Mitigating Alarm Fatigue and Improving the Bedside Experience by Reducing Nonactionable Alarms.

OBJECTIVE: To assess whether conditional bedside alarm triggers can reduce the frequency of nonactionable alarms without compromising patient safety and enhance nursing and family satisfaction. STUDY DESIGN: Single-center, quality improvement initiative in an acute care cardiac unit and pediatric intensive care unit. Following the 4-week preintervention baseline period, bedside monitors were programmed with hierarchical time delay and conditional alarm triggers. Bedside alarms were tallied for 4 weeks each in the immediate postintervention period and 2-year follow-up. The primary outcome was alarms per monitored patient day. Nurses and families were surveyed preintervention and postintervention. RESULTS: A total of 1509 patients contributed to 2034, 1968, and 2043 monitored patient days which were evaluated in the baseline, follow-up, and 2-year follow-up periods, respectively. The median number of alarms per monitored patient day decreased by 75% in the pediatric intensive care unit (P < .001) and 82% in the acute care cardiac unit (P < .001) with sustained effect at the 2-year follow-up. No increase of rapid response calls, emergent transfers, or code events occurred in either unit. Nursing surveys reported an improved capacity to respond to alarms and fewer perceived nonactionable alarms. Family surveys, however, did not demonstrate improved sleep quality. CONCLUSIONS: Implemented changes to bedside monitor alarms decreased total alarm frequency in both the acute care cardiac unit and pediatric intensive care unit, improving the care provider experience without compromising safety.

Locus coeruleus noradrenaline depletion and its differential impact on CO2-induced panic and hyperventilation in male and female mice.

CO2 exposure has been used to investigate the panicogenic response in patients with panic disorder. These patients are more sensitive to CO2, and more likely to experience the "false suffocation alarm" which triggers panic attacks. Imbalances in locus coeruleus noradrenergic (LC-NA) neurotransmission are responsible for psychiatric disorders, including panic disorder. These neurons are sensitive to changes in CO2/pH. Therefore, we investigated if LC-NA neurons are differentially activated after severe hypercapnia in mice. Further, we evaluated the participation of LC-NA neurons in ventilatory and panic-like escape responses induced by 20% CO2 in male and female wild type mice and two mouse models of altered LC-NA synthesis. Hypercapnia activates the LC-NA neurons, with males presenting a heightened level of activation. Mutant males lacking or with reduced LC-NA synthesis showed hypoventilation, while animals lacking LC noradrenaline present an increased metabolic rate compared to wild type in normocapnia. When exposed to CO2, males lacking LC noradrenaline showed a lower respiratory frequency compared to control animals. On the other hand, females lacking LC noradrenaline presented a higher tidal volume. Nevertheless, no change in ventilation was observed in either sex. CO2 evoked an active escape response. Mice lacking LC noradrenaline had a blunted jumping response and an increased freezing duration compared to the other groups. They also presented fewer racing episodes compared to wild type animals, but not different from mice with reduced LC noradrenaline. These findings suggest that LC-NA has an important role in ventilatory and panic-like escape responses elicited by CO2 exposure in mice.

In Situ Accumulation of CaOx Crystals in C. quitensis Leaves and Its Relationship with Anatomy and Gas Exchange.

The accumulation of crystal calcium oxalate (CaOx) in plants is linked to a type of stress-induced photosynthesis termed 'alarm photosynthesis', serving as a carbon reservoir when carbon dioxide (CO2) exchange is constrained. Colobanthus quitensis is an extremophyte found from southern Mexico to Antarctica, which thrives in high-altitude Andean regions. Growing under common garden conditions, C. quitensis from different latitudinal provenances display significant variations in CaOx crystal accumulation. This raises the following questions: are these differences maintained under natural conditions? And is the CaOx accumulation related to mesophyll conductance (gm) and net photosynthesis (AN) performed in situ? It is hypothesized that in provenances with lower gm, C. quitensis will exhibit an increase in the use of CaOx crystals, resulting in reduced crystal leaf abundance. Plants from Central Chile (33°), Patagonia (51°), and Antarctica (62°) were measured in situ and sampled to determine gas exchange and CaOx crystal accumulation, respectively. Both AN and gm decrease towards higher latitudes, correlating with increases in leaf mass area and leaf density. The crystal accumulation decreases at higher latitudes, correlating positively with AN and gm. Thus, in provenances where environmental conditions induce more xeric traits, the CO2 availability for photosynthesis decreases, making the activation of alarm photosynthesis feasible as an internal source of CO2.

