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Atualmente, há escassez de recursos financeiros no ambiente hospitalar, a busca da excelência da gestão está se tornando cada vez mais presente e crescente. A auditoria é uma ferramenta de gestão hospitalar no sentido de manter a sustentabilidade financeira das instituições, incluindo a manutenção dos processos que envolvem a assistência e, principalmente, as fontes pagadoras e os prestadores de serviços médicos hospitalares. O objetivo deste trabalho foi demonstrar que a auditoria operacional em saúde pode atuar como uma ferramenta estratégica de gestão hospitalar para o controle de desperdícios. O estudo foi realizado por meio de revisão da literatura. A Auditoria operacional possibilita ao gestor hospitalar identificar meios de favorecer a qualificação do serviço sem agregar custos aos atendimentos prestados e a cobrança de forma correta conforme o prontuário do atendimento hospitalar. Este estudo deixa evidente que a auditoria utilizada como ferramenta de gestão nas instituições de saúde, atinge resultados satisfatórios tanto no controle de desperdícios, quanto em ações estratégicas. Destaca-se que o estudo se limitou a uma pesquisa bibliográfica visando analisar a auditoria operacional como ferramenta de gestão para as organizações de saúde. Dessa forma se sugere para futuras pesquisas feitas avaliando as organizações de saúde quanto à atuação da auditoria operacional para melhorar o seu desempenho, por meio da redução de desperdícios.

Purpose: Inflammatory biomarkers and neutrophil-to-lymphocyte ratio (NLR) are associated with prognosis in several tumors. Data on sarcomas are limited, and insufficient on retroperitoneal sarcoma (RPS). Experimental Design: Patients with primary RPS operated between 2002 and 2016 were included. Hemoglobin, monocytes, NLR, platelet-to-lymphocyte ratio (PLR) were retrieved and analyzed both individually and combined into a prognostic index (IBPI). Correlation with clinicopathologic variables was studied, as well as postoperative morbidity according to NLR and IBPI risk categories. The association between overall survival (OS) and biomarkers and, in addition, the 7-year Sarculator-predicted OS probability (pOS) was analyzed using univariable and multivariable Cox models. Results: 423/463 patients had complete data. The median follow-up was 84 months. The median NLR was 3.3 (IQR, 2.4–4.7), with significant variation across histologies. NLR was the only biomarker that independently predicted OS (HR, 1.2; 95% CI, 1.03–1.40; P = 0.02). The IBPI showed good discrimination for subgroups at different OS (log-rank test P < 0.0001). The Cox model for pOS alone showed a 7-year index of prediction accuracy of 26.9, which increased to 29.5 when IBPI was added to pOS as a complementary prognostic tool. IBPI was also associated with the risk of serious infectious postoperative complications (P = 0.0094; noninfectious complications, P = 0.6463). Conclusions: NLR was an independent prognostic factor for OS in RPS. When combined into a prognostic index with hemoglobin, monocytes, and PLR, it serves as a readily available prognostic tool addressing tumor-related inflammation and helps in classifying RPS risk in addition to the Sarculator nomogram.

Effective traceability tools able to characterize milk from pasture are important to safeguard low-input farming systems, niche dairy products, and local traditions. The aims of the present study were to investigate the ability of proton nuclear magnetic resonance (

Resumo Objetivo: Avaliar alterações encontradas nas ressonâncias magnéticas (RMs) encefálicas neonatais, correlacionando com a ultrassonografia transfontanelar (USTF), e descrever os principais fatores de risco encontrados. Materiais e Métodos: Foram avaliados exames de 51 pacientes que realizaram RM utilizando protocolo neonatal durante internação hospitalar, correlacionando com resultados da USTF prévia, sendo utilizada, para minimizar as chances de viés, a última USTF realizada. Os dados foram obtidos de prontuário médico e as imagens foram revisadas por médico radiologista especialista em neuroimagem. Resultados: A população foi composta majoritariamente de recém-nascidos prematuros extremos (21; 41,2%) e de extremo baixo peso (22; 43,1%). Foram encontradas alterações em 16 (31,4%) das USTFs e em 30 (58,8%) das RMs, sendo a hemorragia da matriz germinativa o achado mais frequente. Os valores preditivos positivo e negativo da USTF em relação à RM foram de 87% e 54%, respectivamente. Conclusão: A USTF mostrou-se importante na distinção entre os graus de hemorragia da matriz germinativa leve e moderada (I e II) dos graus acentuados (III e IV), sendo considerada um bom exame de rastreio e acompanhamento, principalmente em pacientes mais graves e com fatores de risco.

