney transplants are growing in absolute numbers, so are patients with failed allografts and thus potential candidates for re-transplantation. Re-transplantation is challenging due to immunological barriers, surgical difficulties and clinical complexities but it has been proven that successful second transplantation improves life expectancy over dialysis. It is important to evaluate re-transplantation outcomes since 20% of patients on the waiting list are waiting for a second graft. Our aim was to compare major clinical outcomes such as acute rejection, graft and patient survival, between patients receiving a first or a second kidney transplant. Method We performed a retrospective study, that included 1552 patients submitted to a first (N=1443, 93%) or a second kidney transplant (N=109, 7%), between January 2008 and December 2018. Patients with more than 2 grafts or multi-organ transplant were excluded. Demographic, clinical and histocompatibility characteristics of both groups were registered from our unit database and compared. Delayed graft function was defined has the need of dialysis in the first week post-transplant. All acute rejection episodes were biopsy proven, according to Banff 2017 criteria. Follow-up time was defined at 1st June 2020 for functioning grafts or at graft failure (including death with a functioning graft). Results Recipients of a second graft were significantly younger (43 ±12 vs 50 ± 13 years old, p Conclusion Although second graft patients presented more episodes of biopsy proven acute rejection, especially at the first-year post-transplant, we found no differences in death censored graft survival or patients’ mortality for patients with a second kidney transplant. Second transplants should be offered to patients whenever feasible.

Background and Aims Delayed graft function (DGF), defined as the need for dialysis within one week post-transplantation, is associated with poorer kidney graft survival. We aimed to identify risk factors for DGF throughout 3 decades and evaluate their effect on graft survival. Method Retrospective study including 3081 kidney transplants performed at our transplantation unit between January 1st, 1989 and December 31st, 2018, split in 3 decades (1: 1989-1998; 2: 1999-2008; 3: 2009-2018). Data regarding donor and recipient demographics, time on dialysis, immunization, cold ischemia time, hemodynamic parameters and immunosuppression were collected from our prospectively maintained data base. Results Main donor, recipient and perioperative characteristics are summarized in table 1. There were clear differences in these characteristics between the decades, standing out more adverse features from both recipients and donors. Overall incidence rate of DGF was 16% (n=493): 14% in decade 1; 19.3% in decade 2 and 15% in decade 3. On univariate analysis, most studied variables included in table 1 were statistically significant as predictors of DGF. However, on multivariate analysis, we found that in the first decade the predominant risk factors for DGF were pre-transplant dialysis time and cold-ischemia time, whilst in the following decades donor characteristics, as well as recipient’s weight became more relevant (table 2). Conclusion The observed shift from donor-unrelated variables in the first decade into donor-related variables in the second and third decades as the main determinants of DGF highlights the impact of expanding donor’s acceptance criteria. Nevertheless, the increase in expanded criteria donors did not translate into poorer overall results, probable contributors being shorter cold-ischemia times and stronger immunosuppression.

Introduction Chronic kidney disease in the pediatric population is associated with numerous comorbidities and an increased risk of mortality. Kidney transplantation (KT) is considered to be the option of choice in children with end-stage renal disease. Aim To characterize a single center experience in pediatric KT in the last 35 years. Methods A retrospective analysis of epidemiologic and clinical data from KT pediatric patients from January 1981 to December 2016. For outcome analysis, cases were divided into decades (1981–89; 1990–99; 2000–09; 2010–16). Results One hundred and 4 children (KT mean age 13.7 ± 3.32 years; 57.7% male) underwent 111 renal transplants (13% with living donors). Congenital anomalies of the kidney and urinary tract (36.5%) and glomerular disease (29%) were the major causes of renal disease. Peritoneal dialysis was the predominant initial therapeutic modality in 69 children (62.2%). Mean dialysis time was 19.2 months, 9 patients (8.1%) having had preemptive KT. Median follow-up was 181 months. Uncensored graft survivals rates at 5, 10, 15, and 20 years were 79.7%, 74.3%, 59.5%, and 52.8%, respectively. Graft survival improved significantly over the decades (P = .03). Higher estimated glomerular filtration rate measured at 1 year, induction immunosuppressive therapy use (thymoglobulin/basiliximab), and lower incidence of acute rejection rates were associated with superior graft survival (P Conclusions Uronephropathies were the most frequent cause of renal failure and peritoneal dialysis, which was the main renal replacement therapy according to the literature. Graft survival improved significantly over the study period; we hypothesize that this was related to surgical advances and the use of more effective immunosuppressive drugs.

Introduction Post-transplant diabetes mellitus is a complication of kidney transplantation with deleterious effects on graft and patient survival and is associated with higher mortality. The goal of this paper is to identify risk factors that contribute to its development so that it can be avoided. Methods We performed a retrospective analysis of 659 kidney transplants performed in adult patients between January 2013 and December 2017. We excluded patients with a previous diagnosis of diabetes mellitus and identified 61 patients with post-transplant diabetes mellitus (10.6%), then compared them to a control group of 61 patients who did not suffer from the disease, namely the kidney transplant pair or the patient submitted for transplant immediately after. Discussion A comparative analysis of the 2 groups revealed significant differences regarding the use of β-blockers, fasting glucose on the fifth day post-transplant, kidney recipient age, and body mass index. Using multivariate logistic regression methods, 2 variables with an impact on post-transplant diabetes development were found: fasting glucose on the fifth day post-transplant (odds ratio 1.044, 95% confidence interval 1.010–1.079, P = .010) and body mass index (odds ratio 1.130, 95% confidence interval 1.009–1.264, P = .034). We did not find any differences for other potential risk factors. Conclusion A high plasma glucose level on the fifth day after the transplant and a high body mass index in the setting of the transplant can potentially impact the transplant's outcomes, so it is important to identify these levels as soon as possible to take measures to prevent this disease.