Cáncer en el paciente pediátrico ¿cuándo sospecharlo? ¿cuándo alarmarse?

Resumen El cáncer infantil se presenta frecuentemente de forma inespecífica, simulando otras enfermedades de curso benigno. Este hecho, asociado a su baja incidencia, dificulta la sospecha y el diagnóstico de cáncer infantil. Si se hace este último de manera precoz junto con la rápida derivación a un centro especializado, se reducen significativamente la morbilidad y la mortalidad, lo que favorece el pronóstico de la enfermedad. Existen muchos signos y síntomas que deben alarmar al médico e incluso a los familiares: palidez, fiebre de larga duración, dolor de cabeza, adenopatías, sangrados o moretones, debilidad marcada, masas, marcha anormal, anormalidades oculares, dolor músculo esquelético, entre otros. Aunque estos tienden a ser inespecíficos, es importante detectar oportunamente los signos de alarma y bandera roja para mejorar la supervivencia en la población pediátrica con esta condición. Con base en la literatura, el objetivo de este artículo de revisión es caracterizar las manifestaciones clínicas en el paciente pediátrico que sugieren una rápida intervención y búsqueda de una neoplasia en él. Metodología de búsqueda Se realizó una búsqueda en la literatura desde el 1 de febrero hasta el 31 de marzo de 2022, en PUBMED, GOOGLE SCHOLAR, MEDLINE, UPTODE con los términos MESH "Neoplasias", "Cáncer infantil", "Signos y síntomas", "Alarma". Los criterios de inclusión fueron artículos que trataran como tema central el cáncer infantil, sus síntomas y signos de alarma, así mismo, se incluyeron libros, artículos de revista, revisiones de tema y reportes de caso publicados en los últimos 20 años en inglés y español; obteniéndose inicialmente 40 artículos. Se excluyeron los relacionados a cáncer en adultos. Aquellos duplicados o con contenido insuficiente o no relevante para desarrollar el tema, tampoco fueron tenidos en cuenta. Finalmente, resultaron 35 publicaciones, de las cuales 22 fueron considerados acordes al objetivo del presente estudio.

Abstract Childhood cancer frequently presents in a non-specific manner, simulating other benign diseases. This fact, associated with its low incidence, difficults the suspicion and diagnosis of childhood cancer. Early diagnosis and prompt referral to a specialized center significantly reduce morbidity and mortality, improving the prognosis of the disease. There are many signs and symptoms that should alarm the physician and even family members, which are: pallor, long-lasting fever, headache, lymphadenopathy, bleeding, or bruising, marked weakness, masses, abnormal gait, ocular abnormalities, skeletal muscle pain, among others. Although these are usually nonspecific, it is important to detect early warning signs and red flags to improve survival in the pediatric population with this condition. Based on the literature, the objective of this review article is to characterize the clinical manifestations in the pediatric patient that suggest a rapid intervention and search for a neoplasm in the child.

Early warning systems and end-user decision-making: A risk formalism tool to aid communication and understanding.

In this work, we introduce a formalism to highlight the role of decision-making implicit in the setup of early warning systems (EWSs) and its consequences with respect to loss avoidance for end users. The formalism, a close relative of the cost/loss approach, combines EWS verification scores with traditional expressions of risk from the point of view of the user. This formalism articulates in mathematical format many well-known issues surrounding EWS usage, offering a conceptual anchor for concepts that otherwise may seem to wobble among the multidisciplinary perspectives participating in the EWS chain. This decision model is visually represented in a variation of the popular "performance diagram" used in forecast and warning verification. Our diagram adds to this the perspective of a generic user, in an effort to gain insight into how choices made regarding EWS settings may determine which users benefit from warnings and which do not. Although these results are based on a conceptual model, they are useful to better understand the actual benefits experienced by users and to highlight aspects that may temper unrealistic expectations on EWSs. The recent United Nations initiative to extend EWSs for natural hazards to all nations within 5 years will make EWSs more common and more public. The approach proposed here can be a tool to promote greater transparency and improve the necessary dialog between warning issuers and users in order to reduce loss.

