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Abstract The need for strategies to prevent complications from diabetic neuropathy (DPN) is well recognized. However, foot-ankle exercise programs show weak to moderate evidence, and barriers to their implementation persist, including broad and facilitated access to exercise programs, which guarantee for equity. In this paper, we report for the first time the effectiveness of a web-based foot-ankle exercise program aiming to improve DPN-related outcomes, gait biomechanics and functional outcomes. Sixty-two participants with DPN were randomly allocated into the control group (CG; n = 31), which received the usual care, or the intervention group (IG; n = 31), which received the usual care plus a 12-week foot-ankle exercise program using a web-based software (the SOPeD software). The primary outcomes, DPN symptoms and severity, were assessed using the Brazilian version of the Michigan Neuropathy Screening Instrument and the Decision Support System for Classification of Diabetic Polyneuropathy, respectively. Secondary outcomes included tactile sensitivity (monofilaments) and vibration perception (tuning fork), functional outcomes, such as foot pain and function (Foot Health Status Questionnaire), foot muscle strength and plantar pressure during gait (emed plate), and foot-ankle kinematics and kinetics during gait. Outcomes were assessed at baseline, 12 and 24 weeks by an assessor blinded to group allocation. DPN symptoms and severity remained unchanged after the web-based foot-ankle program. However, IG showed improvements compared to CG, with greater functional reach at 12 weeks, better foot function, reduced foot pain and greater plantarflexion degree during push-off at 24 weeks. Regarding plantar loading during gait, the forefoot pressure reduced in the IG at 12 weeks compared to baseline, but at 24 weeks, forefoot load increased in the IG compared to CG. The 12-week web-based foot-ankle exercise program was feasible, acceptable, demonstrating safety with minimal adverse events, such as delayed onset muscle soreness and foot muscle cramping. While DPN-related outcomes were unaffected by the 12-week SOPeD program, modest improvements in foot pain and function, functional reach, and changes in plantar pressure and plantarflexion degree during gait were noted, mostly at 24 weeks. Trial registration: ClinicalTrials.gov, NCT04011267. Registered on 8 July 2019.

Harmful algal blooms (HABs) in marine environments have significant adverse effects on public health, aquaculture and recreational activities. Surges of certain phytoplanktonic toxin-producing microalgae (mostly dinoflagellates or diatoms species) can induce Amnesic, Diarrhetic or Paralytic Shellfish Poisoning (ASP, DSP and PSP). Among HAB species, the genus Dinophysis leads to DSP in human consumers; this being the most recurrent problem in the Iberian Peninsula with the biggest economic impact on clam production and harvesting. While complete elimination of HABs is not feasible, timely implementation of appropriate measures can prevent their negative consequences. This is critical for aquaculture. Research on D. acuminata (dominant Dinophysis species in the North Atlantic) has been focused on ecophysiology and population dynamics, although with few modelling attempts. Weekly monitoring along the Portuguese coast since 2006 has revealed that D. acuminata thrives under spring/summer photosynthetically active radiation (PAR) coupled with water temperatures below 20°C, which typically coincide with the local upwelling regime. In order to advance this knowledge numerically, we developed a demographic model linking D. acuminata growth rate to PAR and sea surface temperature (SST). The 13-year (1-Jan-2006 to 31-Dec-2018) time-series of observations was closely fit by model forecasts. However, the model demonstrated limitations in issuing timely warnings of harmful proliferation of D. acuminata, failing to do so in 50% of cases, and issuing incorrect warnings in 5% of the cases. Furthermore, improving the odds of emitting timely warnings always worsened the odds of emitting false warnings, and vice-versa. To simultaneously improve both aspects, the modelling results clearly indicated the need of implementing both census/projection intervals smaller than 7 days and a laboratory detection limit below 20 cell/L. The time resolution of the census and of the model proved to be the most limiting factor that must be addressed in order to improve numerical forecasting of HABs.

