Self-Care, Sense Of Coherence And Depression In Patients Hospitalized For Decompensated Heart Failure

OBJECTIVE To analyze the self-care behaviors according to gender, the symptoms of depression and sense of coherence and compare the measurements of depression and sense of coherence according to gender. METHOD A correlational, cross-sectional study that investigated 132 patients with decompensated heart failure (HF). Data were collected through interviews and consultation to medical records, and analyzed using the chi-square and the Student's t tests with significance level of 0.05. Participants were 75 men and 57 women, aged 63.2 years on average (SD = 13.8). RESULTS No differences in self-care behavior by gender were found, except for rest after physical activity (p = 0.017). Patients who practiced physical activity showed fewer symptoms of depression (p<0.001). There were no differences in sense of coherence according to self-care behavior and gender. Women had more symptoms of depression than men (p = 0.002). CONCLUSION Special attention should be given to women with HF considering self-care and depressive symptoms.

Heart failure as a predictor of functional dependence in hospitalized elderly

AbstractOBJECTIVEIdentify whether Heart Failure (HF) is a predictor of functional dependence for Basic Activities of Daily Living (BADL) in hospitalized elderly.METHODSWe investigated medical records and assessed dependence to BADL (by the Katz Index) of 100 elderly admitted to a geriatric ward of a university hospital. In order to verify if HF is a predictor of functional dependence, linear regression analyzes were performed.RESULTSThe prevalence of HF was 21%; 95% of them were dependent for BADLs. Bathing was the most committed ADL. HF is a predictor of dependence in hospitalized elderlies, increasing the chance of functional decline by 5 times (95% CI, 0.94-94.48), the chance of functional deterioration by 3.5 times (95% CI, 1.28-11.66; p <0.02) and reducing 0.79 points in the Katz Index score (p <0.05).CONCLUSIONHF is a dependency predictor of ADL in hospitalized elderly, who tend to be more dependent, especially for bathing.

Factors affecting the quality of cardiopulmonary resuscitation in inpatient units: perception of nurses

Abstract OBJECTIVE To identify, in the perception of nurses, the factors that affect the quality of cardiopulmonary resuscitation (CPR) in adult inpatient units, and investigate the influence of both work shifts and professional experience length of time in the perception of these factors. METHOD A descriptive, exploratory study conducted at a hospital specialized in cardiology and pneumology with the application of a questionnaire to 49 nurses working in inpatient units. RESULTS The majority of nurses reported that the high number of professionals in the scenario (75.5%), the lack of harmony (77.6%) or stress of any member of staff (67.3%), lack of material and/or equipment failure (57.1%), lack of familiarity with the emergency trolleys (98.0%) and presence of family members at the beginning of the cardiopulmonary arrest assistance (57.1%) are factors that adversely affect the quality of care provided during CPR. Professional experience length of time and the shift of nurses did not influence the perception of these factors. CONCLUSION The identification of factors that affect the quality of CPR in the perception of nurses serves as parameter to implement improvements and training of the staff working in inpatient units.

Association between valvular surgery and mortality among patients with infective endocarditis complicated by heart failure.

Context Heart failure (HF) is the most common complication of infective endocarditis. However, clinical characteristics of HF in patients with infective endocarditis, use of surgical therapy, and their associations with patient outcome are not well described.Objectives To determine the clinical, echocardiographic, and microbiological variables associated with HF in patients with definite infective endocarditis and to examine variables independently associated with in-hospital and 1-year mortality for patients with infective endocarditis and HF, including the use and association of surgery with outcome.Design, Setting, and Patients The International Collaboration on Endocarditis-Prospective Cohort Study, a prospective, multicenter study enrolling 4166 patients with definite native- or prosthetic-valve infective endocarditis from 61 centers in 28 countries between June 2000 and December 2006.Main Outcome Measures In-hospital and 1-year mortality.Results Of 4075 patients with infective endocarditis and known HF status enrolled, 1359 (33.4% [95% CI, 31.9%-34.8%]) had HF, and 906 (66.7% [95% CI, 64.2%-69.2%]) were classified as having New York Heart Association class III or IV symptom status. Within the subset with HF, 839 (61.7% [95% CI, 59.2%-64.3%]) underwent valvular surgery during the index hospitalization. In-hospital mortality was 29.7% (95% CI, 27.2%-32.1%) for the entire HF cohort, with lower mortality observed in patients undergoing valvular surgery compared with medical therapy alone (20.6% [95% CI, 17.9%-23.4%] vs 44.8% [95% CI, 40.4%-49.0%], respectively; P < .001). One-year mortality was 29.1% (95% CI, 26.0%-32.2%) in patients undergoing valvular surgery vs 58.4% (95% CI, 54.1%-62.6%) in those not undergoing surgery (P < .001). Cox proportional hazards modeling with propensity score adjustment for surgery showed that advanced age, diabetes mellitus, health care-associated infection, causative microorganism (Staphylococcus aureus or fungi), severe HF (New York Heart Association class III or IV), stroke, and paravalvular complications were independently associated with 1-year mortality, whereas valvular surgery during the initial hospitalization was associated with lower mortality.Conclusion In this cohort of patients with infective endocarditis complicated by HF, severity of HF was strongly associated with surgical therapy and subsequent mortality, whereas valvular surgery was associated with lower in-hospital and 1-year mortality.