How to perceive the insecticide? The Neotropical termite Nasutitermes corniger (Termitidae: Nasutitermitinae) triggers alert behavior after exposure to imidacloprid.

In eusocial insects, alarm signaling is used to inform nestmates about threats such as predators, competitors, and pathogens. Such behavior is important for the survival of colonies. However, studies evaluating the effect of insecticides on the alarm in termites have not yet been reported. Here, we inspected the effects of insecticide on alarm communication in Nasutitermes corniger. Specifically, we test the following hypotheses: (1) termite groups exposed to insecticide imidacloprid increase the body shaking movements, displaying an alert behavior; and (2) the alert behavior displayed after exposition to insecticide is dose dependent. Bioassays were conducted evaluating the body shaking movements and walking activity of termite groups exposed and non-exposed to insecticide. Thereafter, body shaking movements were evaluated in groups submitted to different doses of insecticide. In general, exposing termite groups to insecticide resulted in significantly higher body shaking movements compared to non-exposed groups. There was a positive effect of imidacloprid doses on the shaking movements. Walking activity, however, decreases in those groups exposed to the insecticide. Our results demonstrate the existence of 'insecticide alert behavior' in N. corniger and it appears to be a previously unrecognized communication mechanism in termites that allows for reducing the intoxication risks in the colony.

Improving the Management of Children with Fevers by Healers in Native Rural Areas in the South of Ecuador.

BACKGROUND: Indigenous populations are represented among the poor and disadvantaged in rural areas. High rates of infectious diseases are observed in indigenous child populations, and fever as a general symptom is common. OBJECTIVE: We aim to improve the skills of healers in rural indigenous areas in the South of Ecuador for managing children with fevers. METHOD: We performed participatory action research (PAR) for this study with 65 healers. RESULTS: The PAR focused on the following four phases: (1) 'observation,' eight focus groups were used. (2) 'planning' phase was developed, and with culturally reflective peer group sessions, a culturally adapted flowchart was constructed titled "Management of children with fever." In phase (3): 'action', the healers were trained to manage children with fever. Phase (4): 'evaluation', 50% of the healers used the flowchart. CONCLUSIONS: Explicit recognition of the need for traditional healers and health professionals in indigenous communities to work together to improve health indicators such as infant mortality exists. Additionally, strengthening the transfer system in rural areas is based on knowledge and cooperation between the community and the biomedical system.

Zebrafish (Danio rerio): comportamento social

The Danio rerio fish (zebrafish) is an experimental animal with many positive features, such as: low maintenance cost, small size, high fecundity, rapid development, high genetic and physiological homology compared to humans, among others. The work discusses their social behavior, elucidating aspects mainly related to aggressiveness, dominance, stress and chemical signaling. Behavioral plasticity was also addressed and behavioral mechanisms that indicate abnormalities were also exposed.

O peixe Danio rerio (zebrafish) é um animal experimental com muitos recursos positivos, tais como: baixo custo para manutenção, tamanho pequeno, alta fecundidade, rápido desenvolvimento, alta homologia genética e fisiológica comparada com os humanos, dentre outros. O trabalho realizado discorre sobre seu comportamento social, elucidando aspectos relacionados principalmente a agressividade, dominância, stress e sinalização química. A plasticidade comportamental também foi abordada e os mecanismos comportamentais que indicam anormalidades também foram expostos.

A detailed alarm management report as a tool for the treatment of bad actors at a gas logistics plant.

