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Introduction/Justification: The use of artificial intelligence using convolutional neural networks in clinical practice is recent. Thus, a growing need exists to validate software performance in different tasks in different diseases. Objectives: To evaluate the performance of artificial intelligence software to determine metabolic tumor burden in the primary staging of rectal cancer. Materials and Methods: A cross-sectional retrospective analysis was conducted on 51 histology-proven rectal cancer patients (35% females; mean age = 61 years) who underwent a staging 18F-FDG PET/CT. Whole-body metabolic tumor burden parameters (wbMTV and wbTLG) were quantified semi-automatically and through AI algorithm (Syngovia VB60; Siemens Healthineers Medical Solutions). The AI software's ability to correctly identify and classify the primary lesion, regional lymph nodes, and distant metastases was evaluated. In addition, the intraclass correlation coefficient (ICC) was applied to evaluate concordance between the AI-based software and the semiautomatic software in determining wbMTV and wbTLG. Values above 0.7 were considered to indicate substantial agreement. Resultados: The AI and semiautomatic tumor burden metrics correlated strongly for both wbMTV (ICC = 1.00; 95% CI = 0.94 - 0.99; P < 0.0000) and wbTLG (ICC = 1.00; 95% CI = 0.80 – 0.90; P < 0.0000). Additionally, the AI software's ability to correctly identify lesions compared to the documented staging was better for the identification of distant metastasis (78,57% of patients), mildly adequate to identify regional lymph nodes (50,00%) and had poor performance for identification of the primary lesion (5,76%). On the other hand, the time spent calculating these metrics was less by AI than by the semiautomatic method, especially in patients with advanced disease. Conclusion: The determination of whole-body metabolic tumor burden on 18F-FDG PET/CT with artificial intelligence software is challenging because of the physiologic bowel activity. However, deep learning may have the ability to overcome these challenges and may therefore improve the primary staging of rectal cancer.

Civil society has played an important role in meeting the challenges of refugee migration in recent years. This commentary documents the importance of civic engagement for the integration of refugees by linking individual survey data on refugees to a regional measure of civic engagement in Germany. Using the density of newly established civic associations at the county level as a measure of civic engagement, we exploit regional differences in civic engagement in order to estimate its association with refugee integration outcomes. We find that in regions with particularly high levels of civic engagement, refugees have significantly more frequent contact to Germans, higher life satisfaction, and better German language skills. This correlation is robust to regional contextual factors such as the local population structure, economic strength, and the state of the labor market. In terms of language acquisition, women and refugees with a low level of education benefit the most from high civic engagement. Moreover, refugees with university degrees find significantly better-paying jobs in areas with higher civic engagement. However, no direct correlation could be established between civic engagement and the likelihood that refugees are employed. Nonetheless, the results suggest that support from civil society translates into improved access to government benefits. Our findings highlight that local civic engagement is an important complement to public assistance services and policy makers should give a high priority to partnering with the civil society to improve refugees’ integration outcomes.

Introducción: El cáncer es una de las enfermedades con mayor prevalencia, mortalidad e incapacidad en la actualidad. Se dice que 1 de cada 5 y 6 hombres y mujeres respectivamente en todo el mundo, desarrollaran cáncer durante su vida, y uno de cada 8 hombres y una de cada 11 mujeres mueren por esta enfermedad. Objetivo: Determinar si el entrenamiento HIIT en modalidad 30-30 mejora la calidad de vida de los pacientes con cáncer en estadio II. Materiales y métodos: Estudio experimental descriptivo con seguimiento longitudinal de cronológia prospectiva con una muestra de 275 pacientes (H:150 vs M:125) con cáncer en estadio II. Se identificaron factores de riesgo y además, prueba de esfuerzo, antropometría, calidad de vida, parámetros clínicos y hemodinámicos. Las pruebas se realizaron pre y post entrenamiento del método 30-30. Cada sesión se realizó de 70 minutos, 3 veces por semana durante 3 meses. Resultados: Este estudio contó con pacientes de cáncer de próstata, mama, colorrectal, cervico-uterino, tiroides, pulmón, estomago, hepático y entre otros. La edad promedio fue de 56±10 años. Los participantes presentaron cambios pos entrenamiento en el Vo2 (7.5±5.7 vs. 13.9±3.3 mL/kg-1/ min-1), frecuencia cardíaca máxima (156±12 vs. 175±14), fracción de eyección (40±4,8 vs 47±5,6), calidad de vida (108±14 vs 121±7,6) y fatiga asociada al cáncer (16,3±9,7 vs 5,5±4,9). Conclusiones: El método de entrenamiento 30-30 se mostró seguro y mejoró todas las variables evaluadas. De hecho, luego de este programa de entrenamiento aumentó la calidad de vida significativamente (< 0,05) de los participantes intervenidos. Trial Registration: NCT03915288.

