Surgical Site Infection in a University Hospital in Northeast Brazil

We examined prevention of surgical site infection (SSI) in a tertiary teaching hospital in northeast Brazil, from January 1994 to December 2003. The survey included 5,742 patients subjected to thoracic, urologic, vascular and general surgery. The criteria for diagnosing SSI were those of the Centers for Disease Control, USA, and the variables of the National Nosocomial Infection Surveillance risk index were used. Data analysis revealed that anesthetic risk scores, wound class and duration of surgery were significantly associated with SSI. A total of 296 SSIs were detected among the 5,742 patients (5.1%). The overall incidence of SSI was 8.8% in 1994; it decreased to 3.3% in 2003. In conclusion, the use of educational strategies, based on guidelines for SSI prevention reduced SSI incidence. Appropriate management of preoperative, intraoperative, and postoperative incision care, and a surveillance system based on international criteria, were useful in reducing SSI rates in our hospital

Interfacial surface charge and free accessibility to the PLA(2)-active site-like region are essential requirements for the activity of Lys49 PLA(2) homologues

Lys49 phospholipase A(2) homologues are highly myotoxic and cause extensive tissue damage but do not display hydrolytic activity towards natural phospholipids. The binding of heparin, heparin derivatives and polyanionic compounds such as suramin result in partial inhibition (up to 60%) of the myotoxic effects due to a change in the overall charge of the interfacial surface. In vivo experiments demonstrate that polyethylene glycol inhibits more than 90% of the myotoxic effects without exhibiting secondary toxic effects. The crystal structure of bothropstoxin-I complexed with polyethylene glycol reveals that this inhibition is due to steric hindrance of the access to the PLA(2)-active site-like region. These two inhibitory pathways indicate the roles of the overall surface charge and free accessibility to the PLA2-active site-like region in the functioning of Lys49 phospholipases A(2) homologues. Molecular dynamics simulations, small angle X-ray scattering and structural analysis indicate that the oligomeric states both in solution and in the crystalline states of Lys49 phospholipases A2 are principally mediated by hydrophobic contacts formed between the interfacial surfaces. These results provide the framework for the potential application of both clinically approved drugs for the treatment of Viperidae snakebites. (c) 2006 Elsevier Ltd. All rights reserved.

Relacionamentos humanos mediados pelo computador: as experiências de intermautas cadastros no site de comunidades UOL K

Os sites de comunidades têm atraído grande número de pessoas. Elas passam a se relacionar à distância, utilizando para isso recursos como envio de recados e mensagens e trocam informações sobre si através da auto-descrição (perfil) e do uso de imagens, ambos abertos ao público. A experiência de possuir uma página pessoal neste tipo de ambiente e se relacionar com pessoas através dela se constitui o objeto desta pesquisa a qual foi realizada com base na metodologia qualitativa. Foram entrevistados 16 usuários da rede de relacionamentos UOL K, pertencente ao UOL (Universo OnLine), considerado o principal portal de conteúdo e provedor pago de acesso à Internet do Brasil. A análise dos resultados destacou os seguintes aspectos: o site possibilita tanto fazer novos contatos quanto manter contatos feitos anteriormente, há uma tendência a fazer novos contatos, a língua escrita é utilizada tanto para se comunicar como para refletir acerca de si mesmo, o anonimato é favorecido pela comunicação à distância e causa receio de se decepcionar com o outro, as experiências são vistas como reais mesmo ocorrendo num ambiente virtual, “estar online” pode ser prazeroso e não significa desprender-se do mundo offline, a afiliação às comunidades é freqüente e tem como base objetivos comuns, o uso da foto é, graças aos recursos do site, um elo entre a comunicação sincrônica (bate-papo) e a comunicação assincrônica (UOL K), há uma ênfase na sexualidade e, por fim, os usuários se vêem na necessidade constante de rever e relativizar conceitos como próximo e distante, público e privado, estar ou não online. Conclui-se que, mesmo não tendo o hábito de marcar encontros face a face, os usuários são capazes de se relacionar virtualmente de forma genuína, trocar afetos, formar vínculos e manter uma vida online na qual o comunicar-se encontra seu sentido em si mesmo, podendo não haver outro objetivo a não ser o de estar em contato.

