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Little is known about the long-term functional outcomes of restorative proctocolectomy.The aim of this study was to examine ileoanal pouch outcomes 20 and 30 years postoperatively.This is a retrospective case series.This study was conducted at a tertiary care referral center.Patients who underwent restorative proctocolectomy between 1980 and 1994 were identified. Those with ≥20 years of in-person follow-up were included.Pouch function, pouchitis, anal stricture, and pouch failure rates were analyzed.A total of 203 patients had ≥20 years of follow-up. Of those, 71 had ≥30 years of follow-up. Initial diagnoses included ulcerative colitis (83%), indeterminate colitis (9%), familial adenomatous polyposis (4%), and Crohn's disease (3%). Twenty-one percent of those with ulcerative or indeterminate colitis later transitioned to Crohn's disease. Mean daily stool frequency was 7 (IQR 6-8), 38% experienced seepage, 31% had anal stenosis, 47% experienced pouchitis, and 18% had pouch failure. Over time, stool frequency increased in 41% of patients, stayed the same in 43%, and decreased in 16%. Patients older than 50 years at the time of construction had more daily bowel movements (median 8 vs 6; p = 0.02) and more seepage (77% vs 35%; p = 0.005) than those younger than 50 years. Patients with Crohn's disease had higher stool frequency (median 8 vs 6; p0.001) and higher rates of anal stenosis (44% vs 26%; p = 0.02), pouchitis (70% vs 40%; p0.001), and pouch failure (38% vs 12%; p0.001) compared to non-Crohn's patients. Patients with ≥30 years of follow-up had similar function as those with 20-30 years of follow-up.This was a retrospective, single-institution study. Only 35% of pouches created during the study period had20 years of follow-up.Most patients maintain reasonably good function and retain their pouches after 20 years. Over time, stool frequency and seepage increase. Older age and Crohn's disease are associated with worse outcomes. See Video Abstract at http://links.lww.com/DCR/B801.ANTECEDENTES:se sabe poco sobre los resultados funcionales a largo plazo de la proctocolectomía restauradora.OBJETIVO:El objetivo de este estudio fue examinar los resultados del reservorio ileoanal 20 y 30 años después de la operación.DISEÑO:Serie de casos retrospectiva.ENTORNO CLÍNICO:Centro de referencia de atención terciariaPACIENTES:Se identificaron pacientes que se sometieron a proctocolectomía restauradora entre 1980 y 1994. Se incluyeron aquellos con ≥20 años de seguimiento en persona.PRINCIPALES MEDIDAS DE VALORACIÓN:Se analizaron la función, inflamación, tasas de falla del reservorio y estenosis anal.RESULTADOS:Un total de 203 pacientes tuvieron ≥20 años de seguimiento. De ellos, 71 tenían ≥30 años de seguimiento. Los diagnósticos iniciales incluyeron colitis ulcerosa (83%), colitis indeterminada (9%), poliposis adenomatosa familiar (4%) y enfermedad de Crohn (3%). El 21% de las personas con colitis ulcerosa o indeterminada pasaron posteriormente a la enfermedad de Crohn. La frecuencia promedio de las deposiciones diarias fue de 7 (rango intercuartil 6-8), el 38% experimentó filtración, el 31% tuvo estenosis anal, el 47% experimentó pouchitis y el 18% tuvo falla del reservorio. Con el tiempo, la frecuencia de las deposiciones aumentó en el 41% de los pacientes, se mantuvo igual en el 43% y disminuyó en el 16%. Los pacientes mayores de 50 años en el momento de la construcción tenían más evacuaciones intestinales diarias (media 8 vs 6, p = 0,02) y más filtraciones (77% vs 35%, p = 0,005) que los menores de 50 años. Los pacientes con enfermedad de Crohn tenían mayor frecuencia de deposiciones (media 8 vs 6, p0,001) y tasas más altas de estenosis anal (44% vs 26%, p = 0,02), inflamacion (70% vs 40%, p0,001) y falla del reservorio (38% frente a 12%, p0,001) en comparación con pacientes que tenian enfermedad de Crohn. Los pacientes con ≥30 años de seguimiento tuvieron una función similar a aquellos con 20-30 años de seguimiento.LIMITACIONES:Este fue un estudio retrospectivo de una sola institución. Solo el 35% de los reservorios creados durante el período de estudio tuvieron más de 20 años de seguimiento.CONCLUSIONES:La mayoría de los pacientes mantienen una función razonablemente buena y conservan el reservorio después de 20 años. Con el tiempo, la frecuencia de las deposiciones y la filtración aumentan. La vejez y la enfermedad de Crohn se asocian con peores resultados. Consulte Video Resumen en http://links.lww.com/DCR/B801. (Traducción - Dr. Ingrid Melo).

Equitable distribution of vaccines is necessary to ensure those at highest risk of illness are protected from COVID-19 (coronavirus disease 2019). Unfortunately, there is significant evidence that vaccines have not been reaching the most vulnerable. At our large hospital system, we created interactive online tools to measure and visualize equitability of vaccine administrations and to help stakeholders identify populations at highest risk within state-designated eligible vaccine groups. Using race, ethnicity, gender, and social vulnerability, we are able to measure and reflect our vaccine administration performance against the communities that we serve. With our visualization tools, stakeholders have been able to target interventions to improve equity in vaccine administrations, including improvements in race, ethnicity, and social vulnerability. We plan to use the data elements incorporated in our electronic health record and data warehouse due to the COVID-19 pandemic to guide further population health efforts at decreasing disparities.

Integrated multi-trophic aquaculture has been considered as an alternative for the sustainable development of mariculture. This study evaluated the use of a multi-trophic system in mariculture in order to improve economic viability indices and reduce environmental impacts, leading to a sustainable production. To do so, the economic indicators of two monotrophic crops were considered: Perna perna mussels and Rachycentron canadum cobias, along with a multi-trophic system involving both species. The indices for the evaluation of profitability were the internal rate of return (IRR), the payback period (PP) and the net present value (NPV). Investment analyses were realized through cash flow and determination of economic viability indicators for a period of 10 years. The systems were evaluated in different scenarios. Each scenario was estimated by means of 20% and 40% variations of the values adopted for the following parameters: unit price of cobia juveniles, average price of the feed, cobia commercial price, mussel commercial price, cobia productivity, and mussel productivity. The multi-trophic system showed greater economic viability in the different scenarios evaluated. This system demonstrated greater resilience, which is more economically attractive to an entrepreneur. Production diversification is an alternative option with a lower associated investment, which can favor economic return and mitigate the risks of small-scale systems dedicated to monocultures.

