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Background: The global need for rapid diagnostic methods for pathogen identification and antimicrobial susceptibility testing (AST) is underscored by the increasing bacterial resistance and limited therapeutic options, especially critical in sepsis management. Summary: This review examines the aspects of the eHealth and mHealth in Antimicrobial Stewardship Programs (ASPs) to improve the treatment of infections and rational use of antimicrobials. Key Messages: The evolution from traditional phenotype-based methods to rapid molecular and mass spectrometry techniques has significantly decreased result turnaround times, improving patient outcomes. Despite advancements, the complex decision-making in antimicrobial therapy often exceeds the capacity of many clinicians, highlighting the importance of ASPs. These programs, integrating mHealth and eHealth, leverage technology to enhance healthcare services and patient outcomes, particularly in remote or resource-limited settings. However, the application of such technologies in antimicrobial management remains underexplored in hospitals. The development of platforms combining antimicrobial prescription data with pharmacotherapeutic algorithms and laboratory integration can significantly reduce costs and improve hospitalization times and mortality rates.

O presente artigo apresenta reflexões sobre os currículos de Educação Física praticados no Instituto Nacional de Educação de Surdos - INES, especialmente frente à mais recente construção curricular de 2021, em que a equipe de Educação Física, de forma coletiva, confeccionou uma proposta curricular sobre o corpo, com múltiplas abordagens e utilização de diversos aportes teórico-metodológicos. Num primeiro momento foi realizada uma síntese do Currículo formal com o objetivo de apresentar primordialmente os fundamentos, pressupostos epistemológicos, princípios e objetivos. Um segundo momento foi dedicado aos currículos praticados pela equipe de Educação Física nos diversos segmentos (Educação Infantil, Ensino Fundamental e Ensino Médio) e modalidades (Regular e EJA) de ensino em que atua dentro do INES, com o intuito de apreender como vem sendo a práxis pedagógica de Educação Física à luz do mencionado currículo. A conclusão deste artigo aponta para a importância do permanente diálogo entre o documento norteador e os desafios que suscitam a constante inovação da prática pedagógica. Estando o currículo em unidade com a práxis, que é constante movimento, torna-se fundamental avançar no atendimento à singularidade do ser surdo existente no Colégio de Aplicação do INES (Cap-INES), buscando, sobretudo, garantir ao estudante, em toda sua diversidade, o acesso ao conhecimento construído historicamente pela humanidade, transformando conceitos e práticas amplamente difundidos entre ouvintes em conhecimentos e vivências apropriados e produzidos também pelo sujeito surdo. Nesta caminhada, a compreensão do que pode ser uma “Educação Física Bilíngue” é o horizonte para o qual nos dirigimos.

The urgent requirement for swift diagnostic methods in pathogen identification and antimicrobial susceptibility testing is emphasized by rising bacterial resistance and limited treatment options, which are particularly critical in sepsis management. The shift from traditional phenotype-based methods to rapid molecular and mass spectrometry techniques has significantly reduced result turnaround times, enhancing patient outcomes. In this systematic review with meta-analysis, the aspects of correct empirical antimicrobial therapy are evaluated to determine their impact on mortality. We performed a systematic review and meta-analysis on EMBASE, the Cochrane Library, Web of Science, and MEDLINE. Studies evaluating mortality associated with empirical adequate and inadequate therapy in different sites of infection were included. Outcomes included clinical cures in microbiologically evaluable patients. Among the sites of infection, the most studied were bloodstream infections (n = 9), followed by respiratory tract infections (n = 5), intra-abdominal infections (n = 5), and urinary tract infections (evaluated by 3 studies). Inadequate therapy was associated with an increase in mortality between 11 and 68%. Technologies to speed up pathogen identification are extremely necessary to reduce mortality.

Diapausing embryos encased within cladoceran ephippia result from sexual reproduction and increase genetic diversity. They are also important means by which species bypass harsh environmental conditions and disperse in space and time. Once released, ephippia usually sink to the benthos and remain there until hatching. Using the Sars’ method (incubating sediments to identify cladoceran hatchlings), ephippial egg bank biodiversity can be evaluated. Yet, even when samples are incubated under a variety of conditions, it is not possible to warrant that all have hatched. Few keys are available that facilitate the identification of cladocerans by using only ephippial morphology. Our goal was to analyze some cladoceran ephippia from Mexico, to develop a means to identify them using easily recognizable characteristics. Ephippia of 23 cladoceran species from waters in Aguascalientes (México) in 11 genera (Alona, Biapertura, Ceriodaphnia, Chydorus, Daphnia, Dunhevedia, Ilyocryptus, Macrothrix, Moina, Pleuroxus, and Simocephalus) were analyzed. In our analysis six morphological features were selected that permitted the identification of ephippia to species(-group) level. The results demonstrate that with a proper catalog of features, some ephippia can be identified.

Measuring the potential effects of future climate changes on the spatio-temporal variance of optimal conditions for seasonal species is a key conservation issue. This study assesses the impact of climate change on the spatial and temporal patterns of optimal conditions for activity in two burrowing frogs, Smilisca fodiens and S. dentata. Ecological Niche Modeling was used to implement niche seasonality models, with calibration performed during the peak activity (July). These models were then transferred to current and future conditions for the remainder of the year, predicting future scenarios up to 2070 with an intermediate trajectory greenhouse gas concentration of 4.5 W/m2. Climate change transferability was assessed for four potential scenarios: 1) high precipitation and low temperature, 2) high precipitation and high temperature, 3) low precipitation and low temperature, and 4) low precipitation and high temperature. We examined the impact across future projected areas and analyzed geographic change trends based on latitude, longitude, and elevation. For both species, the best scenario would involve increased precipitation in the future. However, the worst-case would be a combination of reduced precipitation and higher temperatures. Due to large area loss, northern populations of S. fodiens may be highly vulnerable. Concerning S. dentata, the outlook is worrisome, with all known populations experiencing losses in most months. Area gains may not help either species since they tend to occur at elevations above their known ranges. Using a seasonal approach in spatio-temporal analysis enhances comprehension of the behavioral adaptations of seasonal species and their vulnerability to current and future climatic variations

Introdução: A mediastinite é uma condição rara, caracterizada por sua natureza agressiva e elevada taxa de mortalidade, que pode variar entre 14% e 42%, dependendo da causa subjacente, da rapidez com que o diagnóstico é feito e o tratamento iniciado. Esta doença pode ser desencadeada por diversos fatores, como perfuração esofágica, infecções pós-operatórias, infecções da glândula parótida, além de poder ter origem odontogênica em casos de complicações da Angina de Ludwig. Objetivo: Relatar um caso clínico de mediastinite por infecção odontogênica em um paciente do sexo masculino, descrevendo as manifestações clínicas e o tratamento realizado. Método: Relato de caso e revisão de literatura. Resultados: Homem, previamente hígido, foi admitido no hospital com queixa de dificuldade respiratória há 2 dias, com piora dos sintomas nas últimas 24 horas. Foi avaliado pela clínica médica e cirurgia e constataram derrame pleural, assim, foi realizado a drenagem de tórax bilateral de aproximadamente 1 litro de cada lado de conteúdo purulento. Foi realizado uma investigação minuciosa e o paciente relatou dor de dente há mais de 10 dias. Após a avaliação da Cirurgia Bucomaxilofacial constatou-se edema e presença de exsudato purulento em região submandibular e cervical a direita com imagem tomográfica mostrando pus e gás em todo trajeto de submandibular até mediastino. Paciente foi submetido á drenagem de região submandibular e cervical em conjunto com a CCP. Cirurgia torácica não indicou intervenção em região do mediastino nesse momento, pois os drenos de tórax estavam patentes. A critério da infectologia para o tratamento foi prescrito Tazocin e Vancomicina. No entanto após alguns dias e febre persistente foi feito a toracotomia e limpeza e drenagem bilateralmente. Paciente evoluiu bem e teve alta hospitalar. Conclusão: A identificação precoce de infecções odontogênicas é crucial para evitar complicações graves. A utilização de antibioterapia de amplo espectro ajuda a controlar a disseminação bacteriana. A abordagem cirúrgica é essencial para a remoção do foco infeccioso. Independente da origem a infecção deve ser tratada em todos os seus focos. Mediastinite é grave e tem alta taxa de mortalidade.