A elevada volatilidade e incertezas mercadológicas afetam o preço da soja, dificultando a assertividade do produtor rural em conseguir um preço de venda adequado pelo produto que permita o lucro e a continuidade na atividade. Ferramentas de hedge podem ser utilizadas para a proteção dessas variações, ao permitirem a fixação de preços futuros e o travamento de custos. Para verificar a aplicabilidade dessa ferramenta, o trabalho analisou três diferentes estratégias de comercialização da soja em grão: no mercado à vista, no mercado futuro e uma estratégia mista, para os municípios de Primavera do Leste (MT) e Sorriso (MT), em relação às safras de 2016/17, 2017/18 e 2018/19, visando examinar o impacto da utilização de cada uma delas na rentabilidade do produtor. Utilizaram-se valores reais dos preços da soja no mercado físico e no mercado futuro com negociação na CBOT, produtividade média e custos médios de produção para simular cenários acerca da comercialização da commodity. Em termos de resultados, evidenciou-se que, para o período analisado, a estratégia de comercialização da safra no mercado futuro foi a que apresentou o melhor retorno financeiro ao produtor, registrando um lucro de R$ 930,47/ha para a praça de Sorriso e R$ 632,90/ha com relação à praça de Primavera do Leste.

Ivermectin (IVM) is a drug widely used in veterinary and human medicine for the management of parasitic diseases. Its repositioning potential has been recently considered for the treatment of different diseases, such as cancer and viral infections. However, IVM faces some limitations to its formulations due to its low water solubility and bioavailability, along with reports of drug resistance. In this sense, novel technological approaches have been explored to optimize its formulations and/or to develop innovative medicines. Therefore, this review discusses the strategies proposed in the last decade to improve the safety and efficacy of IVM and to explore its novel therapeutic applications. Among these technologies, the use of micro/nano-drug delivery systems is the most used approach, followed by long-acting formulations. In general, the development of these novel formulations seems to run side by side in veterinary and human health, showing a shared interface between the two areas. Although the technologies proposed indicate a promising future in the development of innovative dosage forms containing IVM, its safety and therapeutic targets must be further evaluated. Overall, these approaches comprise tailoring drug delivery profiles, decreasing the risks of developing drug resistance, and supporting the application of IVM for reaching different therapeutic targets.

O objetivo do estudo foi de compreender as percepções e os sentimentos dos pacientes que utilizam o serviço de hemodiálise e; especificamente, entender os significados da situação do paciente nas relações interpessoais da família. Trata-se de uma pesquisa qualitativa, descritiva, durante dois meses com 10 pacientes. Os sujeitos da pesquisa foram pacientes em tratamento dialítico na modalidade hemodiálise. Resultados: Os dados oriundos das entrevistas, permitiram a construção de duas categorias: sentimentos de pacientes em tratamento dialítico, dividida em duas subcategorias: sentimentos positivos e negativos em relação ao processo de adoecimento. A segunda categoria enfoca as percepções sobre o tratamento dialítico, igualmente dividida em duas subcategorias: percepções positivas e negativas em relação ao processo de adoecimento e tratamento. O estudo permite concluir que, para além dos aspectos técnicos, severamente importantes, o paciente em tratamento dialítico necessita também de cuidados que incluam as suas percepções e sentimentos, haja vista, os sujeitos são unos e indivisíveis, no que concerne ao corpo e a alma.