SUMMARY OBJECTIVE: Several prospective randomized trials have shown that hypofractionation has the same efficacy and safety as the conventional fractionation in the treatment of localized prostate cancer. There are many benefits of hypofractionation, including a more convenient schedule for the patients and better use of resources, which is especially important in low- and middle-income countries like Brasil. Based on these data, the Brazilian Society of Radiotherapy (Sociedade Brasileira de Radioterapia) organized this consensus to guide and support the use of hypofractionated radiotherapy for localized prostate cancer in Brasil. METHODS: The relevant literature regarding moderate hypofractionation (mHypo) and ultra-hypofractionation (uHypo) was reviewed and discussed by a group of experts from public and private centers of different parts of Brasil. Several key questions concerning clinical indications, outcomes and technological requirements for hypofractionation were discussed and voted. For each question, consensus was reached if there was an agreement of at least 75% of the panel members. RESULTS: The recommendations are described in this article. CONCLUSION: This initiative will assist Brazilian radiation oncologists and medical physicists to safely treat localized prostate cancer patients with hypofractionation.

The choice of suitable substrates has received special attention in aquaculture and fishkeeping ventures. The aim of this study was to evaluate the influence of different substrates on water quality and the development of lambari fish (Astyanax bimaculatus) and freshwater shrimp (Macrobrachium potiuna). Two experiments were performed sequentially, one with fish and the other with shrimp. In both experiments, three different substrates were evaluated (shell gravel, river gravel, and dolomite), and the control was without any substrate. The water parameters evaluated were as follows: dissolved oxygen, saturation, oxide-reduction potential, temperature, pH, alkalinity, conductivity, ammonia, nitrite, nitrate, and phosphorus. It was observed that both dolomite and shell gravel interfered with the parameters that are related to the acid-base balance of the water and the availability of calcium and magnesium. The productive performance of lambari fish was not affected considering the different substrates evaluated; however, the productive performance of freshwater shrimp was lower in the absence of substrates in relation to the other treatments.

National Colorectal Cancer Awareness Month occurs each March to promote awareness and screening for colorectal cancer. The effectiveness of this public health campaign is unknown. The aim of this study was to determine the impact of National Colorectal Cancer Awareness Month on rates of screening endoscopies and on public interest in colorectal cancer. To examine the impact of National Colon Cancer Awareness Month on screening endoscopy rates, the National Endoscopy Database was retrospectively reviewed from 2002 through 2014. A time series of monthly number of colorectal cancer screening endoscopies per endoscopist in the data set was evaluated. To examine public interest in colorectal cancer, Google Trends data were collected on the monthly rates of terms related to colorectal cancer from January 2004 to July 2019. Impact of the month on screening endoscopies and public interest was assessed through an analysis of variance. Seasonality was tested for by how well a sinusoidal model fit the time series as opposed to a linear model utilizing a sum-of-squares F test. Review of National Endoscopy Database yielded 1,398,996 endoscopies, 94% were colonoscopies and 6% sigmoidoscopies, with 47% for colorectal cancer screening. Colorectal cancer screening endoscopy rates were not impacted by the month of the year, and these rates had no seasonality. However, Google searches related to colorectal cancer were significantly impacted by month of the year, specifically March, with significant seasonality observed in the data. National Colorectal Cancer Awareness Month is associated with an increased public interest in colorectal cancer based on user Google search trends. Yet, this has not translated into a demonstrable increase in the rates of screening. This presents an opportunity to capitalize on this increased public interest and harness this enthusiasm into increased screening.

Objective: Cystectomy with urinary diversion is the gold standard for muscle invasive bladder cancer. It also may be performed as part of pelvic exenteration for non-urologic malignancy, neurogenic bladder dysfunction, and chronic conditions that result in a non-functional bladder (e.g., interstitial cystitis, radiation cystitis). Our objective is to describe the surgical technique of urinary diversion using large intestine as a conduit whilst creating an end colostomy, thereby avoiding a primary bowel anastomosis and to show its applicability with respect to urologic conditions. Materials and Methods: We retrospectively reviewed five cases from a single institution that utilized the described method of urinary diversion with large intestine. We describe operative times, hospital length of stay (LOS), and describe post-operative complications. Results: Five patients with a variety of urologic and oncologic pathology underwent the described procedures. Their operative times ranged from 5 hours to 11 hours and one patient experienced a Clavien III complication. Conclusion: We describe five patients who underwent this procedure for various medical indications, and describe their outcomes, and believe dual diversion of urinary and gastrointestinal systems with colon as a urinary conduit to be an excellent surgical option for the appropriate surgical candidate.

Breast cancer (Bca) is the most common type of cancer among women worldwide, and oxidative stress caused by adjuvant treatment may be decreased by antioxidant intake. The aim of this study is to investigate the associations between Dietary antioxidant Capacity (DaC) and oxidation and antioxidant biomarkers in women undergoing adjuvant treatment (AT) for Bca. This prospective study had a sample of 70 women (52.2 ± 10.7 y). DaC (mmol/g) was calculated using nutritional data obtained from a Food Frequency Questionnaire, and blood was collected to measure the oxidation and antioxidant biomarkers at baseline (T0), and after AT (T1). Carbonylated protein levels were inversely associated with DaC at T1 (p = 0.004); women showed an increased risk of having increment on lipid hydroperoxides and thiobarbituric acid reactive substances (TBARS), and decrement on ferric reducing antioxidant power (FRAP) and reduced glutathione after AT, in response to lowered DaC (p < 0.05). Carbonylated proteins, TBARS and FRAP levels remained stable between the periods for women at the 3rd DaC tertile at T1, differentiating them from those at the 1st tertile, who showed negative changes in these biomarkers (p < 0.04). DaC may be beneficial for women undergoing AT for Bca, since it promoted a reduction in oxidative stress.

Deep learning is a trending field in bioinformatics; so far, mostly known for image processing and speech recognition, but it also shows promising possibilities for data processing in food analysis, especially, foodomics. Thus, more and more deep learning approaches are used. This review presents an introduction into deep learning in the context of metabolomics and proteomics, focusing on the prediction of shelf-life, food authenticity, and food quality. Apart from the direct food-related applications, this review summarizes deep learning for peptide sequencing and its context to food analysis. The review’s focus further lays on MS (mass spectrometry)-based approaches. As a result of the constant development and improvement of analytical devices, as well as more complex holistic research questions, especially with the diverse and complex matrix food, there is a need for more effective methods for data processing. Deep learning might offer meeting this need and gives prospect to deal with the vast amount and complexity of data.

