Lung ultrasound (LUS) is becoming an invaluable tool in the management of critically ill patients. We report two cases showing the importance of LUS as a guide to optimize respiratory physiotherapy ...in the intensive care unit, allowing a successful lung donation process and to redirect the physiotherapist's approach. The use of LUS requires an adequate training but it is becoming an important tool in management algorithms for critically ill patients.
Biomedical simulation is an effective educational complement for healthcare training, both at undergraduate and postgraduate level. It enables knowledge, skills and attitudes to be acquired in a ...safe, educationally orientated and efficient manner. In this context, simulation provides skills and experience that facilitate the transfer of cognitive, psychomotor and proper communication competences, thus changing behavior and attitudes, and ultimately improving patient safety. Beyond the impact on individual and team performance, simulation provides an opportunity to study organizational failures and improve system performance. Over the last decades, simulation in healthcare had a slow but steady growth, with a visible maturation in the last ten years. The simulation community must continue to provide the core leadership in developing standards. There is a need for strategies and policy development to ensure its coordinated and cost-effective implementation, applied to patient safety. This paper reviews the evolutionary movements of biomedical simulation, including a review of the Portuguese initiatives and nationwide programs. For leveling knowledge and standardize terminology, basic but essential concepts in clinical simulation, together with some considerations on assessment, validation and reliability are presented. The final sections discuss the current challenges and future initiatives and strategies, crucial for the integration of simulation programs in the greater movement toward patient safety.
Enquadramento: O envelhecimento da população contribui para o aumento de acidentes domésticos, com graves consequências pessoais, familiares, sociais. Objetivos: Avaliar a prevalência e ...caraterísticas de acidentes domésticos em pessoas idosas clientes de unidades funcionais de um Centro de Saúde. Metodologia: Estudo observacional transversal, amostra não probabilística, por conveniência, de 139 pessoas idosas. Resultados: As quedas no domicílio são os acidentes domésticos com maior prevalência nos últimos 12 meses, em sequência de escorregamento. Observaram-se algumas associações baixas, mas estatisticamente significativas, entre o número de quedas, o risco de queda e medo de cair, e entre a idade, o risco de queda e medo de cair. Conclusão: Os resultados observados implicam medidas adequadas por parte dos enfermeiros, integrados em equipas interdisciplinares. A realização de novos estudos de cariz longitudinal, permitirá a monitorização das medidas adotadas e as adaptações necessárias para prevenir e diminuir o risco de queda, e melhorar a qualidade de vida da população envelhecida.
Cultures of adventitious roots of
Stevia rebaudiana
(Bert.) Bertoni were performed in a roller bottle system for the production of both primary and secondary metabolites. Adventitious roots were ...induced from 1-cm-long root tip explants derived from in vitro regenerated plantlets on solid Murashige and Skoog (MS 1962) media supplemented with 10.7 μM of α-naphthaleneacetic acid. These cultures were successfully maintained in the same medium for 6 months with regular subcultures after 4 weeks. Thereafter, the roots were cut into 1.0- to 1.5-cm-long segments and transferred to the roller bottle system containing a fresh root tissue culture on liquid MS medium supplemented with 10.7 μM NAA. The apparatus consisted of a flask rolling system adjusted to 4
g
, and 3° of flask inclination. The roots were allowed to grow in the absence of light for adaptation and adventitious root formation. The best conditions for cultivation were investigated, considering culture volume (25 ml), culture period (4 weeks), salt concentrations in the nutrient medium (33%) and optimal initial inoculum (0.2 g) of
S. rebaudiana
roots. These results could give important information on how to improve the development of adventitious roots of
S. rebaudiana
for the production of primary and secondary metabolites.
Although effective and appropriate fluid management is a critical aspect of quality care during hospitalization, the widespread adoption of consistent policies that ensure adequate fluid stewardship ...has been slow and heterogenous. Despite evidence-based guidelines on fluid management being available, clinical opinions continue to diverge on important aspects of care in this setting, and the consistency of guideline implementation is far from ideal. A multidisciplinary panel of leading practitioners and experts convened to discuss best practices for ongoing staff education, intravenous fluid therapy, new training technologies, and strategies to track the success of institutional fluid stewardship efforts. Fluid leads should be identified in every hospital to ensure consistency in fluid administration and monitoring. In this article, strategies to communicate the importance of effective fluid stewardship for the purposes of education, training, institutional support, and improvement of patient outcomes are reviewed and recommendations are summarized.