this study analysed primary myxofibrosarcoma (MFS) to investigate patient outcomes focusing on histopathologic margins and perioperative treatments.data from consecutive patients affected by primary and localized MFS of the extremities or trunk wall who underwent surgery (2002-2017) were analysed. Local recurrence (LR), amputation rate, incidence of distant metastasis (DM), and overall survival (OS) were studied.Of 293 included patients, 52 (17%) patients received perioperative treatments and 54 (18%) had positive microscopic histopathologic margins (R1). Median follow-up was 80 months (IQR, 49-109). 5-yr CCI of LR was 0.12 (SE: 0.02). Status of histopathologic margins (P lt; 0.001), tumour malignancy grade (P = 0.018) and size (P = 0023) were independent prognostic factor for LR. Nine amputations (amputation rate: 3%) were performed (N = 1 for primary tumour; N = 8 for LR). Larger tumour size (P = 0.015) and higher grade (P = 0.025) were independent prognostic factor for DM. 5-year OS was 0.84 (95%CI 0.79-0.88). Patient age (P = 0.008), tumour size (P = 0.013) and malignancy grade (P = 0.018) were independently associated to OS. In the subgroup of patients who had a re-excision for a primary MFS (N = 116, 40%), the presence of residual disease was not associated with LR, DM, or OS.in this study 5-year LR, DM and OS were 12%, 17%, and 84%, respectively. One in six patients had a positive surgical margin, which was a prognostic factor for LR, while DM and OS were predicted by tumour grade and size. Findings from this large patient cohort may set benchmarks for investigating new treatment options for MFS.

Neuropathological studies have demonstrated distinct profiles of microglia activation and myelin injury among different multiple sclerosis (MS) phenotypes and disability stages. PET imaging using specific tracers may uncover the in vivo molecular pathology and broaden the understanding of the disease heterogeneity.We used the 18-kDa translocator protein (TSPO) tracer (R)-[sup11/supC]PK11195 and [sup11/supC]PIB PET images acquired in a hybrid PET/MR 3 T system to characterize, respectively, the profile of innate immune cells and myelin content in 47 patients with MS compared to 18 healthy controls (HC). For the volume of interest (VOI)-based analysis of the dynamic data, (R)-[sup11/supC]PK11195 distribution volume (VsubT/sub) was determined for each subject using a metabolite-corrected arterial plasma input function while [sup11/supC]PIB distribution volume ratio (DVR) was estimated using a reference region extracted by a supervised clustering algorithm. A voxel-based analysis was also performed using Statistical Parametric Mapping. Functional disability was evaluated by the Expanded Disability Status Scale (EDSS), Multiple Sclerosis Functional Composite (MSFC), and Symbol Digit Modality Test (SDMT).In the VOI-based analysis, [sup11/supC]PIB DVR differed between patients and HC in the corpus callosum (P = 0.019) while no differences in (R)-[sup11/supC]PK11195 VsubT/subwere observed in patients relative to HC. Furthermore, no correlations or associations were observed between both tracers within the VOI analyzed. In the voxel-based analysis, high (R)-[sup11/supC]PK11195 uptake was observed diffusively in the white matter (WM) when comparing the progressive phenotype and HC, and lower [sup11/supC]PIB uptake was observed in certain WM regions when comparing the relapsing-remitting phenotype and HC. None of the tracers were able to differentiate phenotypes at voxel or VOI level in our cohort. Linear regression models adjusted for age, sex, and phenotype demonstrated that higher EDSS was associated with an increased (R)-[sup11/supC]PK11195 VsubT/suband lower [sup11/supC]PIB DVR in corpus callosum (P = 0.001; P = 0.023), caudate (P = 0.015; P = 0.008), and total Tsub2/sublesion (P = 0.007; P = 0.012), while better cognitive scores in SDMT were associated with higher [sup11/supC]PIB DVR in the corpus callosum (P = 0.001), and lower (R)-[sup11/supC]PK11195 VsubT/sub(P = 0.013).Widespread innate immune cells profile and marked loss of myelin in Tsub2/sublesions and regions close to the ventricles may occur independently and are associated with disability, in both WM and GM structures.