Salt‐water recirculation systems using automatic feeders are a new frontier for marine aquaculture. The definition of the feed frequency is fundamental for the correct use of automatic feeders. Different feeding frequencies (1, 3, 6, 12 and 18 times a day) using automatic feeders were evaluated in two experiments on the performance of the dusky grouper (Epinephelus marginatus) in salt‐water recirculation system. In the first experiment, three feeding frequencies were evaluated: feeding once a day; three times a day and six times a day. In the second experiment, three feeding frequencies were evaluated: feeding six times a day; 12 times a day and 18 times a day. Waters parameters (temperature, salinity, oxygen level, total ammonia, pH and oxidation‐reduction potential) were maintained at specific ranges for the species. Among all the evaluated frequencies, 12 times a day provided the best productive performance, obtaining superior results for final weight, final biomass, specific growth rate and daily weight gain. For juveniles of the dusky grouper, the ideal feeding frequency is regular feedings every 2 hours, which is impractical to run without the use of automatic feeders.

We show that individuals’ macroeconomic expectations are influenced by their socioeconomic status (SES). People with higher income or higher education are more optimistic about future macroeconomic developments, including business conditions, the national unemployment rate, and stock market returns. The spread in beliefs between high- and low-SES individuals diminishes significantly during recessions. A comparison with professional forecasters and historical data reveals that the beliefs wedge reflects excessive pessimism on the part of low-SES individuals. SES-driven expectations help explain why higher-SES individuals are more inclined to invest in the stock market and more likely to consider purchasing homes, durable goods, or cars. Received November 13, 2017; editorial decision February 12, 2019 by Editor Wei Jiang. Authors have furnished an Internet Appendix, which is available on the Oxford University Press Web site next to the link to the final published paper online.

In desiring to understand the application of environmental psychology in the sphere of health proposes to contemplate the relationships that people establish with the places they inhabit. It is therefore objective to systematically revise literature in order to examine the concepts of restorative environment, environmental significance and urban social identity in relation to health Contexts. This triad contemplates the interaction of the subject with the spaces, emphasizing, above all, the search for Well-being. In order to do so, a systematic review of the literature was carried out in the BVS-PSI, Scielo, Lilacs, Pepsic data bases. In addition, the international databases that give access to the main journals of environmental psychology were contemplated: Science Direct and Sage journals. They resulted in twenty seven studies, analyzed and subdivided into three structured categories in order to contemplate the thematic, theoretical and methodological differences. Although they have distinct boundaries, the articles examined communicate with each other through the common perspective of investing in the search for health improvement strategies and health promotion considering the relationship with the Environment. In this way, scientific findings are expected to provide indicators and subsidies in the assessment and structuring of environmental actions and planning in the context of health care.

Made available in DSpace on 2021-06-25T10:55:34Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-06-01 Forensic Facial Reconstruction (FFR) is a technique that enables the recognition of an individual, by modeling the contours of facial tissues on a skull found without identification. It it is necessary to know the facial soft tissue thickness (FSTTs) that covers some craniometric points in the underlying skull to perform a FFR, as they are used as a basis for obtaining the facial contour. The objective of this study was to measure FSTTs of living adult Brazilian subjects, using images from cone beam computed tomography (CBCT), considering the variables sex, ancestry, age and body mass index. Twenty-one anatomical landmarks (10 midsagittal and 11 bilateral) were measured, using Osirix Lite software. A total of 106 images were analyzed (71 females and 35 males). It was observed that, in general: 1. males presented thicker facial soft tissues than females; 2. older individuals had higher FSTT values than younger ones; 3. black individuals presented higher means, compared with white individuals, and; 4. subjects with BMI above normal had thicker facial tissues than those with normal BMI. However, more studies with the Brazilian population are necessary. In order to obtain data related to subgroups concerning, for example, sex and ancestry, sex and age, or sex and BMI, larger samples must be considered. Department of Community Dentistry School of Dentistry Araraquara São Paulo State University – Unesp, Rua Humaitá 1680 Department of Diagnosis and Surgery School of Dentistry Araraquara São Paulo State University – Unesp, Rua Humaitá 1680 Department of Community Dentistry School of Dentistry Araraquara São Paulo State University – Unesp, Rua Humaitá 1680 Department of Diagnosis and Surgery School of Dentistry Araraquara São Paulo State University – Unesp, Rua Humaitá 1680

Two-dimensional imaging records, as conventional radiographies, are part of the orthodontic clinic routine; frontal sinus images are often present in these exams. The characteristics of the frontal sinus are information of great relevance for the Forensic Sciences, as their images may be used for human identification purposes. With the advent of new three-dimensional technologies and computerized image examinations such as Computed Tomography (CT), three-dimensional analysis of the frontal sinuses has become possible. This article evaluates the possibilities of human identification using frontal sinuses 2D and 3D images and the role of orthodontists in this context. Pubmed, SciELO, LILACS and Web of Science were used as databases. As inclusion criteria, were selected texts concerning the studied issue. Although the analysis of frontal sinuses is traditionally carried out using two-dimensional images, there is a growing trend of studies employing CT scans. Cone-Beam Computed Tomography (CBCT) is an important diagnosis tool, more frequently used in orthodontics, which allows a three-dimensional approach and great precision in measurements. Together with two-dimensional analysis of frontal sinuses, 3D images are of great value for human identification. Although three-dimensional analysis is not yet a routine, its Forensic use is undoubtedly an excellent tool provided by new technologies. It is important that the orthodontist knows this possibility by properly keeping the patients’ imaging exams. Los registros de imágenes bidimensionales, como las radiografías convencionales, son parte de la rutina de la clínica de ortodoncia; las imágenes del seno frontal están presentes con frecuencia en estos exámenes. Las características del seno frontal son información de gran relevancia para las Ciencias Forenses, ya que sus imágenes pueden ser utilizadas con fines de identificación humana. Con el advenimiento de las nuevas tecnologías tridimensionales y los exámenes de imágenes computarizados, como la tomografía computarizada (TC), se ha hecho posible el análisis tridimensional de los senos frontales. Este artículo evalua las posibilidades de identificación humana a través de imágenes 2D y 3D de los senos frontales y el papel del ortodoncista en este contexto. Se utilizaron como bases de datos Pubmed, SciELO, LILACS y Web of Science. Como criterio de inclusión, se seleccionaron textos que retrataran el tema. Aunque el análisis de los senos frontales se ha realizado tradicionalmente mediante imágenes bidimensionales, existe una tendencia creciente en los estudios con tomografía computarizada. La tomografía computarizada de haz cónico (CBCT) es una importante herramienta de diagnóstico, más utilizada en ortodoncia, que permite un abordaje tridimensional y una gran precisión en las mediciones. Junto con el análisis bidimensional de los senos frontales, las imágenes en 3D son de gran valor para la identificación humana. Aunque el análisis tridimensional aún no es una rutina, su uso forense es sin duda una excelente herramienta proporcionada por las nuevas tecnologías. Es importante que el ortodoncista conozca esta posibilidad conservando adecuadamente los exámenes por imágenes del paciente. Registros de imagens bidimensionais, como as radiografias convencionais, fazem parte da rotina da clínica ortodôntica; imagens do seio frontal estão frequentemente presentes nesses exames. As características do seio frontal são informações de grande relevância para as Ciências Forenses, pois suas imagens podem ser utilizadas para fins de identificação humana. Com o advento de novas tecnologias tridimensionais e exames de imagem computadorizados, como a tomografia computadorizada (TC), a análise tridimensional dos seios frontais tornou-se possível. Este artigo avalia as possibilidades de identificação humana por meio de imagens 2D e 3D dos seios frontais e o papel do ortodontista nesse contexto. Foram utilizadas como bases de dados: Pubmed, SciELO, LILACS e Web of Science. Como critérios de inclusão foram selecionados textos que retratassem a temática. Embora a análise dos seios frontais seja tradicionalmente realizada por meio de imagens bidimensionais, há uma tendência crescente de estudos com tomografia computadorizada. A Tomografia Computadorizada de Feixe Cônico (TCFC) é uma importante ferramenta diagnóstica, mais utilizada na Ortodontia, que permite abordagem tridimensional e grande precisão nas medidas. Juntamente com a análise bidimensional dos seios frontais, as imagens 3D são de grande valor para a identificação humana. Embora a análise tridimensional ainda não seja uma rotina, seu uso Forense é, sem dúvida, excelente ferramenta proporcionada pelas novas tecnologias. É importante que o ortodontista conheça essa possibilidade guardando de maneira adequada os exames de imagem dos pacientes.

