Microbiological contamination of a hemodialysis center water distribution system

The microbiological monitoring of the water used for hemodialysis is extremely important, especially because of the debilitated immune system of patients suffering from chronic renal insufficiency. To investigate the occurrence and species diversity of bacteria in waters, water samples were collected monthly from a hemodialysis center in upstate São Paulo and tap water samples at the terminal sites of the distribution system was sampled repeatedly (22 times) at each of five points in the distribution system; a further 36 samples were taken from cannulae in 19 hemodialysis machines that were ready for the next patient, four samples from the reuse system and 13 from the water storage system. To identify bacteria, samples were filtered through 0.22 µm-pore membranes; for mycobacteria, 0.45 µm pores were used. Conventional microbiological and molecular methods were used in the analysis. Bacteria were isolated from the distribution system (128 isolates), kidney machine water (43) and reuse system (3). Among these isolates, 32 were Gram-positive rods, 120 Gram-negative rods, 20 Gram-positive cocci and 11 mycobacteria. We propose the continual monitoring of the water supplies in hemodialysis centers and the adoption of effective prophylactic measures that minimize the exposure of these immunodeficient patients to contaminated sources of water.

Ostracodes (Crustacea) from Cananéia-Iguape estuarine/lagoon system and geographical distribution of the mixohaline assemblages in southern and southeastern Brazil

The ostracode assemblages from Cananéia-Iguape estuarine/lagoon system (southernmost State of São Paulo) are here discussed in detail for the first time. Thirty-four sites, approximately 1 km equidistant, were sampled along the system, including the Cananéia Sea, Pequeno Sea, Cubatão Sea, Ribeira de Iguape River and Itapitangui River. The ostracodes throughout this area have poor assemblages, with a total of 662 specimens of dead and living organisms. The majority of the ostracode fauna is composed of euryhaline species, as follows: Cyprideis multidentata Hartmann, 1955 (174 specimens), Minicythere heinii Ornellas, 1974 (54 specimens), Tanella gracilis Kingma, 1948 (96 specimens) and Whatleyella sanguinettiae Coimbra, Carreño & Ferron, 1994 (226 specimens). Although there are few studies on the Brazilian mixohaline ostracode faunas, including the euryhaline marginal marine taxa, the published data show that the group is best known in the south and southeast regions. Based on this review and with the new data presented in this paper, the geographical distribution of eight mixohaline key species in southern and southeastern Brazil is also discussed.

Scientific Literature on the Reliability and Validity of the Manchester Triage System (MTS) Protocol: A Integrative Literature Review

OBJECTIVE To analyze the scientific production about the validity and reliability of the Manchester Triage System (MTS) protocol. METHOD A descriptive study of an integrative literature review. Articles on the validity and reliability of the MTS developed with children and adults published between 1999 and 2013 were included. RESULTS 14 articles were selected from a total of 8438, nine of validity and five of reliability. The reliability of the MTS ranged from moderate to almost perfect, with higher intra-evaluation. Regarding validity, the results seem to point to equivalent and satisfactory sensibility and specificity levels of the MTS. The instrument proved to be a good predictor of the need for hospitalization and of hospital mortality. CONCLUSION The reliability and validity of the MTS obtained in the studies is varied. It is recommended that new studies indicate necessary modifications to the MTS so that it is more safely used by nurses.

Root system distribution of sugar cane as related to nitrogen fertilization, evaluated by two methods: monolith and probes