In the Siberian Traps Large igneous province (LIP), the emplacement of magma in sedimentary strata led to explosive release of volatiles and the formation of large pipe structures with explosion craters. Of the hundreds of pipes present, several still have preserved crater lake sediments, representing the only known end-Permian sedimentary archive proximal to the Siberian Traps. Here we present new data from a core from the best studied crater lake section, the October pipe/crater located west of Bratsk in East Siberia. The S26 core contains 505 meters of sediments and in order to investigate the geochemical processes in the lake and the possible role of brine influx from the breccia pipe below, we have analysed carbon isotopes, the mercury content, δ34S and δ56Fe in pyrite and δ56Fe in magnetite, from the breccia pipe and crater sediments. In addition, reference samples from two other breccia pipes and relevant sedimentary strata from the Tunguska Basin were analysed for comparison. Our previous work has shown that the lake was saline, stratified and anoxic/euxinic, with up to 4 wt.% TOC, and abundant framboidal pyrite. The sediments are dominated by sandstone and siltstone, sourced from the material ejected during the pipe formation, and have not experienced heating above ca. 50 °C. The basal deposits are coarse and contain reworked magnetite-apatite ore that originally precipitated from hydrothermal fluids within the upper parts of the pipe. The sediments are calcite-cemented and the volcanic minerals altered to clays and zeolites, with occasional oxidized zones showing that the water level fluctuated, in accordance with rapid subsidence resulting from dissolution of deeper-seated Cambrian evaporites. New results show a marked shift in the isotope systems from the breccia pipe and into the basal lake deposits. The δ34S shifts from background sedimentary values (+20-30‰) in the pipe breccia, to -7-0‰ in the lower half of the lake sediments followed by an increase to +20 ‰ towards the top of the lake. The trend is evident in the δ56Fe in magnetite as well, with a 0.4 ‰ negative shift from the breccia and into the lake sediments, followed by an upward increase in the stratigraphy. We suggest that basinal brines rich in iron and sulphate were partly reduced in the stratified lake, leading to pyrite precipitation and isotope fractionation. The data shows the interplay between lake processes and fluid seepage from a hydrothermal system, making these deposits unique for understanding the consequences of LIP formation.

Self-organizing memristive nanowire connectomes have been exploited for physical (in materia) implementation of brain-inspired computing paradigms. Despite the emergent behavior was shown to rely on weight plasticity at single junction/synapse level and wiring plasticity involving topological changes, a shift to multiterminal paradigms is needed to unveil dynamics at the network level. Here, we report on tomographical evidence of memory engrams(or memory traces) in nanowire connectomes, i.e., chemical and physical changes in biological neural substrates supposed to endow the representation of experience stored in the brain. An experimental/modeling approach shows that spatially correlated short-term plasticity effects can turn into long-lasting engram memory patterns inherently related to network topology inhomogeneities. The ability to exploit both encoding and consolidation of information on the same physical substrate would open radically new perspectives for in materiacomputing, while offering to neuroscientists an alternative platform to understand the role of memory in learning and knowledge.

Supplemental Table 2. Prognostic Index of Inflammatory Biomarkers for primary Retroperitoneal Sarcoma (IBPI)

Purpose:Inflammatory biomarkers and neutrophil-to-lymphocyte ratio (NLR) are associated with prognosis in several tumors. Data on sarcomas are limited, and insufficient on retroperitoneal sarcoma (RPS).Experimental Design:Patients with primary RPS operated between 2002 and 2016 were included. Hemoglobin, monocytes, NLR, platelet-to-lymphocyte ratio (PLR) were retrieved and analyzed both individually and combined into a prognostic index (IBPI). Correlation with clinicopathologic variables was studied, as well as postoperative morbidity according to NLR and IBPI risk categories. The association between overall survival (OS) and biomarkers and, in addition, the 7-year Sarculator-predicted OS probability (pOS) was analyzed using univariable and multivariable Cox models.Results:423/463 patients had complete data. The median follow-up was 84 months. The median NLR was 3.3 (IQR, 2.4–4.7), with significant variation across histologies. NLR was the only biomarker that independently predicted OS (HR, 1.2; 95% CI, 1.03–1.40; P = 0.02). The IBPI showed good discrimination for subgroups at different OS (log-rank test P < 0.0001). The Cox model for pOS alone showed a 7-year index of prediction accuracy of 26.9, which increased to 29.5 when IBPI was added to pOS as a complementary prognostic tool. IBPI was also associated with the risk of serious infectious postoperative complications (P = 0.0094; noninfectious complications, P = 0.6463).Conclusions:NLR was an independent prognostic factor for OS in RPS. When combined into a prognostic index with hemoglobin, monocytes, and PLR, it serves as a readily available prognostic tool addressing tumor-related inflammation and helps in classifying RPS risk in addition to the Sarculator nomogram.

