Search

With globalization and the knowledge society, the expansion of higher education has become an 'object of desire' among governments to bolster both economic growth and social development. In recent decades, just as in other countries, Brazil has expanded the system and become the fourth largest in the world in enrollment numbers, significantly increasing distance education at for-profit private institutions. However, massification without the necessary attention to quality and equity may present undesired consequences. Thus, considering Brazil has created one of the largest information databases that allow for studies with huge samples, we statistically analyzed performance in a wide scale national examination (Enade) with approximately 222,000 students, disaggregated by background and education modalities. The results back the argument that learning possibilities and performance in distance education are inferior in relation to in-person modalities and that the expansion based on distance education at for-profit private institutions may be reproducing inequalities within the higher education system in one of the most unequal nations in the world.

Abstract Background Clinical practice guidelines recommend spinal manipulation for patients with low back pain. However, the effects of spinal manipulation have contradictory findings compared to placebo intervention. Therefore, this study investigated the immediate effects of lumbar spinal manipulation on pressure pain threshold (PPT) and postural stability in people with chronic low back pain (cLBP). Second, we investigated the immediate effect of lumbar spinal manipulation on pain intensity and the interference of the participant beliefs about which treatment was received in the PPT, postural stability, and pain intensity. Methods A two-arm, randomised, placebo-controlled, double-blind trial was performed. Eighty participants with nonspecific cLPB and a minimum score of 3 on the Numeric Pain Rating Scale received one session of lumbar spinal manipulation (n = 40) or simulated lumbar spinal manipulation (n = 40). Primary outcomes were local and remote PPTs and postural stability. Secondary outcomes were pain intensity and participant’s perceived treatment allocation. Between-group mean differences and their 95% confidence intervals (CIs) estimated the treatment effect. One-way analysis of covariance (ANCOVA) was performed to assess whether beliefs about which treatment was received influenced the outcomes. Results Participants had a mean (SD) age of 34.9 (10.5) years, and 50 (62.5%) were women. Right L5 [between-group mean difference = 0.55 (95%CI 0.19 to 0.90)], left L5 [between-group mean difference = 0.45 (95%CI 0.13 to 0.76)], right L1 [between-group mean difference = 0.41 (95%CI 0.05 to 0.78)], left L1 [between-group mean difference = 0.57 (95%CI 0.15 to 0.99)], left DT [between-group mean difference = 0.35 (95%CI 0.04 to 0.65)], and right LE [between-group mean difference = 0.34 (95%CI 0.08 to 0.60)] showed superior treatment effect in the spinal manipulation group than sham. Neither intervention altered postural stability. Self-reported pain intensity showed clinically significant decreases in both groups after the intervention. A higher proportion of participants in the spinal manipulation group achieved more than two points of pain relief (spinal manipulation = 90%; sham = 60%). The participants’ perceived treatment allocation did not affect the outcomes. Conclusion One spinal manipulation session reduces lumbar pain sensitivity but does not affect postural stability compared to a sham session in individuals with cLPB. Self-reported pain intensity lowered in both groups and a higher proportion of participants in the spinal manipulation group reached clinically significant pain relief. The participant’s belief in receiving the manipulation did not appear to have influenced the outcomes since the adjusted model revealed similar findings.

Abstract Background Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is the only curative treatment for myeloid malignancies such as some acute myeloid leukemias (AML) and high-risk myelodysplastic syndromes (MDS). It aims to eradicate the malignant clone using immunocompetent donor cells (graft-versus-leukemia effect, GVL). Unfortunately, relapse is the primary cause of transplant failure mainly related on HLA loss or downregulation and upregulation of inhibitory ligands on blasts which result in donor immune effector dysfunctions. Methods Between 2018 and 2021, we conducted a monocentric prospective study including 61 consecutive patients transplanted for AML or high-risk MDS. We longitudinally investigated immune cells at days + 30, + 90 and + 180 post-transplant from bone marrow and peripheral blood. We assessed the dynamics between myeloid derived suppressor cells (MDSCs) and T-cells. Results Among the 61 patients, 45 did not relapse over the first 12 months while 16 relapsed during the first year post-transplant. Through months 1 to 6, comparison with healthy donors revealed an heterogenous increase in MDSC frequency. In all recipients, the predominant MDSC subset was granulocytic with no specific phenotypic relapse signature. However, in relapsed patients, in vitro and in vivo functional analyses revealed that MDSCs from peripheral blood were highly immunosuppressive from day + 30 onwards, with an activated NLRP3 inflammasome signature. Only circulating immunosuppressive MDSCs were statistically correlated to circulating double-positive Tim3+LAG3+ exhausted T cells. Conclusion Our simple in vitro functional assay defining MDSC immunosuppressive properties might serve as an early biomarker of relapse and raise the question of new preventive treatments targeting MDSCs in the future. Trial registration NCT03357172

Introduction: This study evaluated outcomes and risk factors for COVID-19 in 91 Brazilian multiple myeloma (MM) patients between April 2020 and January 2022. Results: Of the 91 MM patients diagnosed with COVID-19, 64% had comorbidities and 66% required hospitalization due to COVID-19, with 44% needing ventilatory support and 37% intensive care. Age (OR 2.02; 95%CI 1.02 – 7.7) and hypertension OR 4.5; 95%CI 1.3 – 15.5) were independently associated with hospitalization and certain MM therapies (corticosteroids and monoclonal drugs) were associated with ventilatory support (OR 4.3; 95%CI 1.3 – 14 and OR 5.7; 95%CI 1.8 – 18, respectively), while corticosteroids and immunomodulatory drugs were linked to ICU admission (OR 5.1; 95% CI 1.4 – 18 and OR 3.4; 95%CI 1.1 – 10, respectively). The overall mortality rate was 30%, with the highest rate observed in the ICU (73%). Additionally, the ECOG performance status was linked to increased mortality (OR 11.5; 95%CI 1.9 – 69). The MM treatment was delayed in 63% of patients who recovered from COVID-19. Conclusions: The findings highlight the need for preventing COVID-19 and prioritizing vaccination among MM patients, as they have high rates of severe outcomes in the event of COVID-19. It is also essential to monitor the potential clinical impacts of COVID-19 on MM patients in the long-term. Given the limited resources available in treating MM patients in Brazil during the COVID-19 pandemic, outcomes might be worse in this population.