Este estudo propõe a discussão sobre a memória da educação materializada nos textos de apresentação de livros didáticos de Projeto de Vida do PNLD 2021. Respaldado na Análise de Discurso Materialista, implicou gestos que, comprometidos com a busca de compreensão dos movimentos de (des)estabilização dos sentidos, permitiram depreender que a identificação dos autores com uma FD Meritocrática resultou na constituição de efeitos de sentido de protagonismo, promessa de possibilidade e responsabilização do estudante. A FD representa uma FI Mercadológica-Educacional que torna óbvia a responsabilidade individual sobre sucesso ou fracasso e produz um silenciamento de desigualdades e injustiças.

This study evaluates a new multiport device with single access to the abdominal cavity produced with routine hospital supplies that could be applied to laparoscopically assisted cryptorchidectomy in standing horses. Initially, the new device was evaluated on five cadavers of bovine fetuses (n = 5), placed assisted in a minilaparotomy performed in the flank region. Subsequently, the device was evaluated in four cryptorchid horses treated during the hospital routine. During the evaluation of the new device, the possibilities of exploring the abdominal cavity, inspection, and intra-abdominal manipulation with two Babcock forceps were verified. The possibilities were described, and surgical time data were recorded and analyzed using descriptive statistics. In the cadavers, a wide exploration of the abdominal cavity was possible, with a laparoscopic inspection through the right paralumbar fossa and manipulation of intra-abdominal structures with Babcock forceps inserted by the new device. In cryptorchid horses, laparoscopically assisted cryptorchidectomy with a new device was feasible in two patients, and in the others, it allowed the diagnosis of adhesions and ectopic locations in the inguinal region of testicles retained in the cavity. Therefore, the new device was efficient in exploring the inguinal region of cryptorchid horses in the standing position. The present study is preliminary and can support future studies that aim to improve the developed prototype.

ABSTRACT BACKGROUND: Stroke is one of the main causes of death worldwide. Educational interventions on stroke are potentially effective in reducing the period between the onset of symptoms and the initial emergency medical assistance. OBJECTIVES: To assess high school students’ knowledge of stroke. DESIGN AND SETTING: Cross-sectional study conducted in high schools in northeastern Brazil. METHODS: A self-structured questionnaire survey regarding stroke awareness was applied among high school students in northeastern Brazil. Data were collected between 2018 and 2019. The chi-square test and other descriptive statistics were used. Univariate and multivariate analyses were performed using logistic regression. RESULTS: A total of 1,788 students were analyzed. Eighty percent (n = 1430) of them did not have the minimum knowledge on how to act in a stroke situation. Only 10% (n = 179) presented the ideal knowledge on how to act. Males presented lower levels of knowledge on risk factors (odds ratio, OR: 0.62%; 95% confidence interval, CI: 0.49-0.79) and signs and symptoms of stroke (OR: 0.63%; 95% CI: 0.52-0.77). Students with ≥ 10 years of schooling (OR: 1.64%; 95% CI: 1.30-2.07) demonstrated greater knowledge of signs and symptoms of stroke. Students aged 18 years (OR: 1.70%; 95% CI: 1.14-2.52) demonstrated greater knowledge than other ages regarding the telephone number of the emergency medical services. CONCLUSIONS: There was a knowledge deficit with regard to recognizing stroke and activating the emergency medical services. The findings apply to the sample investigated and suggest that there is a need for stroke educational interventions, starting in high school.

Objective The goal of the present study was to investigate possible effects of the COVID-19 pandemic on long-distance running training. Methods This is a retrospective study with a within-subject design. We analyzed 10,703,690 records of running training during 2019 and 2020, from 36,412 athletes from around the world. The records were obtained through web scraping of a large social network for athletes on the internet. A potential long-distance runner was defined as a user of the social network who had a record of running at least one of the six World Marathon Majors by 2019. Results In 2020, compared with 2019, in total there was a 3.6% decrease in the number of athletes running, a 7.5% decrease in the distance and 6.7% in the duration of running training. There were large variations in these variables throughout 2020, reaching 16% fewer athletes running weekly and 35% lower running distance (Cohen’s d = 0.34, p

