VV-ECMO in critical COVID-19 obese patients

Objectives: Obesity is a condition prone to pose difficulties to a successful extra-corporeal membrane oxygenation (ECMO) support. Not being a contraindication, it yields significant challenges to physicians and may interfere with patient;s outcome. The number of obese patients supported by ECMO has increased during COVID-19 pandemic due to severe illness in this population. We designed a retrospective study in order to identify prognostic factors for 180-day survival in critical COVID-19 obese patients in venovenous ECMO (VV-ECMO). Method(s): Single-center retrospective cohort of critical COVID-19 adult patients in VV-ECMO, obese and overweight (according to WHO classification), admitted in a tertiary hospital;s ICU from April 1st 2020 to May 31th2022. Univariate logistic regression analysis was performed to assess 180-day mortality differences. Result(s): The analysis included 41 patients. The median [interquartile range (IQR)] age was 55 (IQR 45-60) years and 70,7% were male. Median body mass index (BMI) was 36 (IQR 31-42,5) Kg/m2 ;39% of patients had a BMI >=40 kg/m2 . The sampling had 3 (IQR 1,5-4) days of invasive ventilation prior to ECMO and 63,4% were weaned from ECMO-VV support after a median of 19 (IQR 10-34) days. The median ICU length of stay was 31,9 (IQR 17,5-44,5) days. The invasive ventilation period was 30 (IQR 19-49,5) days. The 60, 90 and 180-day mortalities were 41,5%. On the univariate logistic regression analysis we found that higher BMI was associated with higher 180-day survival (odds ratio [OR] 1,157 (1,038-1,291), p 0,009). Younger age, female patients, less invasive ventilation time prior to ECMO and fewer complications at time of ECMO cannulation were associated with higher 180-day survival [respectively, OR 0,858 (0,774- 0,953), p 0,004;OR 0,074 (0,008-0,650), p 0,019;OR 0,612 (0,401-0,933), p 0.022;OR 0.13 (0,03-0,740), p 0,022)]. Conclusion(s): In this retrospective cohort of critical COVID-19 obese adult patients supported by VVECMO, a higher BMI, younger age and female patients were associated with higher 180-day survival. A shorter invasive ventilation time prior to ECMO and fewer complications at ECMO cannulation were also associated with increased survival.

Ninety-day outcomes in patients diagnosed with COVID-19 in São Paulo, Brazil: a cohort study.

OBJECTIVE: COVID-19 has been associated with a significant burden to those who survive the acute phase. We aimed to describe the quality of life and symptoms of anxiety, depression, and posttraumatic stress disorder (PTSD) at 90 days after hospital discharge of COVID-19 patients. METHODS: Patients with COVID-19 admitted to a private hospital in the city of São Paulo, Brazil, between April of 2020 and April of 2021 were interviewed by telephone at 30 and 90 days after discharge to assess the quality of life and symptoms of depression, anxiety, and PTSD. RESULTS: A total of 2,138 patients were included. The mean age was 58.6 ± 15.8 years, and the median length of hospital stay was 9.0 (5.0-15.8) days. Between the two time points, depression increased from 3.1% to 7.2% (p < 0.001), anxiety increased from 3.2% to 6.2% (p < 0.001), and PTSD increased from 2.3% to 5.0% (p < 0.001). At least one physical symptom related to COVID-19 diagnosis persisted in 32% of patients at day 90. CONCLUSIONS: Persistence of physical symptoms was high even at 90 days after discharge. Although the prevalence of symptoms of anxiety, depression, and PTSD was low, these symptoms persisted for three months, with a significant increase between the time points. This finding indicates the need to identify at-risk patients so that they can be given an appropriate referral at discharge.