Few studies on sugar cane have evaluated the root system of the crop, in spite of its importance. This is mainly due to the difficulty of evaluation and high variability of results. The objective of this study was to develop an evaluation method of the cane root system by means of probes so as to evaluate the mass, distribution and metabolically active roots related to N fertilization at planting. For this purpose, an experiment was conducted in an Arenic Kandiustults with medium texture in Jaboticabal/SP, in a randomized block design with four replications and four treatments: control (without N) and 40, 80 and 120 kg ha-1 of N applied in the form of urea in the planting furrow of the cane variety SP81 3250. One week before harvest, a urea-15N solution was applied at the cane stalk base to detect active metabolism in the root system. Trenches of 1.5 m length and 0.6 m depth were opened between two sugar cane rows for root sampling by two methods: monoliths (0.3, 0.2 and 0.15 m wide, deep and long respectively) taken from the trench wall and by probe (internal diameter 0.055 m). For each method, 15 samples per plot were collected. The roots were separated from the soil in a sieve (2 mm mesh), oven-dried (at 65 ºC) and the dry matter was measured. Root sampling by probes resulted in root mass that did not differ from the evaluation in monoliths, indicating that this evaluation method may be used for sugar cane root mass, although neither the root distribution in the soil profile nor the rhizome mass were efficiently evaluated, due to the small sample volume. Nitrogen fertilization at planting did not result in a greater root accumulation in the sugar cane plant, but caused changes in the distribution of the root system in the soil. The absence of N fertilization led to a better root distribution in the soil profile, with 50, 34 and 16 % in the 0-0.2, 0.2-0.4 and 0.4-0.6 m layers, respectively; in the fertilized treatments the roots were concentrated in the surface layer, with on average 70, 17 and 13 % for the same layers. The metabolically active roots were concentrated in the center of the cane stool, amounting to 40 % of the total root mass, regardless of N fertilization (application of 120 kg ha-1 N or without N).

Root system distribution and yield of 'Conilon' coffee propagated by seeds or cuttings

The objective of this work was to evaluate the root system distribution and the yield of 'Conilon' coffee (Coffea canephora) propagated by seeds or cuttings. The experiment was carried out with 2x1 m spacing, in an Oxisol with sandy clay loam texture. A randomized complete block design was used, following a 2x9x6 factorial arrangement, with two propagation methods (seeds and cuttings), nine sampling spacings (0.15, 0.30, 0.45, 0.60, 0.75, and 0.90 m between rows, and 0.15, 0.30, and 0.45 between plants within rows), six soil depths (0.10-0.20, 0.20-0.30, 0.30-0.40, 0.40-0.50, and 0.50-0.60 m), and six replicates. Soil cores (27 cm3) with roots were taken from 12 experimental units, 146 months after planting. The surface area of the root system and root diameter, length, and volume were assessed for 13 years and, then, correlated with grain yield. The highest fine root concentration occurred at the superficial soil layers. The variables used to characterize the root system did not differ between propagation methods. Moreover, no differences were observed for net photosynthetic CO2 assimilation rate, stomatal conductance, internal CO2 concentrations, and instantaneous water-use efficiency in the leaves. Cutting-propagated plants were more productive than seed-propagated ones.

Soil sampling intensity and spatial distribution pattern of soils attributes and corn yield in no-tillage system

Taking into account that the sampling intensity of soil attributes is a determining factor for applying of concepts of precision agriculture, this study aims to determine the spatial distribution pattern of soil attributes and corn yield at four soil sampling intensities and verify how sampling intensity affects cause-effect relationship between soil attributes and corn yield. A 100-referenced point sample grid was imposed on the experimental site. Thus, each sampling cell encompassed an area of 45 m² and was composed of five 10-m long crop rows, where referenced points were considered the center of the cell. Samples were taken from at 0 to 0.1 m and 0.1 to 0.2 m depths. Soil chemical attributes and clay content were evaluated. Sampling intensities were established by initial 100-point sampling, resulting data sets of 100; 75; 50 and 25 points. The data were submitted to descriptive statistical and geostatistics analyses. The best sampling intensity to know the spatial distribution pattern was dependent on the soil attribute being studied. The attributes P and K+ content showed higher spatial variability; while the clay content, Ca2+, Mg2+ and base saturation values (V) showed lesser spatial variability. The spatial distribution pattern of clay content and V at the 100-point sampling were the ones which best explained the spatial distribution pattern of corn yield.

