Small hospitals matter: insights from the emergence and spread of vancomycin-resistant enterococci in 2 public hospitals in inner Brazil

Although vancomycin-resistant enterococci (VRE) are reported in Brazil since 1996, data on their impact over settings of different complexity are scarce. We performed a study aimed at identifying determinants ofVRE emergence and spread in a public hospital consortium (comprising 2 hospitals, with 318 and 57 beds) in inner Brazil. Molecular typing and case-control studies (addressing predictors of acquisition or clonality) were performed. Among 122 authocthonous isolates, 106 were Enterococcus faecium (22 clones), and 16, Enterococcus faecalis (5 clones). Incidence was greater in the small-sized hospital, and a previous admission to this hospital was associated with greater risk of VRE colonization or infection during admission to the larger one. Overall risk factors included comorbidities, procedures, and antimicrobials (piperacillin-tazobactam, cefepime, and imipenem). Risk factors varied among different hospitals, species, and clones. Our findings demonstrate that VRE can spread within low-complexity facilities and from these to larger hospitals. (C) 2015 Elsevier Inc. All rights reserved.

Practices related to late-onset sepsis in very low-birth weight preterm infants

Objective: To understand the practices related to late-onset sepsis (LOS) in the centers of the Brazilian Neonatal Research Network, and to propose strategies to reduce the incidence of LOS.Methods: This was a cross-sectional descriptive multicenter study approved by the Ethics Committee. Three questionnaires regarding hand hygiene, vascular catheters, and diagnosis/treatment of LOS were sent to the coordinator of each center. The center with the lowest incidence of LOS was compared with the others.Results: All 16 centers answered the questionnaires. Regarding hand hygiene, 87% use chlorhexidine or 70% alcohol; alcohol gel is used in 100%; 80% use bedside dispensers (50% had one dispenser for every two beds); practical training occurs in 100% and theoretical training in 70% of the centers, and 37% train once a year. Catheters: 94% have a protocol, and 75% have a line insertion team. Diagnosis/treatment: complete blood count and blood culture are used in 100%, PCR in 87%, hematological scores in 75%; oxacillin and aminoglycosides is the empirical therapy in 50% of centers. Characteristics of the center with lowest incidence of LOS: stricter hand hygiene; catheter insertion and maintenance groups; use of blood culture, PCR, and hematological score for diagnosis; empirical therapy with oxacillin and aminoglycoside.Conclusion: The knowledge of the practices of each center allowed for the identification of aspects to be improved as a strategy to reduce LOS, including: alcohol gel use, hand hygiene training, implementation of catheter teams, and wise use of antibiotic therapy. (C) 2013 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

Medium density particleboard reinforced with bamboo laminas

The objective of this work was to evaluate the effect of the addition of bamboo laminas of the species Dendrocalamus giganteus to three-layer medium density particleboard (MDP). These laminas were glued onto both the top and the bottom of each panel. With the manufactured panels laminated with bamboo, mechanical tests based on the Brazilian Standard ABNT NBR 14810 were carried out to determine the modulus of rupture (MOR) in static bending and the tensile strength parallel-to-surface. These mechanical tests were realized in particleboards of eucalyptus and in reinforced particleboard, both produced in the laboratory. The modulus of rupture and tensile strength parallel-to-surface of the laminated MDP had values close to those that have been reported. The reinforcements increased the values of these studied properties. Nevertheless, this fact indicated the possibility to produce a stronger MDP using bamboo lamina as surface layers. These results show the possibility of using coatedbamboo MDP for utilization in large spans, for example, in flooring for mezzanines with finish on both sides, and for robust furniture as bookshelves, beds, tables, etc.

Protein-energy malnutrition as a consequence of the hospitalization of gastroenterologic patients

The effects of the clinical and dietetics in patient managements on the protein-energy status of hospitalized patients were retrospectively (four yr) investigated in 243 adult (49 +/- 16 yr), male (168) and female (75) patients suffering from chronic liver diseases (42%), intestinal diseases with diarrhea (14%), digestive cancers (11%), chronic pancreatitis (10%), stomach and duodenum diseases (7%), acute pancreatitis (7%), primary protein-energy malnutrition (3%), esophagus diseases (3%), intestinal diseases with constipation 14 (2%) and chronic alcoholism (2%). The protein-energy nutritional status assessed by combinations of anthropometric and blood parameters showed 75% of protein energy malnutrition at the hospital entry mostly (4/5) in severe and moderate grades. The overall average of hospitalization was 20 +/- 15 days being the shortest (13 +/- 5,7 days) for esophagus diseases and the longest (28 +/- 21 days) for the intestinal diseases with diarrhea patients which also received mostly (42%) of the enteral and/or parenteral feedings followed by acute pacreatitis (41%) and digestive cancers (31%) patients. When compared to the entry the protein-energy malnutrition rate at the discharge decreased only 5% despite the increasing of 30% found on the protein-energy intake. The main improvement of the protein-energy nutritional status were attained to those patients showing protein-energy malnutrition milder degrees at the entry which belonged mostly to primary protein-energy malnutrition, acute pancreatitis and intestinal diseases with diarrhea diseases. The later two groups showed protein-energy nutritional status improvement only after the second week of hospitalization. The digestive cancers patients had their protein-energy nutritional status worsened throughout the hospitalization whereas it happened only in the first week for the intestinal diseases with diarrhea and chronic liver diseases patients, improving thereafter up to the discharge. The protein-energy nutritional status improvement found in few patients could be attributed to some complementary factors such as theirs mild degree of protein-energy malnutrition at entry and/or non-invasive propedeutics and/or enteral-parenteral feddings and/or longer hospitalization staying. The institutional causes for the unexpected lack of nutritional responses by the patients were probably the high demand for the few available beds which favour the hospitalization of the most severed patients and the university-teaching pressure for the high rotation of the available beds. Both often resulting in early discharging. In persisting the current physical area and attendance demand one could suggest an aggressive support early at the entry preceding and/or accompanying the more invasive propedeutical procedures.