PURPOSEThis paper aims to present the results of a series of several Brazilian institutions that have been carrying out lung cancer screening (LCS).MATERIALS AND METHODSThis is a retrospective, cohort study, with follow-up of individuals of both sexes, with a heavy smoking history, who participated in LCS programs between December 2013 and January 2021 in six Brazilian institutions located in the states of São Paulo, Rio Grande do Sul, and Bahia.RESULTSThree thousand four hundred seventy individuals were included, of which 59.8% were male (n = 2,074) and 50.6% were current smokers (n = 1,758), with 60.7 years (standard deviation 8.8 years). Lung-RADS 4 was observed in 233 (6.7%) patients. Biopsy was indicated by minimally invasive methods in 122 patients (3.5%). Two patients who demonstrated false-negative biopsies and lung cancer were diagnosed in follow-up. Diagnosis of lung cancer was observed in 74 patients (prevalence rate of 2.1%), with 52 (70.3%) in stage I or II. Granulomatous disease was found in 20 patients. There were no statistical differences in the incidence of lung cancer, biopsies, granulomatous disease, and Lung-RADS 4 nodules between public and private patients.CONCLUSIONThere are still many challenges and obstacles in the implementation of LCS in developing countries; however, our multi-institutional data were possible to obtain satisfactory results in these scenarios and to achieve similar results to the main international studies. Granulomatous diseases did not increase the number of lung biopsies. The authors hope that it could stimulate the creation of organized screening programs in regions still endemic for tuberculosis and other granulomatous diseases.

Abstract Background Understanding the effects of gait speed on biomechanical variables is fundamental for a proper evaluation of alterations in gait, since pathological individuals tend to walk slower than healthy controls. Therefore, the aim of the study was to perform a systematic review of the effects of gait speed on spatiotemporal parameters, joint kinematics, joint kinetics, and ground reaction forces in healthy children, young adults, and older adults. Methods A systematic electronic search was performed on PubMed, Embase, and Web of Science databases to identify studies published between 1980 and 2019. A modified Quality Index was applied to assess methodological quality, and effect sizes with 95% confidence intervals were calculated as the standardized mean differences. For the meta-analyses, a fixed or random effect model and the statistical heterogeneity were calculated using the I 2 index. Results Twenty original full-length studies were included in the final analyses with a total of 587 healthy individuals evaluated, of which four studies analyzed the gait pattern of 227 children, 16 studies of 310 young adults, and three studies of 59 older adults. In general, gait speed affected the amplitude of spatiotemporal gait parameters, joint kinematics, joint kinetics, and ground reaction forces with a decrease at slow speeds and increase at fast speeds in relation to the comfortable speed. Specifically, moderate-to-large effect sizes were found for each age group and speed: children (slow, − 3.61 to 0.59; fast, − 1.05 to 2.97), young adults (slow, − 3.56 to 4.06; fast, − 4.28 to 4.38), and older adults (slow, − 1.76 to 0.52; fast, − 0.29 to 1.43). Conclusions This review identified that speed affected the gait patterns of different populations with respect to the amplitude of spatiotemporal parameters, joint kinematics, joint kinetics, and ground reaction forces. Specifically, most of the values analyzed decreased at slower speeds and increased at faster speeds. Therefore, the effects of speed on gait patterns should also be considered when comparing the gait analysis of pathological individuals with normal or control ones.

Introduction: Technological advancements in computed tomography (CT) have enabled the frequent detection of small pulmonary nodules (PNs), especially in patients with an oncologic history. It is important the malignant versus benign etiology of PNs be determined. The aim of the present study was to evaluate the behavior and clinical/radiological characteristics of subcentimeter PNs detected by CT in oncologic patients. Methods: An observational, longitudinal, retrospective and single-center study was conducted with a sample of 100 patients with a diagnosis of a primary malignant solid tumor outside of the lungs who developed indeterminate subcentimeter PNs (n = 251) detected on consecutive thoracic CT scans from 2015 to 2017. Follow-up CTs for each patients were examined in each of three periods (0–3 months, 3–6 months, and 6 months to 1 year). Results: In our study sample, 28 patients (28 %) showed one or more signs suspicious of pulmonary metastasis, including ≥50 % PN growth, nodule growth followed by size reduction in patients undergoing chemotherapy, and the appearance of multiple nodules. The majority (56 %) of the PNs were detected during the 3–6-month follow-up CT scan. PNs with irregular, lobuled, or spiculated margins exhibited faster growth than PNs with regular, smooth margins. Malignancy of PNs was found to be significantly associated with being male, a primary colorectal cancer diagnosis, and advanced stage disease. Conclusion: Our findings reinforce the necessity of an individualized CT follow-up strategy for patients with an oncologic history, as well as the importance of early nodule screening, with the inter-scan interval being dependent on the primary neoplasm.

