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Globally, geospatial concepts are becoming increasingly important in epidemiological and public health research. Individual level linked population-based data afford researchers with opportunities to undertake complex analyses unrivalled by other sources. However, there are significant challenges associated with using such data for impactful geohealth research. Issues range from extracting, linking and anonymising data, to the translation of findings into policy whilst working to often conflicting agendas of government and academia. Innovative organisational partnerships are therefore central to effective data use. To extend and develop existing collaborations between the institutions, in June 2019, authors from the Leeds Institute for Data Analytics and the Alan Turing Institute, London, visited the Geohealth Laboratory based at the University of Canterbury, New Zealand. This paper provides an overview of insight shared during a two-day workshop considering aspects of linked population-based data for impactful geohealth research. Specifically, we discuss both the collaborative partnership between New Zealand’s Ministry of Health (MoH) and the University of Canterbury’s GeoHealth Lab and novel infrastructure, and commercial partnerships enabled through the Leeds Institute for Data Analytics and the Alan Turing Institute in the UK. We consider the New Zealand Integrated Data Infrastructure as a case study approach to population-based linked health data and compare similar approaches taken by the UK towards integrated data infrastructures, including the ESRC Big Data Network centres, the UK Biobank, and longitudinal cohorts. We reflect on and compare the geohealth landscapes in New Zealand and the UK to set out recommendations and considerations for this rapidly evolving discipline.

The aim of this paper is to discuss the risk of recurrence in patients with differentiated thyroid cancer and emphasize the importance of risk-group stratification, early recurrence identification and application of new imaging modalities, what is the PET-CT. Moreover, follow-up of patients with thyroid carcinoma should be carried out by specialized teams throughout life. Therefore, interdisciplinary case discussions in tumor conferences may improve the use of multimodal therapy especially in patients with poorly differentiated thyroid carcinomas. After baseline follow-up, if there is a suspicion of thyroid carcinoma, early PET-CT should be used for early detection and appropriate planning. Fortunately, due to the good localization possibility, the PET-CT enables a focused surgical procedure with avoidance of an unnecessary tumor search and thereby a reduction of the risk of injury of neighboring structures which is a concern with reoperative neck surgery.

A base de conhecimento de professores vem sendo objeto de pesquisas, em diversas áreas da educação, ao longo de muitas décadas, sendo abordada por diferentes perspectivas teóricas e autores, dentre os quais o conceito introduzido por Lee Shulman (1986; 1987), Conhecimento Pedagógico de Conteúdo (PCK), é o foco deste artigo. Mesmo com a longevidade do tema PCK, as bases teóricas e metodológicas usadas nestas investigações são dispersas, não há consenso quanto a conceitos, terminologia, abrangência e componentes dos modelos adotados para estudo do conhecimento de professores. Com o objetivo de identificar as diferentes visões sobre o conhecimento de professores de Física, presentes nos modelos apoiados na base teórica do PCK e adotados na condução de pesquisas em Ensino de Física, foi conduzida uma revisão sistemática da literatura para identificação dos modelos nelas adotados. Após a identificação destes, fez-se um estudo aprofundado das referências originais de cada modelo, para então proceder-se a análise comparativa com intuito de identificar suas similaridades, divergências e lacunas. Esta análise aponta que, em sua maioria, os modelos adotados para estudo do conhecimento de professores de Física, contemplam, para caracterização da base de conhecimento de professores, os mesmos Componentes. Porém, há divergências conceituais sobre a formação e desenvolvimento destes conhecimentos, assim como diferem as delimitações da abrangência de cada modelo. Percebe-se também, pela evolução temporal dos modelos adotados, que há uma tendência à especialização na modelagem dos conhecimentos de professores de Física.

Objective To outline the epidemiological profile and identify the hospital outcomes of patients submitted to neuromuscular scoliosis correction surgery. Methods This was a descriptive study that included 50 patients hospitalized following surgery for neuromuscular scoliosis in a tertiary-level hospital in São Paulo from January 2017 to July 2017. The variables were collected retrospectively from the patients’ medical records: age, sex, main diagnosis, length of hospital stay, duration of surgery, hospital complications, and mobility. Results Surgeries were performed in boys and girls in similar proportions, adolescents, many with cerebral palsy (42%), with mean hospital stay of 10.8 days. Fifty-two percent presented some complication, such as constipation. Infection of the surgical site was present in 12% of the sample. Forty-two percent had moderate to intense pain and only 2% did not achieve the proposed mobility goals. Conclusion We observed that the epidemiological profile presented data consistent with the scarce literature available, while the definitions of complications, incidence, and hospital outcomes available in the literature were varied quite a bit from the findings in this study. Level of evidence III; Retrospective study. RESUMO Objetivos Traçar o perfil epidemiológico e identificar os desfechos hospitalares de pacientes submetidos à correção cirúrgica de escoliose neuromuscular. Métodos Trata-se de um estudo descritivo, em que foram incluídos 50 pacientes internados em pós-operatório de escoliose neuromuscular, em um hospital de nível terciário em São Paulo, no período de janeiro de 2017 a julho de 2017. As variáveis foram coletadas de forma retrospectiva, a partir dos prontuários dos pacientes: idade, sexo, diagnóstico principal, tempo de internação, tempo de duração da cirurgia, complicações hospitalares e mobilidade. Resultados As cirurgias foram realizadas em meninos e meninas em proporção semelhante, adolescentes, em sua maioria com paralisia cerebral (42%), sendo que o tempo de internação médio foi de 10,8 dias e 52% apresentaram alguma complicação como a obstipação. A infecção de sítio cirúrgico esteve presente em 12% da amostra, 42% apresentaram dor moderada à intensa e só 2% não cumpriram as metas de mobilidade propostas. Conclusões Observamos que o perfil epidemiológico apresentou dados consistentes com a escassa literatura disponível, enquanto a definição de complicação, incidência e desfechos hospitalares disponíveis na literatura foram bastante variáveis com os achados neste estudo. Nível de Evidência III; Estudo Retrospectivo. RESUMEN Objetivos Trazar el perfil epidemiológico e identificar los resultados hospitalarios de pacientes sometidos a la corrección quirúrgica de escoliosis neuromuscular. Métodos Se trata de un estudio descriptivo, en el que fueron incluidos 50 pacientes internados en postoperatorio de escoliosis neuromuscular, en un hospital de nivel terciario en São Paulo, en el período de enero de 2017 a julio de 2017. Las variables fueron colectadas de forma retrospectiva, a partir de los prontuarios de los pacientes: edad, sexo, diagnóstico principal, tiempo de internación, tiempo de duración de la cirugía, complicaciones hospitalarias y movilidad. Resultados Las cirugías fueron realizadas en niños y niñas en proporción semejante, adolescentes, en su mayoría con parálisis cerebral (42%), siendo que el tiempo de internación promedio fue de 10,8 días y 52% presentaron alguna complicación como el estreñimiento. La infección de sitio quirúrgico estuvo presente en 12% de la muestra, 42% presentaron dolor moderado a intenso y sólo 2% no cumplieron las metas de movilidad propuestas. Conclusiones Observamos que el perfil epidemiológico presentó datos consistentes con la escasa literatura disponible, mientras que la definición de complicación, incidencia y resultados hospitalarios disponibles en la literatura fueron bastante variables con los hallazgos en este estudio. Nivel de Evidencia III; Estudio Retrospectivo.