Clinical characteristics and outcome of patients admitted to a medico-surgical ICU requiring non invasive ventilation (NIV) for hypercapnic respiratory failure

Introduction: Because it decreases intubation rate and mortality, NIV has become first-line treatment in case of hypercapnic respiratory failure (HRF). Whether this approach is equally successful for all categories of HRF patients is however debated. We assessed if any clinical characteristics of HRF patients were associated with NIV intensity, success, and outcome, in order to identify prognostic factors. Methods: Retrospective analysis of the clinical database (clinical information system and MDSi) of patients consecutively admitted to our medico-surgical ICU, presenting with HRF (defined as PaCO2 >50 mm Hg), and receiving NIV between January 2009 and December 2010. Demographic data, medical diagnoses (including documented chronic lung disease), reason for ICU hospitalization, recent surgical interventions, SAPS II and McCabe scores were extracted from the database. Total duration of NIV and the need for tracheal intubation during the 5 days following the first hypercapnia documentation, as well as ICU and hospital mortality were recorded. Results are reported as median [IQR]. Comparisons with Chi2 or Kruskal-Wallis tests, p <0.05 (*). Results: 164 patients were included, 45 (27.4%) of whom were intubated after 10 [2-34] hours, after having received 7 [2-19] hours of NIV. NIV successful patients received 15 [5-22] hours of NIV for up to 5 days. Intubation was correlated with increased ICU (20% vs. 3%, p <0.001) and hospital (46.7% vs. 30.2, p >0.05) mortality. Conclusions: A majority of patients requiring NIV for hypercapnic respiratory failure in our ICU have no diagnosed chronic pulmonary disease. These patients tend to have increased ICUand hospital mortality. The majority of patients were non-surgical, a feature correlated with increased hospital mortality. Beside usual predictors of severity such as age and SAPS II, absence of diagnosed chronic pulmonary disease and non-operative state appear to be associated with increased mortality. Further studies should explore whether these patients are indeed more prone to an adverse outcome and which therapeutic strategies might contribute to alter this course.

Review of the type material of three species of Polietina Schnabl & Dziedzicki (Diptera, Muscidae)

The type material of three species of Polietina Schnabl & Dziedzicki, 1911 was examined. Polietina flavidicincta (Stein, 1904) is redescribed and a lectotype is designated; P. stellata (Couri, 1982) is considered junior synonym of P. flavithorax (Stein, 1904), and for the latter a lectotype is designated. The neotype previously designated is considered invalid.

Once-daily dolutegravir is superior to once-daily darunavir/ritonavir in treatment-naïve HIV-1-positive individuals: 96 week results from FLAMINGO.