BackgroundThe purpose of this study was to determine whether whole-body MRI (WBMRI) with diffusion-weighted sequences, which is free of ionizing radiation, can perform as well as traditional methods when used alone for staging or follow-up of pediatric cancer patients.MethodsAfter obtaining approval from our institutional research ethics committee and appropriate informed consent, we performed 34 examinations in 32 pediatric patients. The examinations were anonymized and analyzed by two radiologists with at least 10 years' experience.ResultsThe sensitivity and specificity findings, respectively, were as follows: 100% and 100% for primary tumor; 100% and 86% for bone metastasis; 33% and 100% for lung metastasis; 85% and 100% for lymph node metastasis; and 100% and 62% for global investigation of primary or secondary neoplasias. We observed excellent interobserver agreement for WBMRI and excellent agreement with standard staging examination results.ConclusionsOur results suggest that pediatric patients can be safely imaged with WBMRI, although not as the only tool but in association with low-dose chest CT (for subcentimeter pulmonary nodules). However, additional exams with ionizing radiation may be necessary for patients who tested positive to correctly quantify and locate the lesions.

Abstract Background Li-Fraumeni syndrome (LFS) is an autosomal dominant disease that is associated with germline TP53 mutations and it predisposes affected individuals to a high risk of developing multiple tumors. In Brazil, LFS is characterized by a different pattern of TP53 variants, with the founder TP53 p.R337H mutation being predominant. The adoption of screening strategies to diagnose LFS in its early stages is a major challenge due to the diverse spectrum of tumors that LFS patients can develop. The purpose of this study was to evaluate two rounds of whole-body magnetic resonance imaging (WB-MRI) which were conducted as a screening strategy for LFS patients. Methods Over a 4-year period, 59 LFS patients underwent two rounds of WB-MRI. Each MRI was characterized as positive or negative, and positive cases were further investigated to establish a diagnosis. The parameters used to evaluate the WB-MRI results included: positive rate, number of invasive investigations of positive results, and cancer detection rate. Results A total of 118 WB-MRI scans were performed. Positive results were associated with 11 patients (9.3%). Seven of these patients (11.8%) were identified in the first round of screening and 4 patients (6.7%) were identified in the second round of screening. Biopsies were performed in three cases (2.5%), two (3.4%) after the first round of screening and one (1.7%) after the second round of screening. The histopathological results confirmed a diagnosis of cancer for all three cases. There was no indication of unnecessary invasive procedures. Conclusions WB-MRI screening of LFS carriers diagnosed cancers in their early stages. When needed, positive results were further examined with non-invasive imaging techniques. False positive results were less frequent after the first round of WB-MRI screening.

INTRODUCTION: There is a strong commitment in pursuing reconstructive solutions for areas of skin or muscular loss that require covering or stable cavity filling. The anterolateral thigh flap, described in China by Song et al. (1984), is considered by many as the optimal flap in large reconstructions. OBJECTIVE: To report the applicability of the anterolateral thigh flap, as a versatile resource in reconstructions of the abdominal wall. METHODS: Two patients were submitted to tumoral resection of the right colon with invasion of the abdominal wall by a team of oncologic surgeons in conjunction with the plastic surgery team that was responsible for the reconstruction of the abdominal wall. In both cases, the pedicled anterolateral thigh flap was used, which was transposed to the defect after partial resection of the abdominal wall at the same surgical time. A PROCEEDTM surgical mesh was fixed between the abdominal viscera and the flap to reinforce the abdominal wall. RESULTS: Both patients had good postoperative evolution and are in follow-up, with no signs of tumor recurrence and with a good quality of life. CONCLUSION: The anterolateral thigh flap is a useful resource for the reconstruction of the abdominal wall due to large tumor resections in oncology.

