Fluid therapy and pulmonary complications in abdominal surgeries: randomized controlled trial.

BACKGROUND: There is no consensus on the most effective strategy for Postoperative Pulmonary Complication (PPC) reduction. This study hypothesized that a Goal-Directed Fluid Therapy (GDFT) protocol of infusion of predetermined boluses reduces the occurrence of PPC in patients undergoing elective open abdominal surgeries when compared with Standard of Care (SOC) strategy. METHODS: Randomized, prospective, controlled study, conducted from May 2012 to December 2014, with ASA I, II or III patients undergoing open abdominal surgeries, lasting at least 120 min, under general anesthesia, randomized into the SOC and the GDFT group. In the SOC, fluid administration was according to the anesthesiologist's discretion. In the GDFT, the intervention protocol, based on bolus infusion according to blood pressure and delta pulse pressure, was applied. Patients were postoperatively evaluated by an anesthesiologist blinded to the group allocation regarding PPC incidence, mortality, and Length of Hospital Stay (LOHS). RESULTS: Forty-two patients in the SOC group and 43 in the GDFT group. Nineteen patients (45%) in the SOC and 6 in the GDFT (14%) had at least one PPC (p = 0.003). There was no difference in mortality or LOHS between the groups. Among the patients with PPC, four died (25%), compared to two deaths in patients without PPC (3%) (p = 0.001). The LOHS had a median of 14.5 days in the group with PPC and 9 days in the group without PPC (p = 0.001). CONCLUSION: The GDFT protocol resulted in a lower rate of PPC; however, the LOHS and mortality did not reduce.

Effect of 3D-Printed Honeycomb Core on Compressive Property of Hybrid Energy Absorbers: Experimental Testing and Optimization Analysis.

This paper presents an innovative method of constructing energy absorbers, whose primary function is to effectively transform kinetic energy into strain energy in events with high deformation rates. Hybrid specimens are proposed considering thin-walled windowed metallic tubes filled with 3D-printed hexagonal honeycombs made of PET-G and ABS thermoplastic. The patterned windows dimensions vary from 20 × 20, 20 × 30, 15 × 20 and 15 × 30 mm2. Although using polymers in engineering and thin-walled sections is not new, their combination has not been explored in this type of structure designed to withstand impacts. Specimens resist out-of-plane quasi-static axial loading, and test results are analyzed, demonstrating that polymer core gives the samples better performance parameters than unfilled samples regarding energy absorption (Ea), load rate (LR), and structural effectiveness (η). An optimization procedure using specialized software was applied to evaluate experimental results, which led to identifying the optimal window geometry (16.4 × 20 mm2, in case) and polymer to be used (ABS). The optimized sample was constructed and tested for axial compression to validate the optimization outcomes. The results reveal that the optimal sample performed similarly to the estimated parameters, making this geometry the best choice under the test conditions.

Influence of spontaneous and inoculated fermentation of açai on simulated digestion, antioxidant capacity and cytotoxic activity.

This work describes the kinetic study of different types (spontaneous, lactic and alcoholic) of açai fermentation in terms of total phenolics and total anthocyanins, as well as antioxidant capacity, before and after simulated digestion (SD). Cytotoxicity (A549, HCT8 and IMR90 cells) and formation of reactive oxygen species (A549 cells) were also evaluated. The results revealed that spontaneous fermentation (SF) for 24 h, followed by SD, generated a product with greater bioaccessibility of phenolics (52.68%) and cyanidin-3-glucoside (27.01%) than unfermented açai. Likewise, lactic fermentation (LF) for 72 h improved the bioavailability of phenolics (64.49%) and cyanidin-3-rutinoside (20.00%). On the other hand, alcoholic fermentation (AF) decreased the bioaccessibility of phenolic compounds and anthocyanins after SD. The SF 24 h (10.16 ± 1.25 µmol Trolox /g) and LF 72 h (15.90 ± 0.51 µmol Trolox /g) significantly increased the antioxidant capacity after SD, when compared to unfermented açai (SF 0 h, 4.00 ± 0.09 µmol Trolox /g; LF 0 h, 10.57 ± 0.91 µmol Trolox /g). It was concluded that the samples did not show cytotoxicity in the cell lines tested and, in addition, AF 24 h showed antioxidant and antimutagenic effects in vitro, reducing about 40% of chromosomal aberrations. The results obtained provide important information that can be used to produce foods with greater bioaccessibility of bioactive compounds.