INTRODUCTION: Dolutegravir (DTG) 50 mg once daily was superior to darunavir/ritonavir (DRV/r) 800 mg/100 mg once daily through Week 48, with 90% vs. 83% of participants achieving HIV RNA 50 c/mL (p=0.025) [1]. We present data through Week 96. MATERIAL AND METHODS: FLAMINGO is a multicentre, randomized, open-label, Phase IIIb non-inferiority study, in which HIV-1-positive ART-naïve adults with HIV-1 RNA≥1000 c/mL and no evidence of viral resistance were randomized 1:1 to receive DTG or DRV/r, with investigator-selected backbone NRTIs (TDF/FTC or ABC/3TC). Participants were stratified by screening HIV-1 RNA (≤100K c/mL) and NRTI backbone. RESULTS: A total of 484 adults were randomized and treated; 25% had baseline HIV RNA 100K c/mL. At Week 96, the proportion of participants with HIV RNA 50 c/mL was 80% in the DTG arm vs. 68% in the DRV/r arm (adjusted difference 12.4%; 95% CI 4.7, 20.2%; p=0.002). Secondary analyses supported primary results: per-protocol [(DTG 83% vs. DRV/r 70%), 95% CI 12.9 (5.3, 20.6)] and treatment-related discontinuation = failure [(98% vs. 95%), 95% CI 3.2 (-0.3, 6.7)]. Overall virologic non-response (DTG 8%; DRV/r 12%) and non-response due to other reasons (DTG 12%; DRV/r 21%) occurred less frequently on DTG. As at Week 48, the difference between arms was most pronounced in participants with high baseline viral load (82% vs. 52% response through Week 96) and in the TDF/FTC stratum (79% vs. 64%); consistent responses were seen in the ABC/3TC stratum (82% vs. 75%). Six participants (DTG 2, none post-Week 48; DRV/r 4, two post-Week 48) experienced protocol-defined virologic failure (PDVF; confirmed viral load 200 c/mL on or after Week 24); none had treatment-emergent resistance to study drugs. Most frequent drug-related adverse events (AEs) were diarrhoea, nausea and headache, with diarrhoea significantly more common on DRV/r (24%) than DTG (10%). Significantly more participants had Grade 2 fasting LDL toxicities on DRV/r (22%) vs. DTG (7%), p<0.001; mean changes in creatinine for DTG (~0.18 mg/dL) observed at Week 2 were stable through Week 96. CONCLUSIONS: Once-daily DTG was superior to once-daily DRV/r in treatment-naïve HIV-1-positive individuals, with no evidence of emergent resistance to DTG in virologic failure and relatively similar safety profiles for DTG and DRV/r through 96 Weeks.

Catálogo do material-tipo de Tachinidae (Diptera) depositado no Museu de Zoologia da Universidade de São Paulo

Catálogo do material-tipo de Tachinidae (Diptera) depositado no Museu de Zoologia da Universidade de São Paulo. O Museu de Zoologia da Universidade de São Paulo abriga a maior e mais representativa coleção brasileira de Diptera. A coleção de Tachinidae destaca-se como a segunda mais numerosa, com 32554 espécimes adultos montados. No presente estudo é apresentado um catálogo de tipos primários e secundários de Tachinidae abrigados no Museu de Zoologia, fornecendo informações sobre dados de coleta, seu estado de conservação, bem como o status taxonômico dos nomes específicos e seu atual posicionamento genérico, quando diferente do original. O catálogo lista um total de 847 espécimes-tipo (99 holótipos, 737 parátipos, 8 síntipos, 1 lectótipo, 1 paralectótipo e 1 neótipo) representando um total de 263 espécies nominais de Tachinidae, predominantemente da Região Neotropical. Também são listados espécimes cujo status (se tipo ou não) foi considerado duvidoso. Uma breve biografia de Charles Henry Tyler Townsend e José Henrique Guimarães é apresentada.

Reutilização do Resíduo Oriundo dos Serviços de Restauração Asfáltica Como Material Alternativo em Camadas de Pavimentos Flexíveis

Uma técnica de restauração de pavimentos, bastante empregada atualmente, é a fresagem do revestimento asfáltico e recomposição com um novo revestimento. Na operação de fresagem é gerado um grande volume de resíduo, material fresado, que normalmente é descartado em bota-fora. Face ao desafio moderno de dar um destino ecologicamente correto para os resíduos, este trabalho apresenta uma solução para a reutilização do material fresado em camadas granulares de pavimentos flexíveis. Os ensaios de caracterização mostram que a granulometria do fresado não se enquadra nas faixas de estabilização granulométrica, carecendo de finos. Apesar de apresentar certa degradação durante o ensaio de compactação Proctor o material fresado tem um índice de suporte califórnia maior do que 20%, para a energia modificada. Para corrigir a deficiência de finos o material fresado foi misturado com pó-de-pedra em dois teores diferentes (30% e 70%). As misturas apresentaram melhoras no comportamento mecânico, alcançando massas específicas maiores que o fresado e também índices de suporte califórnia maiores. Também é relatado a execução de uma pista experimental numa rua lateral a BR-285 na cidade de Bozano, utilizando material fresado estabilizado granulometricamente com a adição de pó-de-pedra, como material de base de pavimento. Além dos processos executivos são apresentados levantamentos defletométricos que permitem concluir que simultaneamente a um descarte adequado a utilização do material fresado na camada de base é uma ótima solução para pavimentos de baixo volume de tráfego.

