The effects of congestion in the daily management of a trauma hospital

Today’s healthcare organizations are under constant pressure for change, as hospitals should be able to offer their patients the best possible medical care with limited resources and, at the same time, to retain steady efficiency level in their operation. This is challenging, especially in trauma hospitals, in which the variation in the patient cases and volumes is relatively high. Furthermore, the trauma patient's care requires plenty of resources as most the patients have to be treated as single cases. Occasionally, the sudden increases in demand causes congestion in the operations of the hospital, which in Töölö hospital appears as an increase in the surgery waiting times within the yellow urgency class patients. An increase in the surgery waiting times may cause the diminution of the patient's condition, which also raises the surgery risks. The congestion itself causes overloading of the hospital capacity and staff. The aim of this master’s thesis is to introduce the factors contributing to the trauma process, and to examine the correlation between the different variables and the lengthened surgery waiting times. The results of this study are based on a three-year patient data and different quantitative analysis. Based on the analysis, a daily usable indicator was created in order to support the decision making in the operations management. By using the selected indicator, the effects of congestion can be acknowledged and the corrective action can also be taken more proactively.

Dendritic thickness: a morphometric parameter to classify mouse retinal ganglion cells

To study the dendritic morphology of retinal ganglion cells in wild-type mice we intracellularly injected these cells with Lucifer yellow in an in vitro preparation of the retina. Subsequently, quantified values of dendritic thickness, number of branching points and level of stratification of 73 Lucifer yellow-filled ganglion cells were analyzed by statistical methods, resulting in a classification into 9 groups. The variables dendritic thickness, number of branching points per cell and level of stratification were independent of each other. Number of branching points and level of stratification were independent of eccentricity, whereas dendritic thickness was positively dependent (r = 0.37) on it. The frequency distribution of dendritic thickness tended to be multimodal, indicating the presence of at least two cell populations composed of neurons with dendritic diameters either smaller or larger than 1.8 µm ("thin" or "thick" dendrites, respectively). Three cells (4.5%) were bistratified, having thick dendrites, and the others (95.5%) were monostratified. Using k-means cluster analysis, monostratified cells with either thin or thick dendrites were further subdivided according to level of stratification and number of branching points: cells with thin dendrites were divided into 2 groups with outer stratification (0-40%) and 2 groups with inner (50-100%) stratification, whereas cells with thick dendrites were divided into one group with outer and 3 groups with inner stratification. We postulate, that one group of cells with thin dendrites resembles cat ß-cells, whereas one group of cells with thick dendrites includes cells that resemble cat a-cells.

Tumor necrosis factor alpha increases epithelial barrier permeability by disrupting tight junctions in Caco-2 cells

The objectives of this study were to determine the effect of tumor necrosis factor alpha (TNF-α) on intestinal epithelial cell permeability and the expression of tight junction proteins. Caco-2 cells were plated onto Transwell® microporous filters and treated with TNF-α (10 or 100 ng/mL) for 0, 4, 8, 16, or 24 h. The transepithelial electrical resistance and the mucosal-to-serosal flux rates of the established paracellular marker Lucifer yellow were measured in filter-grown monolayers of Caco-2 intestinal cells. The localization and expression of the tight junction protein occludin were detected by immunofluorescence and Western blot analysis, respectively. SYBR-Green-based real-time PCR was used to measure the expression of occludin mRNA. TNF-α treatment produced concentration- and time-dependent decreases in Caco-2 transepithelial resistance and increases in transepithelial permeability to the paracellular marker Lucifer yellow. Western blot results indicated that TNF-α decreased the expression of phosphorylated occludin in detergent-insoluble fractions but did not affect the expression of non-phosphorylated occludin protein. Real-time RT-PCR data showed that TNF-α did not affect the expression of occludin mRNA. Taken together, our data demonstrate that TNF-α increases Caco-2 monolayer permeability, decreases occludin protein expression and disturbs intercellular junctions.

Effect of gallium-arsenide laser, gallium-aluminum-arsenide laser and healing ointment on cutaneous wound healing in Wistar rats