Supplemental Figure 1. Relationship between the risk of death, expressed as log-relative hazard from multivariable Cox model, and inflammation-related serum biomarkers.

Supplemental Table 1. NLR changes after neoadjuvant treatments*

Supplementary Tables and Figure Legends

Supplementary Figure 2

Supplementary material

Supplementary Figure 1F

Supplementary Figure 3

Purpose:The role of surgery for first relapse locally recurrent retroperitoneal sarcoma (RPS-LR1) is uncertain. We report outcomes of the largest RPS-LR1 series and propose a new prognostic nomogram.Experimental Design:Patients with consecutive RPS-LR1 without distant metastases who underwent resection at 22 centers (2002–2011) were included. Endpoints were disease-free and overall survival (DFS, OS) and crude-cumulative-incidence (CCI) of local/distant recurrence from second surgery. Nomograms predicting DFS and OS from second surgery were developed and validated (calibration plots); discrimination was assessed (Harrell C index).Results:Of 684 patients identified, full prognostic variable data were available for 602. Initial surgery for primary RPS was performed at our institutions in 188 patients (31%) and elsewhere in 414 (69%). At a median follow-up of 119 months [Interquartile range (IQR), 80–169] from initial surgery and 75 months (IQR 50–105) from second surgery, 6-year DFS and OS were 19.2% [95% confidence interval (CI), 16.0–23.0%] and 54.1% (95% CI, 49.8–58.8%), respectively. Recurrence patterns and survival probability were histology-specific, with liposarcoma subtypes having the highest 6-year CCI of second local recurrence (LR, 60.2%–70.9%) and leiomyosarcoma (LMS) having higher 6-year CCI of distant metastasis (DM, 36.3%). Nomograms included age at second surgery, multifocality, grade, completeness of second surgery, histology, chemotherapy/radiotherapy at first surgery, and number of organs resected at first surgery. OS and DFS nomograms showed good calibration and discriminative ability (C index 0.70 and 0.67, respectively).Conclusions:We developed nomograms to predict DFS and OS for patients undergoing RPS-LR1 resection. Nomograms provide individualized, disease-relevant estimations of survival for RPS-LR1 patients and assist in clinical decisions.

Purpose:Immune components of the tumor microenvironment (TME) have been associated with disease outcome. We prospectively evaluated the association of an immune-related gene signature (GS) with clinical outcome in melanoma and non–small cell lung cancer (NSCLC) tumor samples from two phase III studies.Experimental Design:The GS was prospectively validated using an adaptive signature design to optimize it for the sample type and technology used in phase III studies. One-third of the samples were used as “training set”; the remaining two thirds, constituting the “test set,” were used for the prospective validation of the GS.Results:In the melanoma training set, the expression level of eight Th1/IFNγ-related genes in tumor-positive lymph node tissue predicted the duration of disease-free survival (DFS) and overall survival (OS) in the placebo arm. This GS was prospectively and independently validated as prognostic in the test set. Building a multivariate Cox model in the test set placebo patients from clinical covariates and the GS score, an increased number of melanoma-involved lymph nodes and the GS were associated with DFS and OS. This GS was not associated with DFS in NSCLC, although expression of the Th1/IFNγ-related genes was associated with the presence of lymphocytes in tumor samples in both indications.Conclusions:These findings provide evidence that expression of Th1/IFNγ genes in the TME, as measured by this GS, is associated with clinical outcome in melanoma. This suggests that, using this GS, patients with stage IIIB/C melanoma can be classified into different risk groups.