Publish-subscribe systems are a powerful abstraction to build distributed applications. This paper addresses the problem of reducing subscription latency in reliable publish-subscribe systems. In most systems that offer reliability guarantees, a subscriber needs to wait until its subscription has been propagated throughout the entire system, and known by all relevant publishers, before starting to receive events. Interestingly, this may happen even when a previously deployed subscription covers a new one. In this paper, we study the properties that need to be satisfied to reduce the subscription latency and propose a new publish-subscribe system that leverages causal order multicast to offer low subscription latency when these conditions are met.

Objective: To evaluate the impact of implementing the SafeCare clinical supervision model on nurses’ job satisfaction and emotional competence profile. Methods: This is a quasi-experimental study, with a sample of 28 nurses from a hospital in northern Portugal. A self-administered questionnaire was applied, used as pre and post-test, which included: sociodemographic and professional characterization; “Job Satisfaction Scale”; and “Veiga Emotional Competence Scale”. We conducted descriptive statistical analysis and the Wilcoxon Test. Results: A significant decrease in the nurses’ satisfaction with hierarchical superior was observed in the post-test. No significant differences were found in the nurses’ job satisfaction and emotional competence after the implementation of the SafeCare Model. Conclusion: The SafeCare Model needs improvement, suggesting increasing the amount of training time administered to nurses and strengthening the healthcare institution’s link to the Model. Objetivo: Avaliar o impacto da implementação do Modelo de supervisão clínica SafeCare na satisfação profissional e no perfil de competência emocional dos enfermeiros. Métodos: Estudo quase-experimental, com uma amostra de 28 enfermeiros de um hospital do norte de Portugal. Aplicou-se um questionário de autopreenchimento, utilizado como pré e pósteste, que engloba caracterização sociodemográfica e profissional, “Escala da Satisfação Profissional” e “Escala Veiga de Competência Emocional”. Realizaram-se análise estatística descritiva e Teste de Wilcoxon. Resultados: Observou-se uma diminuição significativa na satisfação dos enfermeiros com o superior hierárquico no pós-teste. Não se verificaram diferenças significativas na satisfação profissional e na competência emocional dos enfermeiros após a implementação do Modelo SafeCare. Conclusão: É necessário aperfeiçoar o Modelo SafeCare, sugerindo que se aumente o tempo de formação administrada aos enfermeiros e fortaleça o vínculo da instituição de saúde ao Modelo. Objetivo: Evaluar el impacto de la aplicación del Modelo de supervisión clínica SafeCare en la satisfacción laboral y en el perfil de competencia emocional de los enfermeros. Métodos: Se trata de un estudio cuasi experimental, realizado con una muestra de 28 enfermeros de un hospital del norte de Portugal. Se aplicó un cuestionario autocompletado como pre y pos test, que incluía la caracterización sociodemográfica y profesional, la “Escala de Satisfacción Laboral” y la “Escala Veiga de Competencia Emocional”. Se llevaron a cabo análisis estadísticos descriptivos y la prueba de Wilcoxon. Resultados: Fue posible observar una disminución significativa de la satisfacción de los enfermeros con su superior jerárquico en la prueba posterior al test. No se encontraron diferencias significativas en la satisfacción laboral y en la competencia emocional de los enfermeros tras la aplicación del modelo SafeCare. Conclusión: Es necesario perfeccionar el Modelo SafeCare, aumentando la cantidad de formación impartida a los enfermeros y reforzando el vínculo de la institución sanitaria con el Modelo. info:eu-repo/semantics/publishedVersion

We present NetSheriff – a system to automatically isolate faulty switches in Software-Defined Networks. To pinpoint the devices responsible for network misbehaviors, NetSheriff performs a differential analysis between expected paths of packets (obtained from a formal model of the network forwarding specification) and the corresponding observed paths taken by flows (obtained through network monitoring). We have built a prototype of NetSheriff supporting both OpenFlow and P4 Programmable devices and evaluated it on different network topologies, simulating real traffic behavior following recent data center studies. Our results show that NetSheriff is able to accurately identify the switch(es) responsible for different types of errors.

Many censorship circumvention tools rely on trusted proxies that allow users within censored regions to access blocked Internet content by tunneling it through a covert channel (e.g,. piggybacking on Skype video calls). However, building tools that can simultaneously (i) provide good bandwidth capacity for accommodating the typical activities of Internet users, and (ii) be secure against traffic analysis attacks has remained an open problem and a stumbling block to the practical adoption of such tools for censorship evasion. We present Protozoa, a censorship-resistant tunneling tool featuring both high-performing covert channels and strong traffic analysis resistance. To create a covert channel, a user only needs to make a video call with a trusted party located outside the censored region using a popular WebRTC streaming service, e.g., Whereby. Protozoa can then covertly tunnel all IP traffic from unmodified user applications (e.g., Firefox) through the WebRTC video stream. This is achieved by hooking into the WebRTC stack and replacing the encoded video frame data with IP packet payload, while ensuring that the payload of the WebRTC stream remains encrypted, and the stream's statistical properties remain in all identical to those of any common video call. This technique allows for sustaining enough throughput to enable common-use Internet applications, e.g., web browsing or bulk data transfer, and avoid detection by state-of-the-art traffic analysis attacks. We show that Protozoa is able to evade state-level censorship in China, Russia, and India.

This paper uses non-traditional data, from a MicroFinance Institution (MFI), in a Credit Scoring loan classification problem and addresses a common problem in emerging markets of the lack of a verifiable customers’ credit history. We perform a set of experiments to define a baseline model and prove the relevance of node embedding features, in credit scoring models, using a real world dataset.

Today, many applications offload computation and storage to the cloud. Unfortunately, the high network latency between clients and datacenters can impair novel, latency-constrained, applications such as augmented reality. Edge computing has emerged as a potential solution to circumvent this problem. To unleash its full potential, the edge must cache data that is frequently used. However, building a storage service that is able to maintain many (partial) replicas while providing meaningful consistency guarantees to clients that migrate among multiple edge caches is an open challenge. In this paper, we present Gesto, a data storage architecture that enables scalable causal consistency for edge networks. Gesto integrates a novel causality tracking mechanism that relies on multi-part timestamps of constant size, independently on the number of edge caches. As our evaluation shows, this mechanism enables Gesto to simultaneously offer scalability, low read/write latency, high throughput, and, unlike previous work, fast client migrations.