Widgets are part of many web applications and implement distinct interaction mechanisms, in reusable user interface components. However, implementing accessible widgets is a challenge, associated to different factors highlighted in the state-of-the-art, such as: lack of developers knowledge of accessibility guidelines, organization support and tools that support accessible development. This paper reports an investigation on JavaScript source-code complexity impacts of implementing accessibility requirements in widgets. We investigated Dialog, Drop-down menu and Tab widgets of 27 open-source JavaScript libraries. The results showed that widget software artifacts reported an increased average of source-code complexity when implementing accessibility requirements. Results also showed that using DOM-oriented JavaScript libraries (eg. jQuery) significantly increased source-code complexity of widgets. Nevertheless, when using Declarative Component-based JavaScript libraries, no significant difference in source-code complexity was observed. These results suggest that using Declarative Component-based widget libraries might reduce maintainability costs of JavaScript front-end projects.

The increasing ubiquity of smartphone data, with greater spatial and temporal coverage than achieved by traditional study designs, have the potential to provide insight into habitual physical activity patterns. This study implements and evaluates the utility of both K-means clustering and agglomerative hierarchical clustering methods in identifying weekly and yearlong physical activity behaviour trends. Characterising the demographics and choice of activity type within the identified clusters of behaviour. Across all seven clusters of seasonal activity behaviour identified, daylight saving was shown to play a key role in influencing behaviour, with increased activity in summer months. Investigation into weekly behaviours identified six clusters with varied roles, of weekday versus weekend, on the likelihood of meeting physical activity guidelines. Preferred type of physical activity likewise varied between clusters, with gender and age strongly associated with cluster membership. Key relationships are identified between weekly clusters and seasonal activity behaviour clusters, demonstrating how short-term behaviours contribute to longer-term activity patterns. Utilising unsupervised machine learning, this study demonstrates how the volume and richness of secondary app data can allow us to move away from aggregate measures of physical activity to better understand temporal variations in habitual physical activity behaviour.

Mobile devices have become popular, and their use for daily activities has spread around the world. A wide variety of mobile applications aims to meet the daily needs of diverse people, such as transportation and commerce. Meanwhile, mobile accessibility is a worldwide concern. Accessibility is a requirement for any user to interact with software. For example, about 25% of the Brazilian population declares themselves as having some disability. Although traditional mobile software development approaches indicate that native development achieves higher computing performances, this implies high-priced development, difficult maintainability, and low accessibility for the interface components. Many mobile applications still lack accessibility, and people with disabilities may find barriers when interacting with them. We understand that Model-Driven Development (MDD) and cross-platform mobile development, together, may help to solve this gap and facilitate the development of more accessible mobile applications. Our goal is to create an MDD solution that generates accessible mobile applications. We place our focus on blind and low vision users to direct the development of our solution. In this work, we investigate MDD approaches for mobile development and appoint recommendations for accessibility in the user interface components. To achieve this goal, we developed AccessMDD, an approach to stimulate developers´ awareness of accessibility recommendations. This approach supports the inclusion of accessibility requirements and generates accessible user interfaces for mobile apps.

Supplemental Digital Content is available in the text., OBJECTIVES: To compare the performance of Sequential Organ Failure Assessment, systemic inflammatory response syndrome, Red Flag Sepsis, and National Institute of Clinical Excellence sepsis risk stratification tools in the identification of patients at greatest risk of mortality from sepsis in nonintensive care environments. DESIGN: Secondary analysis of three annual 24-hour point-prevalence study periods. SETTING: The general wards and emergency departments of 14 acute hospitals across Wales. Studies were conducted on the third Wednesday of October in 2017, 2018, and 2019. PATIENTS: We screened all patients presenting to the emergency department and on the general wards. MEASUREMENTS AND MAIN RESULTS: We recruited 1,271 patients, of which 724 (56.9%) had systemic inflammatory response syndrome greater than or equal to 2, 679 (53.4%) had Sequential Organ Failure Assessment greater than or equal to 2, and 977 (76.9%) had Red Flag Sepsis. When stratified according to National Institute of Clinical Excellence guidelines, 450 patients (35.4%) were in the “High risk” category in comparison with 665 (52.3%) in “Moderate to High risk” and 156 (12.3%) in “Low risk” category. In a planned sensitivity analysis, we found that none of the tools accurately predicted mortality at 90 days, and Sequential Organ Failure Assessment and National Institute of Clinical Excellence tools showed only moderate discriminatory power for mortality at 7 and 14 days. Furthermore, we could not find any significant correlation with any of the tools at any of the mortality time points. CONCLUSIONS: Our data suggest that the sepsis risk stratification tools currently utilized in emergency departments and on the general wards do not predict mortality adequately. This is illustrated by the disparity in mortality risk of the populations captured by each instrument, as well as the weak concordance between them. We propose that future studies on the development of sepsis identification tools should focus on identifying predicator values of both the short- and long-term outcomes of sepsis.