This study determined the effects of gallium-aluminum-arsenide laser (GaAlAs), gallium-arsenide laser (GaAs) and Dersani® healing ointment on skin wounds in Wistar rats. The parameters analyzed were: type I and III collagen fiber concentrations as well as the rate of wound closure. Five wounds, 12 mm in diameter, were made on the animals’ backs. The depth of the surgical incision was controlled by removing the epithelial tissue until the dorsal muscular fascia was exposed. The animals were anesthetized with ketamine and xylazine via intraperitoneal injection. The rats were randomly divided into five groups of 6 animals each, according to the treatment received. Group 1 (L4): GaAs laser (4 J/cm²); group 2 (L30): GaAlAs laser (30 J/cm²); group 3 (L60): GaAlAs laser (60 J/cm²); group 4 (D): Dersani® ointment; group 5 (control): 0.9% saline. The applications were made daily over a period of 20 days. Tissue fragments were stained with picrosirius to distinguish type I collagen from type III collagen. The collagen fibers were photo-documented and analyzed using the Quantum software based on the primary color spectrum (red, yellow and blue). Significant results for wound closing rate were obtained for group 1 (L4), 7.37 mm/day. The highest concentration of type III collagen fibers was observed in group 2 (L30; 37.80 ± 7.10%), which differed from control (29.86 ± 5.15%) on the 20th day of treatment. The type I collagen fibers of group 1 (L4; 2.67 ± 2.23%) and group 2 (L30; 2.87 ± 2.40%) differed significantly from control (1.77 ± 2.97%) on the 20th day of the experiment.

Advances in biliary atresia: from patient care to research

Biliary atresia, the most common cause of liver transplantation in children, remains a challenge for clinicians and investigators. The development of new therapeutic options, besides the typical hepatoportoenterostomy, depends on a greater understanding of its pathogenesis and how it relates to the clinical phenotypes at diagnosis and the rate of disease progression. In this review, we present a perspective of how recent research has advanced the understanding of the disease and has improved clinical care protocols. Molecular and morphological analyses at diagnosis point to the potential contributions of polymorphism in the CFC1 and VEGF genes to the pathogenesis of the disease, and to an association between the degree of bile duct proliferation and long-term outcome. In experimental models, cholangiocytes do not appear to have antigen-presenting properties despite a substantial innate and adaptive immune response that targets the biliary epithelium and produces duct obstruction. Initial clinical trials assessing the efficacy of corticosteroids in decreasing the inflammation and improving outcome do not show a superior effect of corticosteroids as an adjuvant treatment following hepatoportoenterostomy. The best outcome still remains linked to an early diagnosis and surgical treatment. In this regard, the Yellow Alert campaign by the Sociedade Brasileira de Pediatria and the inclusion of the Stool Color Card in the health booklet given to every neonate in Brazil have the potential to decrease the age of diagnosis, shorten the time between diagnosis and surgical treatment, and improve the long-term outcome of children with this devastating disease.

Chromatic spatial contrast sensitivity estimated by visual evoked cortical potential and psychophysics

The purpose of the present study was to measure contrast sensitivity to equiluminant gratings using steady-state visual evoked cortical potential (ssVECP) and psychophysics. Six healthy volunteers were evaluated with ssVECPs and psychophysics. The visual stimuli were red-green or blue-yellow horizontal sinusoidal gratings, 5° × 5°, 34.3 cd/m2 mean luminance, presented at 6 Hz. Eight spatial frequencies from 0.2 to 8 cpd were used, each presented at 8 contrast levels. Contrast threshold was obtained by extrapolating second harmonic amplitude values to zero. Psychophysical contrast thresholds were measured using stimuli at 6 Hz and static presentation. Contrast sensitivity was calculated as the inverse function of the pooled cone contrast threshold. ssVECP and both psychophysical contrast sensitivity functions (CSFs) were low-pass functions for red-green gratings. For electrophysiology, the highest contrast sensitivity values were found at 0.4 cpd (1.95 ± 0.15). ssVECP CSF was similar to dynamic psychophysical CSF, while static CSF had higher values ranging from 0.4 to 6 cpd (P < 0.05, ANOVA). Blue-yellow chromatic functions showed no specific tuning shape; however, at high spatial frequencies the evoked potentials showed higher contrast sensitivity than the psychophysical methods (P < 0.05, ANOVA). Evoked potentials can be used reliably to evaluate chromatic red-green CSFs in agreement with psychophysical thresholds, mainly if the same temporal properties are applied to the stimulus. For blue-yellow CSF, correlation between electrophysiology and psychophysics was poor at high spatial frequency, possibly due to a greater effect of chromatic aberration on this kind of stimulus.