BackgroundEndometrial cancer is of increasing concern in several countries, including Brazil, in part because of an ageing population, declines in fertility, and the increasing prevalence of obesity. Although endometrial tumors had lagged behind other cancer types in terms of treatment improvements, molecular characterization of these tumors is paving the way for novel therapies and an expansion of the therapeutic arsenal. We aimed to help medical oncologists who manage patients with recurrent or metastatic endometrial cancer in the Brazilian healthcare setting.MethodsThe panel, composed of 20 medical oncologists, convened in November 2021 to address 50 multiple-choice questions on molecular testing and treatment choices. We classified the level of agreement among panelists as (1) consensus (≥75% choosing the same answer), (2) majority vote (50% to ResultsConsensus was present for 25 of the 50 questions, whereas majority vote was present for an additional 23 questions. Key recommendations include molecular testing for every patient with recurrent/metastatic endometrial cancer; choice of first-line treatment according to microsatellite instability and HER2, with the addition of programmed death ligand 1 (PD-L1) and hormone receptors (HRs) for second-line therapy; carboplatin and paclitaxel as the preferred option in first-line treatment of HER2-negative disease, with the addition of trastuzumab in HER2-positive disease; pembrolizumab plus lenvatinib as a key option in second line, regardless of HER2, PD-L1 or HRs; and various recommendations regarding treatment choice for patients with distinct comorbidities.ConclusionDespite the existing gaps in the current literature, the vast majority of issues addressed by the panel provided a level of agreement sufficient to inform clinical practice in Brazil and in other countries with similar healthcare environments.

Replacing conventional synchronous generator-based power plants with inverter-based renewable energy resources results in a reduction of the inertia in power systems. To sustain the security and reliability of these low-inertia power systems, frequency support is increasingly required in new standards for grid-connected renewable energy resources, especially distributed photovoltaic (DPV) systems. This paper proposes a frequency droop-based control in DPV inverters to improve frequency response in power grids with high penetration of renewable energy resources. A predefined power reserve is kept in the DPV inverter, using flexible power point tracking. The proposed algorithm uses this available power reserve to support the grid frequency. Furthermore, a recovery process is proposed to continue injecting the maximum power after the disturbance, until frequency steady-state conditions are met. The positive inertia using the proposed recovery mode leads to recovery of the frequency in a shorter period. A composite load model of a distribution feeder, including DPV, is developed to assess the effectiveness of the proposed frequency support algorithm in power systems with high penetration of DPV inverters. The dynamic performance of the proposed frequency support algorithm with over-frequency and under-frequency events is also evaluated experimentally.

Background Fluctuating asymmetry (FA) is widely defined as the deviation from perfect bilateral symmetry and is considered an epigenetic measure of environmental stress. Rinaldi and Fontani hypothesized that the FA morpho-functional changes originate from an adaptive motor behavior determined by functional alterations in the cerebellum and neural circuits, not caused by a lesion, but induced by environmental stress. They called this phenomenon functional dysmetria (FD). On this premise, they developed the radio electric asymmetric conveyer (REAC) technology, a neuromodulation technology aimed at optimizing the best neuro-psycho-motor strategies in relation to environmental interaction. Aims Previous studies showed that specific REAC neuro postural optimization (NPO) treatment can induce stable FD recovery. This study aimed to verify the duration of the NPO effect in inducing the stable FD recovery over time. Materials and methods Data were retrospectively collected from a population of 29,794 subjects who underwent a specific semiological FD assessment and received the NPO treatment, regardless of the pathology referred. Results The analysis of the data collected by the various participants in the study led us to ascertain the disappearance of FD in 100% of the cases treated, with a stability of the result detected up to 18 years after the single administration of the REAC NPO treatment. Conclusions The REAC NPO neurobiological modulation treatment consisting of a single administration surprisingly maintains a very long efficacy in the correction of FD. This effect can be explained as the long-lasting capacity of the NPO treatment to induce greater functional efficiency of the brain dynamics as proven in previous studies.