Abstract Apical periodontitis (AP) is a condition characterized by inflammatory and infectious components in the tooth canal. AP affects periradicular tissues and has systemic repercussions. Physical exercise is a structured activity that requires cardiorespiratory function, and can modulate the inflammatory profile in pathological conditions. As a result, this study aimed to determine the effects of aerobic physical training (PT) on the alveolar bone with and without AP, and its systemic inflammatory repercussions. AP was induced in the mandibular first molars, and PT was performed on a treadmill for five consecutive days over four weeks, with progressive increases in speed and activity time. Blood samples were collected to determine serum cytokine levels using immunoassays, and alveolar bone samples were collected for histopathological evaluation, lesion volume and microarchitecture assessment using computed microtomography. Animals with AP had increased pro-inflammatory cytokines levels compared to those without AP; however, these levels were attenuated or restored by PT. Compared to the AP group, the AP + PT group had a smaller lesion volume and greater preservation of the bone trabeculae in the remaining alveolar bone surrounding the lesion. In overall, PT minimized the severity of AP proving to be a valid strategy for individuals undergoing endodontic treatment.

The Salmonella enterica serovars Typhimurium (S. Typhimurium), Heidelberg (S. Heidelberg), and their monophasic variants (S. 1,4,[5],12:i:-, S. 1,4,[5],12:r:- and S. 1,4,[5],12:-:1,2) are highly disseminated in poultry farming and can contaminate chicken meat, eggs, and other foods of avian origin. A time-consuming bacteriological and serological analysis is usually required to identify serovars by traditional methods. Incomplete and inconclusive serological results are frequent in routine analysis, mainly due to the occurrence of bacterial isolates presenting similar antigenic profiles. Molecular biology assays have been developed to improve the detection of specific Salmonella serovars and strains. This study aimed to develop a multiplex real-time PCR (SHTAmp) for the rapid DNA detection of S. Typhimurium, S. Heidelberg, and their monophasic variants from poultry samples. The methodology was used in the analysis of 147 field isolates from Brazilian poultry flocks previously evaluated with serological analysis. The results demonstrated that it was able to specifically and rapidly detect 21 S. Typhimurium and 57 S. Heidelberg isolates with complete antigenic formulae. Furthermore, SHTAmp was able to differentiate nine S. Typhimurium and 44 S. Heidelberg isolates with incomplete serological formulae (monophasic and aphasic variants). The complete methodology was also successfully used to detect these bacteria directly from 34 poultry samples after pre-enrichment in buffered peptone water (BPW). In conclusion, SHTAmp is a fast and accurate method to detect the two frequent and concerning serovars S. Typhimurium and S. Heidelberg directly from poultry samples.

Abstract We characterize quantum correlations encoded in a three-flavor oscillating neutrino system by using both plane-wave and wave-packet approach. By means of the Complete Complementarity Relations (CCR) we study the trade-off of predictability, local coherence and non-local correlations in terms of the relevant parameters, chosen from recent neutrino experiments. Although the CCR describe very well the contributions associated to bipartite correlations, an attempt of promoting these relations to include the genuine tri-partite contributions in the pure-state case leads to a not completely meaningful result. However, we provide an analysis of the genuine tripartite contributions both for the pure instance and for the mixed case, independently of CCR.

Abstract Recent biological surveys of ancient inselbergs in southern Malawi and northern Mozambique have led to the discovery and description of many species new to science, and overlapping centres of endemism across multiple taxa. Combining these endemic taxa with data on geology and climate, we propose the ‘South East Africa Montane Archipelago’ (SEAMA) as a distinct ecoregion of global biological importance. The ecoregion encompasses 30 granitic inselbergs reaching > 1000 m above sea level, hosting the largest (Mt Mabu) and smallest (Mt Lico) mid-elevation rainforests in southern Africa, as well as biologically unique montane grasslands. Endemic taxa include 127 plants, 45 vertebrates (amphibians, reptiles, birds, mammals) and 45 invertebrate species (butterflies, freshwater crabs), and two endemic genera of plants and reptiles. Existing dated phylogenies of endemic animal lineages suggests this endemism arose from divergence events coinciding with repeated isolation of these mountains from the pan-African forests, together with the mountains’ great age and relative climatic stability. Since 2000, the SEAMA has lost 18% of its primary humid forest cover (up to 43% in some sites)—one of the highest deforestation rates in Africa. Urgently rectifying this situation, while addressing the resource needs of local communities, is a global priority for biodiversity conservation.

Brazil is a country with strong agricultural production, annually producing a large amount of lignocellulosic residues. The valorization of these residues as ingredients for the food industry aims at environmental, social, and economic sustainability. Coffee hull is a by-product generated by the coffee industry that can be used to produce new food ingredients with high added value. This study aimed to obtain a multifunctional fiber-rich ingredient from a coffee hull using a one-step process based on reactive extrusion with alkaline hydrogen peroxide or sulfuric acid. For this purpose, we submitted a coffee hull to extrusion with sulfuric (1% and 3%) acid or alkaline hydrogen peroxide (1% and 3%) in one-step processes. Then, the obtained materials were characterized through their physicochemical and techno-functional properties. All treated samples had an increase in their cellulose and insoluble dietary fiber contents and also presented an increase in their porosity as observed by scanning electron microscopy. The sample modified with 3% alkaline hydrogen peroxide (AHP3) had the highest cellulose content (45.17%), insoluble dietary fiber (78.20%), density (3.54), water absorption capacity (1.96 g/g), and oil absorption capacity (0.86 g/g). All samples had thermal stability from room temperature to 300 °C and in all samples, the crystallinity indexes decreased after treatment. Reactive extrusion was effective in modifying the coffee hull. Our study proposes a green route to obtain a higher value-added product from lignocellulosic waste, with some advantages including short reaction times, low reagents concentrations, little or no effluent generation, and the possibility of scaling to industrial scale.