Reutilização do Resíduo Oriundo dos Serviços de Restauração Asfáltica como Material Alternativo em Camadas de Pavimentos Flexíveis

Uma técnica de restauração de pavimentos, bastante empregada atualmente, é a fresagem do revestimento asfáltico e recomposição com um novo revestimento. Na operação de fresagem é gerado um grande volume de resíduo, material fresado, que normalmente é descartado em bota-fora. Face ao desafio moderno de dar um destino ecologicamente correto para os resíduos, este trabalho apresenta uma solução para a reutilização do material fresado em camadas granulares de pavimentos flexíveis. Os ensaios de caracterização mostram que a granulometria do fresado não se enquadra nas faixas de estabilização granulométrica, carecendo de finos. Apesar de apresentar certa degradação durante o ensaio de compactação Proctor o material fresado tem um índice de suporte califórnia maior do que 20%, para a energia modificada. Para corrigir a deficiência de finos o material fresado foi misturado com pó-de-pedra em dois teores diferentes (30% e 70%). As misturas apresentaram melhoras no comportamento mecânico, alcançando massas específicas maiores que o fresado e também índices de suporte califórnia maiores. Também é relatado a execução de uma pista experimental numa rua lateral a BR-285 na cidade de Bozano, utilizando material fresado estabilizado granulometricamente com a adição de pó-de-pedra, como material de base de pavimento. Além dos processos executivos são apresentados levantamentos defletométricos que permitem concluir que simultaneamente a um descarte adequado a utilização do material fresado na camada de base é uma ótima solução para pavimentos de baixo volume de tráfego.

Reutilização do Resíduo Oriundo dos Serviços de Restauração Asfáltica como Material Alternativo em Camadas de Pavimentos Flexíveis

Uma técnica de restauração de pavimentos, bastante empregada atualmente, é a fresagem do revestimento asfáltico e recomposição com um novo revestimento. Na operação de fresagem é gerado um grande volume de resíduo, material fresado, que normalmente é descartado em bota-fora. Face ao desafio moderno de dar um destino ecologicamente correto para os resíduos, este trabalho apresenta uma solução para a reutilização do material fresado em camadas granulares de pavimentos flexíveis. Os ensaios de caracterização mostram que a granulometria do fresado não se enquadra nas faixas de estabilização granulométrica, carecendo de finos. Apesar de apresentar certa degradação durante o ensaio de compactação Proctor o material fresado tem um índice de suporte califórnia maior do que 20%, para a energia modificada. Para corrigir a deficiência de finos o material fresado foi misturado com pó-de-pedra em dois teores diferentes (30% e 70%). As misturas apresentaram melhoras no comportamento mecânico, alcançando massas específicas maiores que o fresado e também índices de suporte califórnia maiores. Também é relatado a execução de uma pista experimental numa rua lateral a BR-285 na cidade de Bozano, utilizando material fresado estabilizado granulometricamente com a adição de pó-de-pedra, como material de base de pavimento. Além dos processos executivos são apresentados levantamentos defletométricos que permitem concluir que simultaneamente a um descarte adequado a utilização do material fresado na camada de base é uma ótima solução para pavimentos de baixo volume de tráfego.

Analysis of past and future dam formation and failure in the Santa Cruz River (San Juan province, Argentina)

Around 11.5 * 106 m3 of rock detached from the eastern slope of the Santa Cruz valley (San Juan province, Argentina) in the first fortnight of January 2005. The rockslide?debris avalanche blocked the course, resulting in the development of a lake with maximum length of around 3.5 km. The increase in the inflow rate from 47,000?74,000 m3/d between April and October to 304,000 m3/d between late October and the first fortnight of November, accelerated the growing rate of the lake. On 12 November 2005 the dam failed, releasing 24.6 * 106 m3 of water. The resulting outburst flood caused damages mainly on infrastructure, and affected the facilities of a hydropower dam which was under construction 250 km downstream from the source area. In this work we describe causes and consequences of the natural dam formation and failure, and we dynamically model the 2005 rockslide?debris avalanche with DAN3D. Additionally, as a volume ~ 24 * 106 m3of rocks still remain unstable in the slope, we use the results of the back analysis to forecast the formation of a future natural dam. We analyzed two potential scenarios: a partial slope failure of 6.5 * 106 m3 and a worst case where all the unstable volume remaining in the slope fails. The spreading of those potential events shows that a new blockage of the Santa Cruz River is likely to occur. According to their modeled morphometry and the contributing watershed upstream the blockage area, as the one of 2005, the dams would also be unstable. This study shows the importance of back and forward analysis that can be carried out to obtain critical information for land use planning, hazards mitigation, and emergency management.

