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PURPOSE: Left ventricular (LV) fibrosis has a key role in arrhythmogenesis in patients with mitral valve prolapse (MVP). Cardiac magnetic resonance identifies LV fibrosis by using late gadolinium enhancement (LGE) technique. LGE assessment and quantification in patients with MVP lacks of standardization protocols. METHODS: 66 MVP patients with normal systolic function and without significant regurgitation were enrolled. Semi-automated gray-scale thresholding techniques using full width at half maximum (FWHM) and 2, 3 and 5 standard deviation (SD) above the remote myocardium were used and compared with the visual assessment, considered as the gold standard. RESULTS: LGE was identified in 41 MVP patients (62%) and quantified. The mean quantity of LGE visually assessed was 2.40 ± 1.07% or 1.40 ± 0.82 g. With FWHM, LGE resulted 3.56 ± 1.23% or 1.99 ± 1.13 g. Using thresholding, the mean LGE quantity was 9.2 ± 3.1% or 4.82 ± 2.28 g for 2-SD, 5.72 ± 1.75% or 3.06 ± 1.47 g for 3-SD and 2.36 ± 0.99% or 1.29 ± 0.79 g for 5-SD. The 5-SD measurement in percentage demonstrated a good correlation with LGE quantification visually assessed (2.40 ± 1.07 vs. 2.363 ± 0.9909, p = 0.543). When compared with the gold standard, the 5-SD threshold quantification, both in percentage and in grams, revealed the least intra-observer (respectively, ICC: 0.976 and 0.966) and inter-observer variability (respectively ICC: 0.948 and 0.935). CONCLUSION: The 5-SD gray-scale threshold technique in percentage revealed the best correlation with the visual assessment and an optimal reproducibility in MVP patient.

El objetivo de este artículo es obtener una visión sobre el papel de Brasil en un esce­nario multipolar desequilibrado. Para lograr este objetivo, se presentan los principales conceptos y supuestos del neorrealismo y el neorrealismo ofensivo. Se argumenta que la estrategia óptima para Brasil en este momento es perseguir un balance interno para mejorar su posición de negociación entre las grandes potencias y competidores similares. En este sentido, el artículo es normativo, aunque sus recomendaciones se derivan de los imperativos del sistema, como las vulnerabilidades de las alianzas en un mundo multipolar. Estados Unidos está involucrado en áreas clave en Asia y Europa, lo que crea un margen de maniobrabilidad en América Latina, históricamente una zona de influencia para Estados Unidos. Además, Brasil debe fortalecer su poder material, ya que es un país de considerable riqueza y tamaño, y, por lo tanto, de inte­rés para las grandes potencias. Para lograr una posición de negociación sólida, deben abordarse problemas estructurales como el gasto en defensa y la inversión. Concluimos que, independientemente de si Brasil “elige un lado” o mantiene una posición neutral, el balance interno es necesario para alcanzar sus objetivos.

O presente artigo é parte de uma dissertação de mestrado que teve por objetivo compreender os possíveis desdobramentos narcísicos no sujeito com adoecimento crônico e em cuidados paliativos. Neste recorte, enlaçamos o conceito de narcisismo, a partir da perspectiva freudiana, ao processo de morte e morrer, principalmente no que diz respeito à potência do encontro com o outro. Tendo em vista que, na construção do pensamento psicanalítico, teoria e prática se intercruzam com frequência, e que é este "cruzamento" que permite avançar metapsicologicamente, valemos-nos dos relatos clínicos registrados pela primeira autora da sua experiência com pacientes em processo de terminalidade, no contexto dos cuidados paliativos. Para dar vida e sutileza à temática, também utilizamos a literatura e a poesia nessa construção. A análise desse material permitiu visualizar similaridades existentes entre os processos de constituição narcísica do bebê e o de reorganização narcísica daquele que morre, enfatizando o papel fundamental do outro no processo de morrer. Na terminalidade, esse outro pode desempenhar o papel de cuidado, amparo e nomeação desse novo corpo que se apresenta, ajudando o paciente na construção de novos sentidos para as experiências vividas e também para elaborar a trajetória para a morte.

REVIEWED BOOK Gramigna, A. (2024). Il paradigma differente: L’educazione ambientale per i più piccoli. Milano: Biblion. 128 pp. € 16.00. ISBN-13: 9788833833774.

