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Objectives: to describe the available evidence on indications, complications, care and alternative strategies in the use of physical restraint in adult patients in Intensive Care Units.Methods: an integrative review conducted in the LILACS, Nursing Database, Índice Bibliográfico Español en Ciencias de la Salud, Scopus and CINAHL databases and the PubMed portal, in the period from June to August 2018., Results: the final selection was of 19 articles, from which the indications, complications, care and alternative strategies were extracted. The studies were conducted between the years 2003 and 2018, with a predominance of the United States; they were mostly classified (58%) in level 6 evidence, being performed by nurses, with multi-professional participation of psychologists, pharmacists, physicians, and nurses., Conclusions: the most common practices regarding physical restriction were described, and the need for the elaboration and implementation of protocols on intervention to support decision making was observed.

Purpose: DNA damage is one of the main consequences of exposure to ionizing irradiation (IR). Recent studies indicate that IR can modulate the expression of immune system-related genes. However, the effects of IR on the expression of genes and pathways of the B7-CD28 superfamily remain poorly defined. The aim of this study was to evaluate the modulation of genes and pathways related to the B7-CD28 superfamily in response to IR., Materials and Methods: In this study, we used transcriptome data available from the Gene Expression Omnibus (GEO) database to investigate the modulation of the response of genes and pathways of samples of human peripheral blood irradiated with doses of 150, 300, and 600 cGy. The data were obtained at 6 and 24 h after irradiation. The relationship between genes and pathways was established through the Reactome database. The behavior of these pathways was analyzed using mathematical methods based on relative activity and diversity. Analysis of variance (ANOVA) followed by multiple comparisons tests (Bonferroni and Tamhanes) was used to identify differentially expressed genes. Data on transcriptomes were analyzed through ViaComplex V.1.0 and IBM SPSS Statistics 22., Results: For the pathways investigated in this study, we observed that the effects produced by these doses significantly modified the behavior of five pathways associated with the immune system. Also, the dose of 300 cGy might trigger signaling for the activation of T cells through the negative regulation ( p  < .05) of the co-inhibitory PDCD1LG2 gene. Positive regulation caused by 300 cGy ( p  < .05) of the CD80 receptor was observed by us, which might be related to a stimulatory signal. According to our findings, this dose induced the production of cytokines and genes that are associated with the activation and differentiation of T cells., Conclusions: Our findings indicate that the irradiation modulated the organization of the biological system, suggesting that 300 cGy is more efficient in activating the immune system.

Background: The results of studies regarding the relationship between length of stay of patients in emergency departments (EDs) and mortality in intensive care units (ICUs) are contradictory, and nothing is known about the impact of delayed admission of patients to ICUs on nursing workload., Aims and Objectives: To assess the influence of the time lapse between ED and ICU admissions on mortality and nursing workload in relation to intensive care patients., Design: This was a retrospective cohort study that examined the medical records of patients who were 15 years of age or older and admitted directly to the ICU from the ED., Methods: The data were collected between 2014 and 2016 in a hospital located in São Paulo, Brazil. Nursing workload was measured by the Nursing Activities Score. Multiple linear and logistic regressions were applied, with a significance level of 5%., Results: Of the 534 patients analysed, the majority were men (57·49%); the mean age was 55·37 ± 19·64 years. Length of stay in the ED was not associated with nursing workload at the time of admission of patients to the ICU or during their stay in the unit. For mortality, this variable was a risk factor along with cause of admission, length of stay in the ICU and the Simplified Acute Physiology Score 3 score. For every additional hour that patients remained in the ED, their chance of dying in the ICU increased by 1%., Conclusion: Length of stay of patients in the ED was a risk factor for mortality in the ICU; however, this variable did not have any influence on nursing workload., Relevance to Clinical Practice: Strategies need to be implemented to optimize the availability of ICU beds and reduce the length of stay of critical patients in the ED as delays in admitting such patients to the ICU have an impact on mortality., (© 2018 British Association of Critical Care Nurses.)

In the HTML version of this Article originally published, Fig. 4 was a duplicate of Fig. 1. This has now been amended.

The development of agriculture is one of humankind's most pivotal achievements. Questions about plant domestication and the origins of agriculture have engaged scholars for well over a century, with implications for understanding its legacy on global subsistence strategies, plant distribution, population health and the global methane budget. Rice is one of the most important crops to be domesticated globally, with both Asia (Oryza sativa L.) and Africa (Oryza glaberrima Steud.) discussed as primary centres of domestication. However, until now the pre-Columbian domestication of rice in the Americas has not been documented. Here we document the domestication of Oryza sp. wild rice by the mid-Holocene residents of the Monte Castelo shell mound starting at approximately 4,000 cal. yr BP, evidenced by increasingly larger rice husk phytoliths. Our data provide evidence for the domestication of wild rice in a region of the Amazon that was also probably the cradle of domestication of other major crops such as cassava (Manihot esculenta), peanut (Arachis hypogaea) and chilli pepper (Capsicum sp.). These results underline the role of wetlands as prime habitats for plant domestication worldwide.

