Impact of Introducing Full-time In-house Coordinators on Referral and Organ Donation Rates in Rio de Janeiro Public Hospitals: A Health Care Innovation Practice

Establishing an organization to promote organ donation and a good organ procurement team assure quality and improve performance on organ donation rates. Brazil's organ procurement structure is based on 2 models disseminated worldwide: the "Spanish model," based on in-house coordinators, and the "American organ procurement organization (OPO) model," with extra-hospital coordinators. In 2006, Brazil's Federal Government had formally introduced the in-house coordination model for every hospital equipped with a mechanical ventilator bed. In January 2012, the Rio de Janeiro State OPO, Programa Estadual de Transplantes, introduced an innovation in the organization of the in-house coordination model in 4 selected public hospitals with high organ donation potential. It consisted in launching full-time in-house coordination teams, with ≥1 physician and 2 nurses per hospital fully dedicated to organ procurement. The objectives were to observe the impact of this innovation in referral and organ donor conversion rates and to analyze the importance of middle managers in health care innovation implementation. Comparing the year before implementation (2011) and the year of 2014 showed that this innovation led to an overall increase in referrals-from 131 to 305 per year (+132%) and conversion rates-from 20% to 42% per year-resulting in an increase in number of donors from 26 to 128 per year (+390%). Despite wide variations among hospitals in the outcomes, our results seem very encouraging and express a positive impact of this model, suggesting that dissemination to other hospitals may increase the number of donors and transplants in our region.

Awake and unable to move: what can perioperative practitioners do to avoid accidental awareness under general anaesthesia?

I thought the last thing I would remember about my surgery was counting up to 10 ... but that didn't happen... I could hear people talking, instruments banging, the sound of my heart beat coming from the anaesthetic machine and all of a sudden, that horrible pain digging inside my body. Oh my God! I thought. I'm awake! I tried to tell someone but no sound came out of my mouth. I tried to kick my legs, shake my arms, blink, breathe... Nothing!! I couldn't move a muscle. I was paralysed and awake during my operation... I thought I was going to die!!!

Electronic excitation of carbonyl sulphide (COS) by high-resolution vacuum ultraviolet photoabsorption and electron-impact spectroscopy in the energy region from 4 to 11 eV

The electronic state spectroscopy of carbonyl sulphide, COS, has been investigated using high resolution vacuum ultraviolet photoabsorption spectroscopy and electron energy loss spectroscopy in the energy range of 4.0-10.8 eV. The spectrum reveals several new features not previously reported in the literature. Vibronic structure has been observed, notably in the low energy absorption dipole forbidden band assigned to the (4π←3π) ((1)Δ←(1)Σ(+)) transition, with a new weak transition assigned to ((1)Σ(-)←(1)Σ(+)) reported here for the first time. The absolute optical oscillator strengths are determined for ground state to (1)Σ(+) and (1)Π transitions. Based on our recent measurements of differential cross sections for the optically allowed ((1)Σ(+) and (1)Π) transitions of COS by electron impact, the optical oscillator strength f0 value and integral cross sections (ICSs) are derived by applying a generalized oscillator strength analysis. Subsequently, ICSs predicted by the scaling are confirmed down to 60 eV in the intermediate energy region. The measured absolute photoabsorption cross sections have been used to calculate the photolysis lifetime of carbonyl sulphide in the upper stratosphere (20-50 km).

Elastic differential cross sections for C₄F₆ isomers in the 1.5-200 eV energy electron impact: similarities with six fluorine containing molecules and evidence of F-atom like scattering

We report absolute elastic differential cross sections for electron interactions with the C4F6 isomers, hexafluoro-1,3-butadiene (1,3-C4F6), hexafluoro-2-butyne (2-C4F6), and hexafluorocyclobutene (c-C4F6). The incident electron energy range is 1.5-200 eV, and the scattered electron angular range for the differential measurements varies from 15° to 150°. In all cases the absolute scale of the differential cross section was set using the relative flow technique, with helium as the reference species. Atomic-like behaviour in these scattering systems is shown here for the first time, and is further investigated by comparing the elastic cross sections for the C4F6 isomers with other fluorinated molecules, such as SF6 and CnF6 (n = 2, 3, and 6). We note that for all the six-F containing molecules, the scattering process for electron energies above 30 eV is indistinguishable. Finally, we report results for calculations of elastic differential cross sections for electron scattering from each of these isomers, within an optical potential method and assuming a screened corrected independent atom representation. The level of agreement between these calculations and our measurements is found to be quite remarkable in all cases.