Diverticular disease exists on a spectrum, ranging from asymptomatic diverticulosis to complicated diverticulitis. Incidence of diverticulitis in western nations has increased in recent years, although the factors that influence the progression from diverticulosis to diverticulitis are unknown. Geographic/environmental influences, lifestyle variables, and microbiota of the gastrointestinal tract are some of the factors implicated in diverticular disease.

Objective: To evaluate the operational conditions of crash carts in all clinical and surgical hospitalization units of public hospitals in a region in Southern Brazil. Method: Quantitative, cross-sectional study to evaluate crash carts in adult clinical and surgical hospitalization units. The data were collected through a checklist containing 16 continuous variables. Results: Nineteen crash carts in nineteen units were evaluated. Analysis shows that the most frequent problems were excess of equipment and its lack of organization, medication in incorrect compartments and/or with no identification, and inappropriate environment for transportation. Conclusion: The most relevant factors that possibly interfere with the operational conditions of crash carts are directly related to the organization and management of material resources, which may lead to the reduction of its functionality during patient care. Such problem may be solved by readjusting items and performing frequent verification. RESUMEN Objetivo: Evaluar las condiciones de funcionamiento de los carros de paradas en todas las unidades de hospitalización clínica y quirúrgica de los hospitales públicos de una región del sur de Brasil. Método: Estudio cuantitativo, transversal que evaluó los carros de paradas en las unidades de hospitalización clínica y quirúrgica de adultos. Los datos se recogieron mediante un checklist que contenía 16 variables continuas. Resultados: Se evaluaron 19 carros de paradas en 19 unidades. En el análisis, los problemas más frecuentes fueron el exceso de materiales y su falta de organización, la medicación en tabiques cambiados y/o sin identificación, y un entorno inadecuado para el transporte. Conclusión: Los factores más importantes que pueden interferir en las condiciones operacionales de los carros de paradas están directamente relacionados con la organización y la gestión de los recursos materiales, lo que puede llevar a la disminución de su funcionalidad durante la atención al paciente. Este problema puede resolverse con el reajuste de los materiales y verificaciones frecuentes. RESUMO Objetivo: Avaliar as condições operacionais de carros de emergência em todas as unidades de internação clínicas e cirúrgicas em hospitais públicos de uma região no sul do Brasil. Método: Estudo quantitativo transversal que avaliou carros de emergência em unidades de internação clínica e cirúrgica adulto. Os dados foram coletados por meio de checklist contendo 16 variáveis contínuas. Resultados: Foram avaliados 19 carros de emergência em 19 unidades. Na análise, os problemas com maior ocorrência foram: excesso de materiais e sua falta de organização, medicações em divisórias trocadas e/ou sem identificação e ambiente inadequado para o transporte. Conclusão: Os fatores mais relevantes que podem interferir nas condições operacionais dos carros de emergência estão diretamente ligados à organização e gestão dos recursos materiais, que podem levar à diminuição da sua funcionalidade durante o atendimento ao paciente. Tal problema pode ser solucionado com readequação dos itens e conferências frequentes.

Purpose or Objective: The COVID-19 pandemic brought several challenges to cancer practice, especially to ensure continuity of treatment during this period, minimizing the risks of transmission to a vulnerable population. For Radiation Oncology departments in Brazil, this contingency has become even more complex due to the significant impact observed in different sectors of society, the large number of cases and deaths by COVID-19. This study estimated the impact of the COVID-19 pandemic on Brazilian Radiation Oncology departments and the coping measures used in the country. Materials and Methods: The Brazilian Radiotherapy Society (SBRT) developed a questionnaire with 14 questions, sent to all heads of Radiation Oncology departments in the country, between May and June 2020. These data were evaluated regarding cases confirmed and deaths by COVID-19 in epidemiological week 28, on July 11, 2020. Results: One hundred twenty-six questionnaires from different regions were answered, representing 44% of the country’s services. A drop in the number of patients was observed in 61% of services. This drop was observed both in patients from the public and supplementary private health insurance systems. Regarding patients and employees with COVID-19, we observe that services that primarily treat SUS patients reported significantly fewer cases of the disease. About half of the services had collaborators and patients during radiotherapy with a positive diagnosis of COVID-19. Among the coping measures, the services used intensified hygiene and cleanliness, distance, restrictions on access to companions, and other changes in daily practice. (Figure Presented) Conclusion: There was an important drop in the number of radiotherapy patients in the country during the pandemic, and this impact happened in a similar way among the services, regardless of their characteristics and coping measures adopted during the pandemic.

