Search

Introdução: O IHEBE é um serviço de hemoterapia privado, localizado no município de Belém/Pará, responsável pelo atendimento de Maternidades e Hospitais, que atendem público de perfil variado, localizados na região metropolitana. Possui 6 Agências Transfusionais e recebe em média 8.000 solicitações de unidades de plaquetas anuais e transfunde em média 6.000 unidades de plaquetas/ano. Objetivo: Realizar liberação do estoque de concentrado de plaquetas previamente irradiadas para otimizar o atendimento ao receptor. Material e métodos: Estudo retrospectivo, descritivo, realizado no IHEBE no período de 01/01/2021 a 31/07/2021. Foram selecionadas todas as solicitações médicas de plaquetas irradiadas e não-irradiadas deste período e todas as plaquetas processadas neste intervalo de tempo. Todos os dados foram tabulados em planilhas do programa Microsoft Office Excel 2013 para análise. Resultados: Dos 5.152 Concentrados de Plaquetas (CP5) solicitados neste período, foram requeridos em janeiro 819 CP5, sendo 547 (67%) irradiados. Em fevereiro, 630 CP5, sendo 455 (72%) irradiados. Em março, 687 CP5, sendo 624 (91%) irradiados. Em abril, 1.192 CP5, sendo 594 (50%) irradiados. Em maio, 432 CP5, sendo 369 (85%) irradiados. Em junho, 615 CP5, sendo 483 (79%) irradiados. Em julho 777 CP5, sendo 673 (87%) irradiados. Dos 5.152 CP5 solicitados, foram transfundidos 4.500 unidades, sendo a diferença 652 (13%) referente a pacientes que tiveram seus pedidos atendidos parcialmente. Discussão: Analisando a variação percentual de solicitações de concentrado de plaquetas irradiadas, observou-se que a maior demanda é de unidades irradiadas, a exceção aconteceu no mês de abril que devido ao bandeiramento vermelho pela pandemia por Coronavívus, em que houve um incremento de CP5 não-irradiadas devido ao perfil de atendimento da época. Conclusão: Diante deste cenário o IHEBE implementou o protocolo de irradiação de todas as plaquetas previamente à liberação. Desta forma, os Concentrados de Plaquetas Randômicas (CP5) ou Concentrado de Plaquetas de Buffy Coat (CPBC) processados são enviados à Irradiação, sendo em seguida são devolvidos ao Setor de Processamento para liberação, rotulagem e distribuição às Agências Transfusionais, garantindo a otimização da disponibilidade de plaquetas irradiadas e diminuindo o tempo de espera para o atendimento ao receptor.

Snow cover modeling remains a major challenge in climate and numerical weather prediction (NWP) models even in recent versions of high-resolution coupled surface–atmosphere (i.e., at kilometer scale) regional models. Evaluation of recent climate simulations, carried out as part of the WCRP-CORDEX Flagship Pilot Study on Convection (FPSCONV) with the CNRM-AROME convection-permitting regional climate model at 2.5 km horizontal resolution, has highlighted significant snow cover biases, severely limiting its potential in mountain regions. These biases, which are also found in AROME numerical weather prediction (NWP) model results, have multiple causes, involving atmospheric processes and their influence on input data to the land surface models in addition to deficiencies of the land surface model itself. Here we present improved configurations of the SURFEX-ISBA land surface model used in CNRM-AROME. We thoroughly evaluated these configurations on their ability to represent seasonal snow cover across the European Alps. Our evaluation was based on coupled simulations spanning the winters of 2018–2019 and 2019–2020, which were compared against remote sensing data and in situ observations. More specifically, the study tests the influence of various changes in the land surface configuration, such as the use of multi-layer soil and snow schemes, the division of the energy balance calculation by surface type within a grid cell (multiple patches), and new physiographic databases and parameter adjustments. Our findings indicate that using only more detailed individual components in the surface model did not improve the representation of snow cover due to limitations in the approach used to account for partial snow cover within a grid cell. These limitations are addressed in further configurations that highlight the importance, even at kilometer resolution, of taking into account the main subgrid surface heterogeneities and improving representations of interactions between fractional snow cover and vegetation. Ultimately, we introduce a land surface configuration, which substantially improves the representation of seasonal snow cover in the European Alps in coupled CNRM-AROME simulations. This holds promising potential for the use of such model configurations in climate simulations and numerical weather prediction both for AROME and other high-resolution climate models.

