Wearable soft electrochemical microfluidic device integrated with iontophoresis for sweat biosensing.

A soft and flexible wearable sweat epidermal microfluidic device capable of simultaneously stimulating, collecting, and electrochemically analyzing sweat is demonstrated. The device represents the first system integrating an iontophoretic pilocarpine delivery system around the inlet channels of epidermal polydimethylsiloxane (PDMS) microfluidic device for sweat collection and analysis. The freshly generated sweat is naturally pumped into the fluidic inlet without the need of exercising. Soft skin-mounted systems, incorporating non-invasive, on-demand sweat sampling/analysis interfaces for tracking target biomarkers, are in urgent need. Existing skin conformal microfluidic-based sensors for continuous monitoring of target sweat biomarkers rely on assays during intense physical exercising. This work demonstrates the first example of combining sweat stimulation, through transdermal pilocarpine delivery, with sample collection through a microfluidic channel for real-time electrochemical monitoring of sweat glucose, in a fully integrated soft and flexible multiplexed device which eliminates the need of exercising. The on-body operational performance and layout of the device were optimized considering the fluid dynamics and evaluated for detecting sweat glucose in several volunteers. Furthermore, the microfluidic monitoring device was integrated with a real-time wireless data transmission system using a flexible electronic board PCB conformal with the body. The new microfluidic platform paves the way to real-time non-invasive monitoring of biomarkers in stimulated sweat samples for diverse healthcare and wellness applications.

Epidermal Enzymatic Biosensors for Sweat Vitamin C: Toward Personalized Nutrition.

Recent advances in wearable sensor technologies offer new opportunities for improving dietary adherence. However, despite their tremendous promise, the potential of wearable chemical sensors for guiding personalized nutrition solutions has not been reported. Herein, we present an epidermal biosensor aimed at following the dynamics of sweat vitamin C after the intake of vitamin C pills and fruit juices. Such skin-worn noninvasive electrochemical detection of sweat vitamin C has been realized by immobilizing the enzyme ascorbate oxidase (AAOx) on flexible printable tattoo electrodes and monitoring changes in the vitamin C level through changes in the reduction current of the oxygen cosubstrate. The flexible vitamin C tattoo patch was fabricated on a polyurethane substrate and combined with a localized iontophoretic sweat stimulation system along with amperometric cathodic detection of the oxygen depletion during the enzymatic reaction. The enzyme biosensor offers a highly selective response compared to the common direct (nonenzymatic) voltammetric measurements, with no effect on electroactive interfering species such as uric acid or acetaminophen. Temporal vitamin C profiles in sweat are demonstrated using different subjects taking varying amounts of commercial vitamin C pills or vitamin C-rich beverages. The dynamic rise and fall of such vitamin C sweat levels is thus demonstrated with no interference from other sweat constituents. Differences in such dynamics among the individual subjects indicate the potential of the epidermal biosensor for personalized nutrition solutions. The flexible tattoo patch displayed mechanical resiliency to multiple stretching and bending deformations. In addition, the AAOx biosensor is shown to be useful as a disposable strip for the rapid in vitro detection of vitamin C in untreated raw saliva and tears following pill or juice intake. These results demonstrate the potential of wearable chemical sensors for noninvasive nutrition status assessments and tracking of nutrient uptake toward detecting and correcting nutritional deficiencies, assessing adherence to vitamin intake, and supporting dietary behavior change.

Enzymatic biofuel cells based on protective hydrophobic carbon paste electrodes: towards epidermal bioenergy harvesting in the acidic sweat environment.

The operation of wearable epidermal biofuel cells is prone to rapid irreversible deactivation effects under dynamic sweat pH changes from neutral to acidic. We demonstrate that the encapsulation of lactate-oxidase (LOx) within a hydrophobic protective carbon-paste anode imparts unusually high stability during dynamically changing pH fluctuations and allows the BFC to continue harvesting the lactate bioenergy even after long exposures to acidic conditions. The unique power-recovery ability of the carbon-paste BFC after its failure in harsh pH is attributed to the protective action of the non-polar paste environment.

Feasibility of Routine Ambulatory Laparoscopic Cholecystectomy in Brazil.