A key decision in field management is whether or not to acquire information to either improve project economics or reduce uncertainties. A widely spread technique to quantify the gain of information acquisition is Value of Information (VoI). However, estimating the possible outcomes of future information without the data is a complex task. While traditional VoI estimates are based on a single average value, the Chance of Success (CoS) methodology works as a diagnostic tool, estimating a range of possible outcomes that vary because of reservoir uncertainties. The objective of this work is to estimate the CoS of a 4D seismic before having the data, applied to a complex real case (Norne field). The objective is to assist the decision of whether, or not, to acquire further data. The methodology comprises the following steps: uncertainty quantification, selection of Representative Models (RMs), estimation of the acquisition period, production strategy optimization and, finally, quantification of the CoS. The estimates use numerical reservoir simulation, economic analysis, and uncertainty evaluation. We performed analyses considering perfect and imperfect information. We aim to verify the increment in economic return when the 4D data identifies the closest-to-reality reservoir model. While the traditional expected VoI calculation provides only an average value, this methodology has the advantage of considering the increase in the economic return due to reservoir uncertainties, characterized by different RMs. Our results showed that decreased reliability of information affected the decision of which production strategy to select. In our case, information reliability less than 70% is insufficient to change the perception of the uncertain reservoir and consequently decisions. Furthermore, when the reliability reached around 50%, the information lost value, as the economic return became similar to that of the case without information acquisition.

Pollen analysis of a sediment sample obtained at 222 cm from the top of a drilling core collected in the Bay of Guanabara, Rio de Janeiro, was used as a tool to obtain more knowledge about pre-historical human living and environment. 14C datation revealed the age of 4210 years B.P. Most frequent pollen grains came from plants like Alchornea (Euphorbiaceae), Celtis (Ulmaceae), Lecythidaceae, Meliaceae, Ochnaceae and spores from forest Pteridophyta. Palynology and environmental studies revealed that agricultural activities could not be detected. The dense tropical rain forest was the dominant vegetation occurring in this region.

Storytelling has been used as a means to help students of a private school improve their communicative skills. To achieve this goal, we have designed activities that enable students to use English actively and at the same time get in touch with literature. We expect to change students¿ attitudes towards English and to motivate them to develop proficiency in the foreign language through storytelling. In doing so, we are innovating our teaching practices by incorporating a tool that can provide students with both the means and the motivation for using the language and thus develop their communicative skills.

Abstract Background The clinical course of Cystic Fibrosis (CF) is usually measured using the percent predicted FEV1 and BMI Z-score referenced against a healthy population, since achieving normality is the ultimate goal of CF care. Referencing against age and sex matched CF peers may provide valuable information for patients and for comparison between CF centers or populations. Here, we used a large database of European CF patients to compute CF specific reference equations for FEV1 and BMI, derived CF-specific percentile charts and compared these European data to their nearest international equivalents. Methods 34859 FEV1 and 40947 BMI observations were used to compute European CF specific percentiles. Quantile regression was applied to raw measurements as a function of sex, age and height. Results were compared with the North American equivalent for FEV1 and with the WHO 2007 normative values for BMI. Results FEV1 and BMI percentiles illustrated the large variability between CF patients receiving the best current care. The European CF specific percentiles for FEV1 were significantly different from those in the USA from an earlier era, with higher lung function in Europe. The CF specific percentiles for BMI declined relative to the WHO standard in older children. Lung function and BMI were similar in the two largest contributing European Countries (France and Germany). Conclusion The CF specific percentile approach applied to FEV1 and BMI allows referencing patients with respect to their peers. These data allow peer to peer and population comparisons in CF patients.