Graphical Abstract
The present Dissertation’s academic research addresses the impact of oil price shocks on the performance of United States banks in the 2009Q1-2020Q3 period. The two hypotheses advanced are that oil ...price shocks have a direct impact on bank profitability, or that the effect of oil price movements is channeled solely through general economic activity, through an indirect effect. This Dissertation employs an incremental approach based on both Static and Dynamic Panel Data models. Subsequently, two robustness checks are performed, so as to check the possibility that the distance of banks’ Headquarters to Cushing, Oklahoma might affect the severeness of the impact of oil on bank performance; as well as to test the premise that price movements might produce asymmetrical effects. The dependent variable used is ROA, and the independent variables selected are three different oil price shock measures, and vectors of bank-specific and macroeconomic control variables. Bank-specific data were extracted from the Compustat Bank Fundamentals database, while oil and economic data were gathered from Refinitiv Worldscope. This Dissertation’s findings show that oil price shocks have a direct positive impact on U.S. bank performance and are robust for both econometric models. Moreover, several macroeconomic and bank-specific are found to affect bank performance. Additionally, the location of banks is noteworthy, since banks closer to Cushing observe a more significant positive impact of oil price on bank performance. However, no asymmetrical effects were observed. The empirical results of this Dissertation pose multiple management/policy challenges for bank executives, banking supervisors, and energy policymakers.
Polycythemia vera (PV) is a myeloproliferative neoplasm characterized by overproduction of red blood cells. We have performed a comprehensive characterization of blood immune cells for expression of ...naïve and memory receptors as well as β
2
m-associated and β
2
m-free MHC class I heavy chains, also known as closed and open conformers, respectively, in PV patients and age-matched controls (CTR). We show that the peripheral CD3
+
CD8
+
T cell pool in PV patients is clearly divided into two discrete populations, a more granular CD3
+
CD8
high
T cell population enriched in effector-memory CD45RA
+
T cells (CD8
+
T
EMRA
) when compared to CTR (
P
< 0.001), and a less granular CD3
+
CD8
int
T cell population that is completely absent in the CTR group (78 vs. 0%,
P
< 0.001) and is a mixture of naïve (CD8
+
T
N
) and CD8
+
T
EMRA
cells expressing intermediate levels of CD28, i.e., CD3
+
CD8
int
CD28
int
. While the percentage of CD3
+
CD8
int
T
N
cells correlated positively with the number of erythrocytes, the percentage of CD3
+
CD8
int
T
EMRA
correlated negatively with the number of platelets. Finally, we report that PV patients’ lymphocytes and monocytes display lower levels of closed (W6/32
+
) MHC-I conformers at the cell surface while exhibiting increased amounts of open (HC-10
+
) MHC-I conformers. The implications of this distinctive immune signature are discussed.
Human factors and awareness of flight physiology play a crucial role in flight safety. Even so, international legislation is vague relative to training requirements in hypoxia and altitude ...physiology.
Based on a previously developed survey, an adapted questionnaire was formulated and released online for Portuguese pilots. Specific questions regarding the need for pilot attention monitoring systems were added to the original survey. There were 117 pilots, 2 of whom were women, who completed the survey.
Most of the pilots had a light aviation license and flew in unpressurized cabins at a maximum ceiling of 10,000 ft (3048 m). The majority of the respondents never experienced hypoxic symptoms. In general, most of the individuals agreed with the importance of an introductory hypoxia course without altitude chamber training (ACT) for all pilot populations, and with a pilot monitoring system in order to increase flight safety.
Generally, most of the pilots felt that hypoxia education and training for unpressurized aircraft is not extensive enough. However, almost all the respondents were willing to use a flight physiology monitoring system in order to improve flight safety.
Amateur and sports flight is an activity with
growing numbers worldwide. However, the main cause of
flight incidents and accidents is increasingly pilot error, for
a number of reasons. Fatigue, sleep ...issues and hypoxia,
among many others, are some that can be avoided, or, at
least, mitigated. This article describes the analysis of psychological
and physiological parameters during flight in
unpressurized aircraft cabins. It relates cerebral oximetry
and heart rate with altitude, as well as with flight phase.
The study of those parameters might give clues on which
variations represent a warning sign to the pilot, thus preventing
incidents and accidents due to human factors.
Results show that both cerebral oximetry and heart rate
change along the flight and altitude in the alert pilot. The
impaired pilot might not reveal these variations and, if this
is detected, he can be warned in time.
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