BACKGROUND AND OBJECTIVES: In several developed countries, most laparoscopic cholecystectomies (LCs) are performed as an ambulatory operation (ALC) with a high rate of success. In Latin America, the experience with this procedure is still limited. Our objective is to evaluate the feasibility to implement ALC in a Brazilian teaching hospital. METHODS: Data obtained from electronic medical records and study protocols of all patients who underwent an LC between January 2011 and March 2018 were evaluated. All patients with chronic or acute cholecystitis were initially considered for an ALC. RESULTS: Of a total of 1645 patients who underwent LC, 1577 (95.9%) were discharged on the same day of the operation. The main reasons for hospital admission after ALC were patient refusal to be discharged (n = 23; 1.4%), nausea and vomiting (n = 15; 0.9%), and complicated acute cholecystitis. No patient was excluded from consideration for ALC based only on age, history of previous upper abdominal operation, and presence of comorbidity. Patient age ranged from 12 to 100 years, with a mean of 50.23 ± 15.35 years. Intraoperative and postoperative complication rates were 0.4% and 5.5%, respectively. Most perioperative complications were because of technical surgical difficulties and complications common to most abdominal operations (surgical site, pulmonary, urinary, and venous complications). Thirteen (0.8%) patients were readmitted to the hospital because of abdominal pain and fever (n = 4), pneumonia (n = 3), deep venous thrombosis (n = 3), or urinary retention (n = 3). CONCLUSIONS: ALC may be performed in Brazil with low rates of morbidity, mortality, and hospital readmission. Its implementation should be stimulated in Latin America.

Relação entre enfermeiros e médicos no Hospital das Clínicas da Universidade Federal de Goiás: a perspectiva do profissional de enfermagem / Profesional relaationhip between nurses and doctors at the clinical hospital of federal university of goiás: the view ofnuurses / Relacón profesioonal entre enfermeras y médicos en el hospital de la universidad federal de goiás: la visión de las enfermeras

El conflicto en la relación entre médicos y enfermeras es un tema tabú en los servicios de salud y poco discutido en la literatura. Se sabe que el conflicto entre estas dos profesiones, identificados como los principales responsables de la atención al paciente, se debe a la combinación de diversos factores que van desde la creación del equipo multidisciplinario hasta las cuestiones salariales. El estudio tiene por objeto determinar si desde el punto de vista de enfermeria, hay un conflicto en la relación con los médicos en el Hospital das Clínicas de la Universidad Federal de Goiás (HC / UFG) y los factores que intervienen. Con este fin, 82 enfermeras respondieron a un cuestionario con preguntas demográficas y sobre las variables que afectan a la relación (Escala Likert). El resultado muestra predominio del sexo femenino (89%), edad promedio 40,5 años, tiempo promedio de trabajo 11 años y horario semanal promedio de 30 horas. El análisis factorial identificó tres Fatores de Protección (División de tareas, Reconocimento y Reflex en el paciente) y tres Factores de generación de conflictos (Comunicación, Reconocimiento y Condiciones de trabajo), mientras que el conflicto esté subyacente a los procesos de trabajo y de la relación intersubjetiva. El paciente es el principal beneficiario cuando hay buena relación y las fallas en la comunicación, las condiciones de trabajo y remuneración no digna son factores de desestabilización de la relación multiprofesional.

The conflict in the relationship between doctors and nurses is a taboo subject in the health service and little discussed in the literature. It is known that the conflict between these classes, that are directly responsible for the care of the patient, is caused by the combination of diverse factors ranging from the establishment of the group of work until the salary. The research presented here aimed to verify if there is conflict in the relationship between doctors and nurses at the Clinical Hospital of the Federal University of Goiás (HC) and the factors that may promote or prevent it. An amount of 82 nurses were interviewed to study this population and the categories of variables that interfere in their relationship with other professionals. The result was a population with a prevalence of females (89%) with mean age of 40.5 years, average working time at the HC of 11 years and with weekly working hours average of 30. Factor analysis identified three protective factors (Division of tasks, Teaching hospital and Influences in the patient) and three other conflict generator factors (Communication, Recognition and working conditions), while the conflict underlies the processes related to work and personal relationship. The patient is the primary beneficiary when there is a good relation. Bad communication, non-appropriate working conditions and unworthy remuneration are destabilizing factors for the inter-professional relationship.