Successful Application of Foamed Cement Slurry in an Ultradeepwater Well of 11,900-ft Water Depth (Claiming World Record)

Foamed cement was successfully used in the riserless section of an ultradeepwater well located in 11,900ft water depth. Foamed cement was selected to minimize operating costs and provide flexibility to adjust slurry density on a short notice. The seawater column exerted 5,319.1-psi hydrostatic pressure on the annulus. Consequently, nitrogen (N2) density could no longer be neglected. This paper presents simulations performed in preparation for the job, operational considerations, and post-job evaluation. The lead slurry needed a density of 1.25 SG and develops a compressive strength of at least 300 psi within 48 hr. Considering the cost and challenges associated with outsourcing resources under current Covid-19 pandemic restrictions, the foamed cement system was preferred over chemical-or particle-extended cement or blend systems. The N2 ratio for the foamed cement slurry system was 700 scf/bbl. With a base slurry pumping rate of 5 bbl/min, the required N2 pumping rate was 3,500 scf/min, which was greater than the capability of a single N2 pump (3,000-scf/min rate). Because the rig deck space could not accommodate three N2 pumps, one pump would serve as backup;thus, the final plan consisted of using two N2 pumps simultaneously. Two parallel foamed slurry treating lines were rigged up to reduce the fluid velocity in a single line. All laboratory testing was conducted locally. Additives used in the foamed slurry were environmentally friendly. A proprietary process-control system was used during the cementing operation and automatically synchronized the N2 pumps and foam pump rates with the base slurry rate. The cementing crew consisted of 11 individuals, including 2 client representatives. The entire pumping operation was completed in 10 hr. A total base slurry volume of 1016.2 bbl was continuously mixed and pumped at the density of 13.35 lbm/ gal (1.60 SG). The resulting foamed slurry volume was 1387.0 bbl with an average foam quality of 27.8% and foamed slurry density of 10.5 lbm/gal (1.26 SG). A total of 119 metric tonne of class G cement and 30,711 L of N2 were consumed during the pumping operation. The lead slurry was followed by 603.9 bbl of 15.86 lbm/gal (1.90 SG) class G cement tail slurry and 349.7 bbl of seawater for displacement. The final surface pressure was 594.6 psi. The lead slurry reached the seabed and the float shoe check was positive. No casing subsidence was observed. neglected when high-hydrostatic pressure is involved. © 2023, Offshore Technology Conference.

The aging seen from prison: psychosocial analysis of LGBT old age with womens and men deprived of freedom at the brazilian context of COVID-19

Old age is a universal phenomenon that has notably expanded in the Brazilian population, including within the prison system. However, the arrival of the coronavirus in Brazilian prisons reinforced the need to pay attention to the psychosocial vulnerabilities that permeate this environment and affect the population in prison. The study aimed to analyze and compare the social representations of women and men in deprivation of liberty about the conditions that LGBT elderly people have to experience a safe old age in the context in which they live. It is characterized as a qualitative research, based on the Theory of Social Representations, of a descriptive and comparative nature, with cross-sectional data and a non-probabilistic convenience sample. There were 28 people living in deprivation of liberty in male and female penal units, during the pandemic period in a Brazilian state. It is evident that in the representations of the participants, old age is not a phase full of tranquility, as there are conditions and resources necessary to live it well. It is concluded that there is a predominance of many stereotypes about sexual orientation, lifestyle, loneliness in old age and sexuality among the elderly, which can be justified by the lack of knowledge on the subject or even the lack of contact with people LGBT's. © 2022, Sociedad Interamericana de Psicologia. All rights reserved.