BACKGROUND: The treatment of bad actors consists of analyzing the most triggered alarms at a plant, seeking to make modifications that provide workers with more efficient and safer operational conditions. The consideration of plant operators' practical knowledge in these proposed changes is both an opportunity and a challenge, as specific conditions are required. OBJECTIVE: To present and discuss how an alarm management report (AMR) could support the treatment of bad actors by promoting structured debates on real work situations and its contribution in improving the solutions proposed by alarm management committees (AMCs). METHODS: Data from nine AMC meetings were gathered and parsed using qualitative content analysis to classify the kind of information that the AMC used to justify the proposed changes and how these changes were decided. RESULTS: More than 60% of the changes were justified by information provided by the AMRs, indicating broad application and adoption. However, our findings suggest that the structured debates addressed variability and emerging strategies and may consider entire subsystems instead of single alarms. CONCLUSION: The use of structured debates is feasible for the treatment of bad actors and is an appropriate option that includes operating experience feedback for alarm optimization in industrial facilities.

Parametrização dos alarmes de frequência respiratória em ventiladores mecânicos de pacientes durante o banho / Parameterization of respiratory rate alarms in mechanical ventilators of patients during the bath / Parametrización de las alarmas de frecuencia respiratoria en ventiladores mecánicos de pacientes durante el baño

RESUMO Objetivo: medir os efeitos da parametrização dos alarmes sonoros de frequência respiratória dos ventiladores mecânicos para redução do número de alarmes disparados durante o banho no leito. Método: ensaio clínico pragmático, para comparar o número de alarmes do ventilador mecânico nos grupos: intervenção - os alarmes de Frequência Respiratória foram parametrizados no início do banho; controle - não realizada parametrização. Estudo registrado em 27/08/2019 no Registro Brasileiro de Ensaios Clínicos, RBR-6y6tyc, Rio de Janeiro, Brasil. Resultados: os modelos de regressão evidenciaram que a parametrização, realizada e mantida durante e após o banho no grupo intervenção, teve o efeito de aumentar 12,5 e 6,4 vezes, respectivamente, o número médio de disparos de alarmes de frequência respiratória alta; e não teve efeito nos alarmes de frequência respiratória baixa. Conclusão: a contribuição deste estudo é auxiliar os profissionais de saúde na formulação de protocolos de parametrização individualizada dos alarmes dos Ventiladores Mecânicos.

ABSTRACT Objective: to measure the effects of parameterizing the audible respiratory rate alarms of mechanical ventilators to reduce the number of alarms triggered during bed bath. Method: pragmatic clinical trial, to compare the number of alarms of the mechanical ventilator, in the groups: intervention - the Respiratory Rate alarms were parameterized at the beginning of the bath; control - no parameterization performed. Study registered on 27/08/2019 in the Brazilian Registry of Clinical Trials, RBR-6y6tyc, Rio de Janeiro, Brazil. Results: Regression models showed that parameterization, performed and maintained during and after bath in the intervention group, had the effect of increasing the average number of high respiratory rate alarm triggers by 12.5 and 6.4 times, respectively; and had no effect on low respiratory rate alarms. Conclusion: The contribution of this study is to assist health professionals in formulating protocols for individualized parameterization of alarms for Mechanical Ventilators.

RESUMEN Objetivo: medir los efectos de la parametrización de las alarmas sonoras de frecuencia respiratoria de los ventiladores mecánicos para reducir el número de alarmas disparadas durante el baño en cama. Método: ensayo clínico pragmático, para comparar el número de alarmas del ventilador mecánico en los grupos: intervención - se parametrizaron las alarmas de Frecuencia Respiratoria al inicio del baño; control - no se realizó parametrización. Estudio registrado el 27/08/2019 en el Registro Brasileño de Ensayos Clínicos, RBR-6y6tyc, Río de Janeiro, Brasil. Resultados: Los modelos de regresión mostraron que la parametrización, realizada y mantenida durante y después del baño en el grupo de intervención, tuvo el efecto de aumentar 12,5 y 6,4 veces, respectivamente, el número medio de disparos de alarmas de frecuencia respiratoria alta; y no tuvo ningún efecto sobre las alarmas de frecuencia respiratoria baja. Conclusión: la contribución de este estudio es ayudar a los profesionales de la salud en la formulación de protocolos para la parametrización individual de las alarmas de los Ventiladores Mecánicos.

Understanding sex differences in zebrafish pain- and fear-related behaviors.