In a typical clinical gait analysis, the gait patterns of pathological individuals are commonly compared with the typically faster, comfortable pace of healthy subjects. However, due to potential bias related to gait speed, this comparison may not be valid. Publicly available gait datasets have failed to address this issue. Therefore, the goal of this study was to present a publicly available dataset of 42 healthy volunteers (24 young adults and 18 older adults) who walked both overground and on a treadmill at a range of gait speeds. Their lower-extremity and pelvis kinematics were measured using a three-dimensional (3D) motion-capture system. The external forces during both overground and treadmill walking were collected using force plates and an instrumented treadmill, respectively. The results include both raw and processed kinematic and kinetic data in different file formats: c3d and ASCII files. In addition, a metadata file is provided that contain demographic and anthropometric data and data related to each file in the dataset. All data are available at Figshare (DOI: 10.6084/m9.figshare.5722711). We foresee several applications of this public dataset, including to examine the influences of speed, age, and environment (overground vs. treadmill) on gait biomechanics, to meet educational needs, and, with the inclusion of additional participants, to use as a normative dataset.

This article describes a public data set containing the three-dimensional kinematics of the whole human body and the ground reaction forces (with a dual force platform setup) of subjects who were standing still for 60 s in different conditions, in which the subjects’ vision and the standing surface were manipulated. Twenty-seven young subjects and 22 old subjects were evaluated. The data set comprises a file with metadata plus 1,813 files with the ground reaction force (GRF) and kinematics data for the 49 subjects (three files for each of the 12 trials plus one file for each subject). The file with metadata has information about each subject’s sociocultural, demographic, and health characteristics. The files with the GRF have the data from each force platform and from the resultant GRF (including the center of pressure data). The files with the kinematics contain the three-dimensional positions of 42 markers that were placed on each subject’s body and 73 calculated joint angles. In this text, we illustrate how to access, analyze, and visualize the data set. All the data is available at Figshare (DOI: 10.6084/m9.figshare.4525082), and a companion Jupyter Notebook presents programming code to access the data set, generate analyses and other examples. The availability of a public data set on the Internet that contains these measurements and information about how to access and process this data can potentially boost the research on human postural control, increase the reproducibility of studies, and be used for training and education, among other applications.

Background The goals of this study were (1) to present the set of data evaluating running biomechanics (kinematics and kinetics), including data on running habits, demographics, and levels of muscle strength and flexibility made available at Figshare (DOI: 10.6084/m9.figshare.4543435); and (2) to examine the effect of running speed on selected gait-biomechanics variables related to both running injuries and running economy. Methods The lower-extremity kinematics and kinetics data of 28 regular runners were collected using a three-dimensional (3D) motion-capture system and an instrumented treadmill while the subjects ran at 2.5 m/s, 3.5 m/s, and 4.5 m/s wearing standard neutral shoes. Results A dataset comprising raw and processed kinematics and kinetics signals pertaining to this experiment is available in various file formats. In addition, a file of metadata, including demographics, running characteristics, foot-strike patterns, and muscle strength and flexibility measurements is provided. Overall, there was an effect of running speed on most of the gait-biomechanics variables selected for this study. However, the foot-strike patterns were not affected by running speed. Discussion Several applications of this dataset can be anticipated, including testing new methods of data reduction and variable selection; for educational purposes; and answering specific research questions. This last application was exemplified in the study’s second objective.

The goal of this study was to create a public data set with results of qualitative and quantitative evaluations related to human balance. Subject’s balance was evaluated by posturography using a force platform and by the Mini Balance Evaluation Systems Tests. In the posturography test, we evaluated subjects standing still for 60 s in four different conditions where vision and the standing surface were manipulated: on a rigid surface with eyes open; on a rigid surface with eyes closed; on an unstable surface with eyes open; on an unstable surface with eyes closed. Each condition was performed three times and the order of the conditions was randomized. In addition, the following tests were employed in order to better characterize each subject: Short Falls Efficacy Scale International; International Physical Activity Questionnaire Short Version; and Trail Making Test. The subjects were also interviewed to collect information about their socio-cultural, demographic, and health characteristics. The data set comprises signals from the force platform (raw data for the force, moments of forces, and centers of pressure) of 163 subjects plus one file with information about the subjects and balance conditions and the results of the other evaluations. All the data is available at PhysioNet and at Figshare.

