American Society of Anesthesiologists Score: Still Useful After 60 Years? Results of the EuSOS Study

OBJECTIVE: The European Surgical Outcomes Study described mortality following in-patient surgery. Several factors were identified that were able to predict poor outcomes in a multivariate analysis. These included age, procedure urgency, severity and type and the American Association of Anaesthesia score. This study describes in greater detail the relationship between the American Association of Anaesthesia score and postoperative mortality. METHODS: Patients in this 7-day cohort study were enrolled in April 2011. Consecutive patients aged 16 years and older undergoing inpatient non-cardiac surgery with a recorded American Association of Anaesthesia score in 498 hospitals across 28 European nations were included and followed up for a maximum of 60 days. The primary endpoint was in-hospital mortality. Decision tree analysis with the CHAID (SPSS) system was used to delineate nodes associated with mortality. RESULTS: The study enrolled 46,539 patients. Due to missing values, 873 patients were excluded, resulting in the analysis of 45,666 patients. Increasing American Association of Anaesthesia scores were associated with increased admission rates to intensive care and higher mortality rates. Despite a progressive relationship with mortality, discrimination was poor, with an area under the ROC curve of 0.658 (95% CI 0.642 - 0.6775). Using regression trees (CHAID), we identified four discrete American Association of Anaesthesia nodes associated with mortality, with American Association of Anaesthesia 1 and American Association of Anaesthesia 2 compressed into the same node. CONCLUSION: The American Association of Anaesthesia score can be used to determine higher risk groups of surgical patients, but clinicians cannot use the score to discriminate between grades 1 and 2. Overall, the discriminatory power of the model was less than acceptable for widespread use.

The Intensive Care Global Study on Severe Acute Respiratory Infection (IC-GLOSSARI): a Multicenter, Multinational, 14-Day Inception Cohort Study

PURPOSE: In this prospective, multicenter, 14-day inception cohort study, we investigated the epidemiology, patterns of infections, and outcome in patients admitted to the intensive care unit (ICU) as a result of severe acute respiratory infections (SARIs). METHODS: All patients admitted to one of 206 participating ICUs during two study weeks, one in November 2013 and the other in January 2014, were screened. SARI was defined as possible, probable, or microbiologically confirmed respiratory tract infection with recent onset dyspnea and/or fever. The primary outcome parameter was in-hospital mortality within 60 days of admission to the ICU. RESULTS: Among the 5550 patients admitted during the study periods, 663 (11.9 %) had SARI. On admission to the ICU, Gram-positive and Gram-negative bacteria were found in 29.6 and 26.2 % of SARI patients but rarely atypical bacteria (1.0 %); viruses were present in 7.7 % of patients. Organ failure occurred in 74.7 % of patients in the ICU, mostly respiratory (53.8 %), cardiovascular (44.5 %), and renal (44.6 %). ICU and in-hospital mortality rates in patients with SARI were 20.2 and 27.2 %, respectively. In multivariable analysis, older age, greater severity scores at ICU admission, and hematologic malignancy or liver disease were independently associated with an increased risk of in-hospital death, whereas influenza vaccination prior to ICU admission and adequate antibiotic administration on ICU admission were associated with a lower risk. CONCLUSIONS: Admission to the ICU for SARI is common and associated with high morbidity and mortality rates. We identified several risk factors for in-hospital death that may be useful for risk stratification in these patients.

Evolution in public procurement and the impact of e-procurement platforms: A case study

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Management from the NOVA – School of Business and Economics

Caracterização da produção da agricultura familiar no projeto de assentamento Panelão no município de Careiro Castanho-AM.

O contexto vivenciado com a criação de assentamentos traz novas reflexões sobre a realidade econômica, social e política da agricultura familiar no Brasil, que pode representar bases para impulsionar a construção de uma nova realidade rural no país. O referido trabalho, através da caracterização da produção da agricultura familiar no Assentamento Panelão, no município de Careiro Castanho, no Estado do Amazonas, procura contribuir na construção de parâmetros que sirvam de base para a introdução de tecnologias adequadas em comunidades rurais amazônicas de acordo com seus perfis. O levantamento exploratório realizado com agricultores familiares no assentamento permitiu algumas reflexões: a necessidade de reformular o olhar sobre as comunidades, assim como a geração de tecnologias adequadas para o ambiente em estudo, fortalecendo a importância da produção de alimentos voltados à comercialização, ao autoconsumo, contribuindo assim, para a manutenção das famílias no campo.

An internationalisation research project into the German market for the Portuguese canned seafood company COFACO.