Impact of different roasting conditions on the chemical composition, antioxidant activities, and color of Coffea canephora and Coffea arabica L. samples.

This work aimed to evaluate the physicochemical changes during the roasting process of Robusta and Arabica coffee. The highest content of total phenolics was detected in roasted coffee at temperatures of 135 °C/20.20 min, 210 °C/9.02 min, 210 °C/11.01 min, and 220 °C/13.47 min for both species. Robusta coffee showed greater antioxidant activity compared to Arabica coffee, except for the profiles at 230 °C/17.43 min and 275 °C/7.46 min that did not differ between samples by the DPPH and FRAP methods. For Arabica coffee, the antioxidant activity was independent of the roasting profile used. Robusta coffee presented higher values of the indexes b* (intensity of yellow vs blue), c* (chroma) and hue, being characterized as lighter and with greater chroma and hue. The highest levels of caffeoylquinic acid (5-CQA) were observed in Robusta coffee. Arabica coffee had lower trigonelline values. Caffeic acid and hydroxymethylfurfural were identified only in Robusta coffee. However, the results provided solid knowledge for the design of general properties and chemical compounds generated from binomials of roasting time and temperature that are little used in the world market.

Protein Coronas on Functionalized Nanoparticles Enable Quantitative and Precise Large-Scale Deep Plasma Proteomics.

Background: The wide dynamic range of circulating proteins coupled with the diversity of proteoforms present in plasma has historically impeded comprehensive and quantitative characterization of the plasma proteome at scale. Automated nanoparticle (NP) protein corona-based proteomics workflows can efficiently compress the dynamic range of protein abundances into a mass spectrometry (MS)-accessible detection range. This enhances the depth and scalability of quantitative MS-based methods, which can elucidate the molecular mechanisms of biological processes, discover new protein biomarkers, and improve comprehensiveness of MS-based diagnostics. Methods: Investigating multi-species spike-in experiments and a cohort, we investigated fold-change accuracy, linearity, precision, and statistical power for the using the Proteograph™ Product Suite, a deep plasma proteomics workflow, in conjunction with multiple MS instruments. Results: We show that NP-based workflows enable accurate identification (false discovery rate of 1%) of more than 6,000 proteins from plasma (Orbitrap Astral) and, compared to a gold standard neat plasma workflow that is limited to the detection of hundreds of plasma proteins, facilitate quantification of more proteins with accurate fold-changes, high linearity, and precision. Furthermore, we demonstrate high statistical power for the discovery of biomarkers in small- and large-scale cohorts. Conclusions: The automated NP workflow enables high-throughput, deep, and quantitative plasma proteomics investigation with sufficient power to discover new biomarker signatures with a peptide level resolution.

A comprehensive analysis of charge transfer effects on donor-pyrene (bridge)-acceptor systems using different substituents.