This bibliometric review aims to explore and discuss the scope and limitations of the literature addressing the consequences of Zika virus infection and its impact on child development. The objective is to comprehensively demonstrate the collaboration network among countries and institutions and track emerging trends. A systematic literature review was conducted using the Web of Science database, covering publications from 2016 to June 2022. The VOSviewer tool was employed for bibliometric analysis, examining co-authorship, keyword co-occurrence, and co-citation of journals, authors, and references in the literature. Data were obtained from 161 studies published across 44 categories, with pediatrics and clinical neurology as primary fields. Three main research trends were identified: one focusing on congenital Zika syndrome and its association with cerebral palsy and epilepsy, and the other trend examining the relationship between infection during pregnancy, geographic location, and the neurodevelopmental characteristics of affected children. Our study provides a comprehensive overview of the current state of Zika virus research, specifically regarding its effects on child development. The findings highlight global collaboration patterns and research institution affinities, with Brazil emerging as a leading contributor to the literature.

JUSTIFICATIVA E OBJETIVOS: Freqüentemente, crianças com refluxo gastroesofágico têm que ser submetidas a anestesia para estudos diagnósticos e/ou procedimentos cirúrgicos. Considera-se que o esvaziamento gástrico seja retardado na doença do refluxo gastroesofágico pediátrico. Portanto, a anestesia nesses pacientes tem aspectos peculiares, especialmente no que se refere ao risco de aspiração pulmonar. O objetivo deste estudo é comparar o volume gástrico residual de crianças com ou sem refluxo gastroesofágico e determinar se as crianças com refluxo têm, de fato, risco aumentado para a aspiração pulmonar do conteúdo gástrico durante a anestesia. MÉTODO: Participaram do estudo 38 crianças, estado físico ASA I ou II, submetidas à endoscopia digestiva alta diagnóstica. As crianças foram divididas em dois grupos: grupo R, portadoras de refluxo gastroesofágico e grupo N, sem refluxo gastroesofágico com endoscopia digestiva alta normal. Durante o procedimento, todo o conteúdo gástrico foi aspirado e seu volume medido. RESULTADOS: Das 38 crianças estudadas, 18 (47%) foram incluídas no grupo R e 20 (53%) no grupo N. Não foram constatadas diferenças significativas entre os dois grupos no que se refere à idade, ao peso e tempo de jejum. Em todos os pacientes, o volume gástrico residual observado foi inferior a 0,4 ml.kg-1; e não houve diferenças significativas entre os grupos. CONCLUSÕES: Nas condições deste estudo, o volume gástrico residual não diferiu entre as crianças portadoras, ou não, de refluxo gastroesofágico. Portanto, as crianças com refluxo gastroesofágico não apresentaram risco aumentado de aspiração pulmonar, quando comparadas a crianças sem refluxo gastroesofágico, podendo-se dispensar sua profilaxia.

We aimed to access the genetic diversity of Apergillus fumigatus strains obtained from cystic fibrosis (CF) patients from southern Brazil. A. fumigatus sensu stricto isolates from respiratory clinical specimens were genotyped by microsatellite markers and azole resistance was evaluated by azole-agar screening. Twenty-seven isolates from twenty-seven patients showed a high genetic diversity, with the differentiation of 25 different genotypes (25 unique and one common to two isolates). All isolates were susceptible to the azoles tested. We believe that prospectively monitoring A. fumigatus genetic diversity is essential to identify interpatient transmission and outbreaks, as is the identification of resistant strains.

This paper presents a novel information generation methodology to support safer cycling patterns in urban environments, leveraging for that Large Language Models (LLMs), AI-based agents, and open geospatial data. By processing multiple files containing previously computed urban risk levels and existing mobility infrastructure, which are generated by exploiting open data sources, our method exploits multi-layer data preprocessing procedures and prompt engineering to create easy-to-use, user-friendly assistive systems that are able to provide useful information concerning cycling safety. Through a well-defined processing pipeline based on Data Ingestion and Preparation, Agents Orchestration, and Decision Execution methodological steps, our method shows how to integrate open-source tools and datasets, ensuring reproducibility and accessibility for urban planners and cyclists. Moreover, an AI agent is also provided, which fully implements our method and acts as a proof-of-concept implementation. This paper demonstrates the effectiveness of our method in enhancing cycling safety and urban mobility planning. • A novel method that combines LLMs and AI agents is defined to enhance the processing of multi-domain open geospatial data, potentially promoting cycling safety. • It integrates urban risk data and cycling infrastructure for a more comprehensive understanding of cycling resources, which become accessible by textual or audio prompts.

Erythema elevatum diutinum (EED) is a rare cutaneous neutrophilic vasculitis with many associated diseases reported in the literature. We report a 65-year-old woman with painful and itchy lesions on her elbows, hands, knees, and foot for a year. Histopathologic examination confirmed the diagnosis of erythema elevatum diutinum and treatment with dapsone produced significant clinical improvement within few weeks. Erythema elevatum diutinum is a rare disease that should be considered in patients with violaceous nodular plaques located over the extensor regions of the limbs. Knowledge of this unusual pathology and its association helps to avoid misdiagnosis and late treatment.

Antimicrobial resistance in urinary tract infections (UTIs) is a major public health concern. This study aims to characterize the phenotypic and genetic basis of multidrug resistance (MDR) among expanded-spectrum cephalosporin-resistant (ESCR) uropathogenic Escherichia coli (UPEC) causing UTIs in California patient populations. Between February and October 2019, 577 ESCR UPEC isolates were collected from patients at 6 clinical laboratory sites across California. Lineage and antibiotic resistance genes were determined by analysis of whole-genome sequence data. The lineages ST131, ST1193, ST648, and ST69 were predominant, representing 46%, 5.5%, 4.5%, and 4.5% of the collection, respectively. Overall, 527 (91%) isolates had an expanded-spectrum β-lactamase (ESBL) phenotype, with blaCTX-M-15, blaCTX-M-27, blaCTX-M-55, and blaCTX-M-14 being the most prevalent ESBL genes. In the 50 non-ESBL phenotype isolates, 40 (62%) contained blaCMY-2, which was the predominant plasmid-mediated AmpC (pAmpC) gene. Narrow-spectrum β-lactamases, blaTEM-1B and blaOXA-1, were also found in 44.9% and 32.1% of isolates, respectively. Among ESCR UPEC isolates, isolates with an ESBL phenotype had a 1.7-times-greater likelihood of being MDR than non-ESBL phenotype isolates (P < 0.001). The cooccurrence of blaCTX-M-15, blaOXA-1, and aac(6')-Ib-cr within ESCR UPEC isolates was strongly correlated. Cooccurrence of blaCTX-M-15, blaOXA-1, and aac(6')-Ib-cr was associated with an increased risk of nonsusceptibility to piperacillin-tazobactam, cefepime, fluoroquinolones, and amikacin as well as MDR. Multivariate regression revealed the presence of blaCTX-M-55, blaTEM-1B, and the ST131 genotype as predictors of MDR. IMPORTANCE The rising incidence of resistance to expanded-spectrum cephalosporins among Escherichia coli strains, the most common cause of UTIs, is threatening our ability to successfully empirically treat these infections. ESCR E. coli strains are often MDR; therefore, UTI caused by these organisms often leads to treatment failure, increased length of hospital stay, and severe complications (D. G. Mark, Y.-Y. Hung, Z. Salim, N. J. Tarlton, et al., Ann Emerg Med 78:357-369, 2021, https://doi.org/10.1016/j.annemergmed.2021.01.003). Here, we performed an in-depth analysis of genetic factors of ESCR E. coli associated with coresistance and MDR. Such knowledge is critical to advance UTI diagnosis, treatment, and antibiotic stewardship.