Introduction Synthetic anabolic-androgenic steroids (AAS) were developed with the purpose of obtaining drugs capable of increasing protein synthesis associated with a lower degree of virilization. Its use is common among bodybuilders who aim to increase physical strength and muscle mass in the short term. However, AAS cause side effects, which restrict their therapeutic use. Objective To identify factors associated with AAS use by exercise enthusiasts at gyms in São Luís, MA. Methods A cross-sectional study was carried out at 17 gyms. The sample totaled 723 exercise enthusiasts, who answered a structured questionnaire with multiple choice questions related to their lifestyle and the consumption of nutritional supplements and AAS use. Logistic regression analysis was used to verify the association of socioeconomic, demographic and behavioral factors with AAS use. Results Of the 723 exercise enthusiasts, 10.65% reported having used AAS. Of these, 97.4% declared their awareness of some side effect caused by AAS use. Factors associated with AAS use were: being male, age between 20 and 29 years, consumption of food supplements and participation in exercise for over a year. Conclusion The prevalence of AAS use by exercise enthusiasts at gyms in São Luís is high, and the risk factors identified enable us to target specific populations with preventive actions. Level of Evidence IIC; Cross-sectional study. RESUMO Introdução Os esteroides anabólicos androgênicos (EAA) sintéticos foram desenvolvidos com o propósito de obter fármacos capazes de produzir aumento na síntese proteica, associados a menor grau de virilização. Seu uso é comum entre praticantes de musculação que visam aumento da força física e da massa muscular a curto prazo. Contudo, eles geram efeitos adversos, o que restringe seu uso terapêutico. Objetivo Identificar os fatores associados ao uso de EAA por praticantes de exercício físico em academias de São Luís, MA. Métodos Estudo transversal, realizado em 17 academias de ginástica. A amostra totalizou 723 praticantes de exercício físico, que responderam a um questionário estruturado, com questões de múltipla escolha relacionadas com seu estilo de vida e com o consumo de suplementos nutricionais e EAA. A análise de regressão logística foi empregada para verificar a associação de fatores socioeconômicos, demográficos e comportamentais ao uso de EAA. Resultados Dos 723 praticantes de exercício físico, 10,65% informaram ter utilizado EAA. Destes, 97,4% afirmaram ter conhecimento de algum efeito adverso ocasionado pela utilização de EAA. Mostraram-se fatores associados ao uso de EAA: ser do sexo masculino, ter entre 20 a 29 anos, consumir suplementos alimentares e praticar exercício físico há mais de um ano. Conclusão O consumo de EAA por praticantes de exercício físico em academias de São Luís é alto e os fatores de risco identificados permitem direcionar ações preventivas às populações específicas. Nível de Evidência IIC; Estudo transversal. RESUMEN Introducción Los esteroides anabólicos androgénicos (EAA) sintéticos se desarrollaron con el propósito de obtener agentes capaces de producir aumento en la síntesis de proteínas, asociados con un menor grado de virilización. Su uso es común entre los culturistas que buscan aumentar la fuerza física y la masa muscular a corto plazo. Sin embargo, tienen efectos adversos que restringen el uso terapéutico. Objetivo Identificar los factores asociados con el uso de EAA por parte de practicantes de ejercicio físico en gimnasios de São Luis, MA. Métodos Estudio transversal realizado en 17 gimnasios. La muestra totalizó 723 practicantes de ejercicio físico, quienes respondieron un cuestionario estructurado con preguntas de opción múltiple relacionadas con su estilo de vida y el consumo de suplementos nutricionales y EAA. El análisis de regresión logística se utilizó para verificar la asociación de factores socioeconómicos, demográficos y de comportamiento con el uso de los EAA. Resultados De los 723 practicantes de ejercicio físico, el 10,65% informó haber usado EAA. De estos, el 97,4% dijo que tenían conocimiento de alg ú n efecto adverso causado por el uso de EAA. Se mostraron los siguientes factores asociados con el uso de EAA: ser hombre, tener entre 20 y 29 años, consumir suplementos dietéticos y practicar ejercicio físico por más de un año.. Conclusión El consumo de EAA por los practicantes de ejercicio físico en gimnasios de São Luis es alto y los factores de riesgo identificados pueden orientar las acciones preventivas a poblaciones específicas. Nivel de Evidencia IIC; Estudio transversal.

Background and Aims Post-transplant lymphoproliferative disorders (PTLD) are a group of heterogeneous lymphoid proliferations in chronic immunosuppressed recipients of solid organ and hematopoietic stem cell transplantation. Due to rarity of this disease, retrospective studies from transplant centers have been the main source to provide knowledge and treatment guidelines, which are still in evolution. This study examined the clinical outcomes and identified the predictors of mortality in adult renal transplant recipients who developed PTLD. Method We have studied the incidence of PTLD in adult renal transplant recipients who were transplanted in our hospital from 1996 to 2019. Data was collected for demographics, transplant and immunosuppression history, EBV and CMV serostatus, diagnosis, treatment and outcomes of PTLD. We performed univariate and multivariate analysis to identify prognostic factors. PTLD was classified according to 2018 WHO lymphoma classification. Results Twenty-four patients (12 males and 12 females) were eligible for the analysis. Mean age at time of the transplant was 43.1 ± 16.9 years, with a time between grafting and PTLD of 66 months (IQR 36-98 months). Mean follow-up time was 87 months (IQR 61-117 months). 25% of patients received a living donor renal transplant. 12,5% of patients received induction therapy with thymoglobulin. Mean age at time of PTLD diagnosis was 48,8 ± 17,9 years. Five cases were from Epstein-Barr virus (EBV) mismatched (D+/R-) transplants and there was seroconversion at time of PTLD diagnosis. 25% of patients had central nervous system involvement. 19 patients have monomorphic PTLD and the most common histological diagnosis was diffuse large B cell lymphoma. We identified that age >30 years at time of the transplant was predictor of mortality (HR 33.01; 95% CI: 3.24-336.14; p=0.003). Surprisingly, presence of B symptoms at time of PTLD diagnosis confer a better prognosis (HR 0,143; 95% CI: 0,035-0,579; p=0.006). All cases were managed with reduction in immunosuppression and converted to everolimus. 8 patients were treated with rituximab and there was no significant difference in the survival of these patients. By the end of follow-up, 7 patients went into remission, 1 returned to chronic dialysis, and 16 patients died (15 of them due to the disease). Mean time between PTLD and death was 3 months (IQR 1-6 months). Conclusion PTLD is an infrequent disease with a poor prognosis in renal transplant patients. Some cases have a close relationship with EBV, but it can also develop in the absence of the classical risk factors. The factor affecting mortality in our population was age >30 years at time of the transplant. Presence of B symptoms at time of PTLD diagnosis seems to confer a better prognosis probably due to early investigation and diagnosis of the disease.