Currently, there is a growing need to develop machines that replace human work efficiently and effectively in horticulture with the same sensibility of the human hand, since horticultural foods are notably very fragile to handle and process, especially considering machinery and systems. This work aimed to determine the mechanical properties of lettuce (Lactuca sativa L.) variety Crispa. For that, two methodologies were used in the field of material engineering: one specific for polymers and composites – the standard ASTM D3039 – Standard test method for tensile properties of polymer matrix composite materials (ASTM, 2002a) and the other specific for plastic films – the ASTM 882 – Standard test method for tensile properties of thin plastic sheeting (ASTM, 2002b). The tests were adapted for lettuce samples. The mechanical properties for the leaf and stem of head lettuce (var. Crispa) were obtained with appropriate statistical rigor, which can be considered valid initial estimates for dimensioning mechanisms and systems of machines for horticultural works specialized in lettuce. These properties provide fundamental engineering parameters to design machine elements that interact with biological materials, allowing to develop devices that generate minor damage to biological structures in lettuce.

Graphical abstract, Highlights • Risk of RLN palsy during thyroidectomy for Graves’ disease is high. • I-IONM and C-IONM are feasible and useful during thyroidectomy for Graves’ disease. • Proportion of complete thyroidectomy was significantly higher using IONM technology., We evaluate the role of intraoperative neuromonitoring (IONM) in thyroidectomy performed for Graves’ disease (GD) with an emphasis on recurrent laryngeal nerve (RLN) management and completeness of resection. The study is a retrospective series comprising 55 thyroidectomy (control group) versus 82 procedures with intermittent IONM (I-IONM) and 72 by means of continuous IONM (C-IONM). In the control group the laryngeal nerves have been identified by visualization solely. In the I-IONM group both vagal nerve (VN) and RLN have been localized and monitored during thyroid resection. C-IONM was achieved with a vagal stimulation probe. I-IONM group had shorter operating times (P = 0.032). RLN morbidity, meaning palsy rate, was 2.7% in the C-IONM group, 3.6% in I-IONM and 5.4% in the control group (P = 0.058). The proportion of complete procedures (total or near total resections) were significantly higher using monitoring technology (P = 0.049). Persistent positive serum TBII values were found in 25 (45%), 25 (30%) and 20 (27%) patients at 12 months in the control, I-IONM and C-IONM groups respectively (P = 0,04). IONM is an effective technology in GD patients.

Background Rapid response systems aim to achieve a timely response to the deteriorating patient; however, the existing literature varies on whether timing of escalation directly affects patient outcomes. Prior studies have been limited to using ‘decision to admit’ to critical care, or arrival in the emergency department as ‘time zero’, rather than the onset of physiological deterioration. The aim of this study is to establish if duration of abnormal physiology prior to critical care admission [‘Score to Door’ (STD) time] impacts on patient outcomes. Methods A retrospective cross-sectional analysis of data from pooled electronic medical records from a multi-site academic hospital was performed. All unplanned adult admissions to critical care from the ward with persistent physiological derangement [defined as sustained high National Early Warning Score (NEWS) > / = 7 that did not decrease below 5] were eligible for inclusion. The primary outcome was critical care mortality. Secondary outcomes were length of critical care admission and hospital mortality. The impact of STD time was adjusted for patient factors (demographics, sickness severity, frailty, and co-morbidity) and logistic factors (timing of high NEWS, and out of hours status) utilising logistic and linear regression models. Results Six hundred and thirty-two patients were included over the 4-year study period, 16.3% died in critical care. STD time demonstrated a small but significant association with critical care mortality [adjusted odds ratio of 1.02 (95% CI 1.0–1.04, p = 0.01)]. It was also associated with hospital mortality (adjusted OR 1.02, 95% CI 1.0–1.04, p = 0.026), and critical care length of stay. Each hour from onset of physiological derangement increased critical care length of stay by 1.2%. STD time was influenced by the initial NEWS, but not by logistic factors such as out-of-hours status, or pre-existing patient factors such as co-morbidity or frailty. Conclusion In a strictly defined population of high NEWS patients, the time from onset of sustained physiological derangement to critical care admission was associated with increased critical care and hospital mortality. If corroborated in further studies, this cohort definition could be utilised alongside the ‘Score to Door’ concept as a clinical indicator within rapid response systems.

Aims: Social prescribing continues to grow and change across healthcare services in Wales; however, research of the day-to-day performance of social prescribers is limited. This study aimed to explore which roles are perceived to be the most important and frequently used by social prescribers in Wales and compare these results to reports in studies of services in other countries in order to support future role development and potential standardisation. Methods: This study used the Group Concept Mapping via the Concept Systems Global Max™ software to collect and analyse all data from both participants and literature. Results: There was a total of 101 statements generated (119 participants, 84 literature) ranging from generic interpersonal skills to specialised training (cognitive behavioural therapy). These statements were then sorted by conceptual similarity into seven clusters (Providing a Specialist Service, Working in a person-centred way, Skills, Connecting Clients with Community, Collaborative Working, Evaluating and postprogramme duties, and Networking/Community). Statements were rated based on their perceived importance and frequency, with the ‘Skills’ cluster having the highest overall average and ‘Providing a Specialist Service’ having the lowest. Conclusions: Reports indicate that in general there is variation in the roles performed by individual participants in Wales; however, greater variation was observed between participants and literature suggesting geographical divergence in practice. In the top 12 highest rated statements for both frequency and importance, individualistic traits such as empathy and ‘being a listener’ are favoured over specialised methods such as cognitive behavioural therapy and behaviour change taxonomy. Results suggest that local need plays a part in the choices and performance of social prescribers and as such should be considered in future standardisation.