The alternant polycyclic aromatic hydrocarbon pyrene has photophysical properties that can be tuned with different donor and acceptor substituents. Recently, a D (donor)-Pyrene (bridge)-A (acceptor) system, DPA, with the electron donor N,N-dimethylaniline (DMA), and the electron acceptor trifluoromethylphenyl (TFM), was investigated by means of time-resolved spectroscopic measurements (J. Phys. Chem. Lett. 2021, 12, 2226-2231). DPA shows great promise for potential applications in organic electronic devices. In this work, we used the ab initio second-order algebraic diagrammatic construction method ADC(2) to investigate the excited-state properties of a series of analogous DPA systems, including the originally synthesized DPAs. The additionally investigated substituents were amino, fluorine, and methoxy as donors and nitrile and nitro groups as acceptors. The focus of this work was on characterizing the lowest excited singlet states regarding charge transfer (CT) and local excitation (LE) characters. For the DMA-pyrene-TFM system, the ADC(2) calculations show two initial electronic states relevant for interpreting the photodynamics. The bright S1 state is locally excited within the pyrene moiety, and an S2 state is localized ~0.5 eV above S1 and characterized as a donor to pyrene CT state. HOMO and LUMO energies were employed to assess the efficiency of the DPA compounds for organic photovoltaics (OPVs). HOMO-LUMO and optical gaps were used to estimate power conversion and light-harvesting efficiencies for practical applications in organic solar cells. Considering the systems using smaller D/A substituents, compounds with the strong acceptor NO2 substituent group show enhanced CT and promising properties for use in OPVs. Some of the other compounds with small substituents are also found to be competitive in this regard.

Machine Learning Determination of New Hammett's Constants for meta- and para-Substituted Benzoic Acid Derivatives Employing Quantum Chemical Atomic Charge Methods.

Hammett's constants σ quantify the electron donor or electron acceptor power of a chemical group bonded to an aromatic ring. Their experimental values have been successfully used in many applications, but some are inconsistent or not measured. Therefore, developing an accurate and consistent set of Hammett's values is paramount. In this work,we employed different types of machine learning (ML) algorithms combined with quantum chemical calculations of atomic charges to predict theoretically new Hammett's constants σm, σp, σm0, σp0, σp+, σp-, σR, and σI for 90 chemical donor or acceptor groups. New σ values (219), including previously unknown 92, are proposed. The substituent groups were bonded to benzene and meta- and para-substituted benzoic acid derivatives. Among the charge methods (Mulliken, Löwdin, Hirshfeld, and ChelpG), Hirshfeld showed the best agreement for most kinds of σ values. For each type of Hammett constant, linear expressions depending on carbon charges were obtained. The ML approach overall showed very close predictions to the original experimental values, with meta- and para-substituted benzoic acid derivative values showing the most accurate values. A new consistent set of Hammett's constants is presented, as well as simple equations for predicting new values for groups not included in the original set of 90.

A Hammett's analysis of the substituent effect in functionalized diketopyrrolopyrrole (DPP) systems: Optoelectronic properties and intramolecular charge transfer effects.

Diketopyrrolopyrrole (DPP) systems have promising applications in different organic electronic devices. In this work, we investigated the effect of 20 different substituent groups on the optoelectronic properties of DPP-based derivatives as the donor ( D )-material in an organic photovoltaic (OPV) device. For this purpose, we employed Hammett's theory (HT), which quantifies the electron-donating or -withdrawing properties of a given substituent group. Machine learning (ML)-based σ m , σ p , σ m 0 , σ p 0 , σ p + , σ p - , σ I , and σ R Hammett's constants previously determined were used. Mono- (DPP-X1 ) and di-functionalized (DPP-X2 ) DPPs, where X is a substituent group, were investigated using density functional theory (DFT), time-dependent DFT (TDDFT), and ab initio methods. Several properties were computed using CAM-B3LYP and the second-order algebraic diagrammatic construction, ADC(2), an ab initio wave function method, including the adiabatic ionization potential ( I P A ), the electron affinity ( E A A ), the HOMO-LUMO gaps ( E g ), and the maximum absorption wavelengths ( λ max ), the first excited state transition 1 S0 → 1 S1 energies ( ∆ E ) (the optical gap), and exciton binding energies. From the optoelectronic properties and employing typical acceptor systems, the power conversion efficiency ( PCE ), open-circuit voltage ( V OC ), and fill factor ( FF ) were predicted for a DPP-based OPV device. These photovoltaic properties were also correlated with the machine learning (ML)-based Hammett's constants. Overall, good correlations between all properties and the different types of σ constants were obtained, except for the σ I constants, which are related to inductive effects. This scenario suggests that resonance is the main factor controlling electron donation and withdrawal effects. We found that substituent groups with large σ values can produce higher photovoltaic efficiencies. It was also found that electron-withdrawing groups (EWGs) reduced E g and ∆ E considerably compared to the unsubstituted DPP-H. Moreover, for every decrease (increase) in the values of a given optoelectronic property of DPP-X1 systems, a more significant decrease (increase) in the same values was observed for the DPP-X2 , thus showing that the addition of the second substituent results in a more extensive influence on all electronic properties. For the exciton binding energies, an unsupervised machine learning algorithm identified groups of substituents characterized by average values (centroids) of Hammett's constants that can drive the search for new DDP-derived materials. Our work presents a promising approach by applying HT on molecular engineering DPP-based molecules and other conjugated molecules for applications on organic optoelectronic devices.