We analyze different Latin American scenarios from a perspective that brings together contributions from performance studies and critical theories of colonialism. In this crossroads we put in dialogue two artistic devices (the work Tierra by Regina José Galindo and Reunión: Lof Lauken Winkul Mapu by Dani Zelko) with the notion of conquistuality, by the Argentine anthropologist Rita Segato. We examine the productivity of these materials (theoretical and artistic) to reflect on recent events that, from our perspective, are part of a colonial history.

This study aimed to evaluate the effect of early growth (EG) and time of maximum pubertal growth peak (I2) on development, feed efficiency, carcass composition, and sexual maturation of broiler breeder females. Target BW trajectories were designed by changing coefficients of a 3-phase Gompertz model fit to the recommended BW target of Ross 308 breeders, BW=∑i=1i=3giexp(−exp(−bi(t−Ii))). In each phase i, biologically relevant coefficients describe the amount of BW gain (gi), the rate of growth (bi), and the inflection point (Ii), which is the time when the growth rate for that phase is at its maximum rate. The study consisted of a 6 × 2 factorial arrangement, with six I2 levels (I from phase 2) and two EG levels. The I2 coefficients were 15, 17, 19, 21 (standard), 22, and 23 in wk. The EG treatments were: EG0, where g1 and g2 coefficients estimated from the standard from the breeder recommended BW were unchanged; and EG20, where 20% of the gain (g2) in phase 2 (pubertal phase) was shifted to phase 1 (g1; prepubertal phase). Two-hundred-eighty-eight Ross 308 pullets were randomly assigned to the twelve BW growth trajectories and fed using a precision feeding system from 0 to 28 wk of age. Body composition variables were submitted to three-way ANOVA, with EG, I2, and age as fixed sources of variation. Analysis of covariance was conducted on the remaining dependent variables with EG as fixed effect, I2 as a continuous fixed effect, and age as continuous random effect. Differences were reported at P ≤ 0.05. The BW of females followed their target BW, and ADFI differed depending on the amount of feed required to achieve their respective BW targets. Breast fleshing score was 0.2 greater in the EG20 compared to EG0. The number of juvenile primary wing feathers and age at first egg decreased by 0.4 and 0.9 d, respectively, per wk of earlier I2. Advancing I2 resulted in birds with increased carcass fat deposition from 16 to 28 wk of age. Carcass fat was 1.3- to 1.6-fold greater in the EG20 only from 4 to 16 wk of age. Early growth increased mostly pullet muscle and skeletal characteristics whereas advancing I2 advanced sexual maturity and increased carcass fat deposition around sexual maturation time.

Background & Aims: Patients with nonalcoholic fatty liver disease (NAFLD)/metabolic dysfunction-associated steatotic liver disease (MASLD) face a multifaceted disease burden which includes impaired health-related quality of life (HRQL) and potential stigmatization. We aimed to assess the burden of liver disease in patients with NAFLD and the relationship between experience of stigma and HRQL. Methods: Members of the Global NASH Council created a survey about disease burden in NAFLD. Participants completed a 35-item questionnaire to assess liver disease burden (LDB) (seven domains), the 36-item CLDQ-NASH (six domains) survey to assess HRQL and reported their experience with stigmatization and discrimination. Results: A total of 2,117 patients with NAFLD from 24 countries completed the LDB survey (48% Middle East and North Africa, 18% Europe, 16% USA, 18% Asia) and 778 competed CLDQ-NASH. Of the study group, 9% reported stigma due to NAFLD and 26% due to obesity. Participants who reported stigmatization due to NAFLD had substantially lower CLDQ-NASH scores (all p

Objective: To analyze morphometric measurements in dry jaws, chins, and hip bones to contribute to clinical predictability in the reconstruction of grafted areas. Material and Methods: The sample comprised 619 anatomical specimens. Anatomical structures were measured at predetermined points using a digital vernier caliper. Measurements of average thickness and linear dimensions of the coronoid process, as well as the average thickness of the mentum and iliac crest points, were obtained. Results: The average morphometric measurements of anatomical structures revealed that male individuals exhibit larger values than female individuals, with a mean difference of 1.57 mm. The mean estimated bone volume of the iliac crest and iliac fossa was 21,347.19 mm³ and 21,125.56 mm³ for the left and right sides, respectively. The coronoid process displayed a smaller thickness (2.11 mm) and linear measurement (5.77 mm) in its upper portion and a larger thickness (3.63 mm) and linear measurement (14.51 mm) at its base, on average. In the mentum, the greatest average thickness was found at the midline, with a value of 12.90 mm. Conclusion: The surgeon can predict the amount of bone that can be obtained from donor areas, as well as the predominant type of bone in each area, aiming to optimize its clinical application. It is important to highlight that both the iliac crest and iliac fossa provide a significant bone volume in comparison to intraoral areas.

Abstract The main objective of this study was to optimize the fermentation process using Serratia sp. BR13816, a bacterial isolate from Amazonian soil, and to evaluate the formation of nanoemulsions. Submerged fermentation was carried out with different carbon and nitrogen sources. Based on the emulsification index and surface tension results, we selected a hydrophobic (corn oil) and a hydrophilic (glycerol) carbon source, and a nitrogen one (urea). For fermentation using corn oil/urea greater emulsification indexes and lower surface tensions were verified at pH 8, 25 °C, and 48 h, whereas for glycerol/urea-supplemented medium the best conditions were attained at pH 7, 30 °C, and 96 h. These pre-selected factors (pH, temperature, and time) were used in a central composite rotatable design (CCRD) for an additional fermentation optimization of the two carbon/nitrogen mediums, corn oil/urea and glycerol/urea. The two best nutritional systems based on corn oil/urea and glycerol/urea were selected using a central composite rotatable design (CCRD). The mathematical models using the response surface methodology showed adequate adjustment. The best run of the experimental design for corn oil/urea (6.00% /0.60%) and glycerol/urea (3.00% /1.40%) systems presented surface tension values of 35.70 mN/m and 37.10 mN/m, respectively. The nanoemulsions produced by a low-energy method presented average sizes by dynamic light scattering varying from 453.1 nm to 667.3 nm when 0.1% of the oil was employed. Therefore, Serratia sp. BR13816 showed promising biosurfactant-producing potential for future industrial applications.

Abstract Sustainable forest management (SFM) can harbor different discourses on sustainability. In this paper, based on discourse theory, the main ideas, concepts and narratives that have been proposed about the SFM of the native vegetation of the Caatinga Domain (DC) were characterized. Three main speeches were highlighted: a) Bioenergetic SFM: emphasizes the production of forest biomass to supply regional energy demands; additionally, it seeks to contribute strongly to the reduction of deforestation and forest conservation; b) Silvopastoral SFM: seeks to offer alternatives to improve forage availability; c) Non-timber SFM: seeks to value traditional knowledge about biodiversity, to expand the ways of managing multiple species and strengthen strategies for coexistence with the semi-arid region. The existence of different discourses, together with the range of sustainable practices they present, offers the opportunity for policy change and institutional innovation.