Sex is an important variable in translational biomedical research. While overt sex differences have been reported for pain and fear-like behaviors in humans and rodents, these differences in other popular model organisms, such as zebrafish, remain poorly understood. Here, we evaluate potential sex differences in zebrafish behavioral responses to pain (intraperitoneal administration of 5% acetic acid) and fear stimuli (exposure to alarm substance). Overall, both male and female zebrafish exposed to pain (acetic acid injection) show lesser distance traveled, fewer top entries and more writhing-like pain-related behavior vs. controls, whereas female fish more robustly (than males) altered some other pain-like behaviors (e.g., increasing freezing episodes and time in top) in this model. In contrast, zebrafish of both sexes responded equally strongly to fear evoked by acute alarm substance exposure. Collectively, these findings emphasize the growing importance of studying sex differences in zebrafish behavioral and pain models.

Parametrização dos alarmes de frequência respiratória em ventiladores mecânicos de pacientes durante o banho / Parameterization of respiratory rate alarms in mechanical ventilators of patients during the bath / Parametrización de las alarmas de frecuencia respiratoria en ventiladores mecánicos de pacientes durante el baño

RESUMO Objetivo: medir os efeitos da parametrização dos alarmes sonoros de frequência respiratória dos ventiladores mecânicos para redução do número de alarmes disparados durante o banho no leito. Método: ensaio clínico pragmático, para comparar o número de alarmes do ventilador mecânico nos grupos: intervenção - os alarmes de Frequência Respiratória foram parametrizados no início do banho; controle - não realizada parametrização. Estudo registrado em 27/08/2019 no Registro Brasileiro de Ensaios Clínicos, RBR-6y6tyc, Rio de Janeiro, Brasil. Resultados: os modelos de regressão evidenciaram que a parametrização, realizada e mantida durante e após o banho no grupo intervenção, teve o efeito de aumentar 12,5 e 6,4 vezes, respectivamente, o número médio de disparos de alarmes de frequência respiratória alta; e não teve efeito nos alarmes de frequência respiratória baixa. Conclusão: a contribuição deste estudo é auxiliar os profissionais de saúde na formulação de protocolos de parametrização individualizada dos alarmes dos Ventiladores Mecânicos.

ABSTRACT Objective: to measure the effects of parameterizing the audible respiratory rate alarms of mechanical ventilators to reduce the number of alarms triggered during bed bath. Method: pragmatic clinical trial, to compare the number of alarms of the mechanical ventilator, in the groups: intervention - the Respiratory Rate alarms were parameterized at the beginning of the bath; control - no parameterization performed. Study registered on 27/08/2019 in the Brazilian Registry of Clinical Trials, RBR-6y6tyc, Rio de Janeiro, Brazil. Results: Regression models showed that parameterization, performed and maintained during and after bath in the intervention group, had the effect of increasing the average number of high respiratory rate alarm triggers by 12.5 and 6.4 times, respectively; and had no effect on low respiratory rate alarms. Conclusion: The contribution of this study is to assist health professionals in formulating protocols for individualized parameterization of alarms for Mechanical Ventilators.

RESUMEN Objetivo: medir los efectos de la parametrización de las alarmas sonoras de frecuencia respiratoria de los ventiladores mecánicos para reducir el número de alarmas disparadas durante el baño en cama. Método: ensayo clínico pragmático, para comparar el número de alarmas del ventilador mecánico en los grupos: intervención - se parametrizaron las alarmas de Frecuencia Respiratoria al inicio del baño; control - no se realizó parametrización. Estudio registrado el 27/08/2019 en el Registro Brasileño de Ensayos Clínicos, RBR-6y6tyc, Río de Janeiro, Brasil. Resultados: Los modelos de regresión mostraron que la parametrización, realizada y mantenida durante y después del baño en el grupo de intervención, tuvo el efecto de aumentar 12,5 y 6,4 veces, respectivamente, el número medio de disparos de alarmas de frecuencia respiratoria alta; y no tuvo ningún efecto sobre las alarmas de frecuencia respiratoria baja. Conclusión: la contribución de este estudio es ayudar a los profesionales de la salud en la formulación de protocolos para la parametrización individual de las alarmas de los Ventiladores Mecánicos.

