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•NaOH-activated carbon was produced from guava seeds (AC–GS).•AC–GS exhibited microporous feature (85%) and SBET of 2573.6m2g−1.•Kinetic, isotherm and thermodynamic studies for ...amoxicillin removal were evaluated.•AC–GS presented maximum monolayer adsorption capacity of 570.48mgg−1 at 25°C.
We report the preparation and characterization of NaOH-activated carbon of high surface area produced from guava seeds (AC–GS) and its application for amoxicillin (AMX) adsorption. The AC–GS was fully characterized from the N2 adsorption and desorption isotherms, scanning electron microscopy (SEM), thermogravimetric analysis (TG), Fourier transform infrared spectroscopy (FTIR), Boehm titration and pHPZC. Additionally, the kinetics, equilibrium and thermodynamic parameters on the adsorption of AMX onto AC–GS were evaluated. The AC–GS showed BET surface area of 2573.6m2g−1 and microporous features (85%), presenting average pore diameter of 1.96nm, which are suitable for AMX adsorption. The experimental adsorption data were modelled using several kinetic (pseudo-first order, pseudo-second order and Elovich) and isotherm (Freundlich, Langmuir, Redlich–Peterson and Dubinin–Radushkevich) models, which suggested that the adsorption of AMX onto AC–GS occurs predominantly by chemisorption showing a maximum monolayer adsorption capacity of 570.48mgg−1 (pH=4.0; T=25°C), which stands out compared to various adsorbents found in literature. Additionally, the thermodynamic parameters revealed the spontaneity of AMX adsorption (ΔG°=−1.915kJmol−1 at 298K) and its endothermic characteristic (ΔH°=21.33kJmol−1), evidencing the high-efficiency of AC–GS for AMX adsorption and its great potential for organic pollutants removal.
Second opinions may improve quality of patient care. The primary objective of this study was to determine the concordance between first and second diagnoses and opinions regarding need for spinal ...surgery among patients with back or neck pain that have been recommended spinal surgery.
We performed a prospective observational study of patients who had been recommended for spinal surgery and received a second opinion between May 2011 and May 2012 at the Hospital Israelita Albert Einstein on the advice of their health insurance company. A physiatrist and orthopaedic surgeon independently performed the second assessment. If both agreed surgery was indicated, or consensus could not be reached, participants attended a spine review panel for a final recommendation. Descriptive analyses compared diagnoses and management plans of the first and second opinions.
Of 544 referred patients, 16 (2.9%) did not meet inclusion criteria, 43 (7.9%) refused participation and 485 were included. Diagnoses differed from the first opinion for 290 (59.8%). Diagnoses of cervical and lumbar radiculopathy were concordant in 36/99 (36.4%) and 116/234 (49.6%) respectively. The second opinion was for conservative treatment for 168 (34.6%) participants, 27 (5.6%) were not considered to have a spine condition, and 290 (59.8%) were referred to the review board. 60 participants did not attend the board review and therefore did not receive a final recommendation. Board review was conservative treatment for an additional 67 participants, 20 were not considered to have a spine condition and 143 participants were recommended surgery. Overall, 33.6% received a final opinion of surgery (143/425) although only 66 (15.5%) received the same surgical recommendation, 235 (55.3%) were advised to have conservative treatment, and 47 (11.1%) were not considered to have a spinal diagnosis.
We found a large discordance between first and second opinions regarding diagnosis and need for spinal surgery. This suggests that obtaining a second opinion could reduce potentially unnecessary surgery.
Current Controlled Trials ISRCTN07143259 . Registered 21 November 2011.
•A new method for acrylamide determination in brewed coffee was developed.•A DLLME procedure was optimized to extract acrylamide from coffee brewed samples.•Samples were submitted to the DLLME ...without additional previous preparation.•Quantitative analyzes were carried out by UPLC-MS/MS.•The proposed method was applied to seventeen brewed coffee samples.