Small area vulnerability, household food insecurity and child malnutrition in Medellin, Colombia: results from a repeated cross-sectional study.

Background: Malnutrition and food insecurity might be driven not only by individual factors but also by contextual conditions, such as area-level deprivation or vulnerability. This study aimed to analyze the association between area-level vulnerability and i) household food insecurity and ii) malnutrition in children in Medellin, Colombia, during the years 2017 and 2018. Methods: We obtained data from two different sources: the Living Standards Measurement Survey (LSMS) and the nutrition surveillance system of Medellin. The main outcomes were food insecurity in households with children and anthropometric indicators for children under five. The main predictor was area-level vulnerability. Mixed effects Poisson regression with robust standard errors models were conducted to test the association of quintiles of deprivation with each outcome. Findings: Households with children living in areas with the highest deprivation had 1.9 times the prevalence of food insecurity as compared to those living in areas with the lowest deprivation (PR 1.91, 95% CI 1.42-2.57). Similar results were observed for underweight/risk of underweight (PR 1.26, 95% CI 1.11-1.42), stunting/risk of stunting (PR 1.36, 95% CI 1.22-1.53) and stunting (PR 1.93 95% CI 1.55-2.39) among children under five. We found no consistent associations with wasting/risk of wasting or excess weight/risk of overweight across quintiles of deprivation. Interpretation: This study sheds light on the role of area-level vulnerability on malnutrition in children in Medellin, Colombia, showing a pattern of increasing prevalence of food insecurity, underweight and stunting by quintile of deprivation. Funding: Swiss School of Public Health (SSPH+) and Centre for Global Health Inequalities Research (CHAIN).

Oral health policies and decision-making process in Brazil, Colombia and Chile.

Public health policies are crucial for the well-being of the general population; however, the health systems of developed countries still do not include oral health in its system. Thus, it is necessary to understand the process of decision-making in oral health policies to create opportunities for countries to achieve an overall positive health outcome, including oral health. This study aimed to identify the factors influencing the inclusion of oral health on the political agenda in Brazil, Colombia, and Chile. The study sample involved decision-makers at political, technical, and academic levels. The extracted data were analyzed using the software Maxqda® and Kingdon´s theoretical model; defining interactive variables that produce a "window of opportunity" to define the agenda and the insertion of theme in formulating public policies. The decision-making process regarding oral health is influenced by many factors like the need to improve the overall oral health of the population, identified through national epidemiological studies, and the importance of individuals in positions involving political decision-making, who advocate for oral health. Strategies were developed in partnership with the academy that focused on the health rights of the population provided by law; territorial and national programs were also developed. The inclusion and creation of oral health policies depend on actors who advocate for thematic and scientific evidence to support decision-making. A close relationship between academia and stakeholders and knowledge translation is important for the development of public policies that can be effective for health systems.