Background: Osteoarthritis is the most common cause of arthritis affecting millions of people worldwide, characterized by joint pain and inflammation. It is a complex disease involving inflammatory factors and affecting the whole joint including synovium. Since drug combination is widely used to treat chronic inflammatory diseases, a similar strategy may be worth of interest to design plant-derived natural products to reduce inflammation in OA joint. Here, we characterized the response of OA synovial cells to lipopolysaccharide (LPS) and investigated the biological action of the combination of curcumin, harpagophytum and bromelain in this original in vitro model of osteoarthritis.Methods: Primary, human synovial cells from OA patients were stimulated with LPS and proteomic analysis was performed. Bioinformatics analysis were performed using Cytoscape App and SkeletalVis databases. Additionally, cells were treated with curcumin, harpagophytum and bromelain alone or the three vegetal compounds together. The expression of genes involved in inflammation, pain or catabolism were determined by RT-PCR. The release of the encoded proteins by these genes and of prostaglandin E2 (PGE2) were also assayed by ELISA. Results: Proteomic analysis demonstrated that LPS induces the expression of numerous proteins involved in OA process in human OA synovial cells. In particular, it stimulates inflammation through the production of pro-inflammatory cytokines (Interleukin-6, IL-6), the catabolism through an increase of metalloproteases (MMP-1, MMP-3, MMP-13), and the production of pain-mediating neurotrophin (Nerve Growth Factor, NGF). These increases were observed at level of mRNA levels and of protein release. LPS also increases the amount of PGE2, another inflammation and pain mediator. At doses tested, vegetal extracts had little effects: only curcumin slightly counteracted the effects of LPS on NGF and MMP13 mRNA, and PGE2, IL-6 and MMP13 release. In contrast the association of curcumin with harpagophytum and bromelain reversed lots of effects of LPS in human OA synovial cells. It significantly reduced the gene expression and/or the release of proteins involved in catabolism (MMP3 and 13), inflammation (IL-6) and pain (PGE2 and NGF).Conclusion: We show that the stimulation of human OA synovial cells with LPS permit to induce protein changes similar to an inflamed OA synovial tissues. In addition, using this model, we demonstrate that the combination of three vegetal compounds, namely curcumin, harpagophytum and bromelain have anti-inflammatory and anti-catabolic action in synovial cells and may thus reduce OA progression and related-pain.

Sustainability is focussed on avoiding the long-term depletion of natural resources. Under the terms of a government plan to tackle climate change, a driver for improved sustainability is the cut of greenhouse gas emissions in the UK to almost zero by 2050. With this type of change, new themes are continuously being developed which drive complex projects, such as the development of new power generation methods, which encompass challenging lead times and demanding requirements. Consideration of the implementation of strategies and key concepts, which may engender sustainability within complex projects therefore presents an opportunity for further critical debate, review, and application through a project management lens. Sustainability incorporation in project management has been documented in academic literature, with this emerging field providing new challenges. For example, project management education can provide a holistic base for the inculcation of sustainability factors to a range of industries, including complex projects. Likewise, practitioner interest and approaches to sustainability in project management are being driven by the recently Chartered Association for Project Management (APM). Whilst this body makes a significant contribution to the UK economy across many sectors, it also addresses ongoing sustainability challenges. Therefore, by drawing on research and practitioner developments, the authors argue that by connecting with the next generation through practice simulation approaches, and embedding sustainability issues within project management tools and methods, improved focus on sustainability in complex project management may be achieved., Suggested Citation: Tite, Caroline N J, Pontin, David., & Dacre, Nicholas. (2021). Embedding Sustainability in Complex Projects: A Pedagogic Practice Simulation Approach. Advanced Project Management, 21(2)

Sustainability is focussed on avoiding the long-term depletion of natural resources. Under the terms of a government plan to tackle climate change, a driver for improved sustainability is reducing greenhouse gas emissions in the UK to almost zero by 2050. With this type of change, new themes are continuously being developed that drive engineering projects, such as developing new cars and new power generation methods, which encompass challenging lead times and demanding requirements. The implementation of strategies and key concepts, which may engender sustainability within engineering and engineering projects, presents an opportunity for further critical debate, review, and application through a project management lens. Sustainability incorporation in project management has been documented in academic literature (Okland, 2015), with this emerging field providing new challenges. For example, project management education can provide a holistic base for the inculcation of sustainability factors to a range of industries, including engineering project management. Likewise practitioner interest and approaches to sustainability in project management are being driven by the recently Chartered profession of Project Management. Whilst this body makes a significant contribution to the UK economy across many sectors, it also addresses ongoing sustainability challenges. Therefore, by drawing on research and practitioner developments, the authors argue that an improved focus on sustainability in engineering project management may be achieved by connecting with the next generation through solution-based approaches and embedding sustainability issues within project management tools and methods.

Guidelines, techniques, and methods have been presented in the literature in recent years to contribute to the development of accessible software and to promote digital inclusion. Considering that software product quality depends on the quality of the development process, researchers have investigated how to include accessibility during the software development process in order to obtain accessible software. Two Systematic Literature Reviews (SLR) have been conducted in the past to identify such research initiatives. This paper presents a new SLR, considering the period from 2011 to 2019. The review of 94 primary studies showed the distribution of publications on different phases of the software life cycle, mainly the design and testing phases. The study also identified, for the first time, papers about accessibility and software process establishment. This result reinforces that, in fact, accessibility is not characterized as a property of the final software only. Instead, it evolves over the software life cycle. Besides, this study aims to provide designers and developers with an updated view of methods, tools, and other assets that contribute to process enrichment, valuing accessibility, as well as shows the gaps and challenges which deserve to be investigated.

BACKGROUND AND OBJECTIVES: It is possible that patients submitted to lumbar spine surgery present chronic pain and need a multidimensional assessment of postoperative pain due to the variables that influence pain. The objective of this study was to evaluate the correlation between uni and multidimensional scales for postoperative pain assessment. METHODS: Longitudinal and observational study carried out in the inpatient units of an orthopedic reference hospital in São Paulo. 53 patients were selected in the preoperative period of lumbar spine arthrodesis, 28 were excluded and 25 were evaluated with the numerical verbal scale and Brief Pain Inventory on the preoperative day and on postoperative day 2. RESULTS: In the sample, all patients had chronic pain with a mean previous pain time of 9.24 years. There was variation between the pre and postoperative periods on the Brief Pain Inventory in almost all items, but only the item regarding the amount of pain ‘’right now’’ (in the moment) was equivalent to the numerical verbal scale (Kappa=almost complete correlation). CONCLUSION: The numerical verbal scale and Brief Pain Inventory were not comparable since the Numerical Verbal Scale showed a worsening of postoperative pain, while the Brief Pain Inventory reflected improvement in the perception of postoperative pain. The Brief Pain Inventory seemed to be a better tool for pain assessment in this study RESUMO JUSTIFICATIVA E OBJETIVOS: É possível que pacientes submetidos a cirurgia de coluna lombar apresentem dor crônica e necessitem de avaliação multidimensional da dor pós-operatória devido às variáveis que influenciam a dor. O objetivo deste estudo foi avaliar a correlação entre as escalas uni e multidimensional para avaliação de dor pós-operatória. MÉTODOS: Estudo longitudinal e observacional desenvolvido nas unidades de internação de um hospital ortopédico de referência em São Paulo. Foram selecionados 53 pacientes no pré-operatório de artrodese da coluna lombar, 28 foram excluídos e 25 avaliados com a escala verbal numérica e o Inventário Breve de Dor no dia do pré-operatório e no 2° dia de pós-operatório. RESULTADOS: Na amostra todos os pacientes apresentavam dor crônica com tempo médio de dor prévia de 9,24 anos. Observou-se variação entre o pré e pós-operatório no Inventário Breve de Dor em quase todos os itens, mas apenas o item sobre a dor ‘’neste momento” se equiparou à escala verbal numérica (Kappa=correlação quase completa). CONCLUSÃO: A escala verbal numérica e o Inventário Breve de Dor não foram equiparáveis uma vez que a Escala Verbal Numérica evidenciou piora da dor pós-operatória, enquanto o Inventário Breve de Dor refletiu melhora na percepção da dor pós-operatória. O Inventário Breve de Dor pareceu ser melhor instrumento para avaliação de dor neste estudo.