This work has proposed the application of optimized dispersive liquid–liquid microextraction (DLLME) in order to extract acrylamide from brewed coffee samples for its subsequent determination by ultra-performance liquid chromatography tandem mass spectrometry (UPLC-MS/MS). DLLME achieved superior results employing 300 μL of brewed coffee, 100 μL of dichloromethane, 400 μL of acetonitrile and without sodium chloride addition. Quantitative analyses were carried out by the standard addition method, and the limits of detection and quantification were 0.9 and 3.0 μg L−1, respectively. Recoveries ranged from 97 to 106%, and the intra- and inter-assay precisions ranged from 6 to 9%. The proposed analytical method was applied to seventeen brewed coffee samples prepared in a filter coffee maker, and acrylamide amounts varied from 10.5 to 28.5 μg L−1. Therefore, the suggested DLLME-UPLC-MS/MS method is promising for routine analysis in order to guarantee the quality control of acrylamide in brewed coffee.
The use of regional citrate anticoagulation (RCA) in liver failure (LF) patients can lead to citrate accumulation. We aimed to evaluate serum levels of citrate and correlate them with liver function ...markers and with the Cat/Cai in patients under intensive care and undergoing continuous venovenous hemodiafiltration with regional citrate anticoagulation (CVVHDF-RCA). A prospective cohort study in an intensive care unit was conducted. We compared survival, clinical, laboratorial and dialysis data between patients with and without LF. Citrate was measured daily. We evaluated 200 patients, 62 (31%) with LF. Citrate was significantly higher in the LF group. Dialysis dose, filter lifespan, systemic ionized calcium and Cat/Cai were similar between groups. There were weak to moderate positive correlations between Citrate and indicators of liver function and Cat/Cai. The LF group had higher mortality (70.5% vs. 51.8%, p = 0.014). Citrate was an independent risk factor for death, OR 11.3 (95% CI 2.74-46.8). In conclusion, hypercitratemia was an independent risk factor for death in individuals undergoing CVVHDF-ARC. The increase in citrate was limited in the LF group, without clinical significance. The correlation between citrate and liver function indicators was weak to moderate.
Several factors influence the outcomes in acute kidney injury (AKI), especially in intensive care unit (ICU) patients. In this scenario, continuous renal replacement therapies (CRRT) are used to ...control metabolic derangements and blood volume. Knowing this fact, it may be possible to change the course of the disease and decrease the high mortality rate observed. Thus, we aimed to evaluate the main risk factors for death in AKI patients needing CRRT.
This was a prospective, observational cohort study of ICU patients (N = 183) with AKI who underwent continuous venovenous hemodiafiltration (CVVHDF) as their initial dialysis modality choice. The patients were predominantly male (62.8%) and their median age was 65 (55-76) years. The most frequent comorbidities were cardiovascular disease (39.3%), hypertension (32.8%), diabetes (24%), and cirrhosis (20.7%). The main cause of AKI was sepsis (52.5%). At beginning of CVVHDF, 152 patients (83%) were using vasopressors. The median SAPS 3 and SOFA score at ICU admission was 61 (50-74) and 10 (7-12), respectively. The dialysis dose delivered was 33.2 (28.9-38.7) ml/kg/h. The median time between ICU admission and CVVHDF initiation was 2 (1-4) days. The median cumulative fluid balance during the CVVHDF period was -1838 (-5735 +2993) ml. The mortality rate up to90 days was 58%. The independent mortality risk factors in propensity score model were: chronic obstructive pulmonary disease (OR = 3.441.14-10.4; p = 0.028), hematologic malignancy (OR = 5.141.66-15.95; p = 0.005), oliguria (OR = 2.361.15-4.9; p = 0.02), positive daily fluid balance during CVVHDF (OR = 4.552.75-13.1; p<0.001), and total SOFA score on first dialysis day (OR = 1.271.12-1.45; p<0.001).
Dialysis-related factors may influence the outcomes. In our cohort, positive daily fluid balance during CRRT was associated with lower survival. Multicenter, randomized studies are needed to assess fluid balance as a primary outcome to define the best strategy in this patient population.
To evaluate the effectiveness of a positive deviance strategy for the improvement of hand hygiene compliance in 2 adult step-down units.
A 9-month, controlled trial comparing the effect of positive ...deviance on compliance with hand hygiene.
Two 20-bed step-down units at a tertiary care private hospital.
The first phase of our study was a 3-month baseline period (from April to June 2008) in which hand hygiene episodes were counted by use of electronic handwashing counters. From July to September 2008 (ie, the second phase), a positive deviance strategy was implemented in the east unit; the west unit was the control unit. During the period from October to December 2008 (ie, the third phase), positive deviance was applied in both units.