BackgroundCarbapenem-resistant Enterobacterales (CRE) are an urgent global health threat. Inferring the dynamics of local CRE dissemination is currently limited by our inability to confidently trace the spread of resistance determinants to unrelated bacterial hosts. Whole-genome sequence comparison is useful for identifying CRE clonal transmission and outbreaks, but high-frequency horizontal gene transfer (HGT) of carbapenem resistance genes and subsequent genome rearrangement complicate tracing the local persistence and mobilization of these genes across organisms.MethodsTo overcome this limitation, we developed a new approach to identify recent HGT of large, near-identical plasmid segments across species boundaries, which also allowed us to overcome technical challenges with genome assembly. We applied this to complete and near-complete genome assemblies to examine the local spread of CRE in a systematic, prospective collection of all CRE, as well as time- and species-matched carbapenem-susceptible Enterobacterales, isolated from patients from four US hospitals over nearly 5 years.ResultsOur CRE collection comprised a diverse range of species, lineages, and carbapenem resistance mechanisms, many of which were encoded on a variety of promiscuous plasmid types. We found and quantified rearrangement, persistence, and repeated transfer of plasmid segments, including those harboring carbapenemases, between organisms over multiple years. Some plasmid segments were found to be strongly associated with specific locales, thus representing geographic signatures that make it possible to trace recent and localized HGT events. Functional analysis of these signatures revealed genes commonly found in plasmids of nosocomial pathogens, such as functions required for plasmid retention and spread, as well survival against a variety of antibiotic and antiseptics common to the hospital environment.ConclusionsCollectively, the framework we developed provides a clearer, high-resolution picture of the epidemiology of antibiotic resistance importation, spread, and persistence in patients and healthcare networks.

Objetivo: o presente trabalho tem por objetivo rever as principais publicações sobre aspiração de corpos estranhos em pediatria.Fontes dos dados: a pesquisa bibliográfica foi realizada nas bases de dados Medline, de 1966 a 2000, e no Lilacs, de 1979 a 1999, em português, espanhol e inglês, utilizando-se as palavras-chave aspiração, corpo estranho, crianças e adolescentes.Síntese dos dados: constatou-se uma distribuição universal desses acidentes. Foi também observado predomínio desta afecção no sexo masculino (51,0% a 73,0% dos casos) e entre crianças abaixo de 3 anos, faixa etária em que se concentraram 65,8% a 85,0% dos acidentes. Juntos, a história clínica e o exame físico apresentaram sensibilidade e especificidade em torno de 80% e 40%, respectivamente. O estudo radiológico mostrou-se de grande valia no diagnóstico, demonstrando uma sensibilidade de 57,9% a 100%. Corpos estranhos de natureza alimentar contribuíram com cerca de 70% dos episódios. Conclusões: ficou evidente que a broncoscopia rígida é o procedimento de eleição e requer formação profissional especializada e serviços bem estruturados. Contudo, os aspectos preventivos destes acidentes não receberam a necessária ênfase no contexto destas afecções, sendo a eles dedicada uma seção específica na presente revisão.

ABSTRACT Objective Simulation plays an important role in cardiopulmonary resuscitation training. Comparing postsimulation debriefing with rapid cycle deliberate practice could help determine the best simulation strategy for pediatric cardiopulmonary resuscitation training among pediatric residents. Methods This is a single-blind, prospective, randomized controlled study. First- and second year pediatric residents were enrolled and randomized into two groups (1:1 ratio): rapid cycle deliberate practice group (intervention) or postsimulation debriefing group (control). They participated in two rounds of simulated pediatric cardiopulmonary arrest to assess the simulated pediatric cardiopulmonary resuscitation performance gain (round 1) and retention after a 5-6 week washout period (round 2). Scenarios were video-recorded and analyzed by blinded evaluators. The main outcome was the time to initiation of chest compressions. Secondary outcomes included time to recognize a cardiopulmonary arrest, time to recognize a shockable rhythm, time to defibrillation, time to initiation of chest compressions after defibrillation, and chest compression fraction. Results Sixteen groups participated in the first round and fifteen groups in the second one. Time to intiation of chest compressions decreased from preintervention scenario to the round 1 testing scenario and increased from round 1 to round 2 testing scenario. However, no interaction effects nor group effects were observed (p=0.885 and p=0.329, respectively). There were no significant differences between the two groups regarding the secondary outcomes. Conclusion Despite an overall improvement in simulated pediatric cardiopulmonary resuscitation performance, we did not observe significant differences between the two groups regarding the analyzed variables. The decline in simulated pediatric cardiopulmonary resuscitation performance after 5 weeks suggests the need for shorter time intervals between training sessions.