Background and Aims Histological findings that meet criteria for borderline changes “suspicious” for acute T cell mediated rejection (BR) as defined by the Banff Classification (2017) are frequently seen. However, its clinical significance, as well as the appropriate clinical management, are still controversial. Our goal was to compare clinical outcomes of kidney transplant recipients with biopsy proven BR versus acute T cell mediated rejection (aTCMR) and the influence of treating BR rejection in graft outcomes. Method A retrospective cohort study was performed in all kidney transplant recipients with biopsy proven BR and aTCMR between January 2012 and December 2018. Data related to donor and recipient demographics, treatment and subsequent evolution of serum creatinine, proteinuria and graft survival were collected. Mean time at follow up was 31.2 ± 29.1 months. Results We included 91 patients with biopsy proven T cell rejection of which 34 (37.4%) had a BR and 57 (62.6%) aTCMR: 39 (68.4%) IA, 9 (15.8%) IB, 7 (28.1%) IIA and 2 (3.5%) IIB. There was no difference between groups (BR vs aTCMR) regarding age (45,5 vs 48,1, p=0,38), sex (male 73% vs 60%, p=0,27) or race (Caucasian 100% vs 93%, p=0.114). For both groups, deceased donor was more frequent (82% vs 95%, p=0.074), and there was no difference in cytotoxic PRA (mean 4.5 ± 9.2 vs 3.7 ± 12.8, p=0.762) or number of compatibilities (mean 2.2 ± 1.2 vs 2.4 ± 1.3, p=0.539). At the time of rejection diagnosis, the mean time of transplant was similar between groups (32.9 ± 43.6 vs 42.3 ± 67.4 months, p=0.467), but estimated glomerular filtration rate (GFR) was significantly higher in patients with BR when compared to aTCMR (32.0 ± 22.5 vs 19.9 ± 13.1 ml/min/1.73m2, p=0.009). We found no significant difference in proteinuria at the time of biopsy between the 2 groups. Treatment with steroids was started in 20 (58.8%) patients with BR and all the patients with aTCMR were treated with steroids with or without thymoglobulin, depending on the Banff class. Fourteen (41.2%) patients with BR were followed closely with no acute interventions. At 1-year post biopsy, graft survival was 70%, and we found no significantly statistical difference between the two groups (79.4% vs 64.3%, p=0.129). In patients with preserved graft, there was no difference in GFR (41.9 ± 17.7 vs 37.7 ± 19.8, p=0.401) at 12 months post biopsy for both groups. When performing Kaplan-Meyer survival curves at follow-up, we also found no difference between BR and aTCMR (57.6 ± 7.1 vs 43.6 ± 5.5 months, p=0.157) (Figure 1). When analyzing the BR group (N=34) and comparing the patients that were treated (N=20) versus the patients with conservative approach (N=14), we found no difference in demographic features, sCr at biopsy (3.0 ± 1.1 vs 2.8 ± 2.1 mg/dl, p=0.696) and time post-transplant (28.1 ± 43.2 vs 39.7 ± 44.8 months, p=0.454). Graft survival at 1-year was 80% for treated patients and 79% for non-treated patients, p=0.919 and GFR for patients with preserved graft was not different between groups (43.9 ± 21.0 vs 39.7 ± 13.5 ml/min/1.73m2, p=0.572). When performing survival curves, we found that treated patients had almost the double time with functioning graft compared to non-treated patients (71.9 ± 8.5 vs 41.3 ± 6.2 months, p=0.104), although not statistically different probably due to the small sample size (figure 2). Conclusion Our study showed that despite having better GFR at time of biopsy, patients with BR (overall and treated) did not present better graft survival nor graft function at 1 year post biopsy or at follow up, compared with aTCMR. We also found a tendency to better graft survival in patients with BR treated with steroids compared with conservative approach. These results reinforce the importance of borderline rejection in graft outcomes and that the decision of whether to treat or not can influence long-term outcomes.

Background Interstitial fibrosis, tubular atrophy (IFTA), and glomerulosclerosis are indicators of irrecoverable kidney injury. Modern machine learning (ML) tools have enabled robust, automated identification of image structures that can be comparable with analysis by human experts. ML algorithms were developed and tested for the ability to replicate the detection and quantification of IFTA and glomerulosclerosis that renal pathologists perform. Methods A renal pathologist annotated renal biopsy specimens from 116 whole-slide images (WSIs) for IFTA and glomerulosclerosis. A total of 79 WSIs were used for training different configurations of a convolutional neural network (CNN), and 17 and 20 WSIs were used as internal and external testing cases, respectively. The best model was compared against the input of four renal pathologists on 20 new testing slides. Further, for 87 testing biopsy specimens, IFTA and glomerulosclerosis measurements made by pathologists and the CNN were correlated to patient outcome using classic statistical tools. Results The best average performance across all image classes came from a DeepLab version 2 network trained at 40× magnification. IFTA and glomerulosclerosis percentages derived from this CNN achieved high levels of agreement with four renal pathologists. The pathologist- and CNN-based analyses of IFTA and glomerulosclerosis showed statistically significant and equivalent correlation with all patient-outcome variables. Conclusions ML algorithms can be trained to replicate the IFTA and glomerulosclerosis assessment performed by renal pathologists. This suggests computational methods may be able to provide a standardized approach to evaluate the extent of chronic kidney injury in situations in which renal-pathologist time is restricted or unavailable.