This project is aimed to analyse the German market of canned fish, in order to find out if there is potential of entering the market for the Portuguese canned seafood company named COFACO. The purpose of this foreign market research, carried out for COFACO, is to highlight the main key aspects of the current German seafood market, founded out through a deep analysis. Moreover, the work project is also aimed to give the company suggestions regarding the Brand, the Product and the Distribution strategy to implement in order to succeed, once considered the opportunity to enter the market.

Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the International Collaboration on Endocarditis-Prospective Cohort Study.

We sought to provide a contemporary picture of the presentation, etiology, and outcome of infective endocarditis (IE) in a large patient cohort from multiple locations worldwide. Prospective cohort study of 2781 adults with definite IE who were admitted to 58 hospitals in 25 countries from June 1, 2000, through September 1, 2005. The median age of the cohort was 57.9 (interquartile range, 43.2-71.8) years, and 72.1% had native valve IE. Most patients (77.0%) presented early in the disease (<30 days) with few of the classic clinical hallmarks of IE. Recent health care exposure was found in one-quarter of patients. Staphylococcus aureus was the most common pathogen (31.2%). The mitral (41.1%) and aortic (37.6%) valves were infected most commonly. The following complications were common: stroke (16.9%), embolization other than stroke (22.6%), heart failure (32.3%), and intracardiac abscess (14.4%). Surgical therapy was common (48.2%), and in-hospital mortality remained high (17.7%). Prosthetic valve involvement (odds ratio, 1.47; 95% confidence interval, 1.13-1.90), increasing age (1.30; 1.17-1.46 per 10-year interval), pulmonary edema (1.79; 1.39-2.30), S aureus infection (1.54; 1.14-2.08), coagulase-negative staphylococcal infection (1.50; 1.07-2.10), mitral valve vegetation (1.34; 1.06-1.68), and paravalvular complications (2.25; 1.64-3.09) were associated with an increased risk of in-hospital death, whereas viridans streptococcal infection (0.52; 0.33-0.81) and surgery (0.61; 0.44-0.83) were associated with a decreased risk. In the early 21st century, IE is more often an acute disease, characterized by a high rate of S aureus infection. Mortality remains relatively high.

Genetic variation near IRS1 associates with reduced adiposity and an impaired metabolic profile.

Genome-wide association studies have identified 32 loci influencing body mass index, but this measure does not distinguish lean from fat mass. To identify adiposity loci, we meta-analyzed associations between ∼2.5 million SNPs and body fat percentage from 36,626 individuals and followed up the 14 most significant (P < 10(-6)) independent loci in 39,576 individuals. We confirmed a previously established adiposity locus in FTO (P = 3 × 10(-26)) and identified two new loci associated with body fat percentage, one near IRS1 (P = 4 × 10(-11)) and one near SPRY2 (P = 3 × 10(-8)). Both loci contain genes with potential links to adipocyte physiology. Notably, the body-fat-decreasing allele near IRS1 is associated with decreased IRS1 expression and with an impaired metabolic profile, including an increased visceral to subcutaneous fat ratio, insulin resistance, dyslipidemia, risk of diabetes and coronary artery disease and decreased adiponectin levels. Our findings provide new insights into adiposity and insulin resistance.

Biomasa, distribución y concentración de los principales recursos pelágicos. Crucero 9502-04 BIC NSP-1 9502 (13 febrero - 05 abril, 1995)

Presenta los estimados de biomasa, distribución delos principales recursos pelágicos: anchoveta, sardina, jurel y caballa existentes en el Perú y se determina así mismo el grado de mezcla de estos recursos a partir de los lances de comprobación y la interrelación recurso/ambiente.

Distribución y concentración de los principales recursos pelágicos peruanos durante el invierno de 1995. Crucero BIC Humboldt 9508-09

Se ejecutó un rastreo acústico en plena estación invernal, entre Tambo de Mora y Paita para determinar la distribución geográfica y vertical de las principales especies pelágicas (anchoveta peruana, sardina, jurel y caballa), basados para ello en información oceanográfica, en interpretación de ecotrazos y en los resultados de los lances y otras observaciones. Como parámetro determinante para la distribución de recursos se observó la intromisión de aguas subtropicales superficiales (ASS) que llegó hasta las 20 mn de la costa entre el Callao y Chimbote y sobre el litoral entre Chicama y Eten. En estas condiciones, la anchoveta peruana tuvo un distribución costera. La sardina mostró una distribución predominantemente muy dispersa. El jurel y la caballa fueron detectados mayormente en forma muy dispersa, con mayor continuidad al norte de las Islas Lobos de Afuera.