Potassium-uracil/thymine ring cleavage enhancement as studied in electron transfer experiments and theoretical calculations

We report experimental and theoretical studies on ring cleavage enhancement in collisions of potassium atoms with uracil/thymine to further increase the understanding of the complex mechanisms yielding such fragmentation pathways. In these electron transfer processes time-of-flight (TOF) negative ion mass spectra were obtained in the collision energy range 13.5-23.0 eV. We note that CNO(-) is the major ring breaking anion formed and its threshold formation is discussed within the collision energy range studied. Such a decomposition process is supported by the first theoretical calculations to clarify how DNA/RNA pyrimidine base fragmentation is enhanced in electron transfer processes yielding ion-pair formation.

N-site de-methylation in pyrimidine bases as studied by low energy electrons and ab initio calculations

Electron transfer and dissociative electron attachment to 3-methyluracil (3meU) and 1-methylthymine (1meT) yielding anion formation have been investigated in atom-molecule collision and electron attachment experiments, respectively. The former has been studied in the collision energy range 14-100 eV whereas the latter in the 0-15 eV incident electron energy range. In the present studies, emphasis is given to the reaction channel resulting in the loss of the methyl group from the N-sites with the extra charge located on the pyrimidine ring. This particular reaction channel has neither been approached in the context of dissociative electron attachment nor in atom-molecule collisions yet. Quantum chemical calculations have been performed in order to provide some insight into the dissociation mechanism involved along the N-CH3 bond reaction coordinate. The calculations provide support to the threshold value derived from the electron transfer measurements, allowing for a better understanding of the role of the potassium cation as a stabilising agent in the collision complex. The present comparative study gives insight into the dynamics of the decaying transient anion and more precisely into the competition between dissociation and auto-detachment.

Microbiota benefits after inulin and partially hydrolized guar gum supplementation: a randomized clinical trial in constipated women

INTRODUCTION

Prebiotics positively affect gut microbiota composition, thus improving gut function. These properties may be useful for the treatment of constipation.

OBJECTIVES

This study assessed the tolerance and effectiveness of a prebiotic inulin/partially hydrolyzed guar gum mixture (I-PHGG) for the treatment of constipation in females, as well as its influence on the composition of intestinal microbiota and production of short chain fatty acids.

METHODS

Our study enrolled 60 constipated female health worker volunteers. Participants reported less than 3 bowel movements per week. Volunteers were randomized to treatment with prebiotic or placebo. Treatment consisted of 3 weeks supplementation with 15 g/d IPHGG (fiber group) or maltodextrin (placebo group). Abdominal discomfort, flatulence, stool consistency, and bowel movements were evaluated by a recorded daily questionnaire and a weekly interview. Changes in fecal bacterial population and short chain fatty acids were assessed by real-time PCR and gas chromatography, respectively.

RESULTS

There was an increased frequency of weekly bowel movements and patient satisfaction in both the fiber and placebo groups with no significant differences. Total Clostridium sp significantly decreased in the fiber group (p = 0.046) and increased in the placebo group (p = 0.047). There were no changes in fecal short chain fatty acid profile.

CONCLUSIONS

Consumption of I-PHGG produced clinical results comparable to placebo in constipated females, but had additional protective effects on gut microbiota by decreasing the amount of pathological bacteria of the Clostridium genera.

Cuckoldry features of introduced pumpkinseed sunfish (Lepomis gibbosus) in contrasting environmental conditions in southern Europe

Reproduction of pumpkinseed sunfish ( Lepomis gibbosus (L., 1758)) in the species’ native range often involves cuckoldry, consisting of dominant nest-guarding (parental) males and the participation by small “sneaker” males. However, it remains unknown whether this behaviour occurs in populations of non-native pumpkinseed. Thus, the present study describes the phenotypic features of cuckoldry under contrasting environmental conditions (lentic versus lotic) in southern Europe. Parental and sneaker pumpkinseeds were captured in the summer of 2011 from the River Bullaque (central Spain) and from the Encinarejo Reservoir (southern Spain). No differences in total length were observed in sneaker males, although individuals of ages 1+ and 2+ were significantly predominant in the river and the reservoir, respectively. Parental males were larger and older in the reservoir than in the river. Gonadosomatic and hepatosomatic indices were significantly higher in sneaker than in parental males at both sites. Body condition was lower in sneaker males in the river. Both ingested biomass and the proportion of full stomachs were lower in parental males at both sites, being significant in all cases except ingested biomass in the river. Sneaker males achieved a higher gonadosomatic index than parental males. In contrast, parental males had higher body condition indices than sneakers. Results demonstrate the high ecological plasticity of pumpkinseed sunfish to display natural behaviours out of its native area.