Initiating its operations in 2016, the New Development Bank (NDB) disbursed close to US$ 14.6 billion by the conclusion of 2021. However, Brazil received only US$ 1.86 billion (12.8%) of this sum, marking it as the recipient of the least funding from the Bank thus far. As the NDB approaches its seventh year of operation, it becomes imperative to assess its lending trajectory to Brazil, scrutinizing both the disincentives and the potential for augmenting loans to the country. With this objective in mind, this article endeavors to delve into the obstacles and opportunities for enhancing the NDB’s utilization in Brazil. Our hypothesis suggests that despite the recent surge in operations, there remains room for advancement, particularly in light of the political developments unfolding in Brazil in 2023.Methodologically, the study hinges on analyzing NDB financial data, conducting interviews with pertinent stakeholders in Brazil, and scrutinizing and contrasting the financing institutional frameworks of the NDB and the Brazilian Development Bank (BNDES). Our findings indicate that: i) access to the BNDES partially offsets the necessity for Brazilian firms to seek loans from the NDB; ii) a rigid institutional framework within the NDB and the Brazilian government impedes project approval and proposition; iii) all loans to Brazil thus far have been denominated in US dollars, diminishing their attractiveness; iv) there has been a lack of encouragement from the Brazilian national government, attributed to the reorientation of Brazilian foreign policy following the 2016 impeachment. Consequently, achieving a more prominent role and usage of the NDB necessitates not only an institutional reassessment of certain approval processes within the Brazilian government but also a more active, assertive, and collaborative stance from the Bank itself.

Abstract Background and rationale The literature shows that the prevalence of dietary supplements is high and guidance by a nutritionist or specialized professional is low in professional triathletes. It is reasonable to assume that in recreational triathletes, the prevalence of dietary supplements will also be high and that a significant portion of the sampled population will use supplements without any guidance from a qualified professional. The present study investigated dietary supplement use among Brazilian male recreational triathletes. Methods A total of 724 Brazilian male recreational triathletes (age: 38.00 [10.00] years and body mass index: 24.16 [3.02] kg/m2) took part in this study. All participants answered an online questionnaire containing questions about their demographic characteristics and the nutritional aspects of their diet. Results The results showed that ~ 90% (n = 653) of the interviewed participants reported using at least one dietary supplement. Surprisingly, ~ 25% did not receive supplement advice from a professional nutritionist. Conclusion The prevalence of dietary supplements in male recreational triathletes was high, and a substantial part of the sample did not receive professional recommendations. This situation is worrisome because dietary supplements should be prescribed by a professional nutritionist. Practical implications Our results suggest the need for an appropriate attitude and guidance by health professionals who deal with this population, especially nutritionists, to promote safe practices.

Abstract Purpose To compare the academic performance of undergraduate students in physical education who studied exercise physiology before and after studying human physiology and investigate students’ perceptions of human physiology and exercise physiology courses. Methods This study included 311 undergraduate students pursuing a bachelor’s degree in physical education. Participants were divided into two groups: those who had previously attended and completed the human physiology course (group 1, n = 212, 68.2%) and those who had not previously attended or had attended but failed the human physiology course (group 2, n = 99, 31.8%). The prevalence ratio (PR) and 95% confidence interval (95% CI) were calculated using a Poisson regression model with a robust variance estimator. The second aim comprised 67 students with bachelor’s degrees in physical education who completed an electronic questionnaire about their perceptions of human physiology and exercise physiology curriculum. Results Compared with those who attended human physiology and passed, those who had not previously attended or had attended but failed the human physiology course have a higher PR of 2.37 (95% CI, 1.68–3.34) for failing exercise physiology. Regarding the students’ perceptions of human physiology and exercise physiology courses, most students reported that they were challenging (58.2% and 64.2%, respectively), but they also recognized the importance of these courses for professional practice (59.7% and 85.1%, respectively). Conclusion Human physiology should be considered a prerequisite for an undergraduate course leading to a bachelor’s degree in physical education. Furthermore, students considered human physiology and exercise physiology courses important yet challenging. Therefore, continuous student assessment is vital for improving the teaching–learning process.

High copper (Cu) concentration in soils used for vegetable production is an agricultural, social and environmental issue. The excess of Cu in soil can cause toxicity in plants, reducing growth and yields. Moreover, Cu can also be absorbed and accumulated in edible organs, increasing risks for human health. This study aimed to compare Cu fractions in soils: (1) non-cultivated, natural soil (NC), (2) soils cultivated with open field crops (FCs) and (3) soils cultivated in controlled environments (CEs). The survey was carried out on 25 sites in Rio Grande do Sul (Southern Brazil), with each site containing the three types of soils described above. From these sites, the four with the highest soil Cu concentrations were selected to compare soluble (Cu-CaCl2), available (Cu-EDTA) and total (Cu-EPA) Cu. Both total and available soil Cu concentration in soil solution, in CE and FC areas were higher than in NC. At sites 23R1 (Oxisol) and 11R1 (Molisol) the soluble and available Cu content was higher in the FC environment than in CEs, and the same was observed for the total Cu content at sites 23R1 (Oxisol) and 9R1 (Molisol). Some FC soils showed total Cu concentrations higher than the limits established by Brazilian environmental legislation, being, as a consequence, potentially contaminated. Soil monitoring and cropping practices must be adopted to reduce the Cu content in soils of vegetable crops in this region.