Klebsiella aerogenes is an important opportunistic pathogen with the potential to develop resistance against last-line antibiotics, such as carbapenems, limiting the treatment options. Here, we investigated the antibiotic resistance profiles of 10 K. aerogenes strains isolated from patient samples in the intensive-care unit of a Brazilian tertiary hospital using conventional PCR and a comprehensive genomic characterization of a specific K. aerogenes strain (CRK317) carrying both the blaKPC-2 and blaNDM-1 genes simultaneously. All isolates were completely resistant to β-lactam antibiotics, including ertapenem, imipenem, and meropenem with differencing levels of resistance to aminoglycosides, quinolones, and tigecycline also observed. Half of the strains studied were classified as multidrug-resistant. The carbapenemase-producing isolates carried many genes of interest including: β-lactams (blaNDM-1, blaKPC-2, blaTEM-1, blaCTX-M-1 group, blaOXA-1 group and blaSHVvariants in 20-80% of the strains), aminoglycoside resistance genes [aac(6’)-Ib and aph(3’)-VI, 70 and 80%], a fluoroquinolone resistance gene (qnrS, 80%), a sulfonamide resistance gene (sul-2, 80%) and a multidrug efflux system transporter (mdtK, 70%) while all strains carried the efflux pumps Acr (subunit A) and tolC. Moreover, we performed a comprehensive genomic characterization of a specific K. aerogenes strain (CRK317) carrying both the blaKPC-2 and blaNDM-1 genes simultaneously. The draft genome assembly of the CRK317 had a total length of 5,462,831 bp and a GC content of 54.8%. The chromosome was found to contain many essential genes. In silico analysis identified many genes associated with resistance phenotypes, including β-lactamases (blaOXA-9, blaTEM-1, blaNDM-1, blaCTX-M-15, blaAmpC-1, blaAmpC-2), the bleomycin resistance gene (bleMBL), an erythromycin resistance methylase (ermC), aminoglycoside-modifying enzymes [aac(6’)-Ib, aadA/ant(3”)-Ia, aph(3’)-VI], a sulfonamide resistance enzyme (sul-2), a chloramphenicol acetyltransferase (catA-like), a plasmid-mediated quinolone resistance protein (qnrS1), a glutathione transferase (fosA), PEtN transferases (eptA, eptB) and a glycosyltransferase (arnT). We also detected 22 genomic islands, eight families of insertion sequences, two putative integrative and conjugative elements with a type IV secretion system, and eight prophage regions. This suggests the significant involvement of these genetic structures in the dissemination of antibiotic resistance. The results of our study show that the emergence of carbapenemase-producing K. aerogenes, co-harboring blaKPC-2 and blaNDM-1, is a worrying phenomenon which highlights the importance of developing strategies to detect, prevent, and control the spread of these microorganisms.

The principal limitations of the terms NAFLD and NASH are the reliance on exclusionary confounder terms and the use of potentially stigmatising language. This study set out to determine if content experts and patient advocates were in favor of a change in nomenclature and/or definition. A modified Delphi process was led by three large pan-national liver associations. The consensus was defined a priori as a supermajority (67%) vote. An independent committee of experts external to the nomenclature process made the final recommendation on the acronym and its diagnostic criteria. A total of 236 panelists from 56 countries participated in 4 online surveys and 2 hybrid meetings. Response rates across the 4 survey rounds were 87%, 83%, 83%, and 78%, respectively. Seventy-four percent of respondents felt that the current nomenclature was sufficiently flawed to consider a name change. The terms “nonalcoholic” and “fatty” were felt to be stigmatising by 61% and 66% of respondents, respectively. Steatotic liver disease was chosen as an overarching term to encompass the various aetiologies of steatosis. The term steatohepatitis was felt to be an important pathophysiological concept that should be retained. The name chosen to replace NAFLD was metabolic dysfunction–associated steatotic liver disease. There was consensus to change the definition to include the presence of at least 1 of 5 cardiometabolic risk factors. Those with no metabolic parameters and no known cause were deemed to have cryptogenic steatotic liver disease. A new category, outside pure metabolic dysfunction–associated steatotic liver disease, termed metabolic and alcohol related/associated liver disease (MetALD), was selected to describe those with metabolic dysfunction–associated steatotic liver disease, who consume greater amounts of alcohol per week (140–350 g/wk and 210–420 g/wk for females and males, respectively). The new nomenclature and diagnostic criteria are widely supported and nonstigmatising, and can improve awareness and patient identification.

Objetivo: construir e validar uma cartilha educativa com orientações acerca dos principais medicamentos injetáveis utilizados em pediatria. Método: estudo metodológico, desenvolvido em seis etapas, no estado do Rio de Janeiro, entre julho de 2019 e abril de 2021. A validação foi realizada com 20 especialistas com experiência profissional anterior em terapia medicamentosa, selecionados por conveniência. Para validação utilizou-se o Índice de Validade de Conteúdo, cujos índices deveriam ser maiores ou iguais a 80%. Resultados: a cartilha construída intitulada: “cartilha para o uso correto dos principais medicamentos injetáveis em pediatria” foi validada com o Índice de Validade de Conteúdo geral de 99,2% para os quatro domínios avaliados e uma variação de 95 e 100% entre os itens avaliados individualmente. Conclusão: a cartilha acerca dos principais medicamentos injetáveis foi considerada uma tecnologia educacional em saúde, válida, atrativa e inovadora, capaz de ampliar o conhecimento dos enfermeiros pediatras de modo prático e acessível.

In this article we propose an analysis of the work Happening by the French writer Annie Ernaux. We pay attention to the narrative strategies deployed by the author to bring the experience of abortion into the literary discourse. Ernaux starts from the question of why this practice appears as an ellipsis in literature. From this question, she develops a reflection on the act of writing, and questions herself on how to narrate a traumatic experience. Consequently, the writer's project aims to bring into the literature of the time, a story that circulated as taboo. We start from the hypothesis that Ernaux's voice bursts into the order of the archive by making sense of her own experience lived from the body. We analyze the work from a sociodiscursive perspective, and we focus on the dimensions of the body and the archive.

Biological samples obtained from a coastal system of northern Colombia yielded male and female specimens of an undescribed harpacticoid copepod of the diverse ameirid genus Nitokra Boeck, 1865. The new species is a member of the genus group III. We describe the new species based on adult male and female individuals. Nitokra puebloviejensis sp. nov., appears to be most closely related to N. vietnamensis Tran & Chang, 2012, but they can be separated by the following characters: 1) number of setal elements on second segment of mandibular palp, 2) P1ENP/EXP ratio, 3) relative lengths of P2, P3ENP/EXP, 4) number of elements on male P5EXP and ENP, and 5) segmentation of male antennule. In addition, N. puebloviejensis sp. nov. can be confused with two other congeners: N. taylori Gómez, Carrasco & Morales-Serna, 2012 from South Africa and Colombia and N. kastjanensis Kornev & Chertoprud, 2008 from the White Sea, but the new species can be distinguished from them by: 1) number of setae on the maxillule coxa, 2) P1ENP/EXP ratio, 3) P2,P3ENP/EXP ratio, 4) female and male P5 setophore, 5) setation pattern of female P5EXP and ENP, 6) structure of female P6, 7) ornamentation of female anal operculum, 8) number of setae on male P5EXP, and 9) the male antennule segmentation. Most importantly, the presence of a group of five short setae on the medial surface of the maxilliped syncoxa allows the new species to be readily distinguished from its congeners. Only two subspecies and one species of this genus have been hitherto recorded from Colombia. A key to the 23 known American species of Nitokra is provided.

Recent bioacoustic studies have shown different responses of insectivorous bats to native habitat loss. We examined the activity and species/sonotypes composition of aerial insectivorous bats present in a human-modified karst landscape in Southeast Brazil, characterized by the presence of semideciduous forest, pastures and Eucalyptus globulus monocultures. Using ultrasonic detectors, we investigated activity and identified bat species and/or sonotypes in the three habitat types. We compared the activity (as a surrogate for abundance) and composition of species/sonotypes present and used Generalized Linear Models to investigated whether canopy density, understory density and food availability influence the response of bats in these habitat types. Our main results demonstrate that the variables general passes and species/sonotype richness did not differ significantly between forest and pasture, however, both variables in these two environments differed significantly from the values ​​found for eucalyptus. We conclude that, in the studied agropastoral landscape, pastures interspersed with forest areas can be used by aerial insectivorous bats during foraging. However, we also found evidence that eucalyptus monocultures, not yet mature and without an understory, have a negative impact on the species/sonotype richness and activity of Neotropical aerial insectivorous bats.

This text offers a reflection about the treatment that the PCB – the oldest political party in Brazil – the attention given to the race issue in first decades of existence, mainly in the 1920s and 1930s. Using bibliographic sources, official documents and press articles linked to the party we conclude that: if on the one side, the PCB did not ignore the Brazilian racial issue, on the other, it dealt with it laterally in its documents and institutional action, largely due to the assimilation of the thesis that the uniqueness of Brazilian social and historical development would determine a type of sociability in which the modernization of society would make possible the overcome racism, for this very reason, issues related to social classes would overlap the Brazilian racial issue, even when amalgamated.