HTPSELEX--a database of high-throughput SELEX libraries for transcription factor binding sites.

HTPSELEX is a public database providing access to primary and derived data from high-throughput SELEX experiments aimed at characterizing the binding specificity of transcription factors. The resource is primarily intended to serve computational biologists interested in building models of transcription factor binding sites from large sets of binding sequences. The guiding principle is to make available all information that is relevant for this purpose. For each experiment, we try to provide accurate information about the protein material used, details of the wet lab protocol, an archive of sequencing trace files, assembled clone sequences (concatemers) and complete sets of in vitro selected protein-binding tags. In addition, we offer in-house derived binding sites models. HTPSELEX also offers reasonably large SELEX libraries obtained with conventional low-throughput protocols. The FTP site contains the trace archives and database flatfiles. The web server offers user-friendly interfaces for viewing individual entries and quality-controlled download of SELEX sequence libraries according to a user-defined sequencing quality threshold. HTPSELEX is available from ftp://ftp.isrec.isb-sib.ch/pub/databases/htpselex/ and http://www.isrec.isb-sib.ch/htpselex.

Reutilização do Resíduo Oriundo dos Serviços de Restauração Asfáltica como Material Alternativo em Camadas de Pavimentos Flexíveis

Uma técnica de restauração de pavimentos, bastante empregada atualmente, é a fresagem do revestimento asfáltico e recomposição com um novo revestimento. Na operação de fresagem é gerado um grande volume de resíduo, material fresado, que normalmente é descartado em bota-fora. Face ao desafio moderno de dar um destino ecologicamente correto para os resíduos, este trabalho apresenta uma solução para a reutilização do material fresado em camadas granulares de pavimentos flexíveis. Os ensaios de caracterização mostram que a granulometria do fresado não se enquadra nas faixas de estabilização granulométrica, carecendo de finos. Apesar de apresentar certa degradação durante o ensaio de compactação Proctor o material fresado tem um índice de suporte califórnia maior do que 20%, para a energia modificada. Para corrigir a deficiência de finos o material fresado foi misturado com pó-de-pedra em dois teores diferentes (30% e 70%). As misturas apresentaram melhoras no comportamento mecânico, alcançando massas específicas maiores que o fresado e também índices de suporte califórnia maiores. Também é relatado a execução de uma pista experimental numa rua lateral a BR-285 na cidade de Bozano, utilizando material fresado estabilizado granulometricamente com a adição de pó-de-pedra, como material de base de pavimento. Além dos processos executivos são apresentados levantamentos defletométricos que permitem concluir que simultaneamente a um descarte adequado a utilização do material fresado na camada de base é uma ótima solução para pavimentos de baixo volume de tráfego.

Ejaculation failure on the day of oocyte retrieval for IVF: case report.

Unexpected ejaculation failure on the day of oocyte retrieval for IVF occurs once or twice a year in our Reproductive Medicine Unit, where approximately 500 oocyte retrievals are performed each year. Two clinical situations which occurred in 2001 are presented. In the first case, sperm were finally obtained by epididymal aspiration and resulted in the fertilization of five oocytes by ICSI. The transfer of two fresh embryos did not result in a pregnancy and the three supernumerary zygotes were cryopreserved. The male patient presented an anxio-depressive episode necessitating psychiatric hospitalization 1 week after the oocyte retrieval. In the second case, no sperm were obtained and the four oocytes were therefore lost. The couple went through a crisis in their relationship and tried another cycle of IVF 10 months later, after the preventive cryopreservation of a sperm sample. On the day of oocyte retrieval the patient was unable to produce a fresh sample but three zygotes were obtained through ICSI using the back-up cryopreserved sperm. Two embryos were transferred but no pregnancy ensued. The clinical decision-making processes for these two cases are described, as well as the measures employed to help prevent these unfortunate situations.