Characterization of third generation cephalosporin-resistant Escherichia coli clinical isolates from Ushuaia, Argentina / Caracterización de aislamientos clínicos de Escherichia coli resistente a cefalosporinas de tercera generación de Ushuaia, Argentina

Abstract Escherichia coli is one of the main human pathogens causing different hospital- and community-acquired infections. During the period from January 2013 to March 2015, 1.96% (32/1632) of E. coli isolates recovered at the Hospital Regional de Ushuaia, Tierra del Fuego province, were resistant to third-generation cephalosporins (TGCs). These isolates were resistant to cefotaxime (91%) and/or ceftazidime (28%). No resistance to carbapenems was detected. Twenty-six isolates were positive for blaCTX-M gene, grouped as CTX-M-1/15 (54%); CTX-M-9/14 (25%); CTX-M-2 (17%); and CTX-M-1/15 plus CTX-M-9/14 (4%). Five TGC-resistant strains were positive for blaCMY gene, while one strain harbored TEM-19 ESBL. Twelve isolates were identified as ST131 E. coli hyperepidemic clone, and one as ST69. Genome sequence analysis of seven blaCTX-M-15 E. coli selected isolates confirm the circulation of ST131, ST617 and ST405 international high-risk clones in the city of Ushuaia.

Resumen Escherichia coli es uno de los principales patógenos humanos causantes de diferentes infecciones de inicio hospitalario y comunitario. Se determinó que el 1,96% (32/1.632) de los aislamientos de E. coli recuperados entre enero de 2013 y marzo de 2015 en el Hospital Regional de Ushuaia, provincia de Tierra del Fuego, fueron resistentes a cefalosporinas de tercera generación (CTG). Estos aislamientos fueron resistentes a cefotaxima (91%) y/o a ceftazidima (28%). No se detectó resistencia a los carbapenemes. Veintiséis aislamientos fueron positivos para el gen blaCTX-M, agrupados como CTX-M-1/15 (54%), CTX-M-9/14 (25%), CTX-M-2 (17%) y CTX-M-1/15 más CTX-M-9/14 (4%). Cinco cepas resistentes a CTG dieron positivo para el gen blaCMY, mientras que un aislamiento presentó la BLEE TEM-19. Doce aislamientos se identificaron como clon hiperepidémico E. coli ST131 y uno como ST69. El análisis de las secuencias del genoma de siete aislamientos seleccionados de E. coli blaCTX-M-15 confirmó la circulación de los clones internacionales de alto riesgo ST131, ST617 y ST405 en la ciudad de Ushuaia.

The impact of COVID-19 pandemic on the quality of life of healthcare workers and the associated factors: A systematic review.

Introduction: The COVID-19 pandemic has exacerbated health issues in healthcare workers which in turn impacts their quality of life. Objective: This review aimed to (i) analyze the impact of the COVID-19 pandemic on the quality of life of healthcare professionals and (ii) identify the associated factors with quality of life. Materials and methods: We conducted a systematic review using the PRISMA guidelines previously registered in PROSPERO (CRD42021253075). The searched in Web of Science, Scopus, MEDLINE and EMBASE databases included original articles published till May 2021. Results: We found 19 articles and 14,352 professionals in total, the median age ranged from 29 to 42.5 years and 37% of the studies used the WHOQOL-BREF instrument to assess the outcome. The report was heterogeneous, 7 studies described global scores and 9 by domains. Depression, anxiety and stress were commonly reported factors affecting professional's quality of life and this was significantly lower among professionals working with COVID-19 patients compared to their counterparts. Conclusion: COVID-19 frontline workers perceived lower quality of life, which was mainly associated with psychological states such as the aforementioned besides to working conditions like not being previously trained in COVID-19 cases. On the other hand, social support, resilience and active coping could improved their quality of life.