A narrativa incide no descrever fenômenos, interpretar a história e o contexto social para compreender as histórias de vida. Logo, o objetivo deste texto é relatar, em um contexto de pandemia, a experiência de ser uma pós-graduanda que viveu a interrupção da colheita de pesquisa trazendo reverberações na vida pessoal e profissional. Foi possível compreender a experiência de viver a quarentena a partir de três categorias: “a experiência de parar”, “a experiência de produção acelerada” e “a experiência de compreender como está sendo viver a pós-graduação na pandemia”. Assim, apresenta-se a andarilhagem percorrida entre condições de sofrimento até o caminho de enfrentamento à crise e a ressignificação da identidade, ante a criação de projetos de sentido no encontro com a imprevisibilidade.

Este estudo tem por objetivo traçar um panorama referente à disponibilidade e utilização de tecnologias digitais na educação básica durante a pandemia da COVID-19 e analisar as políticas educacionais no âmbito da rede pública brasileira de ensino. Os resultados da análise documental evidenciaram diferenças entre o uso de internet por estudantes das escolas públicas e privadas, devido à correlação entre o acesso às tecnologias digitais e à renda familiar. Além disso, marcantes desigualdades educacionais regionais e territoriais foram observadas, por exemplo, entre o Nordeste e o Sul e entre espaço rural e urbano. Os dados mostraram que cerca de um milhão de alunos da rede pública de Ensino Médio não teve acesso à internet em 2019, o que dificultou estabelecer um ensino remoto nas unidades educacionais públicas em 2020. A situação é ainda mais alarmante porque não visualizaram políticas públicas para ampliar e assegurar a oferta dos recursos educacionais digitais e promover uma educação para todos.

Introduction and Objectives: With the advent of new therapeutic options for patients with hepatocellular carcinoma (HCC) for intermediate or advanced stages of the Barcelona Clinic Liver Cancer (BCLC), regional real-world data regarding prognostic survival factors are of significant importance. Patients and Methods: A multicenter prospective cohort study was conducted in Latin America including BCLC B or C patients since 15th May 2018. We report here the second interim analysis focusing on prognostic variables and causes of treatment discontinuation. Cox proportional hazard survival analysis was performed, estimating hazard ratios (HR) and 95% confidence intervals (95% CI). Results: Overall, 390 patients were included, 55.1% and 44.9% were BCLC B and C at the time of study enrollment. Cirrhosis was present in 89.5% of the cohort. Among the BCLC-B group, 42.3% were treated with TACE with a median survival since the first session of 41.9 months. Liver decompensation before TACE was independently associated with increased mortality [HR 3.22 (CI 1.64;6.33); P

ABSTRACT To increase knowledge on Brevundimonas pathogens, we conducted in-depth genomic and phenotypic characterization of a Brevundimonas strain isolated from the cerebrospinal fluid of a patient admitted in a neonatal intensive care unit. The strain was identified as a member of the genus Brevundimonas based on Vitek 2 system results and 16S rRNA gene sequencing and presented a multidrug resistance profile (MDR). Several molecular and biochemical tests were used to characterize and identify the species for in-depth results. The draft genome assembly of the isolate has a total length of 3,261,074 bp and a G+C of 66.86%, similar to other species of the genus. Multilocus sequence analysis, Type (Strain) Genome Server, digital DNA-DNA hybridization, and average nucleotide identity confirmed that the Brevundimonas sp. studied represents a distinct species, for which we propose the name Brevundimonas brasiliensis sp. nov. In silico analysis detected antimicrobial resistance genes (AMRGs) mediating resistance to β-lactams (penP, blaTEM-16, and blaBKC-1) and aminoglycosides [strA, strB, aac(6′)-Ib, and aac(6′)-Il]. We also found AMRGs encoding the AcrAB efflux pump that confers resistance to a broad spectrum of antibiotics. Colistin and quinolone resistance can be attributed to mutation in qseC and/or phoP and GyrA/GyrB, respectively. The Brevundimonas brasiliensis sp. nov. genome contained copies of type IV secretion system (T4SS)-type integrative and conjugative elements (ICEs); integrative mobilizable elements (IME); and Tn3-type and IS3, IS6, IS5, and IS1380 families, suggesting an important role in the development and dissemination of antibiotic resistance. The isolate presented a range of virulence-associated genes related to biofilm formation, adhesion, and invasion that can be relevant for its pathogenicity. Our findings provide a wealth of data to hinder the transmission of MDR Brevundimonas and highlight the need for monitoring and identifying new bacterial species in hospital environments. IMPORTANCE Brevundimonas species is considered an opportunistic human pathogen that can cause multiple types of invasive and severe infections in patients with underlying pathologies. Treatment of these pathogens has become a major challenge because many isolates are resistant to most antibiotics used in clinical practice. Furthermore, there are no consistent therapeutic results demonstrating the efficacy of antibacterial agents. Although considered a rare pathogen, recent studies have provided evidence of the emergence of Brevundimonas in clinical settings. Hence, we identified a novel pathogenic bacterium, Brevundimonas brasiliensis sp. nov., that presented a multidrug resistance (MDR) profile and carried diverse genes related to drug resistance, virulence, and mobile genetic elements. Such data can serve as a baseline for understanding the genomic diversity, adaptation, evolution, and pathogenicity of MDR Brevundimonas.

The emergence of SARS-CoV-2, leading to the widespread outbreak of COVID-19, has unveiled a spectrum of symptoms and severe health complications, challenging healthcare systems and impacting millions of lives worldwide. To analyze events allegedly attributable to vaccination or immunization (ESAVI) against SARS-CoV-2 (COVID-19) in the municipality of Santarém, in the interior of the state of Pará, an epidemiological, descriptive study was conducted using data from e-SUS Notifica in Santarém/PA from January 2021 to January 2022. The analyzed data for ESAVI cases included the administered immunobiologicals (Coronavac, Covishield, and Comirnaty), the type of event, case progression, time in days between immunobiological administration, and symptom onset, causality, and classification of ESAVI according to the vaccine package inserts. The incidence rate of ESAVI due to the COVID-19 vaccine was 17 per 100,000 doses administered in the municipality. According to the ESAVI classification, 14.0% were classified as Serious ESAVI (ESAVIG) (IR: 8.12 per 100,000 doses administered), with 100% of these events resulting in full recovery without sequelae, and 82.4% of reported cases were classified as Non-Serious ESAVI (ESAVING) (IR: 47.78), of which 3.60% were immunization errors (IR: 2.08 IE per 100,000 doses). This study fosters discussion on the importance of accurate recording of ESAVI related to COVID-19 vaccines, demonstrating their safety for the population.

Here we discuss the approximations and distances between the contributions of Heidegger’s and Foucault’s thought. We are interested in knowing about the ideas of self-care articulated by Martin Heidegger and of care of the self, according to Michel Foucault, analyzing the convergences and divergences. Contrastive systematization was used in order to highlight the encounters and disagreements between the thinkers. There are similarities regarding the importance given to the issue of caring as something that constitutes the human being, but the distances are given by the way in which the meanings of care are conceived. The approximations and distances regarding self-care and care of the self thought by Heidegger and Michel Foucault make us reflect that each thinker was crossed by singularities, historical, social and cultural processes, unfolding in specific understandings around care.

Introduction and Objectives: Increased utilization of hepatitis C virus (HCV)-positive organ donors has been endorsed as one of several ways to combat organ shortages. However, HCV-positive donors remain poorly characterized. This study aimed to evaluate the prevalence and utilization of HCV antibody (Ab) positive donors in Argentina. Materials and Methods: We performed a cross-sectional study to analyze data from the INCUCAI in Argentina from January 2006 to December 2020. Demographic and allograft characteristics were evaluated, and utilization of HCV Ab-positive donors across Argentina was studied. Anti-HCV (ELISA), was performed on all donors during the procurement process. A stratified analysis according to the type of donor and HCV Ab was done. Results: Overall, 16,140 deceased donors were denounced. Of these, 8627 (53.5%) were organ donors (7802 [90.4%] were effective) and 7513 (46.5%) were tissue donors. Demographic characteristics were age 42 ± 18 years and male/female ratio was 1.59/1. HCV Ab-positive was reported in 0,92% (n=149). The prevalence ratio per period among HCV Ab-positive donors (see graphic 1) showed that the highest prevalence was observed in 2007 (1.3%) and the lowest prevalence was in 2020 (0.1%). Prevalence for HCV Ab-positive among the type of donors was significantly higher in non-effective donors at 5.81% (n=48/825), followed by tissue donors at only 1.01% (n=76/7513) and lower in effective donors at 0.32% (n=25/7802; P