Background: Gastric ulcer has been a major cause of morbidity and mortality worldwide, and it has been linked to factors such as nutritional deficiency, smoking, stress, and continuous intake of non-steroidal anti-inflammatory drugs (NSAIDs). The search for new anti-ulcer therapeutic agents has been the subject of several studies. Recently, the gastroprotective effect of Celtis iguanaea has been reported, with linoleic acid (LA) responsible for many of the therapeutic effects of this medicinal plant. Aim: This study aims to investigate the gastroprotective activity and the possible mechanisms in which LA may be involved, through different experimental assays in mice. Methods: The gastroprotective activity LA was evaluated in the ulcer induced by indomethacin, HCl/EtOH, hypothermicrestraint stress and pyloric ligation. For the gastroprotective mechanisms investigation the quantification of the volume (mL), pH and total acidity of gastric secretion were considered. Results: The oral administrations of 25 mg/kg, 50 mg/kg or 100 mg/kg of body weight of LA were capable of protecting the gastric mucosa against HCl/ethanol (10 mL/kg p.o.), and oral administrations of 50 mg/kg LA showed protection from ulcers induced by indomethacin, hypothermic-restraint stress and pyloric ligation. Conclusion: The results of this study show the gastroprotective role of LA in gastric mucosal damage induced by all assayed distresses. The observed gastroprotection possibly occurs due to the mediated increase of mucosal defensive factors.

Since early 2000, Microfinance Institutions (MFI) have been using credit scoring for their risk assessment. However, one of the main problems of credit scoring in microfinance is the lack of structured financial data. To address this problem, MFI have started using non-traditional data which can be extracted from the digital footprint of their users. The non-traditional data can be used to build algorithms that can identify good borrowers as in traditional banking. This paper proposes an assembled method to evaluate the predictive power of the non-traditional method. By using the Weight of Evidence (WoE), a transformation based on the distribution within the feature, as feature transformation method, and then applying extremely randomized trees for feature selection, we were able to improve the accuracy of the credit scoring model by 20.20% when compared to the credit scoring model built with the traditional implementation of WoE. This paper shows how the assembling of WoE with different feature selection criteria can result in more robust credit scoring models in microfinance.

Future IoT systems will require progressively smaller sizes, cost, complexity and power consumption. This paper proposes a new architecture using a hybrid m-CAP/QAM system with the goal to provide such features to future VLC based IoT devices. The proposed system architecture uses a ceiling LED light fixture implementing an m-CAP digital modulator, connected to several IoT devices, implemented by analog de modulators. The simulated performance presents an increase on BER when compared to a digital m-CAP receiver, between 1 and 2 dB. Nevertheless, considering IoT scenarios, having low cost/size/power devices can surpass the performance penalty. published

Background and Objective: Glaucoma, an eye condition that leads to permanent blindness, is typically asymptomatic and therefore difficult to be diagnosed in time. However, if diagnosed in time, Glaucoma can effectively be slowed down by using adequate treatment; hence, an early diagnosis is of utmost importance. Nonetheless, the conventional approaches to diagnose Glaucoma adopt expensive and bulky equipment that requires qualified experts, making it difficult, costly and time-consuming to diagnose large amounts of people. Consequently, new alternatives to diagnose Glaucoma that suppress these issues should be explored. Methods: This work proposes an interpretable computer-aided diagnosis (CAD) pipeline that is capable of diagnosing Glaucoma using fundus images and run offline in mobile devices. Several public datasets of fundus images were merged and used to build Convolutional Neural Networks (CNNs) that perform segmentation and classification tasks. These networks are then used to build a pipeline for Glaucoma assessment that outputs a Glaucoma confidence level and also provides several morphological features and segmentations of relevant structures, resulting in an interpretable Glaucoma diagnosis. To assess the performance of this method in a restricted environment, this pipeline was integrated into a mobile application and time and space complexities were assessed. Results: Considering the test set, the developed pipeline achieved 0.91 and 0.75 of Intersection over Union (IoU) in the optic disc and optic cup segmentation, respectively. With regards to the classification, an accuracy of 0.87 with a sensitivity of 0.85 and an AUC of 0.93 were attained. Moreover, this pipeline runs on an average Android smartphone in under two seconds. Conclusions: The results demonstrate the potential that this method can have in the contribution to an early Glaucoma diagnosis. The proposed approach achieved similar or slightly better metrics than the current CAD systems for Glaucoma assessment while running on more restricted devices. This pipeline can, therefore, be used to construct accurate and affordable CAD systems that could enable large Glaucoma screenings, contributing to an earlier diagnose of this condition.

Gastric ulcer affects people worldwide, and its inefficacy and recurrence have fueled the search for new therapeutic strategies. Despite the well-known use of allantoin in medicines and cosmetic products, its effect has not yet been studied with regard to gastric ulcer. Hence, the aim of the present study was to explore the pharmaco-mechanistic efficacy of allantoin against commonly harmful agents that cause injuries to the stomach. Ethanol, indomethacin, and stress-induced gastric ulcer models were adopted, in addition to pylorus ligature, a quantification of vascular permeability, glutathione (GSH), gastric adhered mucus, prostaglandin (PGE2), pro-inflammatory cytokines levels, myeloperoxidase (MPO), and catalase (CAT) activities. The gastric lesions were examined by gross, histological, and ultrastructural features. The results showed that treatment with allantoin (60 mg/kg, per oral) reduced the gastric ulcer formation in all models. Furthermore, allantoin reduced the parameters of gastric acid secretion and attenuated both the vascular permeability and MPO activity. The levels of pro-inflammatory cytokines were also reduced, accompanied by a restoration of CAT activity and GSH levels. Notably, allantoin treatment preserved the gastric-adhered mucus and PGE2 levels after ethanol administration. Microscopic and ultrastructural analysis revealed that allantoin maintained tissue integrity and prevented morphological changes in cells caused by ethanol. In summary, we demonstrated for the first time that allantoin possesses gastroprotective activity through anti-inflammatory, anti-oxidative, antisecretory, and cytoprotective mechanisms. The antisecretory and cytoprotective mechanisms are probably associated with an increase in PGE2 levels.