Mineralogy and chemistry of archaeological ceramic fragments from archaeological Dark Earth site in Colombian Amazon

Vários sítios arqueológicos de Terra Preta Arqueológica (TPA) encontrados na floresta Amazônica Colombiana também contêm alto conteúdo de fragmentos cerâmicos semelhantes aqueles da Amazônia Brasileira, como mostra o sítio Quebrada Tacana. Seus fragmentos cerâmicos são amarelo a cinza, exibem matriz argilosa calcinada envolvendo fragmentos de cariapé, carvão e partículas de cinza, grãos de quartzo e micas. A matriz é composta de metacaulinita a material amorfo, quartzo, folhas de micas, clorita e sepiolita. Cariapé e cauixi são constituídos de cristobalita, da mesma forma o carvão e as cinzas. Embora não detectados pela difração de raios x, os fosfatos devem estar presentes, pois foram detectados teores de P2O5 de até 2,90 %, possivelmente como fosfatos de alumínio, já que o conteúdo de Ca está abaixo 0,1 %, o que elimina a possibilidade da presença de apatita. Estas características mineralógicas e químicas permitem relacionar estes fragmentos cerâmicos com aqueles encontrados nos sítios de TPA no Brasil e reforça o fósforo como um importante componente químico, originado pelo contato dos vasos cerâmicos com os alimentos do cotidiano dos povos amazônicos pré-históricos.

Informatização na educação em saúde: avaliação de site educacional

Health education presently experiences the incorporation of information technology, thus making access to information more practical and attainable. The initiatives to make health care scientific content available virtually have shown to be useful for teaching, health care professionals and the general population. A website, however, must be constantly managed. To promote the dissemination of the website at www.educacaoemsaude.fmb.unesp.br among faculty members and undergraduate nursing students and students at Escola Técnica de Enfermagem (Vocational Nursing School) - ETE, by evaluating, among them, its graphic and functional aspects and seeking suggestions for its improvement. This is a descriptive quantitative study for which the participants were asked to fill out an instrument designed for the study. The evaluation was performed among nursing faculty members and students at Univ Estadual Paulista Júlio Mesquita Filho – UNESP and students at Escola Técnica de Enfermagem (Vocational Nursing School) – ETEC in the city of Botucatu. The number of participants totaled 88 individuals, of whom 23 were undergraduate students, 62 were students at ETEC, and 3 were faculty members. Eighty-one were females, and 7 were males. The participants’ age ranged from 17 to 56 years. Among the items that evaluated the website, the answers prevailed from “very good” to “good”. When the participants were asked what they had thought about the website, the answers were mostly positive, and the most frequently description given was “interesting”. Among the facilities, the most frequently reported was “easily understood content”, and as regards difficulties, handling the website was the most often mentioned. One hundred percent of the answers considered the maintenance of the website to be important. Suggestions for its improvement were given, and the most frequent... (Complete abstract click electronic access below)

Participative site-specific agriculture analysis for smallholders

Site-specific agriculture has been adopted in a high-tech context using, for instance, in situ sensors, satellite images for remote sensing analysis, and some other technological devices. However, farmers and smallholders without the economic resources and required knowledge to use and to access the latest technology seem to find an impediment to precision agricultural practices. This article discusses the possibility of adopting precision agriculture (PA) principles for site-specific management but in a low technology context for such farmers. The proposed methodology to support PA combines low technology dependency and a participatory approach by involving smallholders, farmers and experts. The case studies demonstrate how the interplay of low technology and a participative approach may be suitable for smallholders for site-specific agriculture analysis.

Knowledge : custody and access - DAISY

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Differences in access and patient outcomes across antiretroviral treatment clinics in the Free State province: a prospective cohort study

Objective. To assess differences in access to antiretroviral treatment (ART) and patient outcomes across public sector treatment facilities in the Free State province, South Africa. Design. Prospective cohort study with retrospective database linkage. We analysed data on patients enrolled in the treatment programme across 36 facilities between May 2004 and December 2007, and assessed percentage initiating ART and percentage dead at 1 year after enrolment. Multivariable logistic regression was used to estimate associations of facility-level and patient-level characteristics with both mortality and treatment status. Results. Of 44 866 patients enrolled, 15 219 initiated treatment within 1 year; 8 778 died within 1 year, 7 286 before accessing ART. Outcomes at 1 year varied greatly across facilities and more variability was explained by facility-level factors than by patient-level factors. The odds of starting treatment within 1 year improved over calendar time. Patients enrolled in facilities with treatment initiation available on site had higher odds of starting treatment and lower odds of death at 1 year compared with those enrolled in facilities that did not offer treatment initiation. Patients were less likely to start treatment if they were male, severely immunosuppressed (CD4 count ≤50 cells/μl), or underweight (<50 kg). Men were also more likely to die in the first year after enrolment. Conclusions. Although increasing numbers of patients started ART between 2004 and 2007, many patients died before accessing ART. Patient outcomes could be improved by decentralisation of treatment services, fast-tracking the most immunodeficient patients and improving access, especially for men.