Introduction and Objectives: Liver transplantation (LT) selection models for hepatocellular carcinoma (HCC) have not been proposed to predict waitlist dropout due to tumor progression. This study aimed to compare the alfa-fetoprotein (AFP) model and other pre-LT models in their prediction of HCC dropout. Materials and Methods: A multicenter cohort study was conducted in 20 Latin American transplant centers, including 994 listed patients for LT with HCC from 2012 to 2018. Longitudinal tumor characteristics and patterns of progression were recorded at the time of listing, after treatments and at last follow-up over the waitlist period. Competing risk regression models were performed, and the model's discrimination was compared by estimating Harrell's adapted c-statistics. Results: HCC dropout rate was significantly higher in patients beyond [24% (95% CI 16-28)] compared to those within Milan criteria [8% (95% IC 5-12%); P2 [adjusted SHR of 3.17 (CI 2.13-4.71)], c-index of 0.71 (95% CI 0.65-0.77; P=0.09 vs. Milan). Similar discrimination power for HCC dropout was observed between the AFP score and the Metroticket 2.0 model. In patients within Milan, an AFP score >2 points discriminated two populations with a higher risk of HCC dropout [SHR 1.68 (95% CI 1.08-2.61)]. Conclusions: Pre-transplant selection models similarly predicted HCC dropout. However, the AFP model can discriminate a higher risk of dropout among patients within Milan criteria.

Introduction and Objectives: Argentina is considered an area with a low prevalence of hepatitis B virus (HBV). However, the real prevalence of the disease is unknown. We aimed to study the prevalence of HBV in potential cadaveric donors. Materials and Methods: We performed a cross-sectional study to analyze data from the National Procurement of Transplantation in Argentina from all donors from 2006 to 2020. HBV serologic tests included hepatitis B virus antigen (HBsAg), core antigen-antibody (HBcIgG) and anti-HBs performed during the procurement process. HBV status was defined as 1) active HBV: donors with positive HBsAg; 2) Past HBV infection or false positive: isolated positive HBcIgG; 3) Cured infection anti-HBs+/HBcIgG+. Results: Overall, 16140 deceased donors were denounced. The prevalence of HBsAg was 0.37% (n=60) and of isolated HBcIgG+ was 3.6% (n=575). Among organ donors only, 328 (3.8%) presented isolated HBcIgG-positive serology. Of these, 252 (77%) were effective organ donors. Solid-organ transplants performed using isolated HBcIgG+ donors were 220 kidneys, 124 livers, and 27 intrathoracic organs. There was no significant 5-year graft and patient survival difference between HBcIgG+ receptor (kidney transplant 65% and 81%, and for liver 65% and 83% respectively) and the general population. Anti-HBs data were available in only 4455 donors, of which 19% (N=847) were anti-HBs+. In those patients with positive anti-HBs, HBcIgG was positive in 8.3% (n=369), reflecting past HBV infection. Of the remaining 4086 AntiS available, only 11.7% were positive; that is, they were effectively vaccinated. The Patagonia region presented the highest prevalence of HBsAg, especially in the provinces of La Pampa (2.3%), Santa Cruz (2.2.%), and Tierra del Fuego (2.1.%). Conclusions: The prevalence of HBsAg in deceased donors in Argentina is low. Since the probability of being a donor is random, the prevalence in this population could be close to the real one in the country.

Introduction and Objectives: Previously published regional real-world results of overall survival (OS) in Barcelona Clinic Liver Cancer (BCLC) B and C patients demanded a prospective cohort study nested in a systematic and continuous medical educational networking group. This study aimed to describe and evaluate the treatment decisions in patients with hepatocellular carcinoma (HCC) within BCLC B and C stages. Materials and Methods: A multicenter prospective cohort study, conducted in different Latin American centers from Argentina, Brazil and Colombia, started on 15th May 2018 (delayed recruitment during COVID locked-down period). Patients within BCLC B or C stages were included. Survival, tumor progression and patterns of treatment suspension were evaluated. Results: At this second interim analysis (projected final analysis March 2023), 390 HCC BCLC-B or C patients were included (n=15 excluded); mean age 65 years, 75.6% males and 89.5% cirrhotic. Median OS since HCC diagnosis was 27.2 months. Among BCLC-B patients, the most frequent therapy was transarterial chemoembolization (TACE, 42.3%); 51.8% using drug-eluting beads and 47.4% conventional TACE; with a median OS since 1st TACE of 41.9 months. Similar radiological responses after 1st TACE were observed between both modalities. Overall, 48.2% of the cohort received systemic therapy for HCC (n=188), 23.7% still on BCLC-B stage. The most frequent systemic treatments were Sorafenib (74.5%), atezolizumab bevacizumab (17.5%), and lenvatinib (12.2%), with a median OS since systemic therapy of 15.7 months. Lenvatinib or atezolizumab bevacizumab was used as the second line following sorafenib in 5 and 3 patients, respectively. The most common causes of systemic treatment discontinuation were tumor progression and liver function deterioration (15% to 36.4%). Patterns of tumor progression were not specifically associated with prognosis or treatment discontinuation. Conclusions: Liver function deterioration occurs in a third of patients following systemic therapies. The complexity of treatment decisions underly the need for a multidisciplinary team and the role of hepatologists.

Old and abandoned mines are testimonials of ancient industrial activities, and as such, they are able to convey environmental concerns. A multidisciplinary approach combining ground measurements—i.e., portable X-ray fluorescence and optical spectroradiometry—with airborne multispectral images—i.e., Sentinel-2 and unmanned aerial vehicles—was conducted to define a baseline for the characterization of areas that constitute environmental burdens. The Mostardeira mine, an old copper mine located in the Portuguese Ossa-Morena Zone, was selected as a case study. The results reveal that the soils have toxic metals—e.g., As (mean = 1239 ppm) and Cu (mean = 435 ppm)—above the defined health thresholds. The spectroradiometry provided insights into the soil characterization using data from the vis-NIR spectral region, allowing us to distinguish agricultural soil, mine waste, and bare soils. The spectra obtained are comparable with the USGS soil spectra standards, namely Clinozoisite Epidote HS299, Hematitic Alt. Tuff CU91-223, and Sand DWO-3-DEL2ar1 no oil. The airborne images considered through the lens of principal components analysis and supervised and unsupervised machine learning techniques (random forest and K-means) are found to be effective tools in creating cartographic representations of the contaminated soils. The collected data are used to construct a baseline for characterizing these environmentally challenging areas, whereas the methodological approach is revealed to be successful for tackling the posed environmental problems, allowing us to map the old mine environment passives.

Background & Aims: Two recently developed composite models, the alpha-fetoprotein (AFP) score and Metroticket 2.0, could be used to select patients with hepatocellular carcinoma (HCC) who are candidates for liver transplantation (LT). The aim of this study was to compare the predictive performance of both models and to evaluate the net risk reclassification of post-LT recurrence between them using each model’s original thresholds. Methods: This multicenter cohort study included 2,444 adult patients who underwent LT for HCC in 47 centers from Europe and Latin America. A competing risk regression analysis estimating sub-distribution hazard ratios (SHRs) and 95% CIs for recurrence was used (Fine and Gray method). Harrell’s adapted c-statistics were estimated. The net reclassification index for recurrence was compared based on each model’s original thresholds. Results: During a median follow-up of 3.8 years, there were 310 recurrences and 496 competing events (20.3%). Both models predicted recurrence, HCC survival and survival better than Milan criteria (p

O presente artigo, de abordagem qualitativa descritiva, com características de um estudo de casos múltiplos, tem por objetivo apresentar e discutir resultados de uma pesquisa de doutorado que objetivou investigar e discutir características do Pensamento Matemático de alunos surdocegos de uma escola do município de Londrina-PR. Para tanto, assumiu-se como perspectiva epistemológica e metodológica o Modelo dos Campos Semânticos (MCS), proposto por Rômulo Campos Lins. Como suporte teórico, adotou-se uma caracterização para o modo de produção de significados para a Matemática esperado de alunos no contexto educacional paranaense, desenvolvida a partir da produção de significados do primeiro autor deste trabalho para os resíduos de enunciações contidos nas Diretrizes Curriculares da Educação do Paraná para a disciplina de Matemática. Tendo esses referenciais, realizou-se uma leitura dos resíduos de enunciações de dois alunos produzidos durante entrevistas semiestruturadas que tinham por objetivo caracterizar os contextos escolares em que estiveram e/ou estão inseridos e uma caracterização para os modos de produção de significados para a Matemática, ou ainda, para o Pensamento Matemático de cada um deles. O estudo evidenciou que o modo mais presente e valorizado em toda aprendizagem escolar dos alunos, de noções concretas às abstratas, após o surgimento da surdocegueira, esteve indissociável da manipulação, presente ou passada, de objetos físicos. Apenas um dos alunos demonstrou possuir o Pensamento Matemático esperado no contexto em que estão inseridos, e que ambos demonstram, em seus modos de lidar com a Matemática, coisificar noções matemáticas e fazer referência a objetos “concretos”, “cotidianos”.