Bimodal pore distribution on soils under conservation management system for coffee crop

This study aims at detailing bimodal pore distribution by means of water retention curve in an oxidic-gibbsitic Latosol and in a kaolinitic cambisol Latossol under conservation management system of coffee crop. Samples were collected at depths of 20; 40; 80; 120 and 160 cm on coffee trees rows and between rows under oxidic-gibbsitic Latosol (LVd) and kaolinitic cambisol Latossol (LVAd). Water retention curve was determined at matrix potentials (Ψm) -1; -2; -4; -6; -10 kPa obtained from the suction unit; the Ψm of -33; -100; -500; -1,500 kPa were obtained by the Richards extractor, and WP4-T psychrometer was used to determine Ψm -1,500 to -300,000 kPa. The water retention data were adjusted to the double van Genuchten model by nonlinear model procedures of the R 2.12.1 software. Was estimated the model parameter and inflection point slope. The system promoted changes in soil structure and water retention for the conditions evaluated, and both showed bimodal pores distribution, which were stronger in LVd. There was a strong influence of mineralogy gibbsitic in the water retention more negative than Ψm -1500 kPa, reflected in the values of the residual water content.

Root system distribution of sugarcane irrigated with domestic sewage effluent aplication by subsurface drip system

Irrigation with domestic sewage effluent (DSE) has been recommended by subsurface dripping, as it can obtain a high rate of irrigation efficiency and faster use of salts in comparison with other irrigation methods. The study aimed at evaluating the area, the length and the effective depth of the root system of sugarcane irrigated with DSE by subsurface drip system and with different irrigation rates at depths of 0.00-0.20, 0.20-0.40, 0.40-0.60 and 0.60-0.80m. The experiment was carried out in the municipality of Piracicaba, in the state of São Paulo (SP), Brazil, in a sugarcane area irrigated with DSE in a completely randomized blocks set up in furrows, with three replications and four treatments, which are: one area without irrigation (AWI) and three irrigated areas meeting 50% (T50%), 100% (T100%) and 200% (T200%) of the crop's water need between each round of irrigation. T100% and T200% provided smaller areas and lengths of roots in the two deepest layers, as compared to AWI and T50%, which stimulated the development of deeper roots due to the water stress. TWI, T100% and T200% presented 80% of the roots up to a depth of 0.40m and T50% treatment presented 76.43% of roots total.

Distribution of AMPA-type glutamate receptor subunits in the chick visual system

Several glutamate receptor (GluR) subunits have been characterized during the past few years. In the present study, subunit-specific antisera were used to determine the distribution of the AMPA-type glutamate receptor subunits GluR1-4 in retinorecipient areas of the chick brain. Six white leghorn chicks (Gallus gallus, 7-15 days old, unknown sex) were deeply anesthetized and perfused with 4% buffered paraformaldehyde and brain sections were stained using immunoperoxidase techniques. The AMPA-type glutamate receptor subunits GluR1, GluR2/3 and GluR4 were present in several retinorecipient areas, with varying degrees of colocalization. For example, perikarya in layers 2, 3, and 5 of the optic tectum contained GluR1, whereas GluR2/3 subunits appeared mainly in neurons of layer 13. The GluR4 subunit was only detected in a few cells of the tectal layer 13. GluR1 and GluR2/3 were observed in neurons of the nucleus geniculatus lateralis ventralis, whereas GluR4 was only present in its neuropil. Somata in the accessory optic nucleus appeared to contain GluR2/3 and GluR4, whereas GluR1 was the dominant subunit in the neuropil of this nucleus. These results suggest that different subpopulations of visual neurons might express different combinations of AMPA-type GluR subunits, which in turn might generate different synaptic responses to glutamate derived from retinal ganglion cell axons

Distribution of calcium-binding proteins in the chick visual system

The calcium-binding proteins calbindin (CB), calretinin (CR), and parvalbumin (PV) have been extensively studied over the last decade since they appear to be important as buffers of intracellular calcium. In the present study we investigated the distribution of these proteins in the chick visual system by means of conventional immunocytochemistry. The results indicated that CB, CR, and PV are widely distributed in retinorecipient areas of the chick brain. In some regions, all three calcium-binding proteins were present at different intensities and often in different neurons such as in the dorsolateral thalamic complex. In other areas, such as the nucleus geniculatus lateralis ventralis, only CB and CR were detected, whereas PV was absent. These results show that these three calcium-binding proteins are differentially distributed in the visual system of the chick, with varying degrees of co-localization