This paper studies the possibility of using the encrypted video channel of widely used videoconferencing applications, such as Skype, as a carrier for unobservable covert TCP/IP communications. We propose and evaluate different alternatives to encode information in the video stream in order to increase available throughput while preserving the packet-level characteristics of the video stream. We have built a censorship-resistant system, named DeltaShaper, which offers a data-link interface and supports TCP/IP applications that tolerate low throughput / high latency links. Our results show that it is possible to run standard protocols such as FTP, SMTP, or HTTP over Skype video streams.

Made available in DSpace on 2018-11-26T17:42:27Z (GMT). No. of bitstreams: 0 Previous issue date: 2017-09-01 Programa de Internacionalizacao da Pesquisa da UNESP (PROINTER) Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Lauraceae have an ancient evolutionary history and wide distribution, providing a great model for studies of the biogeographical distribution patterns of plant species. The effects of elevational variation on plant diversity in tropical forests have been the subject of many studies. We investigated the following question: How does the Lauraceae family contribute to the diversity of the tree community in the Atlantic Rainforest, along an elevational gradient? Data from 15 floristic surveys (plots of one ha) were analyzed, comparing the variation in the patterns of Lauraceae richness to the richness of the whole tree community. The similarity relations of the plots were analyzed based on Lauraceae species, and the distribution patterns of the family were tested through null distribution models of the species. The surveys recorded 22,895 live individual trees in total, distributed among 859 species belonging to 70 families. Lauraceae contributed 4.3% of the total abundance and presented the third highest species richness (6.4% of the total). In general, Lauraceae diversity was highest in the Montane region and their composition changed along the elevational gradient, presenting four elevational belts. The Lauraceae diversity has a strong positive relationship with abundance. We found an exponential positive correlation between elevation and the richness of the family, differing from the tree community pattern. The results showed a new pattern of species variation along elevational gradients for the tree component in the Tropical Forest. Thus, we suggest that patterns of diversity variation in tree communities should be analyzed separately among the richest families. (C) 2017 Elsevier GmbH. All rights reserved. Univ Estadual Paulista, Inst Biociencias, Dept Bot, Rio Claro, Brazil Univ Estadual Campinas UNICAMP, Inst Biol, Dept Biol Vegetal, Campinas, SP, Brazil Univ Estadual Paulista, Inst Biociencias, Dept Bot, Rio Claro, Brazil FAPESP: 2011/15892-9 FAPESP: 03/12595-7 FAPESP: 10/50811-7 CNPq: 481960/2013-9 CNPq: 34/2012 PELD

This paper addresses the problem of offering reliable causal multicast in a setting where nodes are organized in an overlay network and use this network to disseminate information among each other. The use of overlay networks for this purpose is widely used when the number of nodes is large. For instance, many publish-subscribe systems use an overlay of message brokers to support the exchange of information among publishers and subscribers. To the best of our knowledge, previous multicast algorithms for overlay networks either do not enforce causal order or, in order to do so, require nodes to keep metadata (for instance, sequence numbers) for all senders and are, therefore, inherently non-scalable. In this paper we propose a novel localized algorithm to implement reliable causal multicast, where each node is only required to keep metadata regarding nodes in its neighbourhood (with a radius that is a function of the number of faults that need to be tolerated). Experimental results show that our algorithm can achieve significant improvements over non-localized alternatives, and can even outperform localized algorithms that do not offer causal order.

Introduction/Objective Transplantation is the treatment of choice in end-stage renal disease. However, there are complications that require transplantectomy. The objective of this study was to evaluate predictive factors for transplantectomy in the first 3 months after renal transplantation. Material and Methods This retrospective study included 770 kidney transplants performed between June 2011 and June 2017. Logistic regression was applied to study the relationship between independent variables and the occurrence of transplantectomy. Results Analyzing variables of the recipients, it was verified that age over 65 years; body mass index; dialysis time; history of previous transplant and comorbidities such as obesity, overweight, hypertension, diabetes mellitus, dyslipidemia, peripheral arterial disease; or history of a thrombotic episode were not predictive factors. It was found that the use of expanded criteria donors, their age, or cause of death were not predictive factors. The use of a right renal graft or grafts with multiple arteries; the duration of surgery; the performance of surgery at dawn; the need for transfusion; the cold ischemia time; and hemodynamic parameters at reperfusion (central venous pressure, systolic or diastolic blood pressure) were not predictive factors. The recipient age at transplantation (p = .014; B=–0.059; Exp(B)=0.943 [0.899-0.988]) and reoperation in the first 10 days after transplantation (p Conclusion Reoperation in the first 10 days after transplantation decreased the risk of transplantectomy in the first 3 months. The lower the age of the recipient, the greater the risk of transplantectomy.