Purpose The COVID-19 pandemic brought several challenges to cancer practice, especially to ensure continuity of treatment during this period, minimizing the risks of transmission to a vulnerable population. For Radiation Oncology departments in Brazil, this contingency has become even more complex due to the significant impact observed in different sectors of society, the large number of cases and deaths by COVID-19. This study estimated the impact of the COVID-19 pandemic on Brazilian Radiation Oncology departments and the coping measures used in the country. Methods and Materials The Brazilian Radiotherapy Society (SBRT) developed a questionnaire with 14 questions, sent to all heads of Radiation Oncology departments in the country, between May and June 2020. These data were evaluated regarding cases confirmed and deaths by COVID-19 in epidemiological week 28, on July 11, 2020. Results One hundred twenty-six questionnaires from different regions were answered, representing 44% of the country’s services. A drop in the number of patients was observed in 61% of services. This drop was observed both in patients from the public and supplementary private health insurance systems. Regarding patients and employees with COVID-19, we observe that services that primarily treat SUS patients reported significantly fewer cases of the disease. About half of the services had collaborators and patients during radiotherapy with a positive diagnosis of COVID-19. Among the coping measures, the services used intensified hygiene and cleanliness, distance, restrictions on access to companions and other changes in daily practice. Conclusions Thus, there was an important drop in the number of radiotherapy patients in the country during the pandemic, and this impact happened in a similar way among the services, regardless of their characteristics and coping measures adopted during the pandemic., The Brazilian Radiotherapy Society (SBRT) developed a questionnaire for estimated the impact of the COVID-19 pandemic on Brazilian Radiation Oncology departments (RO). These data were evaluated regarding cases confirmed and deaths by COVID-19 on July 11, 2020. 126 questionnaires were answered (44% of the RO). A drop in the number of patients was observed in 61% of RO, being observed both in patients from the public and supplementary private health insurance systems.

To evaluate the prevalence of metabolic syndrome (MetS) and its components in adult hypopituitary patients. Retrospective, cross-sectional analysis of a cohort of hypopituitary adult patients followed in a single reference center for pituitary diseases. MetS was defined by the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) criteria. Patients with 18 years or older, presenting two or more anterior pituitary deficiencies associated or not with diabetes insipidus (DI), were included, while patients with hypopituitarism due to Acromegaly or Cushing’s disease were excluded. We studied 99 hypopituitary patients (52 males, mean age 50.1 ± 16.3 years, mean age at diagnosis 33.7 ± 17.6 years) who have been followed for a mean time of 15.9 ± 10.1 years. Hypothalamic-pituitary tumors and non-tumoral etiologies were observed in 53.4% and 46.6% of the cases, respectively. FSH/LH, GH, TSH, ACTH deficiency and DI was present in 99%, 98.6%, 96%, 81.8%, and 23.2%, respectively. The prevalence of MetS was 39.4% and was significantly higher in patients older than 50 years (p = 0.02), overweight/obese (p

Radiocarbon is a critical constraint on our estimates of the timescales of soil carbon cycling that can aid in identifying mechanisms of carbon stabilization and destabilization and improve the forecast of soil carbon response to management or environmental change. Despite the wealth of soil radiocarbon data that have been reported over the past 75 years, the ability to apply these data to global-scale questions is limited by our capacity to synthesize and compare measurements generated using a variety of methods. Here, we present the International Soil Radiocarbon Database (ISRaD; http://soilradiocarbon.org, last access: 16 December 2019), an open-source archive of soil data that include reported measurements from bulk soils, distinct soil carbon pools isolated in the laboratory by a variety of soil fractionation methods, samples of soil gas or water collected interstitially from within an intact soil profile, CO2 gas isolated from laboratory soil incubations, and fluxes collected in situ from a soil profile. The core of ISRaD is a relational database structured around individual datasets (entries) and organized hierarchically to report soil radiocarbon data, measured at different physical and temporal scales as well as other soil or environmental properties that may also be measured and may assist with interpretation and context. Anyone may contribute their own data to the database by entering it into the ISRaD template and subjecting it to quality assurance protocols. ISRaD can be accessed through (1) a web-based interface, (2) an R package (ISRaD), or (3) direct access to code and data through the GitHub repository, which hosts both code and data. The design of ISRaD allows for participants to become directly involved in the management, design, and application of ISRaD data. The synthesized dataset is available in two forms: the original data as reported by the authors of the datasets and an enhanced dataset that includes ancillary geospatial data calculated within the ISRaD framework. ISRaD also provides data management tools in the ISRaD-R package that provide a starting point for data analysis; as an open-source project, the broader soil community is invited and encouraged to add data, tools, and ideas for improvement. As a whole, ISRaD provides resources to aid our evaluation of soil dynamics across a range of spatial and temporal scales. The ISRaD v1.0 dataset is archived and freely available at https://doi.org/10.5281/zenodo.2613911 (Lawrence et al., 2019).

The main subject of this work is the concept of adequate food defined by the Brazilian Law No 11.346/06, whose implications are here discussed through a gender – especially ecofeminist – lens. The Law defines the right to food that is also considered a fundamental right in the Brazilian Constitution. At the same time, Brazilian economical politics is centered on crops production for exportation in a large-scale agricultural system. Based on that, the following question is addressed in this paper: is the concept of adequate food compatible with the economical privilege attributed to the massive and monoculture agricultural system and factory farms? The aim is to show that they are incompatible and the alternative is a defense of organic family farming and a plant-based diet, as it is presented in the government’s document “Dietary Guidelines for the Brazilian Population” (2014). Another problem that arises from this issue is that agriculture in this large-scale dimension reflects structures of power and domination (Karen J. Warren) and animals used for corpse eating disappears, becoming absent referents (Carol J. Adams). It reflects the structure of a patriarchal society, where men have power over women, animals and plants. The hypothesis is that in family farming women can participate more in the decision making process, reflecting equality and justice in the private sphere. We will analyze the Special Reports on adequate food, mainly the one related to the mission of the Special Rapporteur to Brazil, whose analysis brings information on the gender category. This analysis draws attention on the situation of women in their struggles to fulfill the right to adequate food.

This extension activity aimed to encourage the use of green leisure spaces by parents and children as a strategy for the promotion of health and well-being. From this purpose, the project worked in two fronts: realization of workshops in the Ecological Municipal Park Professor David Ferreira Lima (Florianopolis) and diffusion of information through Internet channels. The activities were carried out between April 2016 and March 2017 and involved 80 participants — including 41 children — in practical activities. The project also reached 5.648 people through the contents published in a social network and in the page of the Environmental Psychology Laboratory at UFSC. It is considered the project has achieved the objectives of awareness and dissemination of the theme about the benefits of natural environments for human development, interaction between people and connection with nature.