BACKGROUND AND OBJECTIVES: Pain education is a tool that helps health professionals in the biopsychosocial approach and in pain management in patients with musculoskeletal pain. The objectives of the study were to verify the effects of a pain education program in patients with chronic musculoskeletal pain. The evaluated outcomes were pain, kinesiophobia, catastrophizing, quality of life, central sensitization and perception of the disease. METHODS: Observational, retrospective study. Data from 24 participants with chronic pain, mean age 57 years, were analyzed, 83% of whom were female. Patients participated in a pain education program, which addressed topics such as acceptance, pain alarm, sleep, relaxation, negative thoughts, return to activities, relationships, and exercises. RESULTS: Participants showed significant changes in the cognitive representation of the disease measured by the Illness Perception Questionnaire (Brief-IPQ) (p

Magnetic nulls are ubiquitous in space plasmas, and are of interest as sites of localized energy dissipation or magnetic reconnection. As such, a number of methods have been proposed for detecting nulls in both simulation data and in situ spacecraft data from Earth's magnetosphere. The same methods can be applied to detect stagnation points in flow fields. In this paper we describe a systematic comparison of different methods for finding magnetic nulls. The Poincare index method, the first-order Taylor expansion (FOTE) method, and the trilinear method are considered. We define a magnetic field containing fourteen magnetic nulls whose positions and types are known to arbitrary precision. Furthermore, we applied the selected techniques in order to find and classify those nulls. Two situations are considered: one in which the magnetic field is discretized on a rectangular grid, and the second in which the magnetic field is discretized along synthetic `spacecraft trajectories' within the domain. At present, FOTE and trilinear are the most reliable methods for finding nulls in the spacecraft data and in numerical simulations on Cartesian grids, respectively. The Poincare index method is suitable for simulations on both tetrahedral and hexahedral meshes. The proposed magnetic field configuration can be used for grading and benchmarking the new and existing tools for finding magnetic nulls and flow stagnation points., Reproduced with permission from Astronomy & Astrophysics, \c{opyright} ESO

Agricultural mechanization is an area of knowledge that has evolved a lot over the past century, its main actors being agricultural tractors that, in 100 years, have increased their powers by 3,300%. This evolution has resulted in an exponential increase in the field capacity of such machines. However, it has also generated negative results such as excessive consumption of fossil fuel, excessive weight on the soil, very high operating costs, and millionaire acquisition value. This paper aims to present an antiparadigmatic alternative in this area. It is proposing a swarm of small electric robotic tractors that together have the same field capacity as a large tractor with an internal combustion engine. A comparison of costs and field capacity between a 270 kW tractor and a swarm of ten swarm tractors of 24 kW each was carried out. The result demonstrated a wide advantage for the small robot team. It was also proposed the preliminary design of an electric swarm robot tractor. Finally, research challenges were suggested to operationalize such a proposal, calling on the Brazilian Robotics Research Community to elaborate a roadmap for research in the area of swarm robot for mechanized agricultural operations.

This research full paper presents an investigation on pedagogical practices and educational methods used by professionals who work in the teaching of the elderly. The study of the ageing process is one of the most significant research trends of the 21st century and represents new social, educational and computational challenges. Increased life expectancy and the number of elderly elevate the heterogeneity in the segment, beyond the age. This research focuses on education and mobile learning (m-learning) application. Considering the elderly audience, it is necessary to develop m-learning apps based on accessibility and pedagogical proposals, since the elderly may have their physical and cognitive abilities compromised due to age. Currently, there are consolidated accessibility guidelines for software development. However, these guidelines do not regard cognitive, language and learning disabilities. These points are necessary for the process of developing m-learning applications, especially those specific to the elderly user. Thus, this paper aims to present the results of a survey applied with 33 professionals (teachers, pedagogues, gerontologists and others) involved in the education of the elderly. Issues involving teaching practices for the elderly, content preparation, interactivity, and motivation are addressed. This study is part of a larger project aimed to contribute to the development of accessibility and pedagogical guidelines that aim to assist in the process of developing m-learning applications focused on the elderly.

In this research full paper we present a set of requirements for an m-learning application for the elderly. Currently, the elderly population has been growing considerably. This fact leads to the country and society adapt and create new opportunities for this audience, since they can present changes and challenges of aging. One of this challenges involves the educational area. Education can take place formally or informally, with face-to-face or distance classes and, in this context, emerges the concept of mobile learning (or m-learning). This modality of learning has generated great expectations for educators and learners, since it has benefits related to the flexibility of learning, especially regarding the adaptation with respect to space and time of use. Based on this potential for flexibility and adaptation, one of the main goals of m-learning is to democratize access to education. Thus, m-learning applications must be adequate and structured to serve the general population, including the elderly. Considering this audience, it is necessary to develop accessible and pedagogically appropriate m-learning applications, since these users may have different skills in comparison with younger students. Elderly people may have their physical, sensory, perception and cognitive abilities compromised due to the aging process and, therefore, m-learning applications must be developed based on these needs. In this paper we present the requirements elicitation process for a m-learning app, focused on elderly users. The requirements were created based on works that involve eliciting requirements for m-learning in general, pedagogical pattern language for this type of domain and pedagogical and accessibility guidelines for m-learning app focused on the elderly. At the very end, such requirements will support the development of a crossword mobile application to the elderly, which should contribute to the learning process of such audience.