O conflito na relação entre médicos e enfermeiros é assunto tabu nos serviços de saúde e pouco discutido na literatura. Sabe-se que o conflito entre essas duas profissões, tidas como as principais responsáveis pelo cuidado do paciente, é causado pela associação de diversos fatores que vão desde a constituição da equipe multiprofissional até as questões salariais. O estudo pretende averiguar se, na visão da enfermagem, há conflito na relação com médicos, no Hospital das Clínicas da Universidade Federal de Goiás (HC/UFG) e os quais os fatores associados. Para tanto, 82 enfermeiros responderam a um questionário com dados demográficos e perguntas em escala Likert, sobre as variáveis que interferem na relação interprofissional. O resultado demonstra predomínio do gênero feminino (89%), idade média de 40,5 anos, tempo de trabalho médio no HC de 11 anos e carga horária semanal média de 30 horas. Da análise fatorial foram identificados três fatores de proteção (Divisão das tarefas, Influencia hospital escola e Reflexo no paciente) e três de geração de conflitos (Comunicação, Reconhecimento e Condições de trabalho), estando o conflito subjacente aos processos de trabalho e de relação intersubjetiva. O paciente é o principal beneficiado quando existe boa relação. Ruídos de comunicação, condições de trabalho inapropriadas e a remuneração indigna configuram-se como fatores desestabilizadores da relação interprofissional.

Relação entre enfermeiros e médicos em hospital escola: a perspectiva dos médicos / Professional relationship between nurses and doctors at the hospital of medical school: the view of doctors

O conflito entre profissionais da medicina e da enfermagem, historicamente as duas principais categorias profissionais responsáveis pelo cuidado do paciente, é originado a partir da associação de diversos fatores que vão desde a constituição da equipe multiprofissional até as questões salariais. O presente estudo pretende verificar se, na visão dos médicos, existe conflito na relação entre médicos e enfermeiros no Hospital das Clínicas da Universidade Federal de Goiás (HC/UFG) e quais são os fatores associados. Para tanto, 30 médicos responderam a um questionário com dados demográficos e perguntas em escala Lickert, sobre as variáveis que interferem na relação interprofissional. Dentre os resultados, a média de idade é de 42,7 anos, 50 por cento dos participantes é do sexo feminino e 93,3 dos entrevistados trabalha em outro lugar. A média de anos de trabalho no HC é de 16,3. Quanto às categorias de conflitos se destacam quatro fatores preventivos de conflitos (Pc) com Ranking Médio (RM) maior que 3,0 e dois geradores de conflito (2Gc), quais sejam: Comunicação interprofissional (RM =3,03); Autonomia na equipe (RM=3,63); Relação interprofissional (RM=3,36); Condições de trabalho (RM=2,26); Influência do hospital escola (RM=2,83) e Reflexo no paciente (RM=3,93). Conclui-se que na realidade analisada o conflito é inexistente, por haver uma relação favorável de fatores protetores (4Pc:2Gc), porém o mesmo é iminente, devido à permanência de fatores que podem desencadeá-lo (Condições de trabalho e Influência do hospital-escola). Além disso, há disputa de poder com a enfermagem, o que pode desequilibrar a situação e gerar problemas éticos.

The conflict between physicians and nurses, historically the two main groups of professionals responsible for patient care, is originated from the combination of several factors ranging from the establishment of the multidisciplinary team to salary issues. This study aims to determine, in the view of physicians, the existence of conflict in the relationship between them and nurses at the Hospital das Clinicas, Universidade Federal de Goiás (HC / UFG) and what factors are associated with it. To this goal, 30 doctors completed a questionnaire with demographic data and questions about the variables that affect the relationship, using a Lickert scale. Among the results, the average of age is 42.7 years, 50 percent of participants are female and 93.3 percent of the respondents worked elsewhere. The average of years of working in the HC is 16.3. Concerning to the conflict, we highlighted four factors of conflict prevention (Pc), with Middle Ranking (RM) greater than 3.0, and two others generators of conflict (2Gc). These factors are: Interprofessional Communication (RM=3.03); Autonomy in Team (RM=3.63); Interprofessional Relationship (RM=3.36); Working Conditions (RM=2.26), Influence of Hospital as a School (RM=2.83) and Patient Benefits (RM = 3,93). We concluded that in the analyzed reality the conflict is considered non-existent, because there is a favorable ratio of protective factors (4Pc:2Gc), but it is imminent, due to the persistence of factors that can unleash it (Working Conditions and Influence of Hospital as a School). Moreover, there is power struggle with nursing, which can unbalance the situation and create ethical problems.

