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How do people's causal knowledge influence how they seek information? The current work tasks participants with choosing to observe disease symptoms in a setting where they know a disease's etiology and related symptoms. We use causal graphical models (CGMs) to formalize their causal knowledge of the disease, and find that people tend to use their expected information gain, computed over their CGM-generated probability beliefs, to search for information in causal settings.

Humans possess knowledge of causal systems with deep compositional structures. For example, we know that a good soccer team needs players to fill different roles, with each role demanding a configuration of skills from the player. These causal systems operate on multiple object types (player roles) that are defined by features within objects (skills). This study explores how human learners perform on novel causal learning problems in which they need to infer multiple object types in a bottom-up manner, using empirical information as a cue for their existence. We model subjects' learning process with Bayesian models, drawing hypotheses from different spaces of logical expressions. We found that although subjects exhibited partial success on tasks that required learning one object type, they mostly failed at those that required learning multiple types. Our result identifies the learning of object types as a major obstacle for human acquisition of complex causal systems.

Purpose – This teaching case aims to analyze the business model of Amaro, a company that directly sells lifestyle goods to end consumers (B2C), focused on the women's market. Amaro's original business model is introduced and a challenging dilemma is proposed: could Amaro innovate its business model, moving from a digitally native vertical brand (DNVB)-type company to a platform, specifically a vertical marketplace focused on the female audience? Would Amaro be prepared for this evolution or would it be more appropriate to focus on or strengthen the DNVB model? Design/methodology/approach – This teaching case was developed based on in-depth interviews with Amaro's leadership. The teaching notes were proposed based on business model innovation, competitive positioning and market trends concepts. The teaching case considers a new type of business model called DNVB. Students can review the concepts, create analyses and recommend which strategic options can leverage the company for a new growing cycle. Findings – Using the case study in the classroom should promote the discussion and reflections on business model innovation and the future of retail in omnichannel contexts - Amaro offers products online (on an e-commerce platform and native mobile applications) and physically in locations called guide shops. The authors suggested the adoption of frameworks and tools (e.g. the competitive positioning map to allow students to visualize ways to compare strategies and make decisions). Research limitations/implications – The case introduces a fictional dilemma related to the decision to maximize offline or online investments or completely change the company's business model by adding a new vertical marketplace approach. Practical implications – This teaching case contributes to the student's learning about business model innovation and evolution. Case discussions could explore contemporary concepts such as value proposition, disintermediation and omnichannel commerce. Originality/value – Offering goods directly to the consumers by using modern technological architecture through vertical integration within the supply chain makes the DNVB business model an original topic in the start-up segment.

Significant research has been carried out in the last decade to describe the CO2 system dynamics in the Baltic Sea. However, there is a lack of knowledge in this field in the NE Baltic Sea, which is the main focus of the present study. We analysed the physical forcing and hydrographic background in the study year (2018) and tried to elucidate the observed patterns of surface water CO2 partial pressure (pCO2) and methane concentrations (cCH4). Surface water pCO2 and cCH4 were continuously measured during six monitoring cruises onboard R/V Salme, covering the Northern Baltic Proper (NBP), the Gulf of Finland (GoF), and the Gulf of Riga (GoR) and all seasons in 2018. The general seasonal pCO2 pattern showed oversaturation in autumn–winter (average relative CO2 saturation 1.2) and undersaturation in spring–summer (average relative CO2 saturation 0.5), but it locally reached the saturation level during the cruises in April, May, and August in the GoR and in August in the GoF. The cCH4 was oversaturated during the entire study period, and the seasonal course was not well exposed on the background of high variability. Surface water pCO2 and cCH4 distributions showed larger spatial variability in the GoR and GoF than in the NBP for all six cruises. We linked the observed local maxima to river bulges, coastal upwelling events, fronts, and occasions when vertical mixing reached the seabed in shallow areas. Seasonal averaging over the CO2 flux suggests a weak sink for atmospheric CO2 for all basins, but high variability and the long periods between cruises (temporal gaps in observation) preclude a clear statement.