ABSTRACT Objective This study aimed to analyze the relationship between the participation of professionals in simulation-based training and an increase in the rate of vaginal deliveries. Methods This retrospective observational study analyzed professionals’ participation in high-fidelity simulation training during the pilot phase of the Appropriate Delivery Project, spanning from May 21, 2015 to May 21, 2016, along with the rates of vaginal deliveries across various hospitals. Data for participation by nurses and physicians were examined using a gamma distribution model to discern the predictors influencing the changes in the percentage of vaginal births. Results Data from 27 hospitals involved in the project were analyzed. A total of 339 healthcare professionals, including 147 nurses and 192 doctors, underwent the simulation-based training. During the pilot test, the percentage of vaginal births increased from 27.8% to 36.1%, which further increased to 39.8% in the post-intervention period, particularly when the participation rate of nurses exceeded the median. Conclusion This study suggests that simulation-based training is a valuable strategy for achieving positive changes in obstetric practice, specifically an increase in the rate of vaginal births. These findings underscore the potential advantages of incorporating simulation training into improvement initiatives, as evidenced by the correlation between higher training adoption rates and substantial and sustained enhancements in vaginal birth rates.

Resumo O termo “organização alternativa” (OA) tem sido, frequentemente, utilizado de forma assistemática, remetendo a concepções intuitivas e de senso comum. Ao mesmo tempo, autores que o utilizam aspiram incorporar a crítica como elemento distintivo de práticas organizativas. O presente ensaio objetiva problematizar a concepção de OA, buscando na literatura elementos que permitam conceber a crítica como componente das práticas de organizar. Para tanto, foi necessário situar o enfrentamento dos problemas da realidade social, sem cair em concepções dogmáticas ou relegar as OAs a uma posição de subordinação. No intuito de contribuir com a discussão, este ensaio apresenta uma compilação de perspectivas críticas encontradas na literatura que trata da OA, acrescida da abordagem relativamente recente da crítica imanente (CI), conforme concebida por Rahel Jaeggi (2018). Trata-se de uma perspectiva dialética não essencialista, que toma como ponto de partida as reivindicações e condições postas na realidade social, para responder aos problemas e às crises que se colocam em contexto. Portanto seu potencial transformador centra-se nas próprias práticas de organizar, procurando transformá-las. Essa perspectiva aponta para uma concepção de organização como mediadora na solução parcial de problemas decorrentes das contradições da realidade social.

Abstract Introduction: Chronic kidney disease (CKD) and metabolic syndrome (MS) are recognized as public health problems which are related to overweight and cardiometabolic factors. The aim of this study was to develop a model to predict MS in people with CKD. Methods: This was a prospective cross-sectional study of patients from a reference center in São Luís, MA, Brazil. The sample included adult volunteers classified according to the presence of mild or severe CKD. For MS tracking, the k-nearest neighbors (KNN) classifier algorithm was used with the following inputs: gender, smoking, neck circumference, and waist-to-hip ratio. Results were considered significant at p < 0.05. Results: A total of 196 adult patients were evaluated with a mean age of 44.73 years, 71.9% female, 69.4% overweight, and 12.24% with CKD. Of the latter, 45.8% had MS, the majority had up to 3 altered metabolic components, and the group with CKD showed statistical significance in: waist circumference, systolic blood pressure, diastolic blood pressure, and fasting blood glucose. The KNN algorithm proved to be a good predictor for MS screening with 79% accuracy and sensitivity and 80% specificity (area under the ROC curve – AUC = 0.79). Conclusion: The KNN algorithm can be used as a low-cost screening method to evaluate the presence of MS in people with CKD.

Resenha do livro Pensar o neoliberalismo, organizado por CASTELO BRANCO, Felipe; YAZBEK, André Constantino

ABSTRACT Wild lettuce (Lactuca aff. canadensis L.), belonging to the Asteraceae family, occurs subspontaneously in Brazil and may originate from Africa, Asia, Europe and North America. Popularly known as Canada lettuce, it is an unconventional leafy vegetable. Studies on this species are scarce in Brazil, and its scientific name is debated among experts. It has high morphological variability and controversial botanical classification. This study characterized the stomata, organized the karyotype, and determined the nuclear DNA content of four morphotypes of wild lettuce to facilitate correct classification. The genetic material used was acquired from the non-conventional vegetable germplasm in UFLA. The leaves of wild lettuce morphotypes are hypoamphiestomatic with a greater number of stomata in the abaxial epidermis. There were similarities between the morphotypes (green and purple) and between the smooth purple types (narrow leaf and broad leaf) for the number and size of stomata. No variation was found in the number of chromosomes (2n = 18) or DNA content among the four morphotypes. The separation of the morphotypes of wild lettuce did not match the morphological classification or the karyological data. The four morphotypes evaluated were placed under the same species, and the results obtained when compared to other studies led us to infer that the four morphotypes of wild Lactuca belonged to the species L. indica and not L. canadensis as previously assumed. Further investigation may provide insights into the evolutionary history of this species.

Introduction: Molar-Incisor Hypomineralization (MIH) is an enamel defect of systemic origin that affects from 1 to 4 permanent first molars and is frequently associated with permanent incisors. Bibliometric studies may be considered a useful approach to describing a trend of development of a research field. Objective: To identify the 100 most cited articles about MIH and analyze their characteristics. Material and Methods: Two authors evaluated the articles found in Web of Science (WOS) database. The extracted data included: number and mean number of citations, title, authors, country, year, impact factor of journals, study design, thematic field, institutions. To create collaboration and co-occurrence network maps between keywords, the VOSviewer software was used. Results: The most cited articles received 5,354 citations and 138.92 citations per year. The majority of studies were published in the decade of 2010 (58%) and were related to Epidemiology (35%). Europe was the continent with the greatest contribution to the list of the most cited articles (43%). Australia was responsible for most of the papers included (23%). The majority of the studies were of the cross-sectional type (39%). Conclusion: Evaluation of the 100 most cited articles in the area of enamel defects allowed better understanding of the world scenario with reference to MIH.

Infective dermatitis associated with human T-cell lymphotropic virus type-1 (HTLV-1) (IDH) is a severe form of chronically infected eczema occurring in early childhood, although very rarely cases have been reported in adults. Most of the cases are from Jamaica and Brazil and occur in individuals with low socioeconomic status. IDH is always associated with refractory Staphylococcus aureus or beta-hemolytic Streptococcus infection of the skin and nasal vestibules. Patients with IDH may develop other even more severe HTLV-1-associated diseases, such as HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) of early or late appearance and adult T-cell leukemia/lymphoma. In the context of the Brazilian experience, it has been observed that 54% of IDH patients exhibit the juvenile form of HAM/TSP while the estimated incidence of adult HAM/TSP is 3%. As there are no curative treatments for HTLV-1 infection (or vaccines) or most of its associated diseases, prevention of infection is fundamental, mainly by vertical transmission, as it is responsible for the development of IDH, infantojuvenile HAM/TSP, and ATL. Public measures to reduce this transmission must be implemented urgently. Furthermore, it is recommended, mainly in HTLV-1 endemic areas, to search for HTLV-1 infection in all patients with infected eczema, even in adults.