Temporal trends and spatial distribution of unsafe abortion in Brazil, 1996-2012

OBJECTIVE To analyze temporal trends and distribution patterns of unsafe abortion in Brazil. METHODS Ecological study based on records of hospital admissions of women due to abortion in Brazil between 1996 and 2012, obtained from the Hospital Information System of the Ministry of Health. We estimated the number of unsafe abortions stratified by place of residence, using indirect estimate techniques. The following indicators were calculated: ratio of unsafe abortions/100 live births and rate of unsafe abortion/1,000 women of childbearing age. We analyzed temporal trends through polynomial regression and spatial distribution using municipalities as the unit of analysis. RESULTS In the study period, a total of 4,007,327 hospital admissions due to abortions were recorded in Brazil. We estimated a total of 16,905,911 unsafe abortions in the country, with an annual mean of 994,465 abortions (mean unsafe abortion rate: 17.0 abortions/1,000 women of childbearing age; ratio of unsafe abortions: 33.2/100 live births). Unsafe abortion presented a declining trend at national level (R2: 94.0%, p < 0.001), with unequal patterns between regions. There was a significant reduction of unsafe abortion in the Northeast (R2: 93.0%, p < 0.001), Southeast (R2: 92.0%, p < 0.001) and Central-West regions (R2: 64.0%, p < 0.001), whereas the North (R2: 39.0%, p = 0.030) presented an increase, and the South (R2: 22.0%, p = 0.340) remained stable. Spatial analysis identified the presence of clusters of municipalities with high values for unsafe abortion, located mainly in states of the North, Northeast and Southeast Regions. CONCLUSIONS Unsafe abortion remains a public health problem in Brazil, with marked regional differences, mainly concentrated in the socioeconomically disadvantaged regions of the country. Qualification of attention to women’s health, especially to reproductive aspects and attention to pre- and post-abortion processes, are necessary and urgent strategies to be implemented in the country.

Temporal evolution and spatial distribution of maternal death

OBJECTIVE To analyze the temporal evolution of maternal mortality and its spatial distribution.METHODS Ecological study with a sample made up of 845 maternal deaths in women between 10 and 49 years, registered from 1999 to 2008 in the state of Rio Grande do Sul, Southern Brazil. Data were obtained from Information System on Mortality of Ministry of Health. The maternal mortality ratio and the specific maternal mortality ratio were calculated from records, and analyzed by the Poisson regression model. In the spatial distribution, three maps of the state were built with the rates in the geographical macro-regions, in 1999, 2003, and 2008.RESULTS There was an increase of 2.0% in the period of ten years (95%CI 1.00;1.04; p = 0.01), with no significant change in the magnitude of the maternal mortality ratio. The Serra macro-region presented the highest maternal mortality ratio (1.15, 95%CI 1.08;1.21; p < 0.001). Most deaths in Rio Grande do Sul were of white women over 40 years, with a lower level of education. The time of delivery/abortion and postpartum are times of increased maternal risk, with a greater negative impact of direct causes such as hypertension and bleeding.CONCLUSIONS The lack of improvement in maternal mortality ratio indicates that public policies had no impact on women’s reproductive and maternal health. It is needed to qualify the attention to women’s health, especially in the prenatal period, seeking to identify and prevent risk factors, as a strategy of reducing maternal death.