The Internet of Things (IoT) has become a relevant topic of interest in Human-Computer Interaction (HCI) since it makes feasible a future computing scenario that can change the way people experiment and use technology. IoT is a new paradigm in which intelligent objects equipped with sensors, networks, and processing technologies integrate and work together to provide smart services to users. In the face of the rapid growth in the number of connected devices in an IoT scenario, the perspective of a smarter world could be actual. However, it is still too far away due to challenges related to human interaction. To help understand the issues involved in building experiences with multiple devices, we conducted interviews with ten companies exploring the characteristics and challenges surrounding the IoT project to designing IoT technologies. The results identified a set of qualitative data from companies that are developing IoT projects allowing us to discuss future directions for research. Our main contribution is related to the identification of important aspects of IoT that impact the design of user-friendly solutions. We conclude pointing to the need for IoT design that takes into account the users' particularities.

The web has provided users with interactivity through Rich Internet Applications (RIAs). However, due to the dynamic nature of RIAs, most applications still do not implement accessible solutions in their components for a variety of reasons, such as the lack of specialized knowledge by developers. Besides, there is a lack of tools capable of performing an automatic evaluation for accessibility in RIAs. To automatically evaluate accessibility in RIAs, tools mainly require the identification of the dynamic components. In this paper, we propose a solution that aims to automatically identify widgets in RIAs, by simulating interactions of a real user with a web application, through all the possible events their elements can receive. The developed mechanism extracts the properties of the dynamic elements to compose a database to guide the classification of specific widgets. We evaluated the potential of the mechanism, by applying it with different implementations of a particular widget, the Calendar. Also, the mechanism was tested in a controlled environment to verify more accurately the changes that occur on a web page, which could precisely identify the widgets as Calendars.

Recently, Brazilian agriculture and the mechanization process have been improved and developed, particularly in sugarcane cultivation. The developed processes should adopt suitable management practices in terms of the technical, economic, and operational logistical aspects. As a management tool, the present study aimed to measure the impact of the accumulated use of harvesters (life in h) and agricultural productivity (Mg · ha−1) on the harvesting operational capacity (HOC). Mathematical modeling was performed on data obtained from eight sugarcane production units, and equations corresponding to the HOC as a function of the harvester's life and the crop agricultural productivity were developed. The equation that best represented the phenomenon was selected. The values of the HOC depend on operational conditions and range from (17 to 44) Mg · h−1, thereby demonstrating significant operational and economic discrepancies. When the mean life of the harvester was 10,000 h and the mean productivity of the cane field was 80.0 Mg · ha−1, an HOC of 31.7 Mg · h−1 was obtained. It was found that agricultural productivity is directly proportional to the HOC, whereas the harvester's life is inversely proportional to the HOC; the parameters are not linear in both cases.

Case A 36-year-old male professional soccer player sustained an acute left hip injury during a tournament game while defending the goal. Magnetic resonance imaging demonstrated a complete avulsion of the iliopsoas tendon from the left trochanter. The patient was treated nonoperatively, and after 10 weeks, he was able to return to full activity. After 1 year of follow-up, the patient was completely asymptomatic, and was still playing professional soccer without flexion strength deficit. Conclusion In this professional soccer athlete, nonoperative treatment of complete psoas avulsion resulted in a good functional outcome and successful return to play.

Introduction: Transoral endoscopic thyroidectomy vestibular approach (TOETVA) may represent the next phase of minimally invasive endocrine surgery, and early clinical experience shows that TOETVA i...

In endoscopic neck endocrine surgery, the subplatysmal plane is an anatomic key structure that must be identified and preserved, to progress with the dissection. We define the prevalence of platysma, in the intermediate plane of the anterior cervical region, and evaluate potential statistical correlations with clinical and pathologic variables.The study included patients who had thyroid surgery. Morphologies, asymmetry, and patterns of the platysma were described. The analysis of the different considered variables was quantitative and qualitative, using multiple data reports.A total of 23 men and 90 women, aged 19 to 70 (median 41±19) years constituted the study cohort. Their neck circumference and height were 388.5±45 mm (334 to 479 mm) and 200±30 mm (160 to 270 mm), respectively. The hemi-platysmal muscle was bilaterally identified in 109 (96.4%). The mean platysmal thickness was 2.7±1.7 mm (range: 0.7 to 8.2 mm). The intermediate plane between the platysmal muscles was classified into 4 types, depending on the muscle features in the midline: Type A: the left and right platysmal fibers were interlaced with each other in the midline (7%); type B: the platysmal fibers were disconnected by1 cm (27%); type C: between 1 and 3 cm (52%); and type D separated3 cm (14%).We provide descriptive characteristics of the cervical platysma. A better understanding of the anatomic variability in cervical platysma may be useful in performing a more accurate dissection in endoscopic endocrine neck surgery.

Instead of designing for accessibility from the start of a software development project, a common procedure is to consider a substantial group of potential users only when the artifact is almost completed. In particular, the domain of accessible cross-platform mobile apps has only received limited attention by research and practitioners. In this work, we set out to tackle mobile accessibility by identifying distinctive challenges, requirements, and solution techniques for mobile apps in contrast to established web development. Furthermore, a model-driven approach that integrates accessibility concerns into the development of cross-platform mobile apps is presented. To highlight the applicability of the proposed approach, parts of mobile prototypes accessible to visually impaired people were built based on the enhanced MD2 framework.

Optomechanical SiN nano-oscillators in high-finesse Fabry–Perot cavities can be used to investigate the interaction between mechanical and optical degree of freedom for ultra-sensitive metrology and fundamental quantum mechanical studies. In this paper, we present a nano-oscillator made of a high-stress round-shaped SiN membrane with an integrated on-chip 3-D acoustic shield properly designed to reduce mechanical losses. This oscillator works in the range of 200 kHz to 5 MHz and features a mechanical quality factor of $Q\simeq 10^{7}$ and a Q-frequency product in excess of $6.2 \times 10^{12}$ Hz at room temperature, fulfilling the minimum requirement for quantum ground-state cooling of the oscillator in an optomechanical cavity. The device is obtained by MEMS deep reactive-ion etching (DRIE) bulk micromachining with a two-side silicon processing on a silicon-on-insulator wafer. The microfabrication process is quite flexible such that additional layers could be deposited over the SiN membrane before the DRIE steps, if required for a sensing application. Therefore, such oscillator is a promising candidate for quantum sensing applications in the context of the emerging field of quantum technologies. [2018-0186]