Abstract Background The genetic diversity of the human immunodeficiency virus type 1 (HIV-1) is critical to lay the groundwork for the design of successful drugs or vaccine. In this study we aimed to characterize and define the molecular prevalence of HIV-1 subclade F1 currently circulating in São Paulo, Brazil. Methods A total of 36 samples were selected from 888 adult patients residing in São Paulo who had previously been diagnosed in two independent studies in our laboratory as being infected with subclade F1 based on pol subgenomic fragment sequencing. Proviral DNA was amplified from the purified genomic DNA of all 36 blood samples by 5 fragments overlapping PCR followed by direct sequencing. Sequence data were obtained from the 5 fragments of pure subclade F1 and phylogenetic trees were constructed and compared with previously published sequences. Subclades F1 that exhibited mosaic structure with other subtypes were omitted from any further analysis Results Our methods of fragment amplification and sequencing confirmed that only 5 sequences inferred from pol region as subclade F1 also holds true for the genome as a whole and, thus, estimated the true prevalence at 0.56%. The results also showed a single phylogenetic cluster of the Brazilian subclade F1 along with non-Brazilian South American isolates in both subgenomic and the full-length genomes analysis with an overall intrasubtype nucleotide divergence of 6.9%. The nucleotide differences within the South American and Central African F1 strains, in the C2-C3 env, were 8.5% and 12.3%, respectively. Conclusion All together, our findings showed a surprisingly low prevalence rate of subclade F1 in Brazil and suggest that these isolates originated in Central Africa and subsequently introduced to South America.

Las presas tienen un papel trascendental dentro de los sistemas de abastecimiento de agua para las poblaciones, desde hace muchos años. Estas estructuras involucran grandes volúmenes de agua y sedimento retenidos, por lo cual el colapso parcial o total de una presa puede dar lugar a importantes pérdidas materiales y/o humanas. Para la elaboración de planes de contingencia durante la etapa de diseño resulta provechoso utilizar aplicaciones informáticas de modelación numérica, las cuales representan una poderosa herramienta en la estimación de las consecuencias que pudiera producir un evento de falla de una presa. Se presentan los resultados de dos (2) casos de estudios situados en el estado Lara, Venezuela, que han sido simulados por separado con las aplicaciones de simulación hidrodinámica ISIS 2D y Delft3D, a partir de modelos bidimensionales adaptados a las condiciones reales de cada presa, en los que se han empleado técnicas y recursos distintos sobre la base de fundamentos teóricos y experiencias prácticas recopiladas, obteniendo en cada caso la magnitud de la inundación producto de los desembalses respectivos y analizando el comportamiento de la propagación hacia aguas abajo. Se permite dar una afirmación conclusiva sobre la factibilidad del empleo de los procedimientos y programas utilizados, a partir de la congruencia de los valores obtenidos y la estabilidad numérica observada, representando una puerta de acceso al campo de la modelación hidrodinámica de rotura de presas, área que ha sido escasamente explorada en Latinoamérica.

Las presas tienen un papel trascendental dentro de los sistemas de abastecimiento de agua para las poblaciones, desde hace muchos años. Estas estructuras involucran grandes volúmenes de agua y sedimento retenidos, por lo cual el colapso parcial o total de una presa puede dar lugar a importantes pérdidas materiales y/o humanas. Para la elaboración de planes de contingencia durante la etapa de diseño resulta provechoso utilizar aplicaciones informáticas de modelación numérica, las cuales representan una poderosa herramienta en la estimación de las consecuencias que pudiera producir un evento de falla de una presa. Se presentan los resultados de dos (2) casos de estudios situados en el estado Lara, Venezuela, que han sido simulados por separado con las aplicaciones de simulación hidrodinámica ISIS 2D y Delft3D, a partir de modelos bidimensionales adaptados a las condiciones reales de cada presa, en los que se han empleado técnicas y recursos distintos sobre la base de fundamentos teóricos y experiencias prácticas recopiladas, obteniendo en cada caso la magnitud de la inundación producto de los desembalses respectivos y analizando el comportamiento de la propagación hacia aguas abajo. Se permite dar una afirmación conclusiva sobre la factibilidad del empleo de los procedimientos y programas utilizados, a partir de la congruencia de los valores obtenidos y la estabilidad numérica observada, representando una puerta de acceso al campo de la modelación hidrodinámica de rotura de presas, área que ha sido escasamente explorada en Latinoamérica.