Cut slope design for the access to an underground copper mine

Slope stability analysis is a major area of research in geotechnical engineering. That being said, very little is written in the geotechnical engineering literature on the design of box-cuts. The goal of this thesis will be to investigate the proper design of a boxcuts, and to design a box-cut for access to an underground copper mine. Issues that need to be considered in the box-cut design include, long term dewatering design, slope stability analysis, and erosion control. The soils at the project site were extremely low permeability, as a result a system of ejectors was designed both to improve the stability of the slopes and prevent flooding. Based on the results of limit equilibrium analysis and finite element analysis, a slope design of two horizontal on one vertical was selection, with a rock fill buttress providing reinforcement. Finally, Michigan DOT standards for seeding were used to provide erosion control

Access technique and its problems in parenteral nutrition - Guidelines on Parenteral Nutrition, Chapter 9

Catheter type, access technique, and the catheter position should be selected considering to the anticipated duration of PN aiming at the lowest complication risks (infectious and non-infectious). Long-term (>7-10 days) parenteral nutrition (PN) requires central venous access whereas for PN <3 weeks percutaneously inserted catheters and for PN >3 weeks subcutaneous tunnelled catheters or port systems are appropriate. CVC (central venous catheter) should be flushed with isotonic NaCl solution before and after PN application and during CVC occlusions. Strict indications are required for central venous access placement and the catheter should be removed as soon as possible if not required any more. Blood samples should not to be taken from the CVC. If catheter infection is suspected, peripheral blood-culture samples and culture samples from each catheter lumen should be taken simultaneously. Removal of the CVC should be carried out immediately if there are pronounced signs of local infection at the insertion site and/or clinical suspicion of catheter-induced sepsis. In case PN is indicated for a short period (max. 7-10 days), a peripheral venous access can be used if no hyperosmolar solutions (>800 mosm/L) or solutions with a high titration acidity or alkalinity are used. A peripheral venous catheter (PVC) can remain in situ for as long as it is clinically required unless there are signs of inflammation at the insertion site.

Does Immediate Access to Birth Control Help Prevent Pregnancy? A Comparison of Onsite Provision Versus Off Campus Referral for Contraception at Two School-Based Clinics

PURPOSE: The purpose of this study was to assess the impact of different policies on access to hormonal contraception and pregnancy rates at two high school-based clinics. METHODS: Two clinics in high schools (Schools A and B), located in a large urban district in the southwest US, provide primary medical care to enrolled students with parental consent; the majority of whom have no health insurance coverage. The hormonal contraceptive dispensing policy of at School clinic A involves providing barrier, hormonal and emergency contraceptive services on site. School clinic B uses a referral policy that directs students to obtain contraception at an off-campus affiliated family planning clinic. Baseline data (age, race and history of prior pregnancy) on female students seeking hormonal contraception at the two clinics between 9/2008-12/2009 were extracted from an electronic administrative database (AHLERS Integrated System). Data on birth control use and pregnancy tests for each student was then tracked electronically through 3/31/2010. The outcomes measures were accessing hormonal contraception and positive pregnancy tests at any point during or after birth control use were started through 12/2009. The appointment keeping rate for contraceptive services and the overall pregnancy rates were compared between the two schools. In addition the pregnancy rates were compared between the two schools for students with and without a prior history of pregnancy. RESULTS: School clinic A: 79 students sought hormonal contraception; mean age 17.5 years; 68% were > 18 years; 77% were Hispanic; and 20% reported prior pregnancy. The mean duration of the observation period was 13 months (4-19 months). All 79 students received hormonal contraception (65% pill and 35% long acting progestin injection) onsite. During the observation period, the overall pregnancy rate was 6% (5/79); 4.7% (3/63) among students with no prior pregnancy. School clinic B: 40 students sought hormonal contraception; mean age 17.5 years; 52% > 18 years; 88 % were Hispanic; and 7.5% reported prior pregnancy. All 40 students were referred to the affiliated clinic. The mean duration of the observation period was 11.9 months (4-19 months). 50% (20) kept their appointment. Pills were dispensed to 85% (17/20) and 15% (3/20) received long acting progestin injection. The overall pregnancy rate was 20% (8/40); 21.6% (8/37) among students with no prior pregnancy. A significantly higher frequency of students seeking hormonal contraception kept their initial appointment for birth control at the school dispensing onsite contraception compared to the school with a referral policy for contraception (p<0.05). The pregnancy rate was significantly higher for the school with a referral policy for contraception compared to the school with onsite contraceptive services (p< 0.05). The pregnancy rate was also significantly higher for students without a prior history of pregnancy in the school with a referral policy for contraception (21.6%) versus the school with onsite contraceptive services (4.7%) (p< 0.05). CONCLUSION: This preliminary study showed that School clinic B with a referral policy had a lower appointment keeping rate for contraceptive services and a higher pregnancy rate than School clinic A with on-site contraceptive services. An on-site dispensing policy for hormonal contraceptives at high school-based health clinics may be a convenient and effective approach to prevent unintended first and repeat pregnancies among adolescents who seek hormonal contraception. This study has strong implications for reproductive health policy, especially as directed toward high-risk teenage populations.