Introducción: La pandemia de COVID-19 ha agravado los problemas de salud del personal sanitario, lo que a su vez repercute en su calidad de vida. Objetivo: Esta revisión tiene como objetivo: (a) Analizar el impacto de la pandemia COVID-19 en la calidad de vida de los profesionales sanitarios y (2) Identificar los factores asociados a su calidad de vida. Materiales y métodos: Se realizó una revisión sistemática utilizando las pautas PRISMA previamente registradas en PROSPERO (CRD42021253075). La búsqueda en las bases de datos Web of Science, Scopus, MEDLINE y EMBASE incluyó artículos originales publicados hasta mayo de 2021. Resultados: Se encontraron 19 artículos y 14.352 profesionales en total, la mediana de edad osciló entre 29 y 42,5 años y el 37% de los estudios utilizaron el instrumento WHOQOL-BREF para evaluar el resultado. El informe fue heterogéneo, 7 estudios describieron puntuaciones globales y 9 por dominios. La depresión, la ansiedad y el estrés fueron los factores comúnmente reportados que afectan a la calidad de vida del profesional, y esta fue significativamente menor entre los profesionales que trabajan con pacientes de COVID-19 en comparación con sus homólogos. Conclusión: Los trabajadores de primera línea de COVID-19 percibieron una menor calidad de vida, que se asoció principalmente a estados psicológicos como los mencionados, además de a condiciones de trabajo como no haber recibido formación previa en casos de COVID-19. Por otro lado, el apoyo social, la resiliencia y el afrontamiento activo mejoraron su calidad de vida.

Characterization of third generation cephalosporin-resistant Escherichia coli clinical isolates from Ushuaia, Argentina.

Escherichia coli is one of the main human pathogens causing different hospital- and community-acquired infections. During the period from January 2013 to March 2015, 1.96% (32/1632) of E. coli isolates recovered at the Hospital Regional de Ushuaia, Tierra del Fuego province, were resistant to third-generation cephalosporins (TGCs). These isolates were resistant to cefotaxime (91%) and/or ceftazidime (28%). No resistance to carbapenems was detected. Twenty-six isolates were positive for blaCTX-M gene, grouped as CTX-M-1/15 (54%); CTX-M-9/14 (25%); CTX-M-2 (17%); and CTX-M-1/15 plus CTX-M-9/14 (4%). Five TGC-resistant strains were positive for blaCMY gene, while one strain harbored TEM-19 ESBL. Twelve isolates were identified as ST131 E. coli hyperepidemic clone, and one as ST69. Genome sequence analysis of seven blaCTX-M-15E. coli selected isolates confirm the circulation of ST131, ST617 and ST405 international high-risk clones in the city of Ushuaia.

Oral health policies and decision-making process in Brazil, Colombia and Chile

Abstract Public health policies are crucial for the well-being of the general population; however, the health systems of developed countries still do not include oral health in its system. Thus, it is necessary to understand the process of decision-making in oral health policies to create opportunities for countries to achieve an overall positive health outcome, including oral health. This study aimed to identify the factors influencing the inclusion of oral health on the political agenda in Brazil, Colombia, and Chile. The study sample involved decision-makers at political, technical, and academic levels. The extracted data were analyzed using the software Maxqda® and Kingdon´s theoretical model; defining interactive variables that produce a "window of opportunity" to define the agenda and the insertion of theme in formulating public policies. The decision-making process regarding oral health is influenced by many factors like the need to improve the overall oral health of the population, identified through national epidemiological studies, and the importance of individuals in positions involving political decision-making, who advocate for oral health. Strategies were developed in partnership with the academy that focused on the health rights of the population provided by law; territorial and national programs were also developed. The inclusion and creation of oral health policies depend on actors who advocate for thematic and scientific evidence to support decision-making. A close relationship between academia and stakeholders and knowledge translation is important for the development of public policies that can be effective for health systems.

Pathway to a land-neutral expansion of Brazilian renewable fuel production.

