Abstract
Lean healthcare visual management has been successfully integrated into infection control programs, leading to lower healthcare-associated infection (HAI) rates and greater provider ...compliance with evidence-based prevention practices; however, its implementation during quality improvement (QI) initiatives in limited-resource settings has not yet been well exploited. We aimed to describe a low-cost strategy involving Kamishibai cards to sustain bundles’ adherence to prevent HAIs in a middle-income country. This descriptive case study evaluated the implementation of a lean healthcare visual management tool—Kamishibai board (K-board)—during a nationwide QI collaborative preventing three critical HAIs in 189 adult and pediatric/neonatal intensive care units (ICUs) from September 2021 to January 2023. Considering a limited-resource setting, our team adapted a K-board using simple, cheap, and easy-to-handle materials for routine monitoring of QI procedures, including safety bundles’ compliance. After test prototypes, the final K-board version was implemented. The chart materials and assembly cost BRL 80.00 (USD 15.48). Before launching, expert working group meetings were held to shape the contents, refine technical issues, and prepare the ICU teams for implementation. After starting, plan-do-study-act cycles were conducted according to the Breakthrough Series model. Participating ICU teams, including leaders and front-line health workers, performed bedside audits following a weekly chronogram. Two indicators were calculated: the percentage of ICUs in which K-boards were being implemented and whether bundles’ compliance was addressed in the K-board. Audit data were recorded in ‘SimpleQI’. After 17 months of this initiative, 177 (93.7%) participating ICUs had included this visual management tool in their daily care routines. When more than 94 (>50%) ICUs posted K-board data, the mean compliance for the bundles for each HAI was sustained above 85%. A lean healthcare visual management tool can be adapted to local settings, including healthcare facilities with limited resources. K-board seems to be a feasible method for auditing evidence-based practices in medical care, including safety bundles to simultaneously prevent three types of HAIs.
BackgroundThe Breakthrough Series model uses learning sessions (LS) to promote education, professional development and quality improvement (QI) in healthcare. Staff divergences regarding prior ...knowledge, previous experience, preferences and motivations make selecting which pedagogic strategies to use in LS a challenge.AimWe aimed to assess new active-learning strategies: two educational games, a card game and an escape room-type game, for training in healthcare-associated infection prevention.MethodsThis descriptive case study evaluated the performance of educational strategies during a Collaborative to reduce healthcare-associated infections in Brazilian intensive care units (ICUs). A post-intervention survey was voluntarily offered to all participants in LS activities.ResultsSeven regional 2-day LS were held between October and December 2022 (six for adult ICUs and one for paediatric/neonatal ICUs). Of 194 institutions participating in a nationwide QI initiative, 193 (99.4%) participated in these activities, totalling 850 healthcare professionals. From these, 641 participants responded to the survey (75.4%). The post-intervention survey showed that the participants responded positively to the educational activities.ConclusionThe participants perceived the various pedagogical strategies positively, which shows the value of a broad and diverse educational approach, customised to local settings and including game-based activities, to enhance learning among healthcare professionals.
Background: Enzootic bovine leukosis (EBL) is a viral and lymphoproliferative disease that attributes negative economic impacts to dairy farming. The immunosuppressive condition of these bovines ...favors the development of bacterial diseases such as tuberculosis, brucellosis, and bovine leptospirosis, which implications to the public health given that they are zoonosis. Diagnosis and control of EBL are neglected in cattle rearing, allowing their dissemination, especially in developing countries. In this sense, the objective of this study was to analyze the risk factors of EBL in dairy cattle from the Brazilian Amazon.Materials, Methods & Results: In order to identify the BLV-infected animals (527 serological samples), we used the agarose gel immunodiffusion serological test (IDGA) to diagnose the EBL and characterize the risk factors through the application of epidemiological questionnaires. We used the logistic regression test to evaluate the existence of a significant association between the variables. The EBL frequency in the study area was 14.42%. We detected seroreagent bovines in all municipalities evaluated with 95% of the properties showing outbreaks of the disease. The reuse of needles was the risk factor with the most significant statistical association (P < 0.01; OR = 2.16).Discussion: The origin of EBL in the Brazilian Amazon is probably related to the expansion of dairy cattle in the 1980s, which, at first, demanded the importation of cattle for the fast formation of the herds, without complying with the sanitary criteria of animal commercialization. The frequency of EBL in the Rio Branco microregion is below the estimated national average, as well as the regional level. The reduced influx of animals due to the geographical situation of Acre, since it is an area of greater physical isolation due to forest and river barriers, may influence the observed frequency. Different environmental conditions, herd size, cattle management, genetics and particularities of the diagnostic techniques should also be considered. The Rio Branco microregion can currently be considered as an area of medium frequency for BLV infection, a situation that ranges from 11 to 30% in the occurrence rate. When compared to herds with low infection frequency (<10%), the elimination of seroreagent animals and their respective outbreaks become more expensive in areas of medium or high frequency. As for the number of outbreaks detected, the finding reflects the