Introduction and Objectives: The Choosing Wisely (CW) initiative aims to improve daily practice supported by evidence concerning unnecessary medical tests, procedures, and treatments. This philosophy is essential in managing viral hepatitis (VH), which primary care physicians increasingly carry out. It is also essential to achieving disease elimination. Thus, the aim of our study was to propose evidence-based CW recommendations in VH. Materials and Methods: The Brazilian Society of Hepatology (SBH) formed a panel of experts in VH who selected evidence-based CW recommendations, which were subsequently scrutinized and ranked by all members of SBH using a web-based approach. Results: Five recommendations were chosen in order of importance: 1) do not order anti-HCV testing after achieving sustained virological response; 2) do not request serial HCV viral load to evaluate HCV progression, 3) do not add ribavirin to direct-acting antivirals in non-cirrhotic, naïve HCV patients; 4) do not screen for hepatocellular carcinoma in HCV patients with none to moderate fibrosis (≤ F2); 5) do not request anti-HBs after HBV vaccination, except for children born to HBV-infected mothers, hemodialysis patients, healthcare professionals, people who have had sexual contact with chronic HBV carriers, HIV-positive persons and immunocompromised individuals (hematopoietic stem-cell transplant recipients or persons receiving chemotherapy). Conclusions: CW recommendations may help general practitioners adopt a more rational and cost-effective approach in managing patients with VH in Brazil and Latin America, leading to lesser waste or harm to patients.

A compreensão da natureza complexa e global das mudanças climáticas demanda um diálogo entre as áreas do conhecimento sob uma perspectiva interdisciplinar. Neste sentido, a adoção de metodologias diversificadas pode se configurar como útil aliada na implementação de ações efetivamente interdisciplinares. Sob essa perspectiva, o presente trabalho visa fornecer um panorama do estado da arte relacionado à elaboração de Unidades de Ensino Potencialmente Significativas (UEPS), que consideraram três aspectos fundamentais no contexto de seu desenvolvimento: interdisciplinaridade, mudanças climáticas e Educação de Jovens e Adultos (EJA). Com esta finalidade, foi realizada uma revisão bibliográfica utilizando-se termos descritores relacionados à pesquisa, na qual foram consultadas as seguintes bases de dados: Biblioteca Digital Brasileira de Teses e Dissertações, Portal de Periódicos da CAPES, Web of Science e Scopus. Dos 80 trabalhos encontrados, quatro utilizaram UEPS com enfoque interdisciplinar, três foram implementados na modalidade EJA de ensino e nenhum abordou o tema mudanças climáticas. O cenário retratado no levantamento bibliográfico revelou a escassez de publicações relacionadas à temática desta pesquisa e evidenciou a necessidade de futuras investigações que reforcem a potencialidade das UEPS para a promoção da aprendizagem significativa na EJA, abrangendo tanto a interdisciplinaridade quanto o tema mudanças climáticas no seu processo de elaboração.

A new species of the harpacticoid copepod genus Esola is described from specimens collected in Rodadero Beach, on Gaira Bay, on the Caribbean coast of Colombia. The species, E. wellsi sp. nov., is described, illustrated, and com­pared with its congeners. Esola wellsi sp. nov. differs from its known congeners in details of the armature of legs 1–4. It most closely resembles E. bulbifera (Norman, 1911) in the armature formula of P1–P5 but differs from the latter in several respects, including the female antennule segmentation (7-segmented in E. bulbifera but distinctly 6-segmented in E. wellsi sp. nov.) and in the shape and size of the male P3ENP2 apophysis, among other characters. This is the second species of the genus known from the Caribbean and the second record of Esola in the Northwestern Tropical Atlantic. The genus now contains eight species. A key to the known species of the genus is also included.

As cobranças de escanteio adquirem um status relevante em relação às outras fases do jogo de futebol. Assim, o presente estudo tem por objetivo descrever e analisar os gols de escanteio na elite do futebol brasileiro, quando cobrados diretamente à zona de pênalti. Este é um estudo observacional retrospectivo, com abordagem descritiva e associativa, cuja amostra é constituída por 172 cobranças de escanteio onde a sequência resultou em gol. Em uma análise inferencial adotamos o teste estatístico Qui-quadrado e o teste de Fisher (Exact Test) para verificarmos as associações entre as variáveis. O software utilizado foi o SPSS v.25 e o nível de significância mantido em 5%. A fiabilidade dos dados foi verificada pelo índice de Kappa de Cohen com valores de concordância acima de 0,81 para inter e intra-avaliador. Os resultados apontaram predominância de gols com finalização de primeira (57%), de cabeça (64,5%), em cobranças com o pé direito (67%). Isso se deu, provavelmente, pelo fato da maioria das cobranças serem altas, pela maioria dos cobradores serem destros e pela curta distância ao gol da equipe defensora. Destacamos também que em 86,1% dos gols a equipe atacante venceu o primeiro confronto aéreo e 61,6% dos gols foram decisivos para vitória ou empate (principalmente para equipe visitante não perder). Concluímos que o primeiro confronto aéreo apresenta uma tendência de ocorrência maior nas zonas centrais da área de pênalti, porém sendo nas zonas da pequena área que mais ocorrem finalizações para gol.

Neste artigo procuramos discutir a violência escolar como eixo estrutural da exclusão das populações periféricas, em especial aquelas em que o índice de concentração da população negra é maior. Assim, tratamos da persistência do racismo no Brasil como um fator que contribui para que o problema violência seja recorrente na nossa sociedade, principalmente na escola. Para isso, primeiramente, apresentamos um estudo teórico-histórico de modo a contextualizar a relação existente entre as desigualdades raciais e as desigualdades escolares. Por conseguinte, abordamos sobre a discussão freireana como instrumento de luta contra as desigualdades. Neste trabalho reforçamos e ampliamos a discussão sobre essa problemática, tecendo, dentre outras, considerações acerca do papel da escola e da atuação docente. Portanto, nosso objeto de estudo é a violência decorrente do racismo e nosso objetivo é compreender os mecanismos de exclusão de crianças e jovens privados de direitos elementares previstos em uma “democracia”. A escola é para “todos”, mas a educação é ainda para poucos. Concluímos que o negacionismo quanto à realidade do negro representa um ponto primordial para o entendimento da violência que circunda a escola e s sua superação se coloca a partir de um ideal de emancipação.

Abstract The insertion of Pharmaceutical Care in Primary Health Care (PHC) improves patients’ clinical outcomes and quality of life. Pharmacotherapeutic follow-up can contribute to the management of chronic diseases such as diabetes, promoting better glycemic control and adherence to therapy. This study aimed to assess the Drug-therapy Problems (DTPs) and Pharmacist Interventions (PIs) on the pharmacotherapeutic management in patients with type 2 diabetes mellitus (T2DM) in a community pharmacy. A quantitative, retrospective, and cross-sectional study was conducted in a Pharmaceutical Care Program within the PHC in Juiz de Fora (Minas Gerais, Brazil). Inclusion criteria were patients with T2DM above 18, who attended at least three pharmaceutical consultations between July 2016 and October 2018 and presented two or more glycated hemoglobin tests. The study group (n = 17) was largely composed of women (65%), elderly (76%), sedentary (72%), and obese people (52%). The resolution was achieved in 79% of the DTPs identified (n = 115). Most of DTPs were related to administration and adherence to pharmacotherapy (46%). 60% of the 437 PIs involved the provision of information and counseling. In other words, accessible interventions lead to high resolvability. Therefore, clinical actuation of pharmacists could improve the prognosis in diabetes treatment.