Evaluation of maternal and neonatal hospital care: quality index of completeness

OBJECTIVE Develop an index to evaluate the maternal and neonatal hospital care of the Brazilian Unified Health System.METHODS This descriptive cross-sectional study of national scope was based on the structure-process-outcome framework proposed by Donabedian and on comprehensive health care. Data from the Hospital Information System and the National Registry of Health Establishments were used. The maternal and neonatal network of Brazilian Unified Health System consisted of 3,400 hospitals that performed at least 12 deliveries in 2009 or whose number of deliveries represented 10.0% or more of the total admissions in 2009. Relevance and reliability were defined as criteria for the selection of variables. Simple and composite indicators and the index of completeness were constructed and evaluated, and the distribution of maternal and neonatal hospital care was assessed in different regions of the country.RESULTS A total of 40 variables were selected, from which 27 single indicators, five composite indicators, and the index of completeness of care were built. Composite indicators were constructed by grouping simple indicators and included the following variables: hospital size, level of complexity, delivery care practice, recommended hospital practice, and epidemiological practice. The index of completeness of care grouped the five variables and classified them in ascending order, thereby yielding five levels of completeness of maternal and neonatal hospital care: very low, low, intermediate, high, and very high. The hospital network was predominantly of small size and low complexity, with inadequate child delivery care and poor development of recommended and epidemiological practices. The index showed that more than 80.0% hospitals had a low index of completeness of care and that most qualified heath care services were concentrated in the more developed regions of the country.CONCLUSIONS The index of completeness proved to be of great value for monitoring the maternal and neonatal hospital care of Brazilian Unified Health System and indicated that the quality of health care was unsatisfactory. However, its application does not replace specific evaluations.

Spatial distribution of specialized cardiac care units in the state of Santa Catarina

OBJECTIVE To analyze the methodology used for assessing the spatial distribution of specialized cardiac care units. METHODS A modeling and simulation method was adopted for the practical application of cardiac care service in the state of Santa Catarina, Southern Brazil, using the p-median model. As the state is divided into 21 health care regions, a methodology which suggests an arrangement of eight intermediate cardiac care units was analyzed, comparing the results obtained using data from 1996 and 2012. RESULTS Results obtained using data from 2012 indicated significant changes in the state, particularly in relation to the increased population density in the coastal regions. The current study provided a satisfactory response, indicated by the homogeneity of the results regarding the location of the intermediate cardiac care units and their respective regional administrations, thereby decreasing the average distance traveled by users to health care units, located in higher population density areas. The validity of the model was corroborated through the analysis of the allocation of the median vertices proposed in 1996 and 2012. CONCLUSIONS The current spatial distribution of specialized cardiac care units is more homogeneous and reflects the demographic changes that have occurred in the state over the last 17 years. The comparison between the two simulations and the current configuration showed the validity of the proposed model as an aid in decision making for system expansion.

Validity and reliability of a health care service evaluation instrument for tuberculosis

OBJECTIVE To evaluate the validity and reliability of an instrument that evaluates the structure of primary health care units for the treatment of tuberculosis.METHODS This cross-sectional study used simple random sampling and evaluated 1,037 health care professionals from five Brazilian municipalities (Natal, state of Rio Grande do Norte; Cabedelo, state of Paraíba; Foz do Iguaçu, state of Parana; Sao José do Rio Preto, state of Sao Paulo, and Uberaba, state of Minas Gerais) in 2011. Structural indicators were identified and validated, considering different methods of organization of the health care system in the municipalities of different population sizes. Each structure represented the organization of health care services and contained the resources available for the execution of health care services: physical resources (equipment, consumables, and facilities); human resources (number and qualification); and resources for maintenance of the existing infrastructure and technology (deemed as the organization of health care services). The statistical analyses used in the validation process included reliability analysis, exploratory factor analysis, and confirmatory factor analysis.RESULTS The validation process indicated the retention of five factors, with 85.9% of the total variance explained, internal consistency between 0.6460 and 0.7802, and quality of fit of the confirmatory factor analysis of 0.995 using the goodness-of-fit index. The retained factors comprised five structural indicators: professionals involved in the care of tuberculosis patients, training, access to recording instruments, availability of supplies, and coordination of health care services with other levels of care. Availability of supplies had the best performance and the lowest coefficient of variation among the services evaluated. The indicators of assessment of human resources and coordination with other levels of care had satisfactory performance, but the latter showed the highest coefficient of variation. The performance of the indicators “training” and “access to recording instruments” was inferior to that of other indicators.CONCLUSIONS The instrument showed feasibility of application and potential to assess the structure of primary health care units for the treatment of tuberculosis.