Resumen ejecutivo sobre el crucero de evaluación hidroacústica de recursos pelágicos BIC SNP-1 9702-03 y BIC Humboldt 9704

El Crucero 9702-04 de Evaluación hidroacústica de Recursos Pelágicos se desarrolló en dos etapas. Al sur, a bordo del BIC SNP-1 (Cr. 9702-03), y al norte, a bordo del BIC Humboldt (Cr. 9704). La prospección se desarrolló en un momento de rápida transición entre las condiciones frías imperantes desde la primavera de 1995, a las actualmente cálida de 1997. Las anomalías térmicas, que en un principio eran sólo consideradas como un calentamiento, fueron identificadas como una fuerte intromisión de Aguas Ecuatoriales Superficiales, cuyo avance fue calificado luego como un fenómeno El Niño de intensidad moderada al momento de culminar el crucero. Los ejemplares juveniles de anchoveta estuvieron ausentes en la zona norte. Se estimó que la población de anchoveta fluctuó, a fines de abril de 1997, entre 9 y 10 millones de toneladas. Se considera que el fenómeno puede afectar los procesos biológicos de desove y reclutamiento de los recursos pelágicos. Durante el crucero, la sardina mostró una clara proyección migratoria hacia el sur, mientras que el jurel y la caballa se dispersaron en gran parte del área de estudio.

Distribución, concentración y biomasa de los principales recursos pelágicos peruanos a principios del otoño de 1997. Crucero BIC Humboldt 9704, Callao - Paita

Las condiciones oceanográficas observadas durante el crucero describen una intromisión de Aguas Ecuatoriales Superficiales (la extensión sur de la Corriente de Cromwell) que ha provocado el repliegue, sobre la zona litoral, del stock de anchoveta y la migración al sur de la sardina y la dispersión de los recursos jurel y caballa. Este fenómeno constituyó el inicio del evento cálido denominado El Niño. Esta condiciones se caracterizaron por presentar anomalías positivas de cerca de 2° C, en promedio en el área prospectada, así como grandes capturas de anchoveta por parte de la flota industrial debido al alto índice promedio de concentración de esta especie (408,15 t/mn2 ). Los estimados de biomasa para las principales especies pelágicas, utilizando el método hidroacústico son los siguientes: anchoveta 6,59 x 106 t ±18,49%; sardina 2,48 x 106 t ±22,16%; jurel 1,25 x 106 t ±29,73%; caballa 1,1 x 106 t ±13,64%. Sin embargo, para el caso de la anchoveta, la biomasa total estimada entre Tacna y Paita es de 9 a 10 x 106 t debido a la migración sur-norte de buena parte del stock que estuvo ubicado entre el Callao y Tacna entre los meses febrero-marzo de 1997, desplazamiento provocado por la intromisión, en casi toda la zona sur de aguas cálidas subtropicales, situación que fuera evaluada por el Crucero 9702-03 a bordo del BIC SNP-1; en esa ocasión una biomasa de 6,4 x 106 t para dicha zona. Esta cifra final ha sido calculada comparando los resultados del Análisis de Población Virtual (IMARPE-DIRP, 1997) con el método hidroacústico.

Biomasa y distribución del krill (euphausia superba) en el estrecho de Bransfield durante las operaciones Perú Antar I, II y III.

Describe las operaciones Perú Antar I, II y III que se ejecutaron entre los meses de enero y febrero de 1988, 1989 y 1991, respectivamente, a bordo del BIC Humboldt en el estrecho de Bransfield, ampliandose el área de estudio, en Antar III, a los alrededores de la isla Elefante. Se presenta la distribución horizontal y vertical así como los estimados de biomasa del krill (Euphausia superba) determinados en el área de estudio en tales expediciones. En todos los casos se emplearon los mismos equipos y similares metodologías. Se incluye una revisión de los antecedentes de evaluación acústica del krill tendientes al cálculo de su biomasa en la zona del Estrecho de Bransfield e Isla Elefante. Los estimados de biomasa fueron los siguientes: ANTAR I, 17.0x106 t (±29,41%) con una densidad de 536,05 g/m2; en ANTAR II, 5,67 x 106 t (±16,66%) con una densidad de 176,66 g/m2 ; en ANTAR III, 8,43 x 106 t (±12,0%) con una densidad de 200,93 g/m2 . Las principales zonas de concentración del krill se observaron entre la Isla Rey Jorge e Isla Elefante en ANTAR I; entre las Islas Bravante y Livingstone en ANTAR II; y, entre las Islas Decepción y Trinidad, y al norte de la Isla Elefante, en ANTAR III.