Hematopoietic Stem Cell Transplantation is a complex treatment, aimed at curing malignant and benign diseases, which directly affects the quality of life of patients and caregivers. Studies prior to the pandemic period presented aspects of caregiver burden and quality of life for both; this current research contributes to this gap on the topic during the pandemic. To evaluate and correlate the quality of life of hematopoietic stem cell transplant recipients with the quality of life and caregiver burden during the COVID-19 pandemic. Case series with 16 dyads, carried out in a public hospital in Brazil, a reference in Latin America. The quality of life of transplant recipients was assessed with the Functional Assessment Cancer Therapy-Bone Marrow Transplantation, caregivers with the Medical Outcomes Studt 36-Item Short Form Health Survey, burden with the Zarit Burden Interview. There was a lower perception of the functional well-being of transplant recipients and a worse general health status of caregivers; the caregiver's mental health interfered in different domains of quality of life; there was a negative correlation between quality of life and caregiver burden. The pandemic impacted the dyads’ quality of life; there is a need for additional support for both the patient and the caregiver.

ABSTRACT Background: Chronic excessive use of alcohol is an important risk factor for several health and social conditions. Methods: A cross-sectional survey, in a sample representative of the Brazilian population,was conducted to evaluate the frequency of consumption of alcoholic beverages and behaviors concerning liver diseases. Participants were prospectively interviewed using a questionnaire regarding alcohol consumption and actions toward liver health. The study accepted at most one sampling error of ±2 percentage points and considered a 95% confidence interval. Results: One thousand nine hundred ninety-five subjects (1.048 women, mean age 44 years) from all Brazilian regions were interviewed. Most of the Brazilian subjects believe that alcohol abuse (63-87%) is the leading cause of cirrhosis and liver cancer, however, most responders (56%) had never been screened to assess liver damage related to alcohol consumption. A total of 55% of Brazilians drink alcoholic beverages. Among Brazilians who drink alcoholic beverages, 44% consume three or more drinks at a time, 11% consume more than 10 doses a day. Among those who consume 1 to 2 drinks a day, women (42%) consume more than men (32%) and more than the national average (37%). Conclusion: There is a high frequency of alcohol consumption, especially among young people, and individuals from lower social classes, with frequent consumption among women. Despite the knowledge of its adverse impact on liver health, less than half of the Brazilians have been evaluated at least once for liver disease. Education and prevention strategies need to be implemented to reduce theharmful use of alcohol.

Até poucos anos atrás, o caminho natural para as pesquisas de pensamento social brasileiro ou de história das ciências sociais passava pelo estudo dos principais personagens (os “fundadores”, os “chefes de escola”), das obras canônicas ou das grandes instituições. Mas, o que acontece se nos detivermos em personagens menos conhecidos ou em textos considerados “menores”, às vezes nem mesmo classificados como uma “obra”? E que perspectiva ganhamos se olharmos não para lugares específicos, mas se movimentarmos nossas inquietações para as relações entre espaços sociais e redes intelectuais? É essa espécie de rotação metodológica que o livro Em busca da Comunidade, de Thiago da Costa Lopes propõe...

Background Cardiovascular disease and cancer share a common risk factor: chronic stress/allostatic load (AL). A 1‐point increase in AL is linked to up to a 30% higher risk of major cardiac events (MACE) in patients with prostate cancer. However, AL's role in MACE in breast cancer, lung cancer, or colorectal cancer remains unknown. Methods and Results Patients ≥18 years of age diagnosed with the mentioned 3 cancers of interest (2010–2019) and followed up at a large, hybrid academic‐community practice were included in this retrospective cohort study. AL was modeled as an ordinal measure (0–11). Adjusted Fine–Gray competing risks regressions estimated the impact of AL precancer diagnosis on 2‐year MACE (a composite of heart failure, ischemic stroke, acute coronary syndrome, and atrial fibrillation). The effect of AL changes over time on MACE was calculated via piecewise Cox regression (before, and 2 months, 6 months, and 1 year after cancer diagnosis). Among 16 467 patients, 50.5% had breast cancer, 27.9% had lung cancer, and 21.4% had colorectal cancer. A 1‐point elevation in AL before breast cancer diagnosis corresponded to a 10% heightened associated risk of MACE (adjusted hazard ratio, 1.10 [95% CI, 1.06–1.13]). Similar findings were noted in lung cancer (adjusted hazard ratio, 1.16 [95% CI, 1.12–1.20]) and colorectal cancer (adjusted hazard ratio, 1.13 [95% CI, 1.08–1.19]). When considering AL as a time‐varying exposure, the peak associated MACE risk occurred with a 1‐point AL rise between 6 and 12 months post‐ breast cancer, lung cancer, and colorectal cancer diagnosis. Conclusions AL warrants investigation as a potential marker in these patients to identify those at elevated cardiovascular risk and intervene accordingly.

In the present investigation, we employ a novel and meticulously structured database assembled by experts, encompassing macrofungi field-collected in Brazil, featuring upwards of 13,894 photographs representing 505 distinct species. The purpose of utilizing this database is twofold: firstly, to furnish training and validation for convolutional neural networks (CNNs) with the capacity for autonomous identification of macrofungal species; secondly, to develop a sophisticated mobile application replete with an advanced user interface. This interface is specifically crafted to acquire images, and, utilizing the image recognition capabilities afforded by the trained CNN, proffer potential identifications for the macrofungal species depicted therein. Such technological advancements democratize access to the Brazilian Funga, thereby enhancing public engagement and knowledge dissemination, and also facilitating contributions from the populace to the expanding body of knowledge concerning the conservation of macrofungal species of Brazil.