Introduction: Vascular access for hemodialysis is a key factor in every patient dependent on this treatment. Maintaining a central venous catheter can be a good choice when all the other options have been exhausted, but unwanted and rare complications may arise from longer catheter dwell time. Case report: We describe a case of a 65-year-old woman undergoing hemodialysis treatment since 1986 after a bilateral nephrectomy due to complicated nephrolithiasis. Her last access, two Tesio® tunneled cuffed catheters implanted via the right internal jugular vein functioned correctly for 14 years without complications, and so, was not replaced in the meantime. She was referred to our hospital due to a rupture in a catheter lumen, which was corrected conservatively by creating a more proximal tunnel and excising the affected area. A few weeks later, a new rupture in the same lumen was identified, so the catheter was replaced with angiographic control. The catheter was frail, so upon its removal, the tip fractured and remained in the right ventricle, being swiftly removed by an endovascular snare without complications. Discussion: This case reports two rare complications associated with catheter handling and identifies a possible technique for conservative resolution of a lumen rupture.

Kidney transplantation (KT) is a surgery performed worldwide and has some complications. The objective of this study is to evaluate our surgical complications, comparing the outcomes with those KTs without surgical complications.An observational cross-sectional study of all surgical complications among 3102 kidney transplants performed between June 1980 and April 2018.Of 3102 kidney transplantations, 490 (15.8%) had the following complications: surgical complications (n = 527); urinary (n = 184; 5.9%); vascular (n = 140; 4.5%); wound-related (n = 78; 2.5%); lymphocele (n = 56; 1.8%); and others (n = 69; 2.2%). The most common complications were ureteral obstruction (n = 85; 2.7%) and urinary fistula (n = 72; 2.3%). The immunosuppression regimen did not influence the surgical complications rate. Surgical complications mainly occurred in male (71.4% vs 66.7%) and heavier (67.6 ± 13.9 vs 65.9 ± 13.5 kg) recipients (P .05). The hospitalization time was also different (26.3 ± 30.6 vs 15.0 ± 38.8 days, P .05). Serum creatinine values were different until the second year. After that, the renal function was approximately the same. Nearly 26.1% of complicated kidney transplants had delayed graft function (vs 14.8%, P .001). Only 23.9% of complicated kidney transplants needed transplant nephrectomy (vs 6.2%, P .001). The survival of kidneys with surgical complications was lower (64.2 ± 4.5 vs 94.09 ± 2.6 months, P .001).Kidney transplant surgical complications occur over time, especially urinary and vascular complications, remaining a problem that leads to prolonged hospitalization and decreased graft survival.

Cutaneous lesions in the presence of fever in patients undergoing immunosuppressive therapy are a diagnostic challenge and may represent manifestations of multiple diseases, such as fungal infections, nocardiosis, lymphoproliferative diseases, zoonosis, and tuberculosis. The authors report a case of a 66-year-old white man with chronic kidney disease since 2014 (chronic pyelonephritis) who had a renal transplant in the previous 6 months. Induction therapy was performed with thymoglobulin, and his current immunosuppression scheme included tacrolimus, mycophenolate mofetil, and prednisolone. The patient had no history of pulmonary tuberculosis. The patient presented with 2 cutaneous lesions, localized on the back and abdomen, that appeared to be firm, painful, subcutaneous, erythematous nodules with an approximately 5 cm diameter overlying an infected focus and purulent material inside. The patient also had a fever and fatigue. Blood analysis showed pancytopenia with an elevation of inflammatory markers and graft dysfunction. Tissue cultures and skin biopsy with histological analysis were performed. Histopathology of the lesion showed a nonspecific inflammatory infiltrate without granulomas, and acid-fast bacillus staining was negative. Nevertheless, serum QuantiFERON testing was positive. But polymerase chain reaction finally confirmed the presence of Mycobacterium tuberculosis, which confirmed the diagnosis of cutaneous tuberculosis. A chest computed tomography scan showed a lung pattern of miliary tuberculosis. The patient was treated with multidrug tuberculosis therapy, resulting in lesion clearance after 3 weeks. Tuberculosis is a serious infection, especially in high-risk patients, such as those in an immunocompromised state. The incidence of cutaneous tuberculosis is rare, but it should be considered in patients presenting with atypical skin lesions suggestive of an underlying infectious etiology.

Pretransplant kidney biopsy from marginal donors is used to guide the decision of whether to accept or discard organs for transplantation; however, there is controversy about this procedure, and the need for a pretransplant biopsy is still a debate. We sought to determine if histologic evaluation before implantation of marginal kidneys would influence the outcome.A retrospective observational cohort study of marginal donor transplants at Centro Hospitalar e Universitário de Coimbra was done. From 2009 to 2016, 650 marginal kidney transplants were analyzed. We evaluated long-term graft survival in a cohort of patients who received marginal kidneys. The recipients were divided into 2 groups based on whether a pretransplant donor biopsy was performed. Continuous variables were summarized by mean and standard deviation or median and range, as applicable. Categorical variables were summarized by relative and absolute frequencies. The survival analysis was obtained and plotted using the Kaplan-Meier method and compared with the log-rank test.The median age of recipients and donors were statistically different between both groups (P .001), with the donors and the recipients being younger in the group without a pretransplant biopsy. The median cold ischemia time was higher in the biopsy group (P = .01). The survival analysis showed that graft survival didn't differ between the groups (P = .2).Selection of kidneys based on histological findings may not influence the graft survival and implies a higher cold ischemia time. More data are necessary to provide insight into which clinical, histologic, and biochemical parameters are necessary for decision making on kidney acceptance.

When running workflows in the cloud it is appealing to use spot instances that can be acquired at a fraction of the cost of on-demand instances. Unfortunately, spot instances can be revoked at any time, creating uncertainty about task completion times, which is an impairment for workflows with timeliness requirements. While workflow scheduling has been subject to extensive research, the problem of optimally scheduling deadline-constraint workflows in the cloud while dealing with the uncertainty caused by spot instance revocations has not been fully addressed. In this paper, we plan the execution of workflows in cloud environments to minimize the monetary cost while being subject to timeliness constraints. Our approach constructs a Markov Decision Process (MDP) of the workflow execution and looks up for the optimal policy taking into account the user preferences in time and cost. The optimal solution is generated offline and actions selected on-the-fly, depending on the occurrence of failures due to instance revocations. Experimental results with a real-world scientific workflow application demonstrate that, in comparison to approaches that rely on simple heuristics to schedule tasks, our planning-based approach is able to generate reliable solutions that are cheaper and able to meet deadlines.