Effective communication is central to children, young people, and their families’ experiences of health care. Most patient complaints in developed health care systems result from ineffective communication, including inadequate information provision, not feeling listened to, failure to value patients concerns, and patients not feeling involved in care decisions. Advanced communication skills training is now embedded within cancer care policy in the United Kingdom and now features prominently within cancer education in many countries. Here, we share findings from a research evaluation of an advanced communication skills training program dedicated to health professionals caring for children and young people with cancer. We evaluated participants’ (n = 59) perceptions of the program, impact on their skills, knowledge, competence, and confidence. An appreciative inquiry design was adopted; data included interviews, precourse-postcourse evaluations, e-mail blog survey, and 360-degree reflective work records. The framework approach underpinned data analysis and triangulation of data sets. Key findings highlighted good and poor practice in health professionals’ engagement with children, young people, and their families; the purpose of communicating effectively was not always consistent with collaborative working. Attending a program helped participants expand their knowledge of communication theories and strategies. Participants valued using simulated scenarios to develop their skills and were keen to use their new skills to enhance care delivery. Our emphasis within this evaluation, however, remained on what was communicated, when and how, rather than to what effect. The impact of programs such as these must now be evaluated in terms of patient benefit.

In the mechanical harvesting of sugarcane, a self-propelled harvester is used in conjunction with an agricultural implement named infield wagon, which has the function of storing and transporting the harvested product. Much of the cost of sugarcane production comes from this operation (30 to 60%). Among the operational costs of agricultural machinery, the cost of repair and maintenance (CRM) is relevant. Therefore, the objective of this study was to determine the parameters of the CRM mathematical model based on the life (hours of use) for the infield wagon, using the method of the American Society of Agricultural and Biological Engineers (ASABE). These CRM models were obtained for two sets of infield wagon from different manufacturers and their costs over up to 12 years. The model was adjusted and then validated using descriptive statistics methods. Fitted CRM equations were different for each analyzed set of infield wagon and, therefore, are a valuable tool in the management of mechanization in sugarcane mills as it provides elements that can support decision-making of managers in the acquisition and management of agricultural implements. RESUMO Na colheita mecanizada de cana-de-açúcar é utilizada uma colhedora autopropelida em conjunto com uma máquina agrícola denominada de transbordo, que tem a função de transportar o produto colhido. Os custos com o corte, carregamento e transporte variam entre 30 e 60% dos custos de produção da cana-de-açúcar. Dentre os custos operacionais de máquinas agrícolas, o custo de reparo e manutenção (CRM) possui relevância, sendo assim, objetivou-se neste trabalho determinar os parâmetros do modelo matemático do CRM em função da vida (horas de uso) para o transbordo, utilizando o método da American Society of Agricultural and Biological Engineers (ASABE). Estes modelos de CRM foram obtidos para dois conjuntos de transbordos de fabricantes diferentes e seus dados despendidos ao longo de até 12 anos. O modelo foi ajustado e posteriormente validado utilizando métodos de estatística descritiva. As equações ajustadas do CRM foram diferentes para cada conjunto de transbordo analisado, sendo portanto, uma ferramenta importante na gestão da mecanização nas usinas pois fornece elementos que podem subsidiar as tomadas de decisão dos gestores na aquisição e gerenciamento de equipamentos agrícolas.

Background: Health professional education has been criticized for not integrating patient expertise into professional curricula to develop professional skills in patient empowerment. Objective: To develop and translate a new expert patientcentered model for teaching empowerment into professional education about routine chronic care management. Methods: Eight Finnish patients (known as expert patients), 31 students, and 11 lecturers from 4 European countries participated in a new pilot intensive educational module. Thirteen focus groups, artefacts, and an online student evaluation were analyzed using a thematic analysis and triangulated using a meta-matrix. Results: A patient-centered pedagogical model is presented, which describes 3 phases of empowerment: (1) preliminary work, (2) the elements of empowerment, and (3) the expected outcomes. These 3 phases were bound by 2 cross-cutting themes “time” and “enabling resources.” Conclusion: Patient expertise was embedded into the new module curriculum. Using an example of care planning, and Pentland and Feldman’s theory of routine organization, the results are translated into a patient-centered educational model for teaching empowerment to health profession students.

The Converging World (TCW) developed-developing world partnership model represents a transparent approach to addressing carbon emission management in a mutually beneficial way, with a substantial ‘multiplier effect’ achieved though reinvestment of operating surpluses from energy generation into tropical dry evergreen forest (TDEF) restoration. Carbon dioxide is averted/sequestered at a theoretical cost of £0.0058 £ per t CO 2 e (≈$US0.01 per t CO 2 e). For the City and County of Bristol, England, cumulative century-long CO 2 e emissions of 256,550,000 t CO 2 e could be matched by one-off investment of £3:56 for each of Bristol City's 442,500 population in commissioning a 2.1 MW wind turbine in Tamil Nadu under the TCW model. Similar considerations apply at institutional level; indicative contributory investment in turbine installation is calculated for a case study institution. Calculated investments relate to the ‘anchor service’ of climate regulation, though the TCW model also generates multiple co-beneficial ecosystem services serving local people and addressing UN Sustainable Development Goals. Restoration of other bioregional habitats could yield additional socio-ecological benefits. TCW's aspirational investment model positions social return on investment (SROI) as primary ‘interest’, rather than maximisation of financial returns to investors. We test the case for founding developing world investment on the basis for ‘payments for ecosystem services’ (PES).

Developing-developed world partnerships potentially present win-win opportunities for addressing climate-active gas emissions at lower cost whilst propelling developing nations on a lower-carbon trajectory, as carbon emissions, capture and storage are geographically independent. Expanded PES (payment for ecosystem service) principles provides a framework for assessing the transparency and efficacy of partnerships, tested on the model developed by The Converging World (TCW). The TCW partnership model currently links south-west England and Tamil Nadu, raising funds for wind turbines in India to avert emissions from conventional sources and reinvesting operating surpluses into restoration of tropical dry evergreen forest (TDEF). Over assumed 100-year progression to climax community, 123 ha of restored TDEF sequesters a conservatively calculated 270,545,880 tCO2. This forest area is restored using operating surpluses from a 2.1MW turbine, which generates renewable energy over 20-year operating life conservatively calculated as averting 80,000 tCO2e compared to a conventional energy mix. Forest restoration funded from turbine generation surpluses represents a substantial ‘multiplier effect’, providing around 3,000 times greater overall carbon reductions. Climate regulation is one of a linked set of ecosystem services, albeit a driving ‘anchor service’, that may be optimised to increase overall benefits to stakeholders and contribute to UN Sustainable Development Goals.