ABSTRACT Objective: To evaluate the seasonality of acute bronchiolitis in Brazil during the 2020–2022 season and compare it with the previous seasons. Methods: Data from the incidence of hospitalizations due to acute bronchiolitis in infants

Abstract Objective This study evaluated the color stability of enamel submitted to 10% hydrogen peroxide (HP) followed by antioxidants agents, and the pH and antioxidant activity (AA%) of these agents. Methodology Bovine enamel-dentin blocks were randomly distributed into groups (n=10/group): GNC (negative control: no treatment); GPC (positive control: bleaching only); TOC_10% (HP+10% α-tocopherol); GT_10% (HP+10% green tea extract); GS_5% (HP+5% grape seed extract); SA_10% (HP+10% sodium ascorbate); QUI_10% (HP+10% quinoa extract); and QC_1% (HP+1% quercetin). Color (ΔE00) and whiteness index (ΔWID) changes were analyzed using a digital spectrophotometer. The pH and AA% were determined using a pH meter and the DPPH method, respectively. Data were analyzed by ANOVA/Tukey’s and Dunnett’s tests (α=0.05). Results At 14 days post-bleaching, GNC promoted the lowest ΔWID and ΔE00 (p0.05). QC_1% and QUI_10% exhibited acidic pH levels (3.64 and 4.75, respectively), whereas TOC_10% and GS_5% exhibited alkaline pH (7.07 and 7.64, respectively). No differences in AA% were found between the agents (p>0.05), ranging from 92.6 to 97.6%. Conclusion The antioxidant agents did not interfere in bleached enamel color stability, showing satisfactory antioxidant activity. However, QUI and QC gels displayed acidic pH. Clinical significance: The antioxidants evaluated showed high AA% and no impact on post-bleaching color stability, suggesting that their capacity to recover bond strength demonstrated elsewhere would not compromise the esthetic efficacy of tooth bleaching. However, those with acidic pH should be used with caution due to potential enamel damage.

A focus on water quality has intensified globally, considering its critical role in sustaining life and ecosystems. Wastewater, reflecting societal development, profoundly impacts public health. Wastewater-based epidemiology (WBE) has emerged as a surveillance tool for detecting outbreaks early, monitoring infectious disease trends, and providing real-time insights, particularly in vulnerable communities. WBE aids in tracking pathogens, including viruses, in sewage, offering a comprehensive understanding of community health and lifestyle habits. With the rise in global COVID-19 cases, WBE has gained prominence, aiding in monitoring SARS-CoV-2 levels worldwide. Despite advancements in water treatment, poorly treated wastewater discharge remains a threat, amplifying the spread of water-, sanitation-, and hygiene (WaSH)-related diseases. WBE, serving as complementary surveillance, is pivotal for monitoring community-level viral infections. However, there is untapped potential for WBE to expand its role in public health surveillance. This review emphasizes the importance of WBE in understanding the link between viral surveillance in wastewater and public health, highlighting the need for its further integration into public health management.

Here, the effectiveness of Beauveria bassiana LCM S19 and Metarhizium anisopliae LCM S01, combined with Illicium verum essential oil (EO) against Aedes aegypti larvae was investigated. The EO compounds were first identified through gas chromatography, with the primary compound being (E)-anethole. Subsequently, in silico analysis was employed to predict the biological activity of (E)-anethole, revealing 89 molecular targets, which included insecticidal activity. Next the impact of EO on fungal viability and colony growth was examined and the EO had no effect on fungal development. Next, we investigated the influence of EO on fungal viability and colony growth, revealing that the EO had no discernible impact on fungal development. Following this, individual assessments were carried out to determine larval susceptibility to EO at concentrations of 40, 60, 80, and 100 ppm, as well as with both fungal isolates at conidial concentrations of 1 × 106, 1 × 107, and 1 × 108 conidia/mL. Larval survival was then monitored over a period of seven days. To further optimize the larvicidal potential, EO at a concentration of 40 ppm was combined with both isolates at a conidial concentration of 1 × 106 conidia/mL and tested against mosquito larvae, as described earlier. The combination of M. anisopliae and EO resulted in a substantial decrease, with only 20 % of larvae surviving over a seven-day period, in contrast to approximately 50 % survival observed in the pure M. anisopliae or EO treatments. B. bassiana, whether used alone or in combination with EO, exhibited a 50 % reduction in larval survival. The combination of M. anisopliae and EO exhibited a synergistic effect in targeting Ae. aegypti larvae, whereas B. bassiana, in conjunction with EO, had an additive effect. Notably, the combination achieved its impact in just 3 days, whereas the pure fungus required 7 days to yield similar results. These findings underscore the substantial potential of combining I. verum essential oil with both fungal isolates against Ae. aegypti larvae.

ABSTRACT Objectives: to identify the factors that influenced the mental capacity to work of nursing technicians during the COVID-19 pandemic. Methods: a cross-sectional study, carried out at two reference hospitals in assisting the population during the COVID-19 pandemic. A total of 237 professionals from Intensive Care Units participated and answered a questionnaire. Multiple linear regression models were used to assess the correlation between mental capacity to work and variables related to risks of contamination, institutional support and health. Results: lack of COVID-19 tests, lack of knowledge of routine, absences in 2021 and mental illness contributed to worse mental capacity to work. Management embracement and physical capacity were considered protective factors. Conclusions: reduced work capacity in relation to mental demands can affect professional performance and quality of care, with implications for patients and health institutions.

This article presents a fragment from a larger research with the intention of anticipating some of its main topics, which aim to assemble a pedagogical theoretical body for music harmony in the context of the globalized and diverse world of the 21st century. The research fragment presented discusses terminological issues and propositions for an ontological study of harmonic structures that concerns itself with the definition of what types of musical sound objects of definite pitch do exist, how many are there, which properties they possess and their musical consequences, all organized in a logical taxonomical system referred to by means of an adequate terminology. The text first establishes the need for such an ontology, and proceeds with a description of the terminological issues involved in a secondary term formation action, a subsequent renaming effort that is all the more challenging when dealing with a field with a huge lifetime such as music theory. The methodology used in the terminological recreation is then described, explaining its preference for terms that, regardless of their lexicographic origins and prevalence, are single-words that provide biunivocal association, that avoid ambiguity by synonymy and polysemy, that are self-explanatory, and that are of easy translation using same-lexeme words similar in graphical form. It is then given a brief summary of the structure of the created ontology, followed by the definitions, lexicographic origins, and neologism-creating derivational strategies for all its main proposed terms, including those to be used in the classifications of harmonic structures according to the criteria of cardinality, chirality, azimuth, triadic intrinsicality, monadic, triadic, and transpositional proclivities, limiting characteristics, and modalization, superset and subset relationships. To close the text, a schematic view of the organizational structure of the ontology is shown, together with its translation into three different languages.