Distributed ledgers have received significant attention as a building block for cryptocurrencies and have proven to be also relevant in several other fields. In cryptocurrencies, this abstraction is usually implemented by grouping transactions in blocks that are then linked together to form a blockchain. Nodes need to exchange information to maintain the status of the chain but this process consumes significant network resources. Unfortunately, naively reducing the number of messages exchanged can have a negative impact in performance and correctness, as some transactions might not be included in the chain. In this paper, we study the mechanisms of information dissemination used in Bitcoin and propose a set of adaptive mechanisms that lower network resource usage. Our experimental evaluation shows that is possible to lower the bandwidth consumed by 10.2% and the number of exchanged messages in 41.5%, without any negative impact in the number of transactions committed.

This paper addresses the key problems that emerge when one attempts to use transient resources to reduce the cost of running time-constrained jobs in the cloud. Previous works fail to address these problems and are either not able to offer significant savings or miss termination deadlines. First, the fact that transient resources can be evicted, requiring the job to be re-started (even if not from scratch) may lead provisioning policies to fall-back to expensive on-demand configurations more often than desirable, or even to miss deadlines. Second, when a job is restarted, the new configuration can be different from the previous, which might make eviction recovery costly, e.g., transferring the state of graph data between the old and new configurations. We present HOURGLASS, a system that addresses these issues by combining two novel techniques: a slack-aware provisioning strategy that selects configurations considering the remaining time before the job's termination deadline, and a fast reload mechanism to quickly recover from evictions. By switching to an on-demand configuration when (but only if) the target deadline is at risk of not being met, we are able to obtain significant cost savings while always meeting the deadlines. Our results show that, unlike previous work, HOURGLASS is able to significantly reduce the operating costs in the order of 60-70% while guaranteeing that deadlines are met.

Modern fault-tolerant distributed architectures can be configured to tolerate a wide-range of faults. For instance, Fireplug is a distributed BFT graph database, based on n-version programming, that can be configured to tolerate crash or Byzantine faults, uncorrelated faults in individual machines, correlated faults that affect all replicas running a given software version, or correlated faults that affect an entire datacenter. Interestingly, in such a system, fault handling heavily depends on the type of faults the system is configured to tolerate. To hardwire all possible behaviours in the fault-handling code is inflexible and may even be impractical. In this paper, we explore a different alternative that consists in specifying not only the system configuration, but also the fault-handling behaviour, and how the system adapts to changes in the workload, in a policy language, that is processed externally to the managed system. We show that, using this approach, a single simplified codebase of the managed system can be used effectively to address a wide range of dependability constraints.

Objetivo: Identificar a prevalência de hemoglobinopatias em gestantes triadas pela Maternidade Dona Evangelina Rosa em Teresina no estado do Piauí. Métodos: Foram analisadas 19 gestantes com padrões hemoglobínicos alterados, triados na Maternidade Dona Evangelina Rosa, no período de outubro de 2015 a junho de 2016. Os dados foram organizados em banco de dados no Microsoft Office Excel. E a análise realizada utilizando o programa Statistical Package for the Social Sciences® (SPSS) versão 23.0. Resultados: O traço falciforme (Hb AS e AC) teve uma prevalência de 5,17% (1:19). Das 19 gestantes com padrões hemoglobínicos alterados, a mais prevalente foi a HbAS com (78,94%), seguida da Hb AC totalizando (21,05%). A maioria das gestantes estudadas que apresentaram hemoglobinopatias era constituída pela etnia parda (69,15%), seguidos por branca (5,25%). Em sua maioria as gestantes com alterações eram prevalentemente de cidades do estado do Piauí, com destaque para Teresina (52,63%) seguido por José de Freitas (15,78%).Também foi evidenciado uma prevalência na faixa etária de 31 a 35 anos (42,10%), escolaridade com médio incompleto (57,89%), idade gestacional no terceiro trimestre (94,73%), histórico gestacional de 2 a 3 gestações (47,36%), tipo de parto com cesariana (52,63%), ausência de histórico de aborto (78,94%) nas gestantes com hemoglobinopatias. Conclusão: A prevalência das hemoglobinas anormais nas gestantes triadas identificou traços falciforme (Hb AS e AC) evidenciando a necessidade de intervenções, como ações voltadas à atenção e cuidado da gestante e da criança durante o primeiro ano de vida, bem como aconselhamento genético para futura gravidez.

Chronic inflammation is a world health problem. There is a need to develop new anti-inflammatory and analgesic drugs with improved activity and reduced side effects. In this context, the aim of this study was to evaluate the antinociceptive and anti-inflammatory effects of the pyrazole compound LQFM-021 after acute and sub-chronic administration in rats submitted to a CFA-induced chronic arthritis model, as well as compare the toxicity of this compound to that of dipyrone, given throughout 7 days. Firstly, we observed that acute oral administration of the higher dose (130 µmol/kg) of LQFM-021 reduced paw lifting time (PET) and edema formation. These effects disappeared on the following day, requiring another dose to maintain the effects. This dose also promoted reduction of the polymorphonuclear recruitment in the synovial fluid. In another experiment, both treatments with LQFM-021, 65 µmol/kg twice a day and 130 µmol/kg once a day, produced a progressive and permanent reduction of the PET and edema, also reducing polymorphonuclear recruitment. However, the single treatment with 130 µmol/kg was more effective than the double treatment with 65 µmol/kg. LQFM-021 did not produce toxicity signs. However, dipyrone (130 µmol/kg once a day) promoted erosion of the epithelial cells and decreased mucus in the gastric mucosa. These data indicate that LQFM-021 produced antinociceptive and anti-inflammatory effects in CFA-induced arthritis in rats. These effects occurred in the absence of apparent toxic effects, indicating that the pyrazole compound LQFM-021 may be considered a good prototype for development of new analgesic/anti-inflammatory drug.