Triatoma melanocephala Neiva & Pinto is found in the Brazilian states of Bahia, Paraíba, Pernambuco, Rio Grande do Norte, and Sergipe. In addition to the species' specific description, eight other articles on this insect were found in the literature. In this study, data was obtained on the morphology, morphometry, and life cycle of T. melanocephala, since this vector is of epidemiological and taxonomic importance. The specimens studied were obtained from a colony that has been kept at the Triatomine Insectarium of the College of Pharmaceutical Sciences of São Paulo State University's in Brazil. The morphological studies were performed using scanning electron microscopy. These studies characterized the eggs, the external adult female genitalia, and the ninth ventral abdominal segments of male and female nymphs. The morphometric studies characterized the five nymphal instars and the adult stage by measuring the head, thorax, abdomen, antennae, and mouthparts parameters. The life cycle of T. melanocephala was developed starting by 15 couples in the fifth instar. They were fed on Swiss mice every two weeks and observed daily. During daily observation, minimum temperature, maximum temperature, and relative humidity of the laboratory were measured. The results of the biological, morphometric, and morphological studies have increased the knowledge available on T. melanocephala.

Irradiation of whole blood and blood components before transfusion is currently the only accepted method to prevent Transfusion-Associated Graft-Versus-Host-Disease (TA-GVHD). However, choosing the appropriate technique to determine the dosimetric parameters associated with blood irradiation remains an issue. We propose a dosimetric system based on the standard Fricke Xylenol Gel (FXG) dosimeter and an appropriate phantom. The modified dosimeter was previously calibrated using a (60)Co teletherapy unit and its validation was accomplished with a (137)Cs blood irradiator. An ionization chamber, standard FXG, radiochromic film and thermoluminescent dosimeters (TLDs) were used as reference dosimeters to determine the dose response and dose rate of the (60)Co unit. The dose distributions in a blood irradiator were determined with the modified FXG, the radiochromic film, and measurements by TLD dosimeters. A linear response for absorbed doses up to 54 Gy was obtained with our system. Additionally, the dose rate uncertainties carried out with gel dosimetry were lower than 5% and differences lower than 4% were noted when the absorbed dose responses were compared with ionization chamber, film and TLDs.

Background: Previous publications have documented the damage caused to red blood cells (RBCs) irradiated with X-rays produced by a linear accelerator and with gamma rays derived from a 137Cs source. The biologic effects on RBCs of gamma rays from a 60Co source, however, have not been characterized., Study Design and Methods: This study investigated the effect of 3000 and 4000 cGy on the in vitro properties of RBCs preserved with preservative solution and irradiated with a cobalt teletherapy unit. A thermal device equipped with a data acquisition system was used to maintain and monitor the blood temperature during irradiation. The device was rotated at 2 r.p.m. in the irradiation beam by means of an automated system. The spatial distribution of the absorbed dose over the irradiated volume was obtained with phantom and thermoluminescent dosimeters (TLDs). Levels of Hb, K+, and Cl(-) were assessed by spectrophotometric techniques over a period of 45 days. The change in the topology of the RBC membrane was investigated by flow cytometry., Results: Irradiation caused significant changes in the extracellular levels of K+ and Hb and in the organizational structure of the phospholipid bilayer of the RBC membrane. Blood temperature ranged from 2 to 4 degrees C during irradiation. Rotation at 2 r.p.m. distributed the dose homogeneously (92%-104%) and did not damage the RBCs., Conclusions: The method used to store the blood bags during irradiation guaranteed that all damage caused to the cells was exclusively due to the action of radiation at the doses applied. It was demonstrated that prolonged storage of 60Co-irradiated RBCs results in loss of membrane phospholipids asymmetry, exposing phosphatidylserine (PS) on the cells' surface with a time and dose dependence, which can reduce the in vivo recovery of these cells. A time- and dose-dependence effect on the extracellular K+ and plasma-free Hb levels was also observed. The magnitude of all these effects, however, seems not to be clinically important and can support the storage of irradiated RBC units for at last 28 days.

Background: To identify the most appropriate dose for the prevention of transfusion-associated graft-versus-host disease, the radiosensitivity of T cells has been determined in blood bags irradiated with X-rays produced by a linear accelerator and gamma rays derived from the cesium-137 source of a specific irradiator. In this study, the influence of doses ranging from 500 to 2500 cGy was investigated on T cells isolated from red blood cell (RBC) units preserved with ADSOL and irradiated with a cobalt teletherapy unit., Study Design and Methods: A thermal device consisting of acrylic and foam was constructed to store the blood bags during irradiation. Blood temperature was monitored with an automated data acquisition system. Dose distribution in the blood bags was analyzed based on isodose curves obtained with a polystyrene phantom constructed for this purpose. The influence of cobalt-60 gamma radiation on T cells was determined by limiting-dilution analysis, which measures clonable T cells. T-cell content of the mononuclear cell population plated was assessed by flow cytometry with a monoclonal antibody specific for CD3., Results: Blood temperature ranged from 2 to 4.5 degrees C during irradiation. Dosimetry performed on the phantom showed a homogenous dose distribution when the phantom was irradiated with a parallel-opposite field. A radiation dose of 1500 cGy led to the inactivation of T cells by 4 log, but T-cell growth was observed in all experiments. At 2500 cGy, no T-cell growth was detected in any of the experiments and a greater than 5 log reduction in functional T cells was noted., Conclusion: The results showed that a dose of 2500 cGy completely inactivates T cells in RBC units irradiated with cobalt-60 source.