The emergence of SARS-CoV-2 variants can affect their detection via RT-qPCR. The Omicron variant has a greater affinity for the upper respiratory system and causes clinical conditions similar to bronchitis, as opposed to the pneumonitis-like conditions caused by other SARS-CoV-2 variants. This characteristic increases the viscosity of clinical samples collected for diagnosis. Coinciding with the arrival of the Omicron variant, we observed a failure in control gene expression in our laboratory. In this report, we have optimized a rapid nucleic acid extraction step to restore gene expression and detect the presence of the SARS-CoV-2 virus. We reevaluated 3000 samples, compared variant types occurring in different time periods, and confirmed that the presence of the Omicron variant was responsible for changes observed in the characteristics of these clinical samples. For samples with large amounts of mucus, such as those containing the Omicron variant, a modification to the nucleic acid extraction step was sufficient to restore the quality of RT-qPCR results.

Chryseobacterium indologenes is a non-glucose-fermenting Gram-negative bacillus. This emerging multidrug resistant opportunistic nosocomial pathogen can cause severe infections in neonates and immunocompromised patients. This study aimed to present the first detailed draft genome sequence of a multidrug-resistant C. indologenes strain isolated from the cerebrospinal fluid of an infant hospitalized at the Neonatal Intensive Care Unit of Brazilian Tertiary Hospital. We first analyzed the susceptibility of C. indologenes strain to different antibiotics using the VITEK 2 system. The strain demonstrated an outstanding resistance to all the antibiotic classes tested, including β-lactams, aminoglycosides, glycylcycline, and polymyxin. Next, C. indologenes was whole-genome-sequenced, annotated using Prokka and Rapid Annotation using Subsystems Technology (RAST), and screened for orthologous groups (EggNOG), gene ontology (GO), resistance genes, virulence genes, and mobile genetic elements using different software tools. The draft genome contained one circular chromosome of 4,836,765 bp with 37.32% GC content. The genomic features of the chromosome present numerous genes related to cellular processes that are essential to bacteria. The MDR C. indologenes revealed the presence of genes that corresponded to the resistance phenotypes, including genes to β-lactamases (blaIND–13, blaCIA–3, blaTEM–116, blaOXA–209, blaVEB–15), quinolone (mcbG), tigecycline (tet(X6)), and genes encoding efflux pumps which confer resistance to aminoglycosides (RanA/RanB), and colistin (HlyD/TolC). Amino acid substitutions related to quinolone resistance were observed in GyrA (S83Y) and GyrB (L425I and K473R). A mutation that may play a role in the development of colistin resistance was detected in lpxA (G68D). Chryseobacterium indologenes isolate harbored 19 virulence factors, most of which were involved in infection pathways. We identified 13 Genomic Islands (GIs) and some elements associated with one integrative and conjugative element (ICEs). Other elements linked to mobile genetic elements (MGEs), such as insertion sequence (ISEIsp1), transposon (Tn5393), and integron (In31), were also present in the C. indologenes genome. Although plasmids were not detected, a ColRNAI replicon type and the most resistance genes detected in singletons were identified in unaligned scaffolds. We provided a wide range of information toward the understanding of the genomic diversity of C. indologenes, which can contribute to controlling the evolution and dissemination of this pathogen in healthcare settings.

Resumo A formação em Psicologia é alvo de discussões desde a sua regulamentação como profissão. O presente estudo teve como objetivo identificar a percepção dos egressos de um curso de graduação em Psicologia, numa universidade federal nordestina, acerca da formação generalista, considerando a sua história “recente” junto à expansão universitária no Brasil e a conformidade com as Diretrizes Curriculares Nacionais. Trata-se de uma pesquisa qualitativa, cujos dados foram obtidos por meio de entrevistas semiestruturadas individuais, com oito psicólogos egressos, atuantes no mercado de trabalho. A análise dos resultados ocorreu com base na Análise de Conteúdo de Bardin (1977), pela qual se observou uma compreensão pouco assertiva quanto ao conceito de formação generalista e certa dificuldade em nomear-se um profissional como generalista, ainda que essa postura faça parte da prática diária. Além disso, percebeu-se a existência de críticas referentes à matriz curricular e ao relacionamento com os docentes. No entanto, sobressai uma avaliação positiva.

Este artigo tem como objetivo analisar a problemática da precarização e proletarização do trabalho docente no contexto político da microrregião dos Inconfidentes. Percebe-se que a docência no Ensino Básico nacional tem passado por um processo de transformação, que tem seu início pós-promulgação da LDB 4024/61 e se estende até os dias atuais. Buscou-se analisar as transformações políticas e educacionais que ocorreram no Brasil, do período ditatorial até a reforma do Estado e das políticas públicas nos anos de 1990 à 2017. Entende-se que, com a mudança no cenário político brasileiro para educação, essa influenciou e tem influenciado professores/as e futuros/as professores/as em avaliar negativamente a condição real da profissão, fato que internalizar o problema da precarização e proletarização, questão fortemente marcada em tempos de pandemia. Com base na análise bibliográfica e documental, essa análise terá como referencial metodológico o caráter qualitativo e quantitativo da produção. Entende-se que essa proposta metodológica é fundamental porque auxiliará na análise das fontes do período em questão e na produção acadêmica acerca do tema, para demonstrar o processo histórico e as medidas que possibilitaram a reformulação do trabalho docente. Para responder sobre essa transformação do ensino básico, busca-se analisar o panorama histórico da educação brasileira, no sentido de demonstrar que as mudanças nas políticas públicas impactam diretamente na realidade escolar de Mariana e Ouro Preto, no que tange a atuação dos e das professores e professoras no contexto escolar da região.

Este artigo tem como objetivo compreender a matriz teórico-metodológica a Organização do Trabalho Didático, como fundamento para entender a História da Escola Pública Contemporânea. Considera-se que esse pressuposto é importante para formação docente na relação entre educador e educando. A base da análise sobre a discussão partirá da crítica ao modelo manufatureiro, ora negligenciado à formação docente, mas que consideramos fundamental para compreendermos a escola do nosso tempo. Para a realização do trabalho utilizamos a pesquisa qualitativa, com base na análise bibliográfica acerca da discussão sobre a produção da escola moderna. A análise sobre a teoria da história para compreensão do processo da formação docente será questão fundamental para a discussão da organização didática de nosso tempo. Nesta perspectiva será fundamental trazer para a discussão, algo que categoricamente está sendo banalizado nos dias de hoje, o ser humano e sua formação docente. Entendermos o sentido da organização do trabalho didático, a fim propiciarmos um mundo educativo melhor para os trabalhadores da educação básica.

Road Traffic Accidents (RTA) cause human losses and irreparable physical and psychological damage to many of the victims. They also involve a very relevant economic dimension. It is urgent to improve the management of human and material resources for more effective prevention. This work makes an important contribution by presenting a methodology that allowed for achieving a predictive model for the occurrence of RTA on a road with a high RTA rate. The prediction is obtained for each road segment for a given time and day and combines results from statistical methods, spatial analysis, and artificial intelligence models. The performance of three Machine Learning (ML) models (Random Forest, C5.0 and Logistic Regression) is compared using different approaches for imbalanced data (random sampling, directional sampling, and Random Over-Sampling Examples (ROSE)) and using different segment lengths (500 m and 2000 m). This study used RTA data from 2016–2019 (training) and from May 2021–June 2022 (test). The most effective model was an ML logistic regression with the ROSE approach, using segments length 500 m (sensitivity = 87%, specificity = 60%, AUC = 0.82). The model was implemented in a digital application, and a Portuguese security force is already using it.