Porcine circovirus type 2 (PCV-2) is the agent of one of the most important diseases in the swine industry. Although it has been controlled through vaccination, viremic piglets at birth may represent a risk by reducing vaccination efficacy. Since there are few reports on the viremic status of pre-suckling piglets regarding PCV-2 infection, we assessed the PCV-2 frequency in sows housed in 18 breeding farms with no history of clinical PCVAD in Brazil, using placental umbilical cord serum (PUCS). The selection criteria were: breeding farms with more than 1,000 sows; sows not vaccinated for PCV-2 at least for 2 years prior to the study; farms with no history of PCV-2 clinical disease in the last 12 months; and production systems with a maximum of two sites. Blood from the umbilical cords in sow placenta or directly from piglet’s immediately after birth was collected from 30 litters on each farm for PCR. In addition, blood from 538 sows was collected for PCV-2 antibody detection. A total of 17.29% of the PUCS tested positive. The PCV-2 DNA was detected in PUCS from 94.4% of all farms. A total of 94.8% of the sows was positive for PCV-2 antibodies. However, seronegative sows were detected in 44.4% of farms. All 18 farms had at least 46.9% seropositive dams. A higher percentage of seronegative sows was observed for farms with more than 10% of PCV-2-positive litters compared to those with ≤10% of PCV-2 positive litters (8.9 +/−1.7% vs. 1.5 +/− 0.7%, p

ABSTRACT Objective: Verify the clinical efficacy and safety of a low-cost tDCS device, in a clinical trial for major depressive disorder. Methods: 168 persons were recruited; 32 depressed individuals with moderate or severe depressive symptoms (HDRS17 scores higher than 18) were included and randomized for the trial (16 individuals in each group). The intervention consisted of 10 active anodal tDCS sessions at 2 mA for 30 minutes over the left dorsolateral prefrontal cortex; or sham. The main outcome was HDRS17; secondary outcomes included satisfaction (TSQM II) and quality of life (WHOQOL-BREF). Assessments at baseline, endpoint and at 30 days follow-up. Results: The sample was composed by a total of 11 men and 21 women, mean age of 42.75 years (95% CI: 38.10-47.40). Active treatment was superior than sham: There was a significant interaction between group and time regarding HDRS-17 scores (F = 4.089, df = 2, p = 0.029; partial Eta squared = 0. 239). Post hoc analyses exhibited a statistically significant difference between active and sham group symptoms after a 30 days follow-up (difference = -7.75, p = 0.008, Cohen’s d = 1.069). There were 3 dropouts, all in the active group, due schedule issues. No severe adverse effects reported. Conclusion: The current active tDCS protocol was related with clinical improvement of depressive symptoms. Intervention was well-tolerated. Non-invasive brain stimulation techniques are still not routinely used, although a viable strategy for treatment-resistant patients, partial responders and people unable to use pharmacological treatment. We aim to increase knowledge and use of tDCS for the Brazilian population.

We examined the effect of amount of muscle mass involved in moderate-intensity continuous physical exercise on executive function. To this end, fifty-five participants completed two acute physical exercise sessions on an airbike ergometer using the upper and lower limbs simultaneously and only the upper limbs, and a resting control session in a randomized order. The physical exercise session lasted 30 min and was performed at moderate intensity (between 64 %–76 % of maximal heart rate evaluated in graded maximal exercise testing). Participants took the Stroop test (congruent and incongruent trials) before and after the sessions to assess executive performance. For the congruent trial, both physical exercise interventions improved executive function performance (pre vs. post, p-value = 0.002 and 0.003 for physical exercise with upper limbs and physical exercise with upper and lower limbs, respectively). Furthermore, executive function performance was higher after the physical exercise interventions than after the control session (p-value = 0.002 and 0.004 for physical exercise with upper limbs and physical exercise with upper and lower limbs, respectively). For the incongruent trial, both physical exercise interventions also improved executive function performance (pre vs. post, p-value < 0.001 for physical exercise with upper limbs and physical exercise with upper and lower limbs, respectively). owever, there were no significant differences after both physical exercise interventions and resting control session (p-value = 0.175). Executive function (congruent trial) was positively impacted by acute aerobic physical exercise regardless of the amount of muscle mass involved (upper limbs or upper plus lower limbs). Therefore, we recommend aerobic physical exercise with less or more muscle mass involved to improve cognitive function.