Size at morphological maturity of Ucides cordatus (Linnaeus, 1763) (Brachyura, Ocypodidae) in the Laranjeiras Bay, Southern Brazil

Análises de crescimento relativo foram realizadas para exemplares de Ucides cordatus, coletados mensalmente durante um ano na Baía das Laranjeiras, sul do Brasil. O comprimento da carapaça, o comprimento do própodo dos quelípodos e a largura do abdome tiveram suas medidas relacionadas à largura da carapaça, para verificar o dimorfismo sexual e o tamanho na maturidade morfológica. O comprimento da carapaça e do própodo dos quelípodos maior e menor apresentaram padrões de crescimento diferenciados entre os sexos, indicando serem caracteres sexuais secundários para a espécie. O programa MATURE II indicou os tamanhos de 44 e 43mm de largura de carapaça para a maturidade sexual morfológica de machos e fêmeas, respectivamente.

A subregional assessment of demographic and health trends in the Americas: 1980-1998.

Close to 14 percent of the world's population lives in the Americas and the total population of this area is expected to reach 823,225,000 by the year 2000. Periodic assessments of the health situation and trends in conditions throughout subregions of the Americas have been undertaken by the Pan American Health Organization (PAHO) since the mid-1950s. These assessments demonstrate and underscore some major disparities in social, health and economic conditions in the various countries within the region. Analysis of some 38 demographic, socioeconomic, vital statistics and resource availability indicators show encouraging health and social progress between 1980 and 1998. Data concerning the health situation and trends in eight subregions of the Americas show a demographic reshape and an overall improvement in a variety of health indicators over this period. Important changes occurred in the epidemiological profile of the populations, shifting from a mainly communicable disease profile to one in which chronic diseases also affect a major portion of the population. This double health burden is unique in the region of the Americas. Improvements in social as well as health indicators were evidenced throughout the various subregions but at differing levels and at varying rates. Marked changes in total fertility, infant mortality, life expectancy and morbidity rates characterized the period between 1980 and 1998. The discrepancies between countries are highlighted and areas in need of further improvement outlined.

Redescrição de Cymodoce madrasensis (Srinivasan, 1959) combinação nova (Sphaeromatidae: Isopoda: Crustacea) de Madras, Índia

O autor estudou quase todas as espécies da família Sphaeromatidae (Isopoda), da Coleção de Crustacea do USNM, e a espécie constante do catálogo 102151 USNM, na época, não possuia identificação razão pela qual o autor enquadrou no gênero Cymodoce. Hoje está classificada como Exosphaeroma madrasensis Srinivasan, 1959. Este gênero não condiz com as características da espécie motivo pelo qual o autor procedeu a transferência para o gênero Cymodoce Leach, 1814, e estabeleceu nova combinação Cymodoce madrasensis (Srinivasan, 1959).

The author studying a male of Exosphaeroma madrasensis Srinivasan, 1959, catalog 102151 Division of Crustacea - USNM, describes and transfers the species to the genus Cymodoce Leach, 1814 establishing a new combination Cymodoce madrasensis (Srinivasan, 1959).

Behaviour of Anopheles albimanus in relation to pyrethroid-treated bednets.