JUSTIFICATIVA E OBJETIVOS: O bloqueio do plexo lombar pela via posterior promove analgesia pós-operatória efetiva na artroplastia total do quadril. Ropivacaína e bupivacaína não apresentaram qualquer diferença na eficácia analgésica em diferentes bloqueios de nervos periféricos. O objetivo deste estudo foi comparar a eficácia da analgesia pós-operatória resultante da administração em dose única da bupivacaína a 0,5% ou da ropivacaína a 0,5% no bloqueio do plexo lombar pela via posterior na artroplastia total do quadril. MÉTODO: Trinta e sete pacientes foram alocados aleatoriamente em dois grupos, segundo o anestésico local utilizado no bloqueio: Grupo B - bupivacaína a 0,5% com epinefrina 1:200.000 ou Grupo R - ropivacaína a 0,5%. Durante o período pós-operatório, os escores de dor e o consumo de morfina na analgesia controlada pelo paciente foram comparados entre os grupos. O sangramento durante a operação e a incidência de efeitos adversos e de complicações também foram comparados. RESULTADOS: Apesar dos escores de dor terem sido menores no Grupo R 8, 12 e 24 horas após o bloqueio, essas diferenças não foram clinicamente significativas. Regressão linear múltipla não identificou o anestésico local como variável independente. Não houve diferença no consumo de morfina, no sangramento intraoperatório e na incidência de complicações e efeitos adversos entre os dois grupos. CONCLUSÕES: A bupivacaína a 0,5% e a ropivacaína a 0,5% produziram alívio eficaz e prolongado da dor pós-operatória após artroplastia total do quadril, sem diferença clínica, quando doses equivalentes foram administradas no bloqueio do plexo lombar pela via posterior.JUSTIFICATIVA Y OBJETIVOS: El bloqueo del plexo lumbar por la vía posterior, genera una analgesia postoperatoria efectiva en la artroplastia total de la cadera. La ropivacaína y la bupivacaína no arrojaron ninguna diferencia en la eficacia analgésica en diferentes bloqueos de nervios periféricos. El objetivo de este estudio, fue comparar la eficacia de la analgesia postoperatoria, resultante de la administración en dosis única de la bupivacaína a 0,5% o de la ropivacaína a 0,5% en el bloqueo del plexo lumbar por la vía posterior en la artroplastia total de la cadera. MÉTODO: Treinta y siete pacientes fueron ubicados aleatoriamente en dos grupos según el anestésico local utilizado en el bloqueo: Grupo B - bupivacaína a 0,5% con epinefrina 1:200.000 o Grupo R - ropivacaína a 0,5%. Durante el período postoperatorio, los puntajes de dolor y el consumo de morfina en la analgesia controlada por el paciente, fueron comparados entre los grupos. El sangramiento durante la operación y la incidencia de efectos adversos y de complicaciones también fueron comparados. RESULTADOS: Pese a que los puntajes de dolor hayan sido menores en el Grupo R 8 horas, 12 horas y 24 horas después del bloqueo, esas diferencias no fueron clínicamente significativas. La regresión lineal múltiple no identificó el anestésico local como una variable independiente. No hubo diferencia en el consumo de morfina, en el sangramiento intraoperatorio y en la incidencia de complicaciones y efectos adversos entre los dos grupos. CONCLUSIONES: La bupivacaína a 0,5% y la ropivacaína a 0,5%, ofrecieron un alivio eficaz y prolongado del dolor postoperatorio después de la artroplastia total de la cadera, sin diferencia clínica, cuando dosis equivalentes fueron administradas en el bloqueo del plexo lumbar por la vía posteriorBACKGROUND AND OBJECTIVES: Posterior lumbar plexus block promotes effective postoperative analgesia in total knee arthroplasty. Ropivacaine and bupivacaine do not show differences in analgesic efficacy when used in different peripheral nerve blocks. The objective of this study was to compare the efficacy of postoperative analgesia resulting from the administration of a single dose of 0.5% bupivacaine or 0.5% ropivacaine in posterior lumbar plexus block for total hip arthroplasty. METHODS: Thirty-seven patients were randomly divided in two groups according to the local anesthetic used: Group B - 0.5% bupivacaine with 1:200,000 epinephrine; or group R - 0.5% ropivacaine. During the postoperative period, pain scores and morphine consumption in patient controlled analgesia were compared between groups. Bleeding during surgery and the incidence of side effects and complications were also compared. RESULTS: Although pain scores were lower in Group R 8 hours, 12 hours, and 24 hours after the blockade, these differences were not clinically significant. Multiple linear regression identified the local anesthetic as an independent variable. Differences in morphine consumption, intraoperative bleeding, and the incidence of complications and side effects were not observed between both groups. CONCLUSIONS: 0.5% Bupivacaine and 0.5% ropivacaine produced effective and prolonged postoperative pain relief after total hip arthroplasty, without clinical differences, when equivalent doses were administered for posterior lumbar plexus block.