Objective: to analyze the emotional health of school adolescents. Methods: a parallel mixed study embedded concomitantly in a dominant model with a quantitative emphasis, carried out in a public school of reference, with a convenience sample of 55 adolescents aged between 13 and 19. The quantitative data was analyzed descriptively, and the qualitative data was analyzed through content analysis. Results: it was found that 80% of the adolescents said they were anxious, 47.2% were sad, and 32.7% had already self-harmed or attempted suicide. They said their sadness was due to their life story, fear of rejection, and low self-esteem, and 70.9% felt lonely and reported that their depressed mood led them to isolate themselves. Conclusion: sadness due to life history, fear of rejection and low self-esteem, sleep problems due to anxiety, loneliness due to fear of being bullied, difficulty in making themselves understood, and depressive symptoms are noticeable. Contributions to practice: this study made it possible to identify the needs and social determinants of mental health that are important to work on in nurses' mental health promotion practice.

ABSTRACT Since the industrial revolution, human activities have emitted approximately 2,500 Gt of CO2, increasing the concentration of atmospheric CO2 by 50 % compared to pre-industrial levels. To better understand the potential for mitigating greenhouse gas (GHG) emissions through proper management of degraded pasture areas, we conducted a systematic literature review and identified 23 publications reporting carbon sequestration values for pastures managed under different conditions in the south and southeast regions of Brazil. From this dataset, 17 publications considered to be in line with the research premises were selected to estimate the potential for soil carbon sequestration (SEQ) through pasture recovery in the southern region of Brazil, using conservative and regenerative agricultural management practices. Results show that managed pastures can sustain carbon sequestration rates of around 2.50 Mg C ha-1 yr-1 over approximately 20 years. However, due to the numerous variables influencing SEQ rates, the limited number of publications, and the lack of data for some variables among them, a more extensive analysis of publications and data is needed to establish causal and preponderance relationships regarding the effect of each variable on the found SEQ rates. Under current pasture occupation conditions in Brazil’s south region, it is estimated these areas could sequester between 0.433 and 1.273 Gt CO2 at the end of 20 years if managed under appropriate practices. These numbers are not representative to reduce atmospheric CO2 concentration from legacy emissions and significantly mitigate physical impacts of climate change, reinforcing the importance of prioritizing the reduction of global GHG emissions as the primary mitigation strategy. On the other hand, from the perspective of mitigating the national agricultural sector’s annual GHG emissions, this potential cannot be considered negligible. Carbon sequestration by soils under agricultural management can play a vital role in mitigating climate change, integrating the set of necessary solutions and actions for a Paris Agreement goals compatible trajectory of limiting global warming to between 1.5 and 2 °C by the end of the century.

ABSTRACT Objective: Cystic fibrosis (CF) affects multiple organs, the most severe consequences being observed in the lungs. Despite significant progress in developing CF transmembrane conductance regulator-specific treatments for CF lung disease, exploring alternative CF-targeted medications seems reasonable. We sought to evaluate the potential beneficial effects of oral benzbromarone as an adjuvant therapy in CF patients with reduced lung function. Methods: This was a prospective open-label pilot study of oral benzbromarone (100 mg/day) administered once daily for 90 days. Patients were followed at a tertiary referral center in southern Brazil. Safety was assessed by the number of reported adverse events. Secondary objectives included percent predicted FEV1 (FEV1%) and pulmonary exacerbations. Results: Ten patients were enrolled. Benzbromarone was found to be safe, with no serious drug-related adverse events. Eight patients completed the study; the median relative change in FEV1% tended to increase during the treatment, showing an 8% increase from baseline at the final visit. However, a nonparametric test showed that the change was not significant (p = 0.06). Of a total of ten patients, only one experienced at least one pulmonary exacerbation during the study. Conclusions: Oral benzbromarone appears to be safe, and improved FEV1% has been observed in patients with CF. Further assessment in larger trials is warranted to elucidate whether oral benzbromarone can be a potential adjuvant therapy for CF.

Predicting operational performance enables organizations to develop operational effectiveness goals considering different combinations of resources. Measuring performance is consolidated with advances in relative efficiency analysis techniques, including data envelopment analysis (DEA) and stochastic frontier analysis (SFA), albeit these methods lack predictive capability. This paper proposes an approach for performance prediction by integrating relative efficiency measurement models with machine learning algorithms. Data analyses were conducted using data provided by the energy assessment project offered to small and medium-sized manufacturing companies in the United States ( n 7,548) using sales as the output, with the inputs being the number of employees, hours of operation, electricity, natural gas, cost of electricity, and cost of natural gas. Performance was estimated differently, employing parametric (SFA) and non-parametric (DEA) methods. The prediction benchmarking process occurred by adopting machine learning algorithms: regression (LM), support vector machine (SVM), K-nearest neighbor (KNN), linear discriminant analysis (LDA), random forest (RF), and decision tree (DT). The findings showed that it is possible to identify the best prediction algorithm associated with a performance model. However, the performance prediction may differ if different strategies for measuring performance or machine learning model configurations are used. In addition, SFA-LOG and SVM had the best performance for regression, and DEA-VRS/IRS excelled with random forest; the RF algorithm was the best fit across all performance approaches. The error rate depends on the algorithm and the performance model, and the number of classes must be reduced to obtain a higher success rate.

Soft law offers the possibility of agile and flexible regulation that can adapt to dynamic digital developments. However, due to its non-binding nature, soft law is not considered to be very effective. With the Digital Services Act (DSA), however, the EU is taking an - at least from a legal dogmatic perspective - unconventional approach by combining hard and soft law in a unique way. The DSA itself is a legally binding EU regulation, but it provides for soft law instruments and even contains provisions for their legal enforcement. Although such regulatory techniques are well known in EU law, they at least call into question the public perception of the DSA as the ‘constitution of the internet’. How far-reaching can such a constitution be that outsources essential issues to (executive-initiated, privately set) soft law?