ObjectiveOur aim was to assess renal function using as laboratory measurements serum creatinine and cystatin C concentrations before and after administration of low-osmolarity (nonionic) iodinated contrast medium in patients with cancer undergoing computed tomography (CT).MethodsThis prospective study included 400 oncologic outpatients. Serum creatinine and cystatin C concentrations were measured before and 72 h after contrast administration. Glomerular filtration rates (GFRs) were estimated using serum creatinine-based [Modification of Diet in Renal Disease (MDRD) and Cockroft-Gault and cystatin C based (Larsson) equations. Exploratory data analysis was performed. The nonparametric Wilcoxon test was used to compare pre and post contrast of test results and estimated clearance. The confidence interval used in the analysis was 95%.ResultsCompared with the pre-contrast values, the mean serum creatinine concentration was significantly higher and average GFRs estimated using MDRD and Cockcroft-Gault equations were significantly lower after the administration of contrast (p ConclusionsAssessment using serum creatinine and cystatin C concentrations showed changes in renal function among patients with cancer undergoing contrast-enhanced CT examination in this study. No significant renal damage related to the use of low-osmolarity iodinated contrast medium of the type and dosage employed in this study was observed. This contrast medium is thus safe for use in patients with cancer.

Harmful algal blooms (HABs) in marine environments have significant adverse effects on public health, aquaculture and recreational activities. Surges of certain phytoplanktonic toxin-producing microalgae (mostly dinoflagellates or diatoms species) can induce Amnesic, Diarrhetic or Paralytic Shellfish Poisoning (ASP, DSP and PSP). Among HAB species, the genus Dinophysis leads to DSP in human consumers; this being the most recurrent problem in the Iberian Peninsula with the biggest economic impact on clam production and harvesting. While complete elimination of HABs is not feasible, timely implementation of appropriate measures can prevent their negative consequences. This is critical for aquaculture. Research on D. acuminata (dominant Dinophysis species in the North Atlantic) has been focused on ecophysiology and population dynamics, although with few modelling attempts. Weekly monitoring along the Portuguese coast since 2006 has revealed that D. acuminata thrives under spring/summer photosynthetically active radiation (PAR) coupled with water temperatures below 20°C, which typically coincide with the local upwelling regime. In order to advance this knowledge numerically, we developed a demographic model linking D. acuminata growth rate to PAR and sea surface temperature (SST). The 13-year (1-Jan-2006 to 31-Dec-2018) time-series of observations was closely fit by model forecasts. However, the model demonstrated limitations in issuing timely warnings of harmful proliferation of D. acuminata, failing to do so in 50% of cases, and issuing incorrect warnings in 5% of the cases. Furthermore, improving the odds of emitting timely warnings always worsened the odds of emitting false warnings, and vice-versa. To simultaneously improve both aspects, the modelling results clearly indicated the need of implementing both census/ projection intervals smaller than 7 days and a laboratory detection limit below 20 cell/L. The time resolution of the census and of the model proved to be the most limiting factor that must be addressed in order to improve numerical forecasting of HABs. [ABSTRACT FROM AUTHOR]

ABSTRACT We consider the problem of selecting private equity funds for investment in Brazil. The proposed methodology is based on multi-criteria decision-making. Real data obtained from one of the largest pension funds in Brazil is used to illustrate a practical application of the methodology when selecting investments among eleven private equity funds available in the local financial market. The multi-criteria method TOPSIS is adopted with a total of twenty two criteria to order the investment alternatives. A sensitivity analysis is also presented. The methodology proposed allows a standardized decision-making process, facilitating the process of selecting private equity funds for investment in Brazilian financial markets.

This study considers the problem of indexing fixed-income portfolios to the ANBIMA Market Index – Series B (IMA-B), composed of Brazilian National Treasury Notes – Series B (NTNBs). We propose a mathematical model that minimizes the deviations of the returns of the chosen portfolio in relation to the returns of the index’s theoretical portfolio. The resulting model is a mathematical programming problem with convex objective function, linear constraints and free and non-negative integer variables. Five numerical examples with real data are presented to illustrate the model’s practical use. The results obtained from the fits are analyzed together with data for funds indexed to the IMA-B existing in the Brazilian financial market. The proposed method resulted in fits with optimal control of the tracking errors of the indexed portfolio.