Biofuels are currently the only available bulk renewable fuel. They have, however, limited expansion potential due to high land requirements and associated risks for biodiversity, food security, and land conflicts. We therefore propose to increase output from ethanol refineries in a land-neutral methanol pathway: surplus CO2-streams from fermentation are combined with H2 from renewably powered electrolysis to synthesize methanol. We illustrate this pathway with the Brazilian sugarcane ethanol industry using a spatio-temporal model. The fuel output of existing ethanol generation facilities can be increased by 43%-49% or ~100 TWh without using additional land. This amount is sufficient to cover projected growth in Brazilian biofuel demand in 2030. We identify a trade-off between renewable energy generation technologies: wind power requires the least amount of land whereas a mix of wind and solar costs the least. In the cheapest scenario, green methanol is competitive to fossil methanol at an average carbon price of 95€ tCO2-1.

Exploratory multigroup structural equation modeling approach to analyzing H. pylori infection, serological pepsinogen levels, and life style factors in an elderly population in Costa Rica / Enfoque exploratorio del modelo de ecuaciones estructurales multigrupo para el análisis de la infección con H. pylori, niveles de pepsinógenos séricos y factores asociados a estilo de vida en una población de adultos mayores en Costa Rica

Abstract The aim of this work is to describe and analyze the association of PGI/PGII ratio (indicator of gastric atrophy) with H. pylori-CagA and life style factors such as caloric intake, obesity, and harmful habits amongst H. pylori-positive elderly people infected in Costa Rica using an exploratory multigroup structural equations model (SEM). Using a sample of 1748 H. pylori-positive elderly people from CRELES first wave study, a SEM was employed analyze if the relationships between PGI/PGII ratio with levels of H. pylori-CagA, caloric intake, obesity, and harmful habits, differs by sex, age and risk areas subgroups. The proposed SEMs exhibited a good fit in males (RMSEA = 0.039), females (RMSEA = 0.000), low-risk area (RMSEA = 0.038), middle-risk area (RMSEA = 0.042), individuals under 80 years (RMSEA = 0.038) and individuals aged 80 and over (RMSEA = 0.042), while an acceptable fit was observed for the high-risk area (RMSEA = 0.061). Fitted SEMs showed that CagA predicted PG-ratio as expected, with effects increasing with the risk area, but similar between sex and age groups. All indicators measuring obesity (BMI, arms, and waist) showed significant standardized coefficients, with similar effects between sex, age and risk area groups. No other significant effects or differences between groups were identified. We propose a good-fitted SEM model for the possible relationships between CagA and PG ratio and the geographical risk area level for elderly people. No differences were observed on measured parameters between male and female population, or between under 80 years and older individuals.

Resumen El objetivo de este trabajo es describir y analizar la asociación entre PGI/PGII (indicador de atrofia gástrica con H. pylori-CagA y factores asociados a estilo de vida como ingesta calórica, obesidad y hábitos nocivos entre adultos mayores positivos por H. pylori en Costa Rica utilizando modelos de ecuaciones estructurales multigrupo (SEM). Con una muestra de 1748 adultos mayores del estudio CRELES, se utilizó un SEM para analizar las relaciones entre PGI/PGII, CagA, ingesta calórica, obesidad y hábitos nocivos difieren por sexo, edad y áreas de riesgo. Los SEMs propuestos exhibieron un buen ajuste en hombres (RMSEA = 0.039), mujeres (RMSEA = 0.000), área de bajo riesgo (RMSEA = 0.038), áreas de riesgo medio (RMSEA = 0.042), individuos menores de 80 años (RMSEA = 0.038) e individuos de 80 años o más (RMSEA = 0.042), mientras que hubo un ajuste aceptable en áreas de alto riesgo (RMSEA = 0.061). Los SEMs ajustados mostraron que CagA predice la relación PGI/II en la dirección esperada con efectos proporcionales al área de riesgo, pero no por sexo y edad. Todos los indicadores medibles de obesidad (IMC, brazos y cintura) mostraron coeficientes estandarizados significativos con efectos similares entre los grupos por sexo, edad y área de riesgo. No se encontraron otros efectos o diferencias significativas. Proponemos un modelo SEM bien ajustado para las posibles relaciones entre CagA y PGI/II y el nivel de riesgo del área geográfica en adultos mayores. No se encontraron diferencias en las variables analizadas entre hombres y mujeres ni entre los grupos de edad.