Assessing past distributions, variability and trends in the mountain snow cover and its first-order drivers, temperature and precipitation, is key for a wide range of studies and applications. In this study, we compare the results of various modeling systems (global and regional reanalyses ERA5, ERA5-Land, ERA5-Crocus, CERRA-Land, UERRA MESCAN-SURFEX and MTMSI and regional climate model simulations CNRM-ALADIN and CNRM-AROME driven by the global reanalysis ERA-Interim) against observational references (in situ, gridded observational datasets and satellite observations) across the European Alps from 1950 to 2020. The comparisons are performed in terms of monthly and seasonal snow cover variables (snow depth and snow cover duration) and their main atmospherical drivers (near-surface temperature and precipitation). We assess multi-annual averages of regional and subregional mean values, their interannual variations, and trends over various timescales, mainly for the winter period (from November through April). ERA5, ERA5-Crocus, MESCAN-SURFEX, CERRA-Land and MTMSI offer a satisfying description of the monthly snow evolution. However, a spatial comparison against satellite observation indicates that all datasets overestimate the snow cover duration, especially the melt-out date. CNRM-AROME and CNRM-ALADIN simulations and ERA5-Land exhibit an overestimation of the snow accumulation during winter, increasing with elevations. The analysis of the interannual variability and trends indicates that modeling snow cover dynamics remains complex across multiple scales and that none of the models evaluated here fully succeed to reproduce this compared to observational reference datasets. Indeed, while most of the evaluated model outputs perform well at representing the interannual to multi-decadal winter temperature and precipitation variability, they often fail to address the variability in the snow depth and snow cover duration. We discuss several artifacts potentially responsible for incorrect long-term climate trends in several reanalysis products (ERA5 and MESCAN-SURFEX), which we attribute primarily to the heterogeneities of the observation datasets assimilated. Nevertheless, many of the considered datasets in this study exhibit past trends in line with the current state of knowledge. Based on these datasets, over the last 50 years (1968–2017) at a regional scale, the European Alps have experienced a winter warming of 0.3 to 0.4 ∘C per decade, stronger at lower elevations, and a small reduction in winter precipitation, homogeneous with elevation. The decline in the winter snow depth and snow cover duration ranges from −7 % to −15 % per decade and from −5 to −7 d per decade, respectively, both showing a larger decrease at low and intermediate elevations. Overall, we show that no modeling strategy outperforms all others within our sample and that upstream choices (horizontal resolution, heterogeneity of the observations used for data assimilation in reanalyses, coupling between surface and atmosphere, level of complexity, configuration of the snow scheme, etc.) have great consequences on the quality of the datasets and their potential use. Despite their limitations, in many cases they can be used to characterize the main features of the mountain snow cover for a range of applications.

Introduction Rapid expansion of mechanical thrombectomy and swift manufacturing development has translated into significant evolution of large bore catheter technology. The objective of this study was to evaluate the association among diverse structural components of large bore aspiration catheters on procedural performance. Methods Retrospective analysis of a prospectively maintained mechanical thrombectomy consortium (SVIN Registry) treated with stand‐alone contact aspiration for the first pass in the MCA M1 or intracranial ICA occlusions from 2012‐2021. Catheters were stratified based on construction materials, tip technology, catheter sizing, and catheter lining. Factors associated with first pass effect (FPE ‐ first‐pass eTICI2c‐3 reperfusion) as well as speed of clot engagement were analyzed. Results We identified 983 patients with proximal occlusion and aspiration as the first pass technique. FPE was observed in 34% and associated with age (OR:1.016;95%CI:1.006‐1.027), cardioembolic stroke etiology (OR:1.685;95%CI:1.77 ‐2.41), MCA M1(OR:2.737;95%CI:1.091 ‐1.867), non‐general anesthesia (OR:0.546;95%CI:0.389 ‐0.767), as well as with 0.070” (OR:2.038;95%CI:1.099 ‐3.779) and 0.088” (OR:3.899;95%CI:1.582 ‐9.606) distal catheter inner diameter in the adjusted analysis. Median time from arterial access to clot contact was 17 minutes with faster times observed in younger patients (OR:0.986;95%CI:0.975 ‐0.996) as well as with the use of aspiration catheters with shorter length of distal outer hydrophilic coating (18‐30cm) on multivariable regression (OR:0.303; 95%CI:0.113‐0.816). Conclusion Larger aspiration catheter distal inner diameter was associated with higher rates of FPE. Aspiration catheters with reduced distal tip hydrophilic coating were associated with faster arterial access to clot contact time.