The acoustic behavior of the Brazilian caatinga big rodent is incongruent to its actual position in Hydrochoerinae.

Our knowledge about the acoustic behavior of Caviinae species drove us to investigate Kerodon rupestris's (Caviidae: Hydrochoerinae) repertoire. This species is endemic to Caatinga and states as vulnerable in the Brazilian list of endangered species. We recorded sounds uttered by individuals from Santa Luzia, State of Paraíba, Brazil. We promoted interactions among 13 animals during intra and intersexual pairing sessions, under undisturbed interactions in captivity, and in free-living conditions. We found a repertoire of 13 call types, most of them (all except three) shared with Cavia and only five possibly shared also with Hydrochoerus: (1) Close contact and cohesion: tonal and noisy contact calls, tweet, slow-whistle; (2) Social regulation (incitement, subordination or auto-defense): whine, peepy-squeak, yelp; (3) Offensive aggression and status display: roar, snort, and teeth-chattering (4) Warning or intimidation: alarm-whistle, drrr, and drumming; (5) Courtship: purr and slow-whistle. The similarity of Kerodon signals to Hydrochoerinae species, despite the ecological differences, needs to be understood in comparative phylogenetic studies tracing back the origin of the courtship display in Caviidae. Thus, future research should focus on playback studies to test signals' biological function hypothesis.

Depredación de huevos de la mirla pechi pálida por el tucán Ariel in Brasil: fallo de la estrategia antidepredatoria / Predation of pale-breasted thrush eggs by the ariel toucan in brazil: failure of the anti-predatory strategy

ABSTRACT The Channel-billed Toucan (Ramphastos vitellinus) is an omnivorous bird that eventually is nest-robbers. Several birdsongs display anti-predatory strategies such as attacks and mobbing calls to face this kind of predator. This note reports a predatory event of one Channel-billed Toucan upon eggs of Pale-breasted Thrush (Turdus leucomelas) and describes the anti-predatory behavior, principally alert and mobbing calls of the thrush. Even though the Pale-breasted Thrush displayed the anti-predatory behaviors to harass the toucan, the egg predation was not avoided. Although the predation upon eggs by Ramphastos vitellinus has been reported several times, the majority of reports lack the identity of the bird species affected, this being the first confirmed record in Turdus leucomelas.

RESUMEN El tucán de Ariel (Ramphastos vitellinus ariel) es un ave omnívora que eventualmente es ladrona de nidos. Varias aves paseriformes muestran estrategias anti-depredatorias, tales como ataques y llamadas de acoso para enfrentarse a este tipo de depredadores. Esta nota reporta un evento de depredación de un tucán de Ariel sobre huevos de la mirla pechi pálida (Turdus leucomelas), y describe el comportamiento antipredador, principalmente el relacionado con las llamadas de alerta y de acoso de la mirla. A pesar de que la mirla pechi pálida mostró un comportamiento anti-depredatorio acosando al tucán, no se evitó la depredación de los huevos. Aunque la depredación de huevos por parte del Ramphastos vitellinus se ha registrado varias veces, la mayoría de los reportes carecen de la identidad de la especie de ave afectada, siendo este el primer registro confirmado en Turdus leucomelas.

Estimating COVID-19 cases and outbreaks on-stream through phone calls.

One of the main problems in controlling COVID-19 epidemic spread is the delay in confirming cases. Having information on changes in the epidemic evolution or outbreaks rise before laboratory-confirmation is crucial in decision making for Public Health policies. We present an algorithm to estimate on-stream the number of COVID-19 cases using the data from telephone calls to a COVID-line. By modelling the calls as background (proportional to population) plus signal (proportional to infected), we fit the calls in Province of Buenos Aires (Argentina) with coefficient of determination R 2 > 0.85. This result allows us to estimate the number of cases given the number of calls from a specific district, days before the laboratory results are available. We validate the algorithm with real data. We show how to use the algorithm to track on-stream the epidemic, and present the Early Outbreak Alarm to detect outbreaks in advance of laboratory results. One key point in the developed algorithm is a detailed track of the uncertainties in the estimations, since the alarm uses the significance of the observables as a main indicator to detect an anomaly. We present the details of the explicit example in Villa Azul (Quilmes) where this tool resulted crucial to control an outbreak on time. The presented tools have been designed in urgency with the available data at the time of the development, and therefore have their limitations which we describe and discuss. We consider possible improvements on the tools, many of which are currently under development.