Validation of a magnetic resonance imaging guided stereotactic access to the ovine brainstem.

BackgroundAnatomical differences between humans and domestic mammals preclude the use of reported stereotactic approaches to the brainstem in animals. In animals, brainstem biopsies are required both for histopathological diagnosis of neurological disorders and for research purposes. Sheep are used as a translational model for various types of brain disease and therefore a species-specific approach needs to be developed. The aim of the present study was to establish a minimally invasive, accurate and reproducible stereotactic approach to the brainstem of sheep, using the magnetic resonance imaging guided BrainsightTM frameless stereotactic system.ResultsA transoccipital transcerebellar approach with an entry point in the occipital bone above the vermis between the transverse sinus and the external occipital protuberance was chosen. This approach provided access to the target site in all heads. The overall mean needle placement error was 1.85¿±¿1.22 mm.ConclusionsThe developed transoccipital transcerebellar route is short, provides accurate access to the ovine caudal cranial fossa and is a promising approach to be assessed further in live animals.

Characteristics and comprehensiveness of adult HIV care and treatment programmes in Asia-Pacific, sub-Saharan Africa and the Americas: results of a site assessment conducted by the International epidemiologic Databases to Evaluate AIDS (IeDEA) Collaboration

INTRODUCTION HIV care and treatment programmes worldwide are transforming as they push to deliver universal access to essential prevention, care and treatment services to persons living with HIV and their communities. The characteristics and capacity of these HIV programmes affect patient outcomes and quality of care. Despite the importance of ensuring optimal outcomes, few studies have addressed the capacity of HIV programmes to deliver comprehensive care. We sought to describe such capacity in HIV programmes in seven regions worldwide. METHODS Staff from 128 sites in 41 countries participating in the International epidemiologic Databases to Evaluate AIDS completed a site survey from 2009 to 2010, including sites in the Asia-Pacific region (n=20), Latin America and the Caribbean (n=7), North America (n=7), Central Africa (n=12), East Africa (n=51), Southern Africa (n=16) and West Africa (n=15). We computed a measure of the comprehensiveness of care based on seven World Health Organization-recommended essential HIV services. RESULTS Most sites reported serving urban (61%; region range (rr): 33-100%) and both adult and paediatric populations (77%; rr: 29-96%). Only 45% of HIV clinics that reported treating children had paediatricians on staff. As for the seven essential services, survey respondents reported that CD4+ cell count testing was available to all but one site, while tuberculosis (TB) screening and community outreach services were available in 80 and 72%, respectively. The remaining four essential services - nutritional support (82%), combination antiretroviral therapy adherence support (88%), prevention of mother-to-child transmission (PMTCT) (94%) and other prevention and clinical management services (97%) - were uniformly available. Approximately half (46%) of sites reported offering all seven services. Newer sites and sites in settings with low rankings on the UN Human Development Index (HDI), especially those in the President's Emergency Plan for AIDS Relief focus countries, tended to offer a more comprehensive array of essential services. HIV care programme characteristics and comprehensiveness varied according to the number of years the site had been in operation and the HDI of the site setting, with more recently established clinics in low-HDI settings reporting a more comprehensive array of available services. Survey respondents frequently identified contact tracing of patients, patient outreach, nutritional counselling, onsite viral load testing, universal TB screening and the provision of isoniazid preventive therapy as unavailable services. CONCLUSIONS This study serves as a baseline for on-going monitoring of the evolution of care delivery over time and lays the groundwork for evaluating HIV treatment outcomes in relation to site capacity for comprehensive care.

RADIX: a minimal-resources rapid-access drilling system

Determining the expected age at a potential ice-core drilling site on a polar ice sheet generally depends on a combination of information from remote-sensing methods, estimates of current accumulation and modelling. This poses irreducible uncertainties in retrieving an undisturbed ice core of the desired age. Although recently perfected radar techniques will improve the picture of the ice sheet below future drilling sites, rapid prospective drillings could further increase the success of deep drilling projects. Here we design and explore a drilling system for a minimum-size rapid-access hole. The advantages of a small hole are the low demand for drilling fluid, low overall weight of the equipment, fast installing and de-installing and low costs. We show that, in theory, drilling of a 20mm hole to a depth of 3000m is possible in ~4 days. First concepts have been realized and verified in the field. Both the drill cuttings and the hole itself can be used to characterize the properties of the ice sheet and its potential to provide a trustworthy palaeo-record. A candidate drilling site could be explored in ~2 weeks, which would enable the characterization of several sites in one summer season.