Introduction Carotid webs (CaWs) have been established as an ischemic stroke etiology although lesion characteristics that may lead to increased stroke risk are still uncertain (1). We aim to evaluate the associations between CaW morphological features evaluated via computed tomography angiography (CTA) with clinical and radiological variables. Methods This is a retrospective analysis of a prospectively collected mechanical thrombectomy database. Individuals that presented with a suspected symptomatic CaW since July 2014 were selected after appropriate workup. The database included symptomatic CaW, asymptomatic CaW contralateral to the symptomatic side in case of bilateral lesions, and incidentally identified CaW (asymptomatic patients). We recorded the following CaW variables (Figure 1): length, base, thickness, caudal/middle/cranial angles in relationship to the vessel axis, area as well as perimeter of the pocket. We used mixed‐effects models to compare measurements between symptomatic and asymptomatic webs in the complete sample and paired Wilcoxon tests to compare webs of individuals with contralateral, symptom‐discordant CaW. Measurements were evaluated against clot burden via Poisson regression.a Results 118 webs (85 symptomatic and 33 asymptomatic) from 98 stroke patients were included. Median [IQR] for age was 52[42‐58] years old, 69.0% were female, 68.4% presented with a single symptomatic web, 18.4% had both a symptomatic and an asymptomatic web, 11.2% had only an asymptomatic web, whereas 2.0% had bilaterally asymptomatic webs. Symptomatic CaW were significantly larger in length (2.5mm[2.1‐3.5] vs. 2.2mm[1.7‐2.7];p=0.004) and pocket area (1.5mm²[0.9‐2.6] vs. 0.9 mm²[0.2‐1.3];p=0.007) compared to the asymptomatic lesions. The cranial angle was more acute for symptomatic CaW (66.9°[57.1°‐78.4°] vs. 76.2°[66.9°‐88.7°];p=0.046). No other significant associations were noted. Among the 18 patients who were analyzed for contralateral/symptom‐discordant webs, symptomatic CaW also showed more extensive lengths (2.9mm[2.3‐4.0] vs. 2.2mm[1.6‐3.1];p=0.009) but less acute rostral angles (33.1°[25.3°‐43.5°] vs. 27.9°[16.8°‐35.9°]) than their asymptomatic counterparts. Among symptomatic webs, clot burden was not significantly associated with base, length, thickness, perimeter or pocket area. Nevertheless, each 15° increase in the angle within the pocket was associated with a 1.1‐fold increase in clot burden (exp(β) = 1.1(95%CI1.0‐1.2), p = 0.044) for each 15° increase), with more obtuse angles indicating a higher intracranial vessel occlusion thrombus load. Conclusion Symptomatic carotid webs displayed larger lengths and pocket areas as compared to asymptomatic lesions. The angles that determine pocket area and degree of stenosis differed between symptomatic and asymptomatic webs.

This work introduces the S2M (SAFRAN–SURFEX/ISBA–Crocus–MEPRA) meteorological and snow cover reanalysis in the French Alps, Pyrenees and Corsica, spanning the time period from 1958 to 2021. The simulations are made over elementary areas, referred to as massifs, designed to represent the main drivers of the spatial variability observed in mountain ranges (elevation, slope and aspect). The meteorological reanalysis is performed by the SAFRAN system, which combines information from numerical weather prediction models (ERA-40 reanalysis from 1958 to 2002, ARPEGE from 2002 to 2021) and the best possible set of available in situ meteorological observations. SAFRAN outputs are used to drive the Crocus detailed snow cover model, which is part of the land surface scheme SURFEX/ISBA. This model chain provides simulations of the evolution of the snow cover, underlying ground and the associated avalanche hazard using the MEPRA model. This contribution describes and discusses the main climatological characteristics (climatology, variability and trends) and the main limitations of this dataset. We provide a short overview of the scientific applications using this reanalysis in various scientific fields related to meteorological conditions and the snow cover in mountain areas. An evaluation of the skill of S2M is also displayed, in particular through comparison to 665 independent in situ snow depth observations. Further, we describe the technical handling of this open-access dataset, available at https://doi.org/10.25326/37#v2020.2. The S2M data are provided by Météo-France – CNRS, CNRM, Centre d'Études de la Neige, through AERIS (Vernay et al., 2022).