Study of clarification process of sugar cane juice for consumption

Sugar cane juice or garapa darkens quickly after extraction due to the oxidation of some of its constituents harming its commercialization thus requiring rapid consumption. The objective of this study was to develop a mild process for sugar cane clarification, obtaining a cloudy, greenish-yellow beverage. The following parameters were combined to aiming at this objective: heat treatment at 65 ºC/50 minutes; pH change (to 7.0, 7.5, and 8.0); addition of flocculant (0, 30, and 60 ppm Aluminum polychloride or APC - "Panclar P-1010"), and clarifier aid (0, 2, or 4 ppm of positively charged polyelectrolyte - "Magnafloc LT-27"). The decantation time was 45 minutes and the supernatant liquid was removed with a vacuum pump. The treatments were defined using the Response Surface Methodology and were submitted to physicochemical analysis for turbidity (%), total polysaccharide content (µg.mL-1), dextran content (µg.mL-1), and sensory analysis (acceptance test) for the attributes of color, appearance, and turbidity. It was concluded that the addition of 60 ppm APC, pH 8, and 0 ppm polyelectrolyte represented the best treatment to obtain a low polysaccharide content, 90% turbidity, and high scores for color, appearance, and turbidity. The beverage was sensorially well accepted by consumers.

Restructuring Passiflora cincinnata fruit pulp: influence of hydrocolloids

This study evaluated the effect of mixtures of alginate, low methoxy pectin and gelatin on characteristics of P. cincinnata fruit gels, containing pulp with high soluble solids content (50 °Brix). The results of a central composite design showed that the models obtained, except for water activity and pH, were predictive. Gelatin was an important factor affecting firmness and colour parameters since higher concentrations of this hydrocolloid, combined with alginate concentrations greater than 1.3% and pectin quantity up to 1.26%, could be used to obtain clear yellow products with firmness greater that 1.2 kg.

Revalorization of cactus pear (Opuntia spp.) wastes as a source of antioxidants

Recently, an increased interest in antioxidant activity and health-improving capacity of cactus pear has been registered. The antioxidant capacity of the pulp of cactus-pear fruits has been previously assessed. In this work, total phenolics, flavonoids and tannins of peel and seeds of four cactus pear cultivars were examined as well as their antioxidant capacity. Tannins were the major phenolics in cactus pear seeds accounting for almost fifty percent for all cultivars. Analysis of variance revealed that ripeness, cultivar, and its interaction had highly significant effect on the total phenolics, tannin, and flavonoid contents of cactus pear peel. With regard to the seeds, only the stage of ripeness and interaction (ripeness stage x cultivar) were significant on total phenolics and tannins contents. The flavonoid content in seeds was not affected by any of the factors or their interactions. The antioxidant capacity was higher in the peel than in the seeds. Generally, fruits with light-green or yellow-brown peel have higher antiradical activity and Trolox equivalent antioxidant capacity (TEAC) values compared with those with red-purple peel. Cactus pear by-products can indeed be exploited as a good and cheap source of natural antioxidants.

Effects of peeling methods on the quality of cubiu fruits

Cubiu (Solanum sessiliflorum Dunal) is an Amazonian Basin native fruit. Its importance comes from its high contents of pectin. Currently, processing technologies are necessary for the substitution of the traditional system (small crops and small-scale processing) for a larger scale system and thus increase the use of biodiversity and promote the implementation of Local Productive Arrangements of agribusiness in the Amazon. This research aims to evaluate the methods of peeling cubiu. Ripe fruits were divided into lots (150 each) and subjected to the following treatments: immersion in 2.5% NaOH boiling solution for 5 minutes, exposure to water vapor, and immersion in water at 96 ºC for 5, 10, 15 and 20 minutes. The peel released during heat treatment and immediately removed under running tap water. In the control treatment, the fruits were manually peeled (unheated) with a stainless steel knife. The treatments were evaluated for completeness and ease of peeling, tissue integrity, texture, and peroxidase activity. The immersion in 2.5% NaOH boiling solution (5 minutes) stood out as the best treatment since it inhibited the enzymatic browning and intensified the natural yellow color of the cubiu fruit and easily and fully peeled the whole fruit more rapidly without damaging its tissues. This treatment was chosen as the most advantageous because it can promote simultaneous peeling and bleaching. Therefore, it is recommended for cubiu industrial processing.

Influence of color on acceptance and identification of flavor of foods by adults

The sensory characteristics color and flavor of food play an important role not only in the selection, but also in the determination of consumption, satiation, and ingestion. With the objective to determine and evaluate the influence of color on the acceptance and identification of flavor of foods for adults, sensory analysis was performed on jellies by non-trained tasters of both sexes aged between 18 and 60 years (1750 tests). A hedonic scale and combinations of five colors (red, yellow, green, blue and purple) and three flavors (strawberry, pineapple, and limes) were used in the acceptance test totaling 15 samples. In the duo-trio discrimination test, together with the reference sample (R), one sample identical to the reference and another of identical color and different flavor were offered, and the judges were requested to identify the sample that was different from the reference sample. The colors used did not influence the acceptance of the samples (P > 0.05), and as there was not significant interaction between color and flavor. However, the limes flavor negatively influenced acceptance when compared to the other flavors. With regard to flavor differentiation, the colors used did not influence flavor identification (P > 0.05); However, differentiated behavior was identified between females and males, and the latter were more error-prone. Therefore, under the experimental conditions tested, color did not influence the acceptance and identification of the flavor of the samples by adults.