degree of negligence regarding the prophylactic measures of EBL since it is a silent propagation disease, as well as the implications for the absence of official control and eradication programs in Brazil. According to the final logistic regression model, the reuse of needles for vaccinations, deworming, and for applying other drugs in different animals was the risk factor of greater association in the region, explaining the widespread occurrence of EBL in the studied farms. In Canadian herds, this practice also was associated with an increase in clinical cases. It is known that only 0.1 mL of blood is necessary as a minimal infectious dose of BLV. However, despite the relevance of this variable, it is little studied in epidemiological surveys, and this practice continues to be repeated in cattle. In conclusion, the wide dissemination of EBL in the dairy herds of the region is related to the practice of reusing needles and its relevance in the iatrogenic transmission of the disease
l-asparaginase (EC 3.5.1.1) is an enzyme that catalysis mainly the asparagine hydrolysis in l-aspartic acid and ammonium. This enzyme is presented in different organisms, such as microorganisms, ...vegetal, and some animals, including certain rodent's serum, but not unveiled in humans. It can be used as important chemotherapeutic agent for the treatment of a variety of lymphoproliferative disorders and lymphomas (particularly acute lymphoblastic leukemia (ALL) and Hodgkin's lymphoma), and has been a pivotal agent in chemotherapy protocols from around 30 years. Also, other important application is in food industry, by using the properties of this enzyme to reduce acrylamide levels in commercial fried foods, maintaining their characteristics (color, flavor, texture, security, etc.) Actually, l-asparaginase catalyzes the hydrolysis of l-asparagine, not allowing the reaction of reducing sugars with this aminoacid for the generation of acrylamide. Currently, production of l-asparaginase is mainly based in biotechnological production by using some bacteria. However, industrial production also needs research work aiming to obtain better production yields, as well as novel process by applying different microorganisms to increase the range of applications of the produced enzyme. Within this context, this mini-review presents l-asparaginase applications, production by different microorganisms and some limitations, current investigations, as well as some challenges to be achieved for profitable industrial production.
Monitoring degraded areas is essential for evaluation of the quality of the rehabilitation process. In this study, we evaluate how the physical and chemical characteristics of the mixture of iron ore ...tailings with the soil have affected the soil microbial biomass and activity in areas along the Gualaxo do Norte River after the Fundão Dam disaster. Composite soil samples were collected from areas that were impacted (I) and not impacted (NI) by the tailings. The following attributes were evaluated: chemical element content; soil density, porosity, and texture; microbial biomass carbon; basal respiration; and enzyme activity and density of microbial groups (bacteria, actinobacteria, fungi, arbuscular mycorrhizae, phosphate solubilizers, cellulolytic microorganisms, nitrifiers, ammonifiers, and diazotrophs). According to result, the deposition of tailings increased the pH and the soil available P, Cr, Fe, and Mn content and reduced organic matter. The physical and biological attributes were negatively affected, with increases in the silt content and density of the soil, and reduction in macroporosity and in the microbial biomass and activity of the soil (respiration and enzymes) in the impacted area. However, the impacted areas exhibited greater densities of some microbial groups (cellulolytic microorganisms, nitrifiers, and diazotrophic bacteria). Modifications in the organic matter and silt content are the main attributes associated with deposition of the tailings that affected soil microbial biomass and microbial activity. This may affect erosive conditions and the functionality of the ecosystem, indicating an imbalance in this environment. In contrast, the higher density of some microbial groups in the impacted areas show the high rehabilitation potential of these areas.
Mining activities can affect the environment either by the tailings releasing or dams failures. The impact of the tailings can last decades and cause chronic effects due to their toxicity. The Fundão ...dam collapse, a relevant environmental disaster, occurred in November 2015 in Southeastern Brazil. Tailing rich in metals reached the Doce River and arrived in the Atlantic Ocean. Previous studies revealed the acute impact of the tailings in the marine planktonic community near the Doce River mouth. The current study aims to characterize the structure of planktonic assemblages in the impacted area after four years of the disaster. Sampling occurred in November 2018, January, April, and July 2019 at 32 stations located at the marine coastal area near the Doce River mouth. Our study detected high metal concentrations in the surface waters during January 2019, when the lowest diversity and abundance of phytoplankton, lowest zooplankton diversity, and low ichthyoplankton abundance were recorded. The zooplanktonic community was structured by environmental parameters and ichthyoplankton assemblages in November 2018, January and April 2019. Nutrients and metals, mainly iron from the tailing carried by the Doce River waters to the marine environment changed the plankton community, confirming the impact of the Fundão Dam collapse in the coastal area near the Doce River mouth. The phytoplankton community, influenced by the nutrients and to a lesser extent metals concentrations, was not decisive in the zooplankton community structure. The environmental variability was driven by the meteoceanographic conditions and the Doce River flow. There was a high correlation between the zooplanktonic community and ichthyoplanktonic assemblage and the environmental factors and metals. These relations indicate the impact of the tailings from the collapse of the Fundão Dam on these communities, even after four years of the Mariana disaster.