Background: Although there are studies on blood pressure (BP) and autonomic cardiac control (ACC) impairments caused by ergogenic aids, research has scarcely addressed this analysis during sleep. This study analyzed BP and ACC during sleep and wake periods in three groups of resistance training (RT) practitioners: ergogenic aid non-users, thermogenic supplement (TS) self-users, and anabolic-androgenic steroid (AAS) self-users. Methods: RT practitioners were selected for the Control Group (CG; n = 15), TS self-users Group (TSG; n = 15), and AAS self-users Group (AASG; n = 15). All individuals underwent cardiovascular Holter monitoring (BP, ACC) during sleep and wake periods. Results: The maximum systolic BP (SBP) during sleep was higher in AASG (p < 0.01) than CG (p < 0.001). CG had lower mean diastolic BP (DBP) than TSG (p < 0.01) and lower mean SBP (p = 0.009) than the other groups. Additionally, CG had higher values (p < 0.01) than TSG and AASG for SDNN and pNN50 during sleep. HF, LF, and LF/HF ratio values during sleep were statistically different in CG (p < 0.001) from the other groups. Conclusions: Our findings demonstrate that high doses of TS and AAS can impair cardiovascular parameters during sleep in RT practitioners who take ergogenic aids.

Background & Aims: Patients with hepatocellular carcinoma (HCC) are selected for liver transplantation (LT) based on pre-LT imaging ± alpha-foetoprotein (AFP) level, but discrepancies between pre-LT tumour assessment and explant are frequent. Our aim was to design an explant-based recurrence risk reassessment score to refine prediction of recurrence after LT and provide a framework to guide post-LT management. Methods: Adult patients who underwent transplantation between 2000 and 2018 for HCC in 47 centres were included. A prediction model for recurrence was developed using competing-risk regression analysis in a European training cohort (TC; n = 1,359) and tested in a Latin American validation cohort (VC; n=1,085). Results: In the TC, 76.4% of patients with HCC met the Milan criteria, and 89.9% had an AFP score of ≤2 points. The recurrence risk reassessment (R3)-AFP model was designed based on variables independently associated with recurrence in the TC (with associated weights): ≥4 nodules (sub-distribution of hazard ratio [SHR] = 1.88, 1 point), size of largest nodule (3–6 cm: SHR = 1.83, 1 point; >6 cm: SHR = 5.82, 5 points), presence of microvascular invasion (MVI; SHR = 2.69, 2 points), nuclear grade >II (SHR = 1.20, 1 point), and last pre-LT AFP value (101–1,000 ng/ml: SHR = 1.57, 1 point; >1,000 ng/ml: SHR = 2.83, 2 points). Wolber’s c-index was 0.76 (95% CI 0.72–0.80), significantly superior to an R3 model without AFP (0.75; 95% CI 0.72–0.79; p = 0.01). Four 5-year recurrence risk categories were identified: very low (score = 0; 5.5%), low (1–2 points; 15.1%), high (3–6 points; 39.1%), and very high (>6 points; 73.9%). The R3-AFP score performed well in the VC (Wolber’s c-index of 0.78; 95% CI 0.73–0.83). Conclusions: The R3 score including the last pre-LT AFP value (R3-AFP score) provides a user-friendly, standardised framework to design post-LT surveillance strategies, protocols, or adjuvant therapy trials for HCC not limited to the Milan criteria. Clinical Trials Registration: NCT03775863. Lay summary: Considering discrepancies between pre-LT tumour assessment and explant are frequent, reassessing the risk of recurrence after LT is critical to further refine the management of patients with HCC. In a large and international cohort of patients who underwent transplantation for HCC, we designed and validated the R3-AFP model based on variables independently associated with recurrence post-LT (number of nodules, size of largest nodule, presence of MVI, nuclear grade, and last pre-LT AFP value). The R3-AFP model including last available pre-LT AFP value outperformed the original R3 model only based on explant features. The final R3-AFP scoring system provides a robust framework to design post-LT surveillance strategies, protocols, or adjuvant therapy trials, irrespective of criteria used to select patients with HCC for LT.

Serratia marcescens is now an important opportunistic pathogen that can cause serious infections in hospitalized or immunocompromised patients. Here, we used extensive bioinformatic analyses based on reverse vaccinology and subtractive proteomics-based approach to predict potential vaccine candidates against S. marcescens. We analyzed the complete proteome sequence of 49 isolate of Serratia marcescens and identified 5 that were conserved proteins, non-homologous from human and gut flora, extracellular or exported to the outer membrane, and antigenic. The identified proteins were used to select 5 CTL, 12 HTL, and 12 BCL epitopes antigenic, non-allergenic, conserved, hydrophilic, and non-toxic. In addition, HTL epitopes were able to induce interferon-gamma immune response. The selected peptides were used to design 4 multi-epitope vaccines constructs (SMV1, SMV2, SMV3 and SMV4) with immune-modulating adjuvants, PADRE sequence, and linkers. Peptide cleavage analysis showed that antigen vaccines are processed and presented via of MHC class molecule. Several physiochemical and immunological analyses revealed that all multiepitope vaccines were non-allergenic, stable, hydrophilic, and soluble and induced the immunity with high antigenicity. The secondary structure analysis revealed the designed vaccines contain mainly coil structure and alpha helix structures. 3D analyses showed high-quality structure. Molecular docking analyses revealed SMV4 as the best vaccine construct among the four constructed vaccines, demonstrating high affinity with the immune receptor. Molecular dynamics simulation confirmed the low deformability and stability of the vaccine candidate. Discontinuous epitope residues analyses of SMV4 revealed that they are flexible and can interact with antibodies. In silico immune simulation indicated that the designed SMV4 vaccine triggers an effective immune response. In silico codon optimization and cloning in expression vector indicate that SMV4 vaccine can be efficiently expressed in E. coli system. Overall, we showed that SMV4 multi-epitope vaccine successfully elicited antigen-specific humoral and cellular immune responses and may be a potential vaccine candidate against S. marcescens. Further experimental validations could confirm its exact efficacy, the safety and immunogenicity profile. Our findings bring a valuable addition to the development of new strategies to prevent and control the spread of multidrug-resistant Gram-negative bacteria with high clinical relevance.

Diante da crise hidroenergética na região Sudeste (SE) do Brasil, ocorrida entre 2012-2015, o objetivo deste trabalho é analisar como os consumidores da região supracitada foram conduzidos a implantar sistemas de Geração Distribuída (GD) nesse período. Para isso, realizou-se uma pesquisa exploratória de dados referentes ao nível dos reservatórios do subsistema Sudeste/Centro-Oeste, ao consumo e ao custo de eletricidade da região e à evolução da GD. Esta pesquisa possibilitou notar que a crise hídrica ampliou a necessidade do uso das usinas térmicas e, consequentemente, aumentou as emissões dos gases do efeito estufa (GEE) e fez com que o custo da energia elétrica fosse elevado, principalmente, para os consumidores das classes residencial e comercial do SE. Assim, como forma de reduzir os custos com eletricidade, os consumidores investiram em fontes renováveis de energia (FRE). Dentre elas, a energia solar fotovoltaica (ESFV) foi a fonte de energia mais utilizada por todas as classes de consumidores, principalmente, a residencial e a comercial, em toda a região SE.

Introduction and objectives: The liver imaging reporting data system (LI-RADS) for hepatocellular carcinoma (HCC) was proposed to standardize and enhance consensus of reporting. However, clinical utility of LI-RADS has not been evaluated in Latin America. We therefore sought to compare LI-RADS categories with histopathology findings in liver transplant (LT) explants in a regional center. Materials and methods: Prospective cohort study conducted between 2012 and 2018 in a single center from Argentina including patients with HCC listed for LT. LI-RADS definitions were applied to magnetic resonance images (MRI) or computed tomography (CT) abdominal scans at time of listing and at final pre-LT reassessment and compared to explant pathology findings; specifically, major nodule (NOD1). Results: Of 130 patients with HCC listed for LT (96.1% with cirrhosis and 35.6% with hepatitis C virus infection), 72 underwent LT. Overall, 65% had imaging HCC diagnosis based on MRI (n = 84), 26% with CT (n = 34) and 9% (n = 12) with both methods. Among LT patients with pre-transplant imaging at our institution (n = 42/72), 69% of the NOD1 were LR-5, 21% LR-4 and 10% LR-3. Definite HCC diagnosis was 50% in LR-3 NOD1 (CI 18–90); none presented microvascular invasion. In LR-4 NOD1, HCC was confirmed in 89% (CI 59–98), of which 11% showed microvascular invasion; whereas in LR-5 NOD1 77% (CI 64–87) had confirmed HCC, 17% with microvascular invasion. Conclusions: LI-RADS was useful to standardize reports; however, no significant differences were observed between LR-4 and LR-5 HCC probability when compared to explant pathology.