The characteristics of the paranasal sinuses (maxillary, frontal, sphenoid and ethmoid sinuses) are information of great relevance to Forensic Sciences, as their images can be used for human identification purposes. Due to their particularities, the paranasal sinuses provide valuable information for human identification, reducing the risk of errors during investigation by experts. Such structures are visualized from several imaging exams. This study evaluates the possibilities of human identification through the analysis of the paranasal sinuses, as well as the effectiveness of their analysis in estimating sex, age and ancestry. A comprehensive search was performed in the PubMed, SciELO, LILACS, and Web of Science databases. As inclusion criteria, texts that addressed the subject were selected. Imaging analysis of the frontal, maxillary and sphenoid sinuses is a useful tool for human identification, as well as for estimating sex, age and ancestry; usually provides a high level of accuracy. Regarding the ethmoid sinus, research is indicated to verify its use in human identification, as no publications on this specific subject were found. Additional research must be carried out (especially three-dimensional analysis of the paranasal sinuses), to develop standardized protocols, improving the work of experts, helping justice and society. Las características de los senos paranasales (maxilar, frontal, esfenoides y etmoides) son información de gran relevancia para las Ciencias Forenses, ya que sus imágenes pueden ser utilizadas con fines de identificación humana. Por sus particularidades, los senos paranasales proporcionan información valiosa para la identificación humana, reduciendo el riesgo de errores durante la investigación por parte de expertos. Estas estructuras se visualizan a partir de varios exámenes por imágenes. Este estudio evalua las posibilidades de identificación humana a través del análisis de los senos paranasales, así como la efectividad de su análisis en la estimación de sexo, edad y ancestralidad. Se realizó una búsqueda exhaustiva en las bases de datos de PubMed, SciELO, LILACS y Web of Science.Como criterio de inclusión se seleccionaron textos que abordaban el tema. El análisis imaginológico de los senos frontal, maxilar y esfenoidal es una herramienta útil para la identificación humana, así como para estimar el sexo, la edad y la ancestralidad; generalmente proporciona un alto nivel de precisión. En cuanto al seno etmoidal, está indicada la investigación para verificar su uso en la identificación humana, ya que no se encontraron publicaciones sobre este tema específico. Se deben realizar investigaciones adicionales (especialmente análisis tridimensional de los senos paranasales), para desarrollar protocolos estandarizados, mejorando el trabajo de los expertos, ayudando a la justicia y la sociedad. As características dos seios paranasais (seios maxilares, frontais, esfenoidais e etmoidais) são informações de grande relevância para as Ciências Forenses, pois as suas imagens podem ser utilizadas para fins de identificação humana. Devido às suas particularidades, os seios paranasais fornecem informações valiosas para a identificação humana, diminuindo os riscos de erros durante a investigação pelos peritos. Tais estruturas são visualizadas a partir de vários exames imaginológicos. Este estudo avalia as possibilidades de identificação humana por meio da análise dos seios paranasais, bem como a efetividade da análise dos mesmos na estimativa do sexo, idade e ancestralidade. Uma busca abrangente foi realizada nas bases de dados PubMed, SciELO, LILACS e Web of Science. Como critérios de inclusão foram selecionados textos que abordavam a temática. A análise imaginológica dos seios frontal, maxilar e esfenoidal é uma ferramenta útil para a identificação humana, bem como para estimativa de sexo, idade e ancestralidade; geralmente fornece um alto nível de precisão. Em relação ao seio etmoidal, são indicadas pesquisas para verificar seu uso na identificação humana, pois não foram encontradas publicações sobre este mote específico. Pesquisas adicionais devem ser realizadas (especialmente análises tridimensionais dos seios paranasais), para desenvolver protocolos padronizados, melhorando o trabalho dos peritos, auxiliando a Justiça e a sociedade.

Die intravaskulare papillare endotheliale Hyperplasie (IPEH)/Masson-Pseudoangiosarkom ist eine seltene Erkrankung des Vorfuses, welche bisher nicht in Europa beschrieben wurde. Eine unklare interdigitale Raumforderung einer jungen Patientin bei gesamtklinisch unauffalligem Erscheinungsbild zeigte in der pathologisch-anatomischen Begutachtung eine IPEH. Hauptmanifestationsort der IPEH sind die oberen Extremitaten sowie zervikal. Ausereuropaisch wurde die IPEH bisher lediglich in Japan und den USA beschrieben. Unser Fallbeispiel zeigt die Erstbeschreibung des klinischen Verlaufes einer interdigitalen Vorfus-IPEH/Masson-Pseudoangiosarkom in Europa.

BACKGROUND Venous thromboembolism after abdominal surgery occurs in 2% to 3% of patients with Crohn's disease and ulcerative colitis. However, no evidence-based guidelines currently exist to guide postdischarge prophylactic anticoagulation. OBJECTIVE We sought to determine the use of postoperative postdischarge venous thromboembolism chemical prophylaxis, 90-day venous thromboembolism rates, and factors associated with 90-day thromboembolic events in IBD patients following abdominal surgery. DESIGN This was a retrospective evaluation of an administrative database. DATA SOURCE Data were obtained from Optum Labs Data Warehouse, a large administrative database containing claims on privately insured and Medicare Advantage enrollees. PATIENTS Seven thousand seventy-eight patients undergoing surgery for Crohn's disease or ulcerative colitis were included in the study. MAIN OUTCOME MEASURES Primary outcomes were rates of postdischarge venous thromboembolism prophylaxis and 90-day rates of postdischarge thromboembolic events. In addition, patient clinical characteristics were identified to determine predictors of postdischarge venous thromboembolism. RESULTS Postdischarge chemical prophylaxis was given to only 0.6% of patients in the study. Two hundred thirty-five patients (3.3%) developed a postdischarge thromboembolic complication. Postdischarge thromboembolism was more common in patients with ulcerative colitis than with Crohn's disease (5.8% vs 2.3%; p < 0.001). Increased rates of venous thromboembolism were seen in patients undergoing colectomy or proctectomy with simultaneous stoma creation compared with colectomy or proctectomy alone (5.8% vs 2.1%; p < 0.001). The strongest predictors of thromboembolic complications were stoma creation (adjusted OR, 1.95; 95% CI, 1.34-2.84), J-pouch reconstruction (adjusted OR, 2.66; 95% CI, 1.65-4.29), preoperative prednisone use (adjusted OR, 1.57; 95% CI, 1.19-2.08), and longer length of stay (adjusted OR, 1.89; 95% CI, 1.41-2.52). LIMITATIONS This study is limited by its retrospective design. CONCLUSIONS The use of postdischarge venous thromboembolism prophylaxis in this patient sample was infrequent. Development of evidence-based guidelines, particularly for high-risk patients, should be considered to improve the outcomes of IBD patients undergoing abdominal surgery.