The constant evolution of the Web has covered various segments of society and, as it evolves, its content must be accessible to different users’ profiles. Older adults (60+) are the fastest growing population of users who face difficulties in interacting with websites, due to limitations in their abilities caused by the aging process. Despite the legislation and guidelines established for the development of accessible and usable web contents, several problems of accessibility and usability still must be solved. In particular, most website designers do not take into account the older adult’s profile. This paper introduces Sene-check checklist, a support to web accessibility and usability evaluations for the Brazilian older profile developed according to scientific procedures, including the following three perspectives: (1) literature review, (2) point of view of experts and developers and (3) point of view of Brazilian older adults. The results enabled an investigation into the main problems encountered by older adults regarding web interaction and reinforced the relevance of a support for the evaluation of web accessibility and usability.

Posterior tibial tendon (PTT) dysfunction is three times more common in females, and some patients may have a predisposition without a clinically evident cause, suggesting that individual characteristics play an important role in tendinopathy. The present study investigated the association of rs4986938 (+ 1730G > A; AluI RFLP) and rs1256049 (− 1082G > A; RsaI RFLP) single nucleotide polymorphisms (SNPs) of estrogen receptor-beta (ER-β) gene with PTT dysfunction. A total of 400 participants were recruited. The PTT dysfunction group: these patients underwent surgery, with PTT tendinopathy confirmed by histopathology and magnetic resonance image (MRI). The control group was composed of participants with no clinical or MRI evidence of PTT dysfunction. Each group was composed of 100 postmenopausal women, 50 premenopausal women, and 50 men. Genomic DNA was extracted from saliva samples, and genotypes were obtained by polymerase chain reaction restriction fragment length polymorphism (PCR–RFLP). Concerning the ER-β SNP rs4986938, there were significant differences in the frequencies of alleles between test and control groups of all the cases, only postmenopausal women and only men (p

Mobile devices have gained more attention from the society that is using them increasingly for a variety of purposes. For complete insertion of the population in this constant digital evolution it is fundamental that mobile applications also offer access to different user profiles, regardless of their disabilities or limitations. Considering quality, productivity, and speed of application creation, there is a wide range of good development practices and evaluations. However, methods that involve usability and accessibility are still developing. The purpose of this article is to present the Acc-MobileCheck, which is a checklist of accessibility and usability for mobile devices apps, based on good software development practices and guided by Design Patterns. The Acc-MobileCheck, composed of 47 verification items, consists of questions that look for evidence of problems of comprehension, operation, perception, and adaptation in mobile apps. The evaluation method aims to address difficulties that can be faced by people with hearing, visual, intellectual, or mobility impairment. Five experts and three developers of mobile apps had evaluated the Acc-MobileCheck. The conclusive results show that the checklist is usable and includes essential issues for the evaluation of accessibility and usability. The data obtained allowed a restructuring of the evaluation method developed, and the positive comments about the checklist demonstrate its adequacy to attend the demand.

Mobile game applications stand as a profitable market, being mostly represented by independent startups striving to overcome their lack of experience. One of their big challenges refers to the adoption of mobile games by older adults. Appropriated methods for usability, accessibility and user experience (UX) evaluation of such domain remains a few in the literature. Engineering methods are still required for startup companies to overcome the challenge. In this paper, we sought to build evaluation methods for the context of startups, mobile games and older adults. This study is an empirical research based on techniques from the constructivist grounded theory methodology. Our findings show a lean framework aiming to guide startup practitioners to diagnose usability, accessibility and UX issues from tests of mobile games with older adults. We also provide a guide to usability and accessibility heuristics that can be employed to inspect the domain.

Smart toys are new to the Internet of Things market, and its connectivity to the cloud have raised concerns about children's privacy. Parents and legal guardians have striven to protect the privacy of their owns. However, current approaches for privacy control still lack usability for lay people. In this paper, we have explored the use of Card Sorting to enhance the usability of a privacy control for smart toys. Our goal was to identify and describe benefits of this technique to the design of more usable privacy controls. For this reason, we conducted a case study with voluntarily participants. We chose a parental control model from the literature to be the subject of evaluation for the experiment. Therefore, we extracted 19 units of information from its interface, and put them into cards for the Card Sorting evaluation. After the experiment, we obtained 30 valid responses. From these responses we performed a cluster analysis to understand the best alternative to group privacy related contents. Our contributions include a new model for nutrition label style mobile parental privacy controls for smart toys, suggestion of Google Material Design icons to be applied as indication for groups of privacy policies and, finally, a six steps process to perform Card Sorting with cluster analysis that does not rely on users' discussions to compose the Information Architecture hierarchy.

International audience; Complex magnetic structures are ubiquitous in turbulent astrophysical plasmas. Such structures can be host to many dynamic processes, such as magnetic reconnection and energy dissipation. Thus, revealing the 3D topologies of these structures is necessary. In this study, we propose a new method to reconstruct complex magnetic topologies in quasi-steady space plasmas, by utilizing eight-point measurements of magnetic fields and particles. Such a method, based on the Second-Order Taylor Expansion (SOTE) of a magnetic field, is nonlinear; it is constrained by \rm∇ · \boldsymbolB=0 and \rm∇ × \boldsymbolB=μ _0\boldsymbolJ, where \boldsymbolJ=ne(\boldsymbolV_\boldsymboli-\boldsymbolV_\boldsymbole) is from particle moments. A benchmark test of this method, using the simulation data, shows that the method can give accurate reconstruction results within an area about three times the size of a spacecraft tetrahedron. By comparing to the previous First-Order Taylor Expansion (FOTE) method, this method (SOTE) gives similar results for reconstructing quasilinear structures but exhibits better accuracy in reconstructing nonlinear structures. Such a method will be useful to the multi-scale missions, such as the future European Space Agency's "cross-scale" mission and China's "self-adaptive" mission. Also, it can be applied to four-point missions, such as Cluster and the Magnetospheric Multiscale Mission. We demonstrated how to apply this method to the four-point missions. In principle, this method will be useful to study shocks, magnetic holes, dipolarization fronts, and other nonlinear structures in space plasmas