O Psicologo No Pronto Socorro E as Emergencias Em Saude Mental Pos Pandemia

Embora os transtornos depressivos e de ansiedade, bem como os casos de TEPT ja se constituissem como endemicos no Brasil, com a pandemia da Coronavirus Disease 2019 (COVID 19), o aumento de casos foi exponencial. Na fase inicial da pandemia na China (2020), houve um aumento de 50% de pacientes apresentando sintomas moderados a severos de ansiedade, depressao e estresse. No inicio de maio de 2020, segundo a Associacao Brasileira de Psiquiatria, 48% dos psiquiatras apontavam um aumento de cerca de 25% no numero de consultas, sendo que 89% desses pacientes com diagnostico previo apresentavam sintomas agravados. Este trabalho tem como objetivo apresentar o aumento da incidencia de pacientes atendidos com queixas psicologicas nas unidades de pronto atendimento (Pronto Socorro) e os esforcos emergenciais em nivel de gestao e acompanhamento psicologico da nova realidade no Hospital Geral, referenciada como 4onda da pandemia Covid 19. Os dados coletados referem-se ao periodo de janeiro a julho de 2021, comparando-se ao ano de 2022, tendo sido avaliados 772 pacientes. A partir de avaliacao psicologica clinica e levantamento de prontuarios de atendimentos psicologicos no Pronto Socorro Adulto, comparando-se os anos de 2021 e 2022, constatou-se um aumento medio de 27,5% pacientes no periodo, com prevalencia de sintomas que incluiam mal estar subito e sensacoes de perigo recorrentes e imprevisiveis, incapacidade de relaxar, sensacoes de sufocamento, dor toracica, distorcoes cognitivas e intensa angustia de morte. Historia de doencas psiquiatricas diagnosticadas;perdas financeiras advindas da pandemia;temor aumentado e exacerbado de ser infectado pelo virus, adoecer e morrer;luto patologico (pela perda de familiares e amigos);sobrecarga e fadiga;estresse;ma qualidade do sono;desesperanca;comportamentos evitativos e irritabilidade tambem constituiram os achados clinicos. A sistematizacao da presenca do Psicologo como profissional de referencia no Pronto Socorro, foi fator fundamental para o melhor cuidado e encaminhamento seguro dos casos. Entender como se apresentou a pandemia em termos de estagios de evolucao do problema foi fundamental para nos preparar para o implemento de estrategias de controle. Passamos a avaliar a situacao critica como momentos encadeados e progressivos, o que facilitou o entendimento de especificidades de fatores estressores relativos a pandemia e o cuidado que deveria ser prestado intra e pos crise. Copyright © 2022

Learning analytics to support teachers in the challenge of overcoming the learning gaps in k-12 students

The emergency remote teaching caused by the covid-19 pandemic has potentiated the learning gaps of several students in Brazilian education, especially in the K-12 settings. Amidst the many challenges imposed by the pandemic, the adoption of digital tools in the school context has provided the generation of educational data, which can be collected and analyzed in order to provide evidence-based decision making, taking into account all the stakeholders in the teaching and learning process. Such decisions can provide for the personalization of learning, which aims to provide the student with educational resources that promote the building of weakened skills caused by learning gaps. The present thesis plan aims to present the work plan for the development of a Learning Analytics Dashboard tool for teachers in a basic education school in order to support data-driven pedagogical decision-making and to enable personalized monitoring of learning. © 2022 Copyright for this paper by its authors. Use permitted under Creative Commons License Attribution 4.0 International (CC BY 4.0).

ETHNOGRAPHY WITH CHILDREN IN TIMES OF PANDEMIC: AN ETHICAL AND METHODOLOGICAL REFLECTION

This article is concerned with the ethical and methodological aspects of research carried out during 2020, which investigated the children’s representation of Covid-19 in the Brazilian state of Maranhão. It queries the fabrication of an ethnography at a distance (with the children’s parents as mediators), taking digital technologies as a means to access children and their narratives through short interviews, audio recordings, and drawings. Adhering to social distancing rules, without access to direct observation, it raises issues regarding the process of obtaining information and transforming it into data through systematization and analysis. © 2022, Fundacao Carlos Chagas. All rights reserved.

Social representations of LGBT old age and sex professionals in brazilian adults

The number of elderly people in the world is growing significantly, thus urging the need to ensure that this population can live a full life, especially given the current pandemic scenario of COVID-19. Objective: To analyze the social representations of LGBT old age for male and female sex professionals through the pandemic. Method: It is a qualitative, descriptive, and exploratory research. 10 men and 10 women participated of the study, aging between 18 and 48 years old, all sex workers. For this study were used a sociodemographic questionnaires and semi-structured interviews. The collection was recorded from the Google Forms and analyzed based on the Hierarchical Descending Classification, in the IRAMUTEQ software. Results: The results show 3 classes: (1) "Social understanding of the topic LGBT old age";(2) "Stigma to genders and sexual orientations");(3) "Double problem: physical transformations and the obstacles that accompany them". Conclusions: The representations are associated with the difficulties the elderly have in aging, as well as to debate LGBT old age. There are also greater obstacles when it comes to aging women and LGBT sex workers. In this way, the study seeks to contribute to the advance of the debate about LGBT aging and old age.