Introduction Dementia has a significant psychological and emotional impact on families, especially for caregivers of people living with dementia. In this perspective, the World Health Organization has developed iSupport for Dementia, an online training and skills program to prevent and/or reduce mental health problems associated with the provision of care and improve the quality of life of caregivers. It is being translated and adapted in different countries and as of August 2022, 31 adaptations using 27 different languages were in progress. However, the availability of the program should only be carried out after evaluating its effects on caregivers’ mental health outcomes (such as burden, depressive and anxious symptoms, quality of life, among others). Objectives To analyze randomized clinical trial protocols to assess the effects of the iSupport program in different countries. Methods This is a data survey carried out in October 2022 on clinical trial registry platforms Clinical Trials, The Brazilian Registry of Clinical Trials, Cochrane Central Register of Controlled Trials, Netherlands Trial Register and Australian New Zealand Clinical Trials Registry by two independent researchers. Descriptive analyzis were performed for sample size, primary outcomes, secondary outcomes and intervention design. Results Seven clinical trial registries were identified, conducted in Australia/China, Brazil, Great Britain, the Netherlands, India, Japan and Portugal, published in English, from 2018 to 2022. The sample size ranged from 184 to 390 participants. Regarding the primary outcomes linked to the effect of using iSupport, five countries will analyze burden, anxiety and depression. Only in Australia/China and the Netherlands, the primary outcome will be quality of life and stress, respectively. Secondary outcomes vary between studies, with measures of quality of life (n=6), self-efficacy (n=4), program usability (n=4), cognition and problematic behaviors (n=3), attitudes (n=3), quality of support (n=3), positive aspects of care (n=2), knowledge, competence, resilience and informal costs of care (n=1). Most studies will carry out assessments at baseline, 3 and 6 months after the intervention, with the exception of Japan that will perform at baseline and at 1 and 3 months after the intervention and 6 months. Conclusions Analysis of the effectiveness of iSupport is one of the World Health Organization guidelines for countries that are culturally adapting this program. Brazil is the only country in Latin America with a clinical trial registration so far. Burden, anxiety and depression are outcomes considered by most countries. The results could provide evidence to strengthen and expand the possibilities for collaboration between researchers, as internet-based interventions have shown promising results on the mental health and well-being. Disclosure of Interest None Declared

Hematomas are common following cosmetic surgery. When minor, they are treated with observation only as they are most often reabsorbed. However, even with small collections of blood, if no early intervention is adopted, poor aesthetic outcomes may occur. Early drainage has been especially described in otorhinolaryngology and radiology journals. The authors present an approach to early treating hematomas. Special emphasis is given to the use of hyaluronidase, which is well known by dermatologists and plastic surgeons for its ability to dissolve hyaluronic acid, but its utility in the treatment of hematomas is not so commonly known by these experts.

From 2014-2016, Scholarship of Teaching and Learning (SoTL) Research Fellows at a mid-sized Canadian research-intensive, medical-doctoral university undertook to study their own formation as scholars of teaching and learning, as well as benefits and challenges of their cross-appointment to our central teaching and learning institute from their home academic departments. Findings from surveys and focus groups identified themes such as identity, community, access, transfer, and structural elements (each with benefits and challenges to practice). Our autoethnographic work confirms assertions in the literature about the uneasy relation between SoTL and traditional scholarship, while also bearing out the need for departmental support, and for key interventions along the path from novice to practitioner identity. Some discussion of the ambassador or translator role that can flow from such arrangements is included. De 2014 à 2016, les chercheurs en Avancement des connaissances en enseignement et en apprentissage (ACEA) d’une université canadienne médicale-doctorale de taille moyenne ayant un coefficient de recherche élevé ont entrepris une étude portant sur leur propre formation en tant que chercheurs érudits en matière d’enseignement et d’apprentissage, ainsi que sur les avantages et les défis de leur nomination conjointe à notre institut central d’enseignement et d’apprentissage tout en enseignant dans leur propre département universitaire. Les résultats des sondages et des groupes de discussion ont permis d’identifier certains thèmes tels que l’identité, la communauté, l’accès, le transfert, ainsi que des éléments structuraux (chacun présentant des avantages et des défis concernant la pratique). Notre travail autoethnographique confirme les assertions présentes dans la documentation existante concernant la relation difficile qui existe entre l’ACEA et la recherche traditionnelle, tout en tenant compte de la nécessité du soutien départemental ainsi que pour les interventions clés sur la voie qui consiste à passer de l’identité de novice à celle de praticien. L’article contient également des discussions sur le rôle d’ambassadeur ou de traducteur qui peut découler de tels arrangements.

Nanoemulsions are submicron-size colloidal systems that have the ability to encapsulate, protect, and deliver active ingredients. They have been used in the pharmaceutical, cosmetics, and food industries to improve the absorption of drugs by the skin or via the gastrointestinal tract, aide in food conservation, and treat skin problems. To proper formulate a nanoemulsion, it is important to know the characteristics of its components (aqueous and oil phases, surfactants and additives), as well as the influence on the production method that will be used. This study investigates the influence of aqueous phase composition, stability and particle size in an oil-and-water nanoemulsion formation. By using a low energy method, the purified water was exchanged for different commercial mineral water and saline solutions, and the results of stability, particle size, pH and conductivity tests, were compared. These results show that the minerals present in commercial waters may alter the particle size, pH and conductivity values of nanoemulsions, as well as their stability.