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•Planktonic community was influenced by changes in the meteoceanographic conditions.•Phytoplankton was affected by nutrients and to a lesser extent metals concentration.•Metal contamination decreased the phyto- and zooplankton diversity.•Zoo- and ichthyoplankton were structured by metals and to a lesser extent by nutrients.•Physicochemical variables and ichthyoplankton structured the zooplankton community.
Objective
Focal stereotactic radiosurgery to the surgical cavity lowers local recurrence after resection of brain metastases (BM). To evaluate local control (LC) and brain disease control (BDC) after ...intraoperative radiotherapy (IORT) for resected BM.
Methods
Adult patients with completely resected single supratentorial BM were recruited and underwent IORT to the cavity with a prescribed dose of 18 Gy to 1 mm-depth. Primary endpoints were actuarial LC and BDC. Local failure (LF) and distant brain failure (DBF), with death as a competing risk, were estimated. Secondary endpoints were overall survival (OS) and incidence of radiation necrosis (RN). Simon’s two-stage design was used and estimated an accrual of 10 patients for the first-stage analysis and a LC higher than 63% to proceed to second stage. We report the final analysis of the first stage.
Results
Between June 2019 to November 2020, 10 patients were accrued. Median clinical and imaging FU was 11.2 and 9.7 months, respectively. Median LC was not reached and median BDC was 5 months. The 6-month and 12-month LC was 87.5%. The 6-month and 12-month BDC was 39% and 13%, respectively. Incidence of LF at 6 and 12 months was 10% and of DBF at 6 and 12 months was 50% and 70%, respectively. Median OS was not reached. The 6-month and 12-month OS was 80%. One patient had asymptomatic RN.
Conclusion
IORT for completely resected BM is associated with a potential high local control and low risk of RN, reaching the pre-specified criteria to proceed to second stage and warranting further studies.
Since November of 2015, when ore tailings from a dam rupture reached the Atlantic Ocean, researchers are trying to assess the degree of impact across the Doce River and adjacent coastal area. This ...study aims to use the zooplankton dynamics as a tool to evaluate the environmental impact in the coastal region, five years after the rupture, during periods of low and high river flow. Doce River flow varied from 49 to 5179 m3/s and structured the zooplankton community between periods of low and high river flow, but salinity and chlorophyll-a had stronger correlation with depth (r = 0.40 and − 0.40 respectively) than with the Doce River discharge variation along the sampling period (r < 0.2). On the other hand, inorganic particles in the water and total metal concentration (dissolved + particulate), used as tracers of the iron enriched tailing (Al, Cd, Cr, Cu, Fe, V), were correlated with fluvial discharge and showed to be the main factor driving the zooplankton community dynamics. For assessing the degree of environmental impact, we tested the ecological indexes for the zooplankton community. Margalef Richness, Pielou Evenness and Shannon-Wiener Diversity varied from 2.52, 0.40 and 1.39 (all registered during high river flow period) to 9.02, 0.85 and 3.44 (all registered during low river flow period), respectively. Along with those community indicators, we evaluated the response of representative taxonomical genera such as Paracalanus, Oikopleura and Temora, regarding the Doce River flow, and found population patterns that established a baseline for future monitoring in the region. Our results showed that the zooplankton community is more fragile when the river discharge is stronger, and this pattern is confirmed by all indicators tested.
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•Dam rupture in 2015 disposed ore tailings into the Doce River, reaching the coast.•Five years later, environmental disturbance is still detected at the region.•Metal concentrations are correlated with zooplankton distribution at the coast.•Zooplankton community and biondicators show impact signs during high river flow.
The introduction of non-native species (NNS) and the resulting biological invasions are conspicuous features of the Anthropocene Epoch. Parallel to these phenomena, some initiatives (political, ...social and scientific) have sought to value and protect invasive populations, recognizing some benefits that NNS may deliver to people and nature. Given this growing trend of valuing NNS, we considered opportune to address this issue in the context of megadiverse tropical countries. We investigated an emerging trend that has advocated the protection of highly invasive fishes by legal instruments, i.e., the protection of invasive peacock basses (genus
Cichla
) in Brazil. We recorded 16 bills or laws proposed between 2017 and 2022 that determine fishing restrictions to protect invasive
Cichla
spp. from overfishing and other impacts, in order to favor population recruitment, growth, colonization and spread. Specifically, they establish restrictions on fishing, capture, transport, trade, and processing, including quotas, compulsory catch and release, length limits, use of gears, and temporal interdictions. They also determine the naturalization of peacock basses in some main basins of South America, which include different watersheds and ecoregions, with risk of intercountry invasions. This particular case is instructive to unveil the risks of positions that emphasize positive contributions of NNS to society and nature, as these misguided conservation actions favor invasive organisms with high potential to cause environmental degradation, biodiversity losses, and social conflicts. These positions find fertile ground in some contexts, especially in tropical developing countries, where economic constraints, poor access to information, opportunism, and bad political behavior have been the norm.
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