Microbiological and physicochemical characterization of surimi obtained from waste of piramutaba fillet

The aim of this work was to perform the microbiological and physicochemical characterization of surimi made from waste of piramutaba filleting. The results of physicochemical characterization of the waste and surimi were: moisture (76.37 and 79.11%), total lipids (5.35 and 0.74%), proteins (14.92 and 10.79%), ash (3.03 and 2.35%), pH (6.9 and 7.4), caloric value (109.15 and 77.86 kcal.g-1), and water activity (both 0.98), respectively. The results of the levels of total volatile bases were 7.29 mgN/100-1 g (waste) and 7.01% carbohydrate (surimi). The values of total lipids and proteins were reduced during the preparation of surimi, probably due to successive washes during the processing. Waste and surimi were examined microbiologically and are in compliance with required parameters. The results show a loss of red (a* parameter) and yellow (b* parameter) color. On the other hand, the L* parameter (lightness) increased after the processing of surimi. It can be concluded that piramutaba waste can be used for surimi preparation and as a source of nutrients for human consumption, providing an alternative use of these wastes avoiding their disposal polluting the environment.

Physicochemical and sensory changes in aged sugarcane spirit submitted to filtering with activated carbon filter

Sugarcane spirit is a drink considered as a national symbol of Brazil. It is produced by large producers and by about 30 thousand small and medium home-distilling producers dispersed throughout the country. The copper originating from the home-distillers can become a serious problem since at high concentrations in beverages it may cause serious human health problems. Therefore, the objective of this study was to investigate the influence of the activated carbon used in commercial filters on the physicochemical and sensory characteristics of aged sugarcane spirit. Analyses of copper, dry extract, alcoholic degree, higher alcohols, volatile acids, aldehydes, esters, furfural, and methanol were performed. The sensory evaluation was performed by seven selected trained judges, who analyzed the yellow color, woody aroma and flavor, and intensity of alcoholic aroma and flavor of the cane spirit before and after the filtration process. The sensory tests were carried out using a 9 cm non-structured intensity scale. A reduction was observed in all compounds analyzed physicochemically, except for the esters, which increased after filtration. This increase is probably due to the esterification of the alcohols and acids present. According to the sensory results obtained, a reduction was observed in the intensity of the yellow color, aroma, and wood flavor characteristics, the major characteristics of the aging process.

Influence of process parameters on the color and texture of passion fruit albedo preserved in syrup

The industrialization of passion fruit in the form of juice produces considerable amounts of residue that could be used as food. The objective of the present study was to determine the effects of the volume of passion fruit juice added to the syrup and the cooking time on the color and texture of passion fruit albedo preserved in syrup. Multi-linear models were well fit to describe the value for a* (for the albedo) the values for b* (for the albedo and syrup), which exhibited high correlation coefficients of 98%, 84%, and 88%, respectively. The volume of passion fruit juice added and the cooking time of the albedos in the syrup, involved in the processing of passion fruit albedo preserves in syrup, significantly affected color analyses. The texture was not affected by the parameters studied. Therefore, the use of larger volumes of passion fruit juice and longer cooking time is recommended for the production of passion fruit albedo preserves in syrup to achieve the characteristic yellow color of the fruit.

Quality of 'Delta Valencia' orange grown in semiarid climate and stored under refrigeration after coating with wax

The effects of carnauba-based wax on the quality of 'Delta Valencia' orange produced in Ceará state, Brazil, were studied. The fruits were coated with carnauba-based wax and refrigerated (7 ± 2 ºC and 85 ± 2% R.H.) for 28 days. The quality attribute parameters assessed were weight loss, peel color (brightness, hue angle, and chromaticity), peel moisture, pH, soluble solids (SS), titratable acidity (TA), SS/TA ratio, ascorbic acid, total soluble sugars, reducing sugars, yellow flavonoids, and polyphenols. The results showed that 'Delta Valencia' oranges grown in the dry climate of Ceará state has excellent quality. The coated fruits lost mass at a lower rate than the the control fruits. No significant loss of soluble solids, titratable acidity, pH, and SS/TA ratio was observed, while ascorbic acid, soluble sugars, reducing sugars, yellow flavonoids, and polyphenols increased during storage in both the coated and control fruits. Carnauba-based wax coated fruits showed no signal of dehydration keeping their shiny green peel up to the end of the storage. The use of coating was crucial for the maintenance of visual quality by reducing mass loss, as well as keeping peel moisture.