Inflammatory bowel disease is a chronic inflammatory disorder of the gastrointestinal tract driven by an exaggerated immune response to luminal microbiota in susceptible individuals. It presents with a heterogenous pattern of clinical disease severity, location, and behavior. Understanding the interaction between the host genome, gut microbiome, and further environmental exposures in the development of IBD is in the early stages, and factors that trigger onset of disease in susceptible individuals remain unknown. This article addresses the genetic, microbial, and environmental influences on development of inflammatory bowel disease and the ability to manipulate these factors through surgery and medical therapy.

Due to the decline of fishing stocks, aquaculture has been expanding throughout the world. Taking into account the possibility of conflicts of aquacultural activities in areas of environmental protection, this study aims at assessing the effects of mariculture upon the local ichthyofauna of Itaguá Bay in Ubatuba, São Paulo state, Brazil, which is within a marine protection area. In order to do so, the fish community was analyzed in areas with mussels and macroalgae farms and in areas without any maricultural activities. After six months of sampling efforts, 230 individuals were captured from 19 different species and 15 families. There was no difference in catchability, richness, diversity, and evenness among the areas. Nevertheless, the species composition was distinct in areas where mussels were farmed. These areas have presented twice as much fish biomass than the others. Based on these results, we can observe that the environmental alterations caused by mussel farming, are sources of habitat complexity, hence able to enrich the marine fauna of the region. Thus, we conclude that mariculture, specifically mussel farming, has a positive impact on ichthyofauna, contributing to biodiversity maintenance in protected areas.

Though laparotomy is the traditional intervention for adhesive small bowel obstruction (SBO), laparoscopy is becoming increasingly accepted and utilized and offers patient advantages in selected cases. Patient history and preoperative imaging are often helpful in determining if the patient is a candidate for a laparoscopic approach. During laparoscopic exploration, initial peritoneal access should be attained away from prior scars, and the bowel should ideally be examined from distal to proximal to identify the point of obstruction, with careful handling of fragile and dilated bowel. Critical goals for surgery include identification and relief of the point of obstruction, resection of nonviable bowel, and avoidance of inadvertent enterotomy. Conversion to open surgery should be undertaken expeditiously when it is determined that one of these goals cannot be safely accomplished laparoscopically. Many studies, though retrospective and not randomized, suggest improved early morbidity with laparoscopic exploration, though with high rates of conversion to open surgery. Conflicting results exist on whether open or laparoscopic exploration carries a higher risk of iatrogenic enterotomy. Further studies are needed to assess how laparoscopic adhesiolysis will impact long-term recurrence SBO.

Despite the high success rate of initial nonoperative management in patients with a diverticulitis-related pericolonic abscess, about 20% of these patients will require urgent colectomy. While recurrence rates after successful medical management of diverticular abscesses are high, it is within the standard of care to consider both interval elective resection and long-term nonoperative management. In summary, a decision regarding elective resection after successful nonoperative management of diverticular abscess should balance the individual patient's risk of recurrence and the associated potential morbidity and mortality versus the risk of an elective surgery.

Made available in DSpace on 2021-06-25T10:51:37Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-03-01 Human identification is indispensable for both legal and humanitarian reasons. However, there are situations where bodies are not recognizable, and there are no suspected identities. In these cases, Forensic Facial Reconstruction (FFR) can be performed. The obtained face later can be conveyed in the media, leading to recognition and bringing chances of future identification. In order to perform a FFR, knowledge of facial soft tissue thicknesses (FSTT) is necessary. The objective of this study was to measure FSTTs of living subadult Brazilian individuals, employing Cone-Beam Computed Tomography (CBCT) images of 126 Brazilian subadults (48 children: 7–11 y.o and 78 adolescents: 12–18 y.o).The FSTTs of 21 craniofacial landmarks were measured, using Osirix Lite software. For each landmark, mean and standard deviation were calculated. Sex, age, ancestry and body mass index (BMI) were considered. Significant difference (p < 0.05) between males and females was observed at supraglabella, glabella, nasion, rhinion, mid-philtrum, supradentale, infradentale, menton and frontal eminence. In these landmarks, males presented higher FSTTs than females. Adolescents presented significant higher FSTTs than children at mid-philtrum and infradentale. Individuals with above normal BMI presented significantly higher FSTTs, compared to normal BMI, at supraglabella, mental eminence, lateral orbit, zygomatic arch, gonion, supra M2, occlusal line and sub M2. The obtained data constitute an important contribution to the realization of FFRs of Brazilian children and adolescents. In Brazil there is a high rate of disappearance and homicides of minors; the FSTT databases could help to achieve more accurate FFRs, increasing the possibilities of recognition. Department of Community Dentistry School of Dentistry Araraquara São Paulo State University – Unesp, Rua Humaitá 1680 Department of Diagnosis and Surgery School of Dentistry Araraquara São Paulo State University – Unesp, Rua Humaitá 1680 Department of Community Dentistry School of Dentistry Araraquara São Paulo State University – Unesp, Rua Humaitá 1680 Department of Diagnosis and Surgery School of Dentistry Araraquara São Paulo State University – Unesp, Rua Humaitá 1680

Studies have shown that contact with nature brings cognitive, social, physical and psychological benefi ts to children, infl uencing their development. In natural environments, children play jumping, running, digging, building, hiding, climbing trees, and develop the capacity of imagination in make-believe play. In the present study, which aimed to understand the child-nature interaction in play, 30 children aged 2 to 10 years were observed in two urban green parks of Florianopolis, southern Brazil (SC). Thus, one observation protocol was developed using the technique of person-centered behavioral mapping. In both contexts, sand was the natural element most used in constructive play. Children were observed gathering sand with plastic shovels or pots to build something. Other elements such as vegetation, water and stone were observed less frequently in play behaviors. In one of the parks, vegetation was used in a turbulent play with a child climbing a tree. Water was used in turbulent play of spreading water and throwing it at one another, and stones were used in constructive play. The preservation of these elements in natural areas or their inclusion in planned areas implies in the expansion of recreational opportunities for children.