Responses of the malaria vector Anopheles albimanus to pyrethroid impregnated bednets made of cotton or nylon, compared with untreated nets, were investigated in houses occupied by two people inside and/or outside two bednets, in coastal Chiapas, México. The pyrethroid used was lambdacyhalothrin 30 mg a.i./m2. Bioassay mortality rates of An.albimanus exposed to treated nets for 3 or 15 min, rose from 40-55% to 90-100% for nylon nets 3-19 weeks post-treatment, but were consistently lower for treated cotton nets. An.albimanus females (collected unfed on human bait) were released in houses surrounded by curtains for trapping mosquitoes that exited from the house. Floor sheets were used in and around each experimental house for retrieving any mosquitoes knocked-down and/or killed. During post-treatment assessment for 17 weeks, An.albimanus blood-feeding success rates were 23-24% with untreated nets, 14-18% with treated cotton nets and 8-15% with treated nylon nets, significantly reduced when both human baits were inside the treated bednets, but not when one or more baits were outside the treated bednet(s) within the house. Proportions of mosquitoes leaving houses < 3 h post-release were 53-59% from houses with untreated bednets versus 65-78% with treated bednets. Except in one case (when both humans were outside treated cotton nets), these increased early exit rates were significant, whether or not the human baits were inside the treated bednets indoors. Mortality rates of An.albimanus females exiting overnight (22.00-06.00 hours) averaged 15-39% from houses with treated cotton and 16-46% with treated nylon nets, very significantly greater than the control mean rates of 6-8% mortality with untreated nets. Observations on wild-caught An.albimanus females marked with fluorescent powder and released indoors revealed that few mosquitoes (3-11%) actually contacted the bednets unless both human baits remained under them - when contact rates were 22% on treated nylon, 23% on treated cotton and 42% on untreated nets (P approximately 0.05). The mean resting time was significantly longer on untreated (14.4 min) than on treated nylon (5.8 min) or cotton (9.5 min) bednets, whereas mean resting times on other surfaces indoors were 16.5-19.8 min. Proportions exiting within 2h of release were significantly more from houses with treated houses (33-35%) than with untreated nets (8%). However, mortality rates of mosquitoes that landed on treated nets were very significantly greater (90-100%) than after landing on untreated nets (10%). Thus, despite some excito-repellency, lambdacyhalothrin-impregnated bednets (especially made of nylon) proved to be effective as an alternative to house-spraying against An.albimanus.

Control of Anopheles albimanus mosquitos in southern Mexico by spraying their preferred indoor resting sites.

The traditional indoor spraying technique to control Anopheles albimanus mosquitos was compared with a selective method that targets their preferred resting sites in coastal villages of southern Mexico. We also determined whether mosquitos changed their preferred resting sites following insecticide applications. In the selective spraying approach, two 1-m wide horizontal swaths of bendiocarb insecticide were applied 0.75-1.75 m from the base of the walls and at 1-m upwards from the base of the inner roof at a target dose of 0.4 g/m2. A 2-year follow-up (1988-90), which included four insecticide treatments, showed that the selective spraying was as effective as full spraying for controlling A. albimanus. Also the mosquitos preferred resting sites that were not modified by the insecticide applications. Finally, the use of this techniques required 46% less time and cost 67% less than conventional spraying.

Quality evaluation of 10 years patient records in forensic odontology.

In forensic odontology, accurate detailed and complete recording of ante-mortem information is essential as the basis for odontological identification. Earlier studies on malpractice cases in Sweden indicated that the quality of the recording procedure was not always acceptable. Therefore, the aim of this retrospective study was to investigate the quality of ante-mortem records and its possible implications for identification work. All forensic odontology cases referred to the Department of Forensic Medicine in Göteborg between 1983 and 1992 were studied with regard to the instructions for dental records from the National Board of Health and Welfare. Information on dental characteristics, normal anatomical findings and restorative treatment was complete in 43 (68%) of the cases, incomplete in 17 (27%) and missing in 3 (5%). Registration of previous therapy was missing in about 75 (94%) of the records. It was possible to identify patient radiographs in only 16 of the 40 records where radiographs were available. In spite of this, the inaccuracies in the records did not seem to hamper the identification procedures in this study which could be explained by the character of the cases and the availability of medical and circumstantial information.

Intradomiciliary behavior of Anopheles albimanus on the coastal plain of southern Mexico: implications for malaria control.

The postfeeding indoor resting behavior of Anopheles albimanus in experimental houses in southern México was investigated by using a mark-recapture procedure. The majority of mosquitoes rested inside houses after taking a blood meal indoors. There was a higher landing frequency on interior surfaces other than walls and roofs; however, mosquitoes rested for longer periods on these 2 surfaces. Successive landings on walls after short flights showed that mosquitoes gradually increased their mean landing height from 1.0 to 1.4 m. Similarly, mosquitoes resting at the base of inner roofs had a successive landing height range of about 0.5 m. Based on these observations and the potential for reduction of nearly 50% in the quantity of insecticide used and the time needed to apply it, village-scale studies involving the selective spraying of a 1-m-wide swath of insecticide on walls and on roofs are recommended in this area.