Super-Alarms with Diagnosis Proficiency Used as an Additional Layer of Protection Applied to an Oil Transport System.

In automated plants, particularly in the petrochemical, energy, and chemical industries, the combined management of all of the incidents that can produce a catastrophic accident is required. In order to do this, an alarm management methodology can be formulated as a discrete event sequence recognition problem, in which time patterns are used to identify the safe condition of the process, especially in the start-up and shutdown stages. In this paper, a new layer of protection (a Super-Alarm), based on the diagnostic stage to industrial processes is presented. The alarms and actions of the standard operating procedures are considered to be discrete events involved in sequences; the diagnostic stage corresponds to the recognition of the situation when these sequences occur. This provides operators with pertinent information about the normal or abnormal situations induced by the flow of the alarms. Chronicles Based Alarm Management (CBAM) is the methodology used in this document to build the chronicles that will permit us to generate the Super-Alarms; in addition, a case study of the petrochemical sector using CBAM is presented in order to build one chronicle that represents the scenario of an abnormal start-up of an oil transport system. Finally, the scenario's validation for this case is performed, showing the way in which, a Super-Alarm is generated.

The Ant Who Cried Wolf? Short-Term Repeated Exposure to Alarm Pheromone Reduces Behavioral Response in Argentine Ants.

In this study we test whether Argentine ants (Linepithema humile) progressively reduce their response to a salient stimulus (alarm pheromone) with increased exposure over time. First, we used a two-chamber olfactometer to demonstrate three focal behaviors of Argentine ants that indicate an alarmed state in response to conspecific alarm pheromone and pure synthetic iridomyrmecin (a dominant component of L. humile alarm pheromone). We then measured how these behaviors changed after repeated exposure to conspecific alarm pheromone from live ants. In addition, we investigate whether there is a difference in the ants' behavioral response after "short" (3 min) versus "long" (6 min) intervals between treatments. Our results show that Argentine ants do exhibit reduced responses to their own alarm pheromone, temporarily ceasing their response to it after four or five exposures, and this pattern holds whether exposure is repeated after "short" or "long" intervals. We suggest alarm pheromones may be perceived as false alarms unless threatening stimuli warrant a continued state of alarm. These results should be kept in mind while developing pheromone-based integrated pest management strategies.

Camphor and Borneol as the Male-Produced Sex Pheromone of the Shield Bug, Orsilochides leucoptera (Hemiptera: Scutelleridae).

The ability of stink bugs to release high amounts of strong-smelling and irritating defensive compounds is related to their metathoracic gland (MTG), which is an exocrine gland with defensive, sexual, alarm and aggregation signal functions. Orsilochides leucoptera (Scutelleridae) is a widespread species in the Neotropical region that feeds on plants of the families Malvaceae, Poaceae and Euphorbiaceae. A series of compounds (ketones, alcohols and esters) have been identified in the MTGs among the three species of Scutelleridae whose MTG secretions have been investigated thus far; however, no sex pheromone compounds have been described for any scutellerid species. The aim of this work was to study sex pheromone communication within this family of stink bugs, and identify the compounds present in the MTG of O. leucoptera. Analysis by gas chromatography/mass spectrometry (GC/MS) revealed two male specific compounds identified as (R)-camphor (1) and (R)-borneol (2), which were attractive to females in Y-tube olfactometer bioassays. Also, GC/MS analysis of secretions from MTG of males and females of O. leucoptera, identified eight additional compounds: 2-(E)-hexenal (3), (E)-4-oxo-2-hexenal (4), (E)-hex-2-enyl acetate (5), (R)-linalool (6), (R)-α-terpineol (7), dodecane (8), 1-tridecene (9) and n-tridecane (10). From these, (R)-α-terpineol was detected only in the gland of males, and is probably a biosynthetic intermediate of the pheromone components. Most of the MTG compounds identified in O. leucoptera have been identified in other heteropteran species. Camphor is often a toxic and repellent compound for insects. However, we report it, for the first time, as a sex pheromone component of an insect.