The link between the Permian–Triassic mass extinction (252 million years ago) and the emplacement of the Siberian Traps Large Igneous Province (STLIP) was first proposed in the 1990s. However, the complex cascade of volcanically driven environmental and biological events that led to the largest known extinction remains challenging to reconstruct. In this Review, we critically evaluate the geological evidence and discuss the current hypotheses surrounding the kill mechanisms of the Permian–Triassic mass extinction. The initial extrusive and pyroclastic phase of STLIP volcanism was coeval with a widespread crisis of terrestrial biota and increased stress on marine animal species at high northern latitudes. The terrestrial ecological disturbance probably started 60–370 thousand years before that in the ocean, indicating different response times of terrestrial and marine ecosystems to the Siberian Traps eruptions, and was related to increased seasonality, ozone depletion and acid rain, the effects of which could have lasted more than 1 million years. The mainly intrusive STLIP phase that followed is linked with the final collapse of terrestrial ecosystems and the rapid (around 60 thousand years) extinction of 81–94% of marine species, potentially related to a combination of global warming, anoxia and ocean acidification. Nevertheless, the ultimate reasons for the exceptional severity of the Permian–Triassic mass extinction remain debated. Improved geochronology (especially of terrestrial records and STLIP products), tighter ecological constraints and higher-resolution Earth system modelling are needed to resolve the causal relations between volcanism, environmental perturbations and the patterns of ecosystem collapse.

The improved outcome of extremity soft tissue sarcoma patients surgically treated until 2007 at the authors' institution was previously reported. This study updates the analysis at a later follow-up and extends the patients' cohort to assess changes in outcomes over time for extremity and superficial trunk soft tissue sarcoma (ESTSTS) treated at a single referral center.All consecutive patients with primary localized adult-type ESTSTS surgically treated at the authors' institution between 1987 and 2017 were included and divided into group 1 (1987-2002) and group 2 (2003-2017) according to primary surgery year. Crude cumulative incidence (CCI) of sarcoma-specific mortality (SSM), local recurrence (LR), and distant metastases (DM) were calculated in a competing-risks framework. DM-free survival (DMFS) and post-DM survival were also assessed.The study identified 2382 patients. The median follow-up was 104 months (range, 63-127 months), and the post-DM follow-up was 76 months (range, 37-126 months). Since 2003, an increased adoption of preoperative treatments was observed: the use of chemotherapy, radiotherapy and combined chemoradiotherapy went from 10.5% to 23.7%, from 1.7% to 17.8%, and from 1% to 11.8% respectively. This change in treatment strategies was associated to an improvement in CCI-SSM (27.8% vs 19.5%; P0.001), CCI-LR (14.1 vs 7.5%; P0.001), DMFS (57.9% vs 65.8%; P = 0.004), and post-DM (12.2% vs 20.1%; P = 0.012), but not in CCI-DM.Increased adoption of preoperative treatments and greater availability of medical agents in the recent years were associated to better outcomes. New treatments are eagerly awaited for further improvement of outcome for ESTSTS patients because no major changes have been observed since 2003.

This paper proposes the characterization of stimulation and detection equipment in the design of wearable brain-computer interfaces based on visually evoked potentials. In particular, methods for the characterization of the optical output of commercial smart glasses, and for the calibration of a low-cost electroencephalograph are presented and discussed. The reported results show that, by proper characterization and calibration, consumer-grade equipment is suitable for brain-computer interface applications. Moreover, unexpected harmonics of the visual stimuli have to be taken into account by suitable processing. Finally, the electroencephalograph shows an adequate linear behavior, but its gain error of around 10% should be corrected by calibration in some applications.

While substantial research covers current control and synchronization of grid-connected photovoltaic (PV) inverters, issues concerning control of the PV input voltage deserve more attention, as they equally affect the reliable and stable operation of the system. Hence, this article analyses the PV voltage regulation in the single-stage single-phase PV inverter. In contrast to previous work, the PV source influence on the input voltage dynamic is analytically formalized, exposing a potential instability when the PV source is operating in its constant current region. A traditional proportional-integral PV voltage controller fails to ensure a consistent and stable voltage regulation. On the other hand, this issue is resolved by the proposed feedback linearization based controller. The new controller is validated on a test setup comprising of a PV source emulating a 1.2 kW PV array, interfaced to a single-phase inverter connected to a grid emulator. Confirming the issues predicted by the theoretical analysis, the experiments prove two main advantages of the proposed controller. First, PV voltage regulation instability is eliminated when the PV array operates in its constant current region. Second, the PV voltage transient behavior is now independent of the operating point of the PV source.