Resumo Em um contexto clínico, existem diversos tipos de silêncio, próprios de cada análise e presentes de diferentes formas no processo analítico. Este artigo visa realizar uma revisão teórica a respeito do silêncio na literatura psicanalítica. Pretende, também, transitar por reflexões existentes na psicanálise acerca de um silêncio específico: silêncio com potência de movimento e função criadora no processo de análise. A partir da revisão realizada, percebe-se que o silêncio na clínica psicanalítica pode ser pensado a partir do silêncio do paciente, do analista ou em seu aspecto intersubjetivo, ou seja, relacional. A revisão da palavra “silêncio” na obra freudiana abre espaço para pensar a presença intrínseca, porém, coadjuvante, do silêncio na psicanálise desde suas origens. A pesquisa também possibilita ampliar o entendimento do silêncio para além de seu aspecto resistencial. Ilumina os aspectos produtivos e potentes desse conceito em psicanálise e no trabalho analítico.

The current investigation scrutinized the strategic approaches employed by the top four teams in the Brazilian Men’s Volleyball Superliga, according to the match’s opponent. The study encompasses the analysis of 22 matches, involving teams ranked first through fourth, competing against each of the 12 teams participating in the 21–22 season of the Brazilian Men’s Volleyball Superliga, including one home and one away match for each team. Social network analysis facilitated the identification of the interconnections and particularities among all variables, offering a comprehensive perspective. The findings unveiled that during the offensive phase, the second-, third-, and fourth-ranked teams consistently exhibited higher eigenvector values, irrespective of the opposing team, notably when the middle-blocker positioned themselves in front and near the setter. Conversely, the championship-winning team displayed variations in offensive tactics. The team securing the second position demonstrated alterations in setting placement, whereas the other teams executed settings aimed at zones 3 and 4. Additionally, the initial setter’s position at the commencement of a rally displayed varying eigenvector values based on the opponent, indicating team rotation as a performance determinant. Thus, barring the finalist team, the performance of the remaining teams is intricately intertwined with the individual characteristics of players.

Introdução: O aumento de casos de malária, mesmo com o desenvolvimento de tratamentos e testes diagnósticos rápidos, apresenta-se como um grande desafio para a saúde global. A malária é uma parasitose transmitida por mosquitos do gênero Anopheles, geralmente silvestres e usualmente encontrados em água parada e límpida. Alterações no ambiente podem forçar o mosquito a conviver com o ser humano, aumentando a incidência de malária. Estas alterações incluem o desmatamento, que sofreu aumento expressivo no Brasil entre o ano de 2011 e 2021. Como visto, a malária é uma doença com forte influência na saúde humana, ambiental e animal, tornando a abordagem de One Health (Saúde Única) ideal para este estudo. Portanto, nossos objetivos são acompanhar e comparar a evolução da incidência anual de casos de malária e a variação do desmatamento em municípios da Amazônia Legal entre 2011 e 2021. Metodologia: Os dados sobre casos de malária no Brasil foram obtidos nos boletins epidemiológicos da Secretaria de Vigilância em Saúde, para cálculo da incidência de malária em cada local e período, a população de cada município foi obtida através das estimativas do Censo demográfico do Brasil de 2010 do Instituto Brasileiro de Geografia e Estatística (IBGE). Dados sobre o desmatamento foram coletados do Instituto Nacional de Pesquisas Espaciais (INPE), na plataforma TerraBrasilis. A partir da incidência da malária anual por município e dos números do desmatamento nos locais estudados, foi ajustado um modelo linear misto generalizado (GLMM) com efeitos fixos para o ano e a área desmatada e interceptos aleatórios para os municípios. O modelo foi ajustado com o pacote “GLMMadaptive” na versão 4.3.0 do software R. A variável dependente foi a incidência de malária e a distribuição usada foi a binomial negativa inflacionada de zeros. Foi realizado um teste de Kolmogorov-Smirnov para verificar a normalidade dos resíduos. Resultados: Observou-se que quanto maior a área desmatada no município maior é a incidência de malária. O coeficiente indica que, em média, um aumento de um desvio padrão na área desmatada está associado a um aumento de 0,1595 na incidência de malária (em escala logarítmica). Essa associação é estatisticamente significativa (p = 0,0164). Conclusões: Apesar da relação positiva, os resíduos não são gaussianos, podendo indicar outras variáveis que influenciam na incidência de malária dentro deste modelo, o próximo passo é investigar estas variáveis e refinar o modelo usado.