In Brazil, zoonotic visceral leishmaniasis (ZVL) control programs based on the mass elimination of seropositive dogs have failed to reduce the number of leishmaniasis cases. However, these programs have been done under sub-optimal conditions. We studied a cohort of dogs in an urban area in Brazil to determine, whether a dog-culling program optimized with: (i) replacement of a relatively low-sensitivity indirect immune-fluorescent test on blood eluate by a more sensitive enzyme-linked immunosorbent assay on serum blood samples; (ii) shortening of the time interval from serodiagnosis to removal of dogs; (iii) screening a high proportion of the dog population could reduce the incidence of canine Leishmania infection (CLI). The study ran from December 1997 to July 2000, with four follow-up assessments performed at approximately 8-month intervals. All dogs seropositive for anti-Leishmania antibodies were promptly eliminated. A large number of new dogs immigrated to the study area throughout the study period. They comprised 43.8-49.8% of the cohort at each follow-up assessment, and upto 15% of them already had Leishmania infection. Overall, 42 news cases of CLI were identified, for a crude incidence rate of 11.8 cases per 100 dog-years (95% CI 8.6-15.6). In the first, second, third and fourth follow-up assessments the incidence rates were 8.2 (95% CI 3.0-17.9), 12.2 (95% CI 6.3-21.2), 16.4 (95% CI 8.5-28.6) and 13.6 (95% CI 7.1-23.8), respectively. There was no statistically significant change in these rates throughout the study period. Our results suggest that dog-culling programs do not reduce the incidence of CLI, even with an optimized intervention. Possible reasons for this failure include: currently available serologic methods lack sufficient sensitivity and/or specificity to accurately identify all infected dogs warranting removal in order to prevent Leishmania transmission; destroyed dogs are immediately replaced by susceptible puppies, and quite often, by already infected dogs; and other reservoirs may be involved in maintaining canine infection. Further efforts on ZVL control should be directed to developing new strategies or to testing control methods already in place with properly designed trials.

Background and Objectives: Irradiation of whole blood and blood components before transfusion is currently the only accepted methodology to prevent transfusion-associated graft-vs.-host disease. In the present work, we developed an automated system for blood bag storage during irradiation, using a teletherapy unit., Materials and Methods: A device with two thermal compartments was constructed in acrylic and foam, for the storage of blood bags during irradiation. An automatic acquisition system, coupled with an amplifier and a thermal-sensitive probe, were developed to check blood temperature during irradiation. A polystyrene phantom was constructed to simulate the volume of blood routinely irradiated. The dose distribution was measured in the phantom using thermoluminescent dosimeters and represented in terms of isodose curves., Results: The thermal device kept the blood temperature below 6 degrees C for more than 2 h. Our system allowed the simultaneous irradiation of two different blood components while maintaining a constant temperature. The temperature monitoring system remained invariant (0.2 degrees C) over the whole irradiation interval. Phantom dosimetric results showed a homogeneous dose distribution when the phantom was irradiated, using rotational fields with a 2 r.p.m. frequency., Conclusions: The methodology developed in the present work provides appropriate storage conditions during irradiation of both red blood cells and platelet blood components using a teletherapy unit.

A prospective cohort study was conducted during a 15-month period to compare nosocomial infections (NIs) among pediatric patients without (n = 989 and with (n = 50) symptomatic human immunodeficiency virus (HIV) infection. Patients with symptomatic HIV infection presented higher overall NI incidence density rates (relative risk, 1.65; P= .0001), and may represent a population at high risk for the acquisition of NI.

An x-ray sensitometer is used to measure the characteristic curve of radiographic films exposed with fluorescent intensifying screens. The series of relative exposures, necessary to cover the full density range of the film, can be obtained by either time-scale or intensity-scale sensitometric methods. We have developed a convenient method of exposing film-screen systems for time-scale sensitometry. In this method, during exposure the x-ray kilovoltage, tube current and x-ray intensity remain constant and a geometric series of exposures of the film is modulated by varying the exposure time. This time variation can be obtained when a lead disc with different sector openings is rotated in front of the film system by a stepping motor. The conditions normally used are 70 kVp x-rays, 3.5 mm Al total filtration at the tube, and 2.4 m focal spot-film distance. This exposure latitude gives a complete characteristic curve of film-screen systems.