Carga e trabalho de enfermagem em unidade de terapia intensiva especializada em queimados

Pós-graduação em Enfermagem (mestrado profissional) - FMB

Physa mezzalirai: um novo gastrópode da formação Adamantina (Bacia Bauru), Cretáceo Superior, São Paulo, Brasil

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Especialização hemisférica e assimetrias comportamentais: o lado da cama tem gênero?

Data relative on the side occupied by females in double beds were collected in order to evaluate the feasebility to carryout a more extensive study to determine if this behavioral pattern is lateralized. Information relative to the side occupied in the bed, manual lateralization, how long lived togheter, and other related questions were collected in a sample of 229 women aged from 20 to 65 years old. Total frequencies of the bed side occupied showed to be equivalent, however, the left side showed to be chosen significantly more (70%)(χ2 = 5.4; 1 d.f.; p<0.05) when the choice was stated to be spontaneous (i.e, not determined by an impositive factor) . It is concluded that the obtained data give favourable support to an extensive study on the subject, which inserts into the area of research devoted to the understanding of the functional characteristics of central nervous functioning.

Incidência e determinantes de infecção de sítio cirúrgico em hospitais de pequeno porte nas divisões regionais de saúde de Araçatuba, Bauru e Botucatu

Pós-graduação em Doenças Tropicais - FMB

Boas práticas para produção de ovos e legislação de bem-estar animal: cenário do município de Bastos/SP

Pós-graduação em Agronegócio e Desenvolvimento - Tupã

Conhecimento dos enfermeiros sobre as ações de prevenção da infecção de corrente sanguinea associada ao cateter venoso central

Pós-graduação em Enfermagem (mestrado profissional) - FMB

Paleocorrentes e paleogeografia do Grupo Aerado, cretáceo inferior da Bacia Sanfranciscana

The Areado Group of the Sanfranciscana Basin is a Lower Cretaceous continental sedimentary system that is correlated to the Brazilian Pre-Salt beds. The Aerado Group is composed of Abaeté, Quiricó and Três Barras formations. Paleocurrent data for the Areado Group were previously presented, although not systematically which prevented significative interpretations on the basin paleogeography. This work attempts to systematically evaluate paleocurrent data, aiming to recognize depositional environment and paleogeographic reconstruction, based on the sedimentary facies and paleocurrents measurements along vertical profiles. Fluvial paleocurrents of the Abaeté Formation indicate paleoflows towards NW whereas aeolian palecurrents of the Três Barras Formation show paleowinds towards SW. The depositional systems interpreted for the Areado Group were: braided river, alluvial fan, lacustrine, playa lake, fluvial-deltaic and aeolian. The combined analyses of facies and paleocurrents allowed a reliable paleogeographic reconstruction of the basin, with paleodip towards northwest, paleowinds towards south-southwest and source-area located at southeast. These results indicate that paleowinds were orthogonal to paleostream, but parallel to depositional strike of the basin. The interpreted depositional systems characterize a desert environment during the Abaeté sub-basin times. The association of dunes and wet interdunes followed by large scale dunes and dry interdunes suggests a decrease in humidity towards the top of the Três Barras Formation, with a dry aeolian system onlapping the basement. The observed decrease of humidity in Sanfranciscana Basin may reflect local or regional paleoclimatic changes during the opening of the South Atlantic, but this assumption is only tentative

Cuidados paliativos para pacientes em estado terminal em Unidades de Terapia Intensiva: revisão sistemática e metanálise

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Desempenho operacional de transplante manual e mecanizado da cultura da alface

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Efeitos da estabulação sobre o trato respiratório de equinos em dois tipos diferentes de camas e a pasto

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Evaluation of Attractants for Live-Trapping Nine-Banded Armadillos

In the past 50 years, the range of the nine-banded armadillo (Dasypus novemcinctus) in the south has been rapidly expanding. As their range expands, armadillos increasingly come into conflict with suburban landowners. When foraging, armadillos often uproot ornamental plants. Their rooting also destroys gardens, lawns, and flower beds. Their burrowing can damage tree roots and building foundations. Most armadillo damage is a result of their feeding habits. Armadillos dig shallow holes, 1- 3 inches deep and 3-5 inches long, as they search for soil invertebrates. A recent survey of Georgia county extension agents by scientists at the University of Georgia found that 77.6% of all agents reported receiving complaints or requests for information on armadillos. Armadillo related inquiries made up 10.1 % all inquiries for all agents across the state, surpassing even the white-tail deer (Odocoileus virginianus). Armadillos are often assumed to destroy nests of ground-nesting birds. Armadillo diets have been studied in several states including Alabama, Louisiana, Texas, Georgia, Arkansas, and Florida. According to these studies, vertebrate matter, especially bird eggs, made up an minor portion of their diet. The armadillo’s diet often consists of more than 90% insects, grubs and earthworms. Based on these studies, it seems that claims of armadillos being significant nest predators are unfounded.