Cochlear implant complications in a low-income area of Brazil.

OBJECTIVE: The primary objective was to analyze and report on the complications that occurred in the cochlear implant surgeries performed at a large philanthropic teaching hospital located in a low-income area of Brazil. METHODS: A historical cohort study that analyzed surgical records of 432 patients of all age groups and both genders who received unilateral cochlear implant in a tertiary referral center that serves only Brazil's Public Health Care System patients, from February 2009 to December 2017. RESULTS: A total of 67 (15.5%) complications occurred in the cochlear implant surgeries, with 21 (5.4%) major complications. Minor complications occurred in 50 (12%) cases. The most frequent major complication was receiver-stimulator displacement (four cases). There were three cases of hardware failure. Only one case of meningitis and one case of facial nerve paralysis (grade VI in House-Brackmann scale) were found. Six patients needed to be explanted due to a major complication. The relative risk of major complications in the population aged 60 years and older was 4.41 (1.53-12.72; 95% confidence interval [CI]). CONCLUSIONS: Elderly patients suffered more complications than younger patients. receiver-stimulator displacement and dizziness were the most frequent complications (major and minor, respectively). The overall complication rates were comparable to those in the literature. Age as an isolated risk factor for complications in cochlear implant surgery is a path to be explored in future observations.

Cochlear implant complications in a low-income area of Brazil

SUMMARY OBJECTIVE: The primary objective was to analyze and report on the complications that occurred in the cochlear implant surgeries performed at a large philanthropic teaching hospital located in a low-income area of Brazil. METHODS: A historical cohort study that analyzed surgical records of 432 patients of all age groups and both genders who received unilateral cochlear implant in a tertiary referral center that serves only Brazil's Public Health Care System patients, from February 2009 to December 2017. RESULTS: A total of 67 (15.5%) complications occurred in the cochlear implant surgeries, with 21 (5.4%) major complications. Minor complications occurred in 50 (12%) cases. The most frequent major complication was receiver-stimulator displacement (four cases). There were three cases of hardware failure. Only one case of meningitis and one case of facial nerve paralysis (grade VI in House-Brackmann scale) were found. Six patients needed to be explanted due to a major complication. The relative risk of major complications in the population aged 60 years and older was 4.41 (1.53-12.72; 95% confidence interval [CI]). CONCLUSIONS: Elderly patients suffered more complications than younger patients. receiver-stimulator displacement and dizziness were the most frequent complications (major and minor, respectively). The overall complication rates were comparable to those in the literature. Age as an isolated risk factor for complications in cochlear implant surgery is a path to be explored in future observations.

Nurturing care indicators for the Brazilian Early Childhood Friendly Municipal Index (IMAPI).

The Nurturing Care Framework (NCF) calls for establishing a global monitoring and accountability systems for early childhood development (ECD). Major gaps to build low-cost and large-scale ECD monitoring systems at the local level remain. In this manuscript, we describe the process of selecting nurturing care indicators at the municipal level from existing routine information systems to develop the Brazilian Early Childhood Friendly Index (IMAPI). Three methodological steps developed through a participatory decision-making process were followed. First, a literature review identified potential indicators to translate the NCF domains. Four technical panels composed of stakeholders from federal, state and municipal levels were consulted to identify data sources, their availability at the municipal level and the strengths and weakness of each potential indicator. Second, national and international ECD experts participated in two surveys to score, following a SMART approach, the expected performance of each nurturing care indicator. This information was used to develop analytical weights for each indicator. Third, informed by strengths and weaknesses pointed out in the previous steps, the IMAPI team reached consensus on 31 nurturing care indicators across the five NCF domains (Good health [n = 14], Adequate nutrition [4], Responsive caregiving [1], Opportunities for early learning [7] and Security and safety [4]). IMAPI represents the first attempt to select nurturing care indicators at the municipal level using data from existing routine information systems.