During the first phase, there was no statistically significant difference between the 2 step-down units in the number of episodes of hand hygiene per 1,000 patient-days or in the incidence density of healthcare-associated infections (HAIs) per 1,000 patient-days. During the second phase, there were 62,000 hand hygiene episodes per 1,000 patient-days in the east unit and 33,570 hand hygiene episodes per 1,000 patient-days in the west unit (P < .01 ). The incidence density of HAIs per 1,000 patient-days was 6.5 in the east unit and 12.7 in the west unit (p = .04). During the third phase, there was no statistically significant difference in hand hygiene episodes per 1,000 patient-days (P = .16) or in incidence density of HAIs per 1,000 patient-days.
A positive deviance strategy yielded a significant improvement in hand hygiene, which was associated with a decrease in the overall incidence of HAIs.
Abstract
In this study, a mixture design with process variables was used to optimize the extraction of total phenolic compounds (TPC) from yerba mate leaves through high hydrostatic pressure ...extraction. The studied variables were pressure (50, 100, and 150 MPa), extraction time (10, 20, and 30 min), and solvent (water, glycerin, and 50% v/v water/50% v/v glycerin). The multiple linear regression model presented an excellent fit (
R
2
adjusted of 0.9792) and demonstrated the major influence of glycerin content on the water/glycerin mixture solvent for TPC extraction. Optimal process conditions obtained were 69% v/v water, 31% v/v glycerin, 50 MPa pressure, and 10 min time.
Practical Application
The paper describes a novel extraction method to obtain phenolic compounds from yerba mate (compounds that can replace synthesized antioxidants in the food industry) using high hydrostatic pressure and environmentally friendly solvents. The extraction process was studied to optimize its performance, obtaining more phenolic compounds from the same amount of yerba mate.
There is ample literature available on the association between both time to antibiotics and appropriateness of antibiotics and clinical outcomes from sepsis. In fact, the current state of debate ...surrounds the balance to be struck between prompt empirical therapy and care in the choice of appropriate antibiotics (both in terms of the susceptibility of infecting organism and minimizing resistance arising from use of broad-spectrum agents). The objective of this study is to determine sepsis bundle compliance and the appropriateness of antimicrobial therapy in patients with severe sepsis and septic shock and its impact on outcomes.
This study was conducted in the ICU of a tertiary care, private hospital in São Paulo, Brazil. A retrospective cohort study was conducted from July 2005 to December 2012 in patients with severe sepsis and septic shock.
A total of 1,279 patients were identified with severe sepsis and septic shock, of which 358 (32.1%) had bloodstream infection (BSI). The inpatient mortality rate was 29%. In evaluation of the sepsis bundle, over time there was a progressive increase in serum arterial lactate collection, obtaining blood cultures prior to antibiotic administration, administration of broad-spectrum antibiotics within 1 hour, and administration of appropriate antimicrobials, with statistically significant differences in the later years of the study. We also observed a significant decrease in mortality. In patients with bloodstream infection, after adjustment for other covariates the administration of appropriate antimicrobial therapy was associated with a decrease in mortality in patients with severe sepsis and septic shock (p = 0.023).
The administration of appropriate antimicrobial therapy was independently associated with a decline in mortality in patients with severe sepsis and septic shock due to bloodstream infection. As protocol adherence increased over time, the crude mortality rate decreased, which reinforces the need to implement institutional guidelines and monitor appropriate antimicrobial therapy compliance.
Aims
The objectives of this research protocol are as follows: to examine the influence of the COVID‐19 pandemic on health and social care for migrant women in the Son Gotleu district of Palma de ...Mallorca, Spain, and to develop outreach tools to target this specific group.
Design
This is a qualitative study that uses content analysis to obtain in‐depth knowledge of personal experience (manifest content) and contextual experience (latent content) in a specific social setting.
Methods
The study population are migrant women living in Son Gotleu district, who are segmented by their age and experience of COVID‐19, defined as positive or negative according to whether or not they have been infected with the disease.
Results
The shortcomings and needs relating to communication and health care that affect this group's current and future quality of life will be identified.
Conclusion
The study of migrant women offers a gateway allowing vulnerability in health care to be detected. An awareness of their needs will allow prototype tools to be developed to facilitate communication and care for general and acute health needs between the scientific community and the vulnerable population.
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