A model to study orienting responses in zebrafish, and applications towards the emotion-cognition interaction.

Orienting responses (ORs) are whole-organism reflexes that are elicited by innocuous stimuli, and which decrease in magnitude after stimulus repetition. ORs represent relatively simple responses that can be used to study attentional processes, and are modulated by the organism's state, including arousal and activation levels, as well as by emotional processes. Here we describe a simple method to study ORs in zebrafish, a model organism increasingly being used in behavioural neuroscience. After presentation of a static visual stimulus, an OR is elicited, characterized by approaching the stimulus and orienting towards it. After repeated stimulation, OR decreases, suggesting habituation. These responses are qualitatively altered by exposure to a fear-eliciting alarm substance (i.e., derived from the skin of a conspecific), since exposed animals avoid the visual stimulus and orient either away from the stimulus or towards it, but at a distance. The protocol can be used to study orienting responses, as well as the impact of fear and arousal on these reflexes.

Caracterización clínica de pacientes internados por Dengue en el Hospital Regional de Encarnación 2018

Resumen Introducción: El Dengue ha sido prominente entre las enfermedades reemergentes y se considera la más importante de las enfermedades virales transmitidas por artrópodos, siendo la arbovirosis más común y distribuida en el mundo. En Paraguay posee una de las tasas de incidencias de dengue más altas de la región, con 444.5 casos por cada 100.000 habitantes, en el 2018 se registraron un total de 29.162 casos. Objetivo: Caracterizar clínicamente los pacientes internados por Dengue en el Hospital Regional de Encarnación año 2018. Materiales y Métodos: Estudio de tipo observacional, descriptivo de corte trasversal, con muestreo intencional, se incluyeron a todos los pacientes internados con diagnostico confirmado de dengue en el servicio de clínica médica, fueron incluidas las fichas clínicas de pacientes con diagnostico confirmado de dengue. Resultados: El total de casos confirmados por dengue internados en el Hospital Regional de Encarnación en el servicio de clínica médica, año de 2018 fue de 47 pacientes. El rango etario con mayor número de casos fue >45 años con el 36,1%. Tuvo picos relevantes de casos en el mes de marzo, 38%, y mayo con 43%. En el análisis de las formas clínicas de presentación, prevalecieron los pacientes clasificados con clase C: Dengue con signos de alarma Conclusión: La prevalencia de la clasificación de la forma grave con signos de alarma de dengue fue alta, significando una relación entre el manejo clínico precoz y una evolución satisfactoria, por los tanto la caracterización clínica constituye una herramienta eficaz para la toma de decisiones.

Abstract Introduction: Dengue has been prominent among reemerging diseases and it is considered the most important of the viral diseases transmitted by arthropods, being the most common and distributed arbovirosis in the world. Paraguay has one of the highest incidence rates of dengue in the region, with 444.5 cases per 100,000 inhabitants, in 2018 a total of 29,162 cases were recorded. Objective: To clinically characterize the patients admitted by Dengue in the Encarnacion Regional Hospital year 2018. Materials and Methods: An observational, descriptive, cross-sectional study, with intentional sampling, all hospitalized patients with a confirmed diagnosis of dengue were included in the medical clinic service, the clinical records of patients with a confirmed diagnosis of dengue were included. Results: The total hospitalized cases of dengue confirmed in the Encarnacion Regional Hospital in the medical clinic service, year of 2018 was 47 patients. The age range with the highest number of cases was> 45 years old with 36.1%. Tube relevant peaks of cases in the month of March, 38%, and May with 43%. In the analysis of the clinical forms of presentation, patients classified with class C prevailed: Dengue with warning signs Conclusion: The prevalence of the classification of the severe form with dengue alarm signs was high, meaning a relationship between early clinical management and a satisfactory evolution, therefore clinical characterization is an effective tool for decision making.