The human genome requires physical activity: What are we learning from COVID-19?

Aim: The primary cause for the development and worsening of chronic diseases is physical inactivity. This article aims to present a proposal for the negative impacts of physical inactivity during social distancing caused by the COVID-19 pandemic. Results: Global levels of physical activity are decreasing, and this behavior can be the start to increase the prevalence and incidence of chronic diseases such as diabetes, high blood pressure, obesity, and mental illness after the COVID-19 pandemic. Conclusion: Staying physically active is a fundamental behavior during the COVID-19 pandemic and social distancing. © 2022 Universidade Estadual Paulista - UNESP. All rights reserved.

THE INTENSIFICATION OF PRIVATIZATION IN HEALTH POLICY IN THE FACE OF THE COVID-19 PANDEMIC IN THE STATE OF TOCANTINS

This article presents an exploratory research on the intensification of health policy privatizations during the Covid-19 pandemic in the state of Tocantins. The state government documents related to health and the Covid-19 pandemic published in the Official Gazette of the State of Tocantins, between the period of March 1 to September 30, 2020, were analyzed. This study shows that non-classic privatizations intensified during the Covid-19 pandemic period and are combined with more radical privatization attempts towards the destruction of all Brazilian social policies, especially the Unified Health System (SUS), which marks the Bolsonaro government. With this exploratory research, a shift in health spending towards the private sector was observed, widening the influence of Social Organizations (OSs) in relation to their role in facing the Covid-19 pandemic in Tocantins territory.

Alternative Seafood Networks During COVID-19: Implications for Resilience and Sustainability

Export-oriented seafood trade faltered during the early months of the COVID-19 pandemic. In contrast, alternative seafood networks (ASNs) that distribute seafood through local and direct marketing channels were identified as a “bright spot.” In this paper, we draw on multiple lines of quantitative and qualitative evidence to show that ASNs experienced a temporary pandemic “bump” in both the United States and Canada in the wake of supply chain disruptions and government mandated social protections. We use a systemic resilience framework to analyze the factors that enabled ASNs to be resilient during the pandemic as well as challenges. The contrast between ASNs and the broader seafood system during COVID-19 raises important questions about the role that local and regional food systems may play during crises and highlights the need for functional diversity in supply chains. © Copyright © 2021 Stoll, Harrison, De Sousa, Callaway, Collier, Harrell, Jones, Kastlunger, Kramer, Kurian, Lovewell, Strobel, Sylvester, Tolley, Tomlinson, White, Young and Loring.

Social Representations of LGBT Old Age and Sex Workers in Brazilian Adults

Background: The number of elderly people in the world is growing significantly, so there is an urgent need to ensure that this population can live a full life, especially taking into account the current COVID-19 pandemic scenario. Objective: To analyze the social representations of LGBT old age for male and female sex workers through the pandemic. Method: A qualitative, descriptive, and exploratory research conducted with 10 male and 10 female sex workers aged between 18 and 48. Sociodemographic questionnaires and semi-structured interviews were administered using Google Forms and then analyzed by descending hierarchical classification through the IRaMuTeQ software. Results: The analysis showed three classes: (1) "Social understanding of the topic LGBT old age," (2) "Stigma of genders and sexual orientations," and (3) "Physical transformations and their accompanying obstacles". Conclusions: The representations are associated with the difficulties that elderly people have with aging in society, as well as debating LGBT old age. There are also greater obstacles regarding aging of female sex workers. In this way, the study seeks to contribute to broaden the knowledge of the psychosocial aspects of LGBT aging and old age, especially those of sex workers.