Vector control remains the sole effective method to prevent dengue virus (DENV) transmission, although a vaccine for dengue has recently become available and testing of its efficacy and coverage is being performed in multiple places. Entomological surveillance is a key factor in alerting authorities to possible outbreaks, but until now natural DENV infection of mosquito populations has been scarcely used as an early warning system to monitor fluctuating prevalence of infected mosquitoes. The purpose of this study was to determine the burden of adult and larval/pupae of Aedes aegypti and Aedes albopictus with DENV in urban areas in the state of Rio Grande do Norte, Brazil.Immature insect forms (larvae and pupae) were collected from April 2011 to March 2012, whereas the collection of adults was conducted along 3 years: May 2011 to April 2014. Total RNAs of the samples were extracted and the nested reverse transcriptase PCR assay for detecting and typing DENV was performed. Of the 1333 immature insects collected during the study period, 1186 (89%) were A. aegypti and 147 (11%) A. albopictus. DENV-4 was identified in pools of A. aegypti larvae. The rate of DENV infection in immature A. aegypti was expressed as MIR = 3.37. DENV wasnot detected in immature A. albopictus. A total of 1360 adult female mosquitoes of the Aedes genus were captured from May 2011 to April 2014. Of this total, 1293 were A. aegypti (95%) and 67 were A. albopictus (5%). From the 130 pools studied, 27 (20.7%) were positive for DENV. DENV-1 was identified in 2/27 (7.4%) pools; 1of A. albopictus and 1 of A. aegypti. DENV-2 was identified in only 1/27 (3.7%) A. aegypti pools. DENV-4 was the most prevalent, identified in 24/27 (88.8%) of the positive pools, with 19 being of A. aegypti and 5 of A. albopictus pools. The minimum infection rate for adults of the Aedes genus was 19.8, considering both A. aegypti and A. albopictus.This work represents the most complete study to date on the interaction between dengue viruses and Aedes mosquitoes in the State of Rio Grande do Norte, and raises important questions about a possible role of A. albopictus in the transmission of dengue virus in Brazil.

OBJECTIVE: This study investigated the acute hemodynamic responses to multiple sets of passive stretching exercises performed with and without the Valsalva maneuver. METHODS: Fifteen healthy men aged 21 to 29 years with poor flexibility performed stretching protocols comprising 10 sets of maximal passive unilateral hip flexion, sustained for 30 seconds with equal intervals between sets. Protocols without and with the Valsalva maneuver were applied in a random counterbalanced order, separated by 48-hour intervals. Hemodynamic responses were measured by photoplethysmography pre-exercise, during the stretching sets, and post-exercise. RESULTS: The effects of stretching sets on systolic and diastolic blood pressure were cumulative until the fourth set in protocols performed with and without the Valsalva maneuver. The heart rate and rate pressure product increased in both protocols, but no additive effect was observed due to the number of sets. Hemodynamic responses were always higher when stretching was performed with the Valsalva maneuver, causing an additional elevation in the rate pressure product. CONCLUSIONS: Multiple sets of unilateral hip flexion stretching significantly increased blood pressure, heart rate, and rate pressure product values. A cumulative effect of the number of sets occurred only for systolic and diastolic blood pressure, at least in the initial sets of the stretching protocols. The performance of the Valsalva maneuver intensified all hemodynamic responses, which resulted in significant increases in cardiac work during stretching exercises.

BACKGROUND: The respiratory pattern is often modified or even blocked during flexibility exercises, but little is known about the cardiovascular response to concomitant stretching and the Valsalva maneuver (VM) in healthy subjects. OBJECTIVES: This study evaluated the heart rate (HR), systolic blood pressure (SBP), and rate-pressure product (RPP) during and after large and small muscle group flexibility exercises performed simultaneously with the VM. METHODS: Asymptomatic volunteers (N = 22) with the following characteristics were recruited: age, 22 ± 3 years; weight, 73 ± 6 kg; height, 175 ± 5 cm; HR at rest, 66 ± 9 BPM; and SBP at rest, 113 ± 10 mmHg. They performed two exercises: four sets of passive static stretching for 30 s of the dorsi-flexion (DF) of the gastrocnemius and the hip flexion (HF) of the ischio-tibialis. The exercises were performed with (V+) or without (V-) the VM in a counterbalanced order. The SBP and HR were measured, and the RPP was calculated before the exercise session, at the end of each set, and during a 30-min post-exercise recovery period. RESULTS: The within-group comparisons showed that only the SBP and RPP increased throughout the sets (p