Oxidative stress produced by adjuvant treatments is associated with cell injury, however, a healthy diet can help mitigate it. The aim of this study is to investigate the association between diet quality and oxidative stress parameters in women subjected to adjuvant treatment for breast cancer. The sample comprised 70 women. Oxidative stress biomarkers and diet quality parameters based on the Brazilian Healthy Eating Index&mdash, Revised (BHEI-R)&mdash, were evaluated at baseline (p0) and after adjuvant treatment (p1). Ferric reducing antioxidant potential (FRAP) was associated with diet quality at p0. BHEI-R scores were not different between p0 and p1, however, scores from total vegetables, total fruits, milk and dairy products, and meat, eggs and legumes were lower during treatment. On the other hand, lower sodium and saturated fat intake observed at p1 counterbalanced the BHEI-R score. Oxidative stress parameters have increased at p1, but they were not associated with diet quality, thus, changes in component intake were not enough to promote changes in oxidative stress during treatment. It appears that diet can enhance patients&rsquo, antioxidant defense before treatment, which could lead to better outcomes in the long term. Further investigations may help to clarify the association between diet and oxidative stress in women with breast cancer.

Biofouling is one of the biggest challenges for mariculture in tropical waters. This study aims to evaluate different materials in control to biofouling in tropical waters through two experiments. For Experiment I, compared the accumulation of biofouling on different nylon panels and the use of antifouling (copper-base) paint that remained submerged for 8 weeks. In experiment II, evaluated multifilament nylon, monofilament nylon and copper alloy metal with and without the use of zinc anode. The experiment were carried for 150 days, in summer with water temperature of 26 °C. Significant biomass of biofouling was observed on nylon meshs, and those of monofilaments presented a lesser amount of diversity of organisms compared to the multifilament. The multifilament mesh painted with copper-based paint proved to be efficient in controlling biofouling. The copper alloy metal was maintained without the accumulation of biofouling throughout the experimental period (150 days). No differences were observed for copper alloy metal with or without a zinc anode. Copper alloy metal was effective as an antifouling agent even in a tropical waters. This data can open the way for a new system of fish farming in tropical seas using copper alloy metal for the construction of net cages.

Background: Enhanced recovery after surgery (ERAS) is a multidisciplinary pathway of perioperative patient care. Objective: To evaluate the effect of an ERAS program on length-of-stay (LOS) among elective colorectal surgery patients at a safety-net hospital. Design: Retrospective chart review Setting: 500+ bed in a safety-net hospital. Patients and Methods: Retrospective review of elective colorectal surgery patients comparing those participating in an ERAS protocol to historical-control (HC) patients from the preceding year. Main Outcome Measures: The primary outcome was LOS. Secondary outcomes of interest included opioid utilization, fluid balance throughout the hospital stay, return of bowel function, 30-day complications emergency department visits, and readmissions. Sample Size: 193. Results: ERAS (n = 94) and HC groups (n = 99) were similar with regards to demographics and operations performed. ERAS patients had a longer operating room (OR) time (P = 0.010), however, OR fluid rates were lower for ERAS patients (P

SUMMARY This recommendation consensus for hypofractionated whole-breast radiotherapy (RT) was organized by the Brazilian Society of Radiotherapy (SBRT) considering the optimal scenario for indication and safety in the technology applied. All controversies and contraindication matters (hypofractionated RT in patients who underwent chemotherapy [CT], hypofractionated RT in lymphatic drainage, hypofractionated RT after mastectomy with or without immediate reconstruction, boost during surgery, hypofractionated RT in patients under 50 years old, hypofractionated RT in large breasts, hypofractionated RT in histology of carcinoma in situ [DCIS]) was discussed during a meeting in person, and a consensus was reached when there was an agreement of at least 75% among panel members. The grade for recommendation was also suggested according to the level of scientific evidence available, qualified as weak, medium, or strong. Thus, this consensus will aid Brazilian radiotherapy experts regarding indications and particularities of this technique as a viable and safe alternative for the national reality. RESUMO Este consenso de recomendações para a radioterapia (RT) hipofracionada de toda a mama foi organizado pela Sociedade Brasileira de Radioterapia (SBRT) considerando o cenário ideal para indicação e segurança na tecnologia aplicada. Questões de controvérsias e contraindicações (RT hipofracionada em pacientes submetidas à quimioterapia [QT], RT hipofracionada nas drenagens linfáticas, RT hipofracionada após mastectomia com ou sem reconstrução imediata, a realização de reforço de dose em leito cirúrgico [ou boost], RT hipofracionada em pacientes com idade menor que 50 anos, RT hipofracionada em mamas volumosas, RT hipofracionada em histologia de carcinoma in situ [CDIS]) foram discutidas em encontro presencial, sendo o consenso atingido quando existisse concordância de pelo menos 75% dos panelistas. O grau de recomendação foi também sugerido de acordo com o nível de evidência científico disponível, qualificado entre fraco, médio ou forte. Assim, este consenso deverá servir para auxiliar os especialistas da radioterapia brasileira em relação às indicações e particularidades dessa técnica, como uma alternativa segura e viável para a realidade nacional.

We describe a primary leiomyosarcoma of bone located in the distal fibula in a 67- year-old man. Plain radiographs and computer tomography scan revealed a lytic destructive lesion in the distal metaepiphyseal region of the left fibula with little involvement of the surrounding soft tissues. The lesion was composed of proliferating spindle-shaped cells with very slim cytoplasm and narrow oval cigar shaped nuclei. Immunohistochemistry studies demonstrated a strong positivity for actin and desmin, and weak positivity for caldesmon.

Using a novel data set from 75 stores of a department store retail chain that changed its incentive plan for store managers to spur greater cooperation among them and with the corporate office, we examine how incentives impact operational decisions and, consequently, store outcomes. We measure store performance using sales growth, accuracy in labor scheduling, and labor productivity. We find that emphasizing corporate goals in managers’ incentives has resulted in worsening of performance at the store level. This effect is mainly the product of store managers exerting less effort in response to the change in their pay schemes. We also document deterioration in three underlying operational decisions involved in labor scheduling, i.e., sales forecasting, labor planning, and labor execution (defined as the adjustments to labor plan in response to new demand information since the labor plan was generated) as a result of the incentive change.

Originare, z. B. narbig verzogene, Schleimhautstrukturen eines nichtneoplastisch veranderten Organs konnen bei fehlerhafter Zuordnung zu anderen Organen bzw. fehlender Kenntnis der korrekten Entnahmelokalisation zur falschen Diagnose eines Adenokarzinoms fuhren – im hier vorgestellten Fall aufgrund einer am rechten Nierenhilus adharenten Gallenblase. Zur korrekten Einordnung sind insbesondere die klinischen (intraoperativen) und radiologischen Angaben und Befunde entscheidend.