Abstract Smooth pursuit eye movements are considered a well-established and quantifiable biomarker of sensorimotor function in psychosis research. Identifying psychotic syndromes on an individual level based on neurobiological markers is limited by heterogeneity and requires comprehensive external validation to avoid overestimation of prediction models. Here, we studied quantifiable sensorimotor measures derived from smooth pursuit eye movements in a large sample of psychosis probands (N = 674) and healthy controls (N = 305) using multivariate pattern analysis. Balanced accuracies of 64% for the prediction of psychosis status are in line with recent results from other large heterogenous psychiatric samples. They are confirmed by external validation in independent large samples including probands with (1) psychosis (N = 727) versus healthy controls (N = 292), (2) psychotic (N = 49) and non-psychotic bipolar disorder (N = 36), and (3) non-psychotic affective disorders (N = 119) and psychosis (N = 51) yielding accuracies of 65%, 66% and 58%, respectively, albeit slightly different psychosis syndromes. Our findings make a significant contribution to the identification of biologically defined profiles of heterogeneous psychosis syndromes on an individual level underlining the impact of sensorimotor dysfunction in psychosis.

This paper discusses the significance of school curricula in reflecting societal priorities and needs, focusing on the incorporation of computational thinking (CT) in Nordic national curricula. Our point of departure is that the preparedness of future generations for a digitally driven society can be determined by analysing how CT is either explicitly or implicitly framed in school curricula. Accordingly, this study examined the school curricula of Denmark, Finland, and Norway in terms of their similarities and differences in how they framed CT, as these countries have different approaches to the inclusion of CT. A framework for analysis that was grounded in influential works on CT in education was developed, focusing on problem-solving, algorithmic and transversal practices. National-level curricula were examined using a content analysis. Despite the differences in the approaches used in these countries, our findings indicate similarities across all three curricula, with an emphasis on how CT was framed.

IntroductionThe design of Pediatric Intensive Care Unit (PICU) rooms significantly impacts patient care and satisfaction. The aims were first, to describe the current physical space across PICUs in the USA, and second, to identify what proportion of PICUs are compliant with current guidelines.MethodsA descriptive cross-sectional survey was conducted, targeting division chiefs and medical directors of PICUs nationwide. The survey collected data on unit type, construction and renovation dates, room sizes, and available amenities. According to the Guidelines for Design and Construction of Hospitals, PICU rooms are recommended to be single rooms, at least 200 sq ft, have a window and a private bathroom. Data were anonymized and reported as median and interquartile ranges or frequencies and percentages.ResultsThirty units responded. Among the respondents, 26 had general PICUs, 9 had cardiac ICUs, and 3 had intermediate care units, with some units containing multiple types of ICUs. The median annual admissions were 1,125, with a median occupancy rate of 78%. Twenty-three percent of units had at least one double room, and 3% had triple or quadruple rooms. The median room size was 265 sq ft (IQR 230; 304), the smallest room size was 220 sq ft (IQR 179; 275), and the largest single room size was 312 sq ft (IQR 273; 330). Thirty-seven percent of units had bathrooms in every room, while 80% had windows in every room. Additionally, 46% of units had dialysis capabilities in every room, and 7% had negative pressure capabilities in every room. The median building year was 2008 (IQR 2001;2014), with 36% of units having undergone at least one renovation. Larger rooms were associated with more recent build dates (p = 0.01). Only 30% of the PICUs met the guidelines for physical space. These compliant units were built at a median of 4 years ago (IQR 1; 8).ConclusionThis study highlights the variability in PICU room design and amenities across healthcare facilities. Many units still fall short of meeting the guidelines for room size, windows, and private bathrooms. Future research should investigate the relationship between room characteristics and patient outcomes to inform better design practices, with a goal of improving patient experiences and clinical outcomes.

Abstract Background In this study we aimed to describe the morphological and pathogenetic differences between tracheal agenesis and tracheal atresia, which are not clearly distinguished from each other in the literature, and to contribute thereby to the understanding and management of these conditions. Both tracheal agenesis and tracheal atresia represent rare disorders of still unknown aetiology that cannot be detected by prenatal ultrasound. If the affected foetuses survive until birth these conditions result in respiratory failure and in futile attempts to rescue the infant’s life. Results Autopsies and genetic analyses, including singleton or trio exome sequencing, were performed on five neonates/foetuses with tracheal agenesis and three foetuses with tracheal atresia. Tracheal agenesis was characterized by absence of the sublaryngeal trachea and presence of a bronchooesophageal fistula and by pulmonary isomerism and occurred as an isolated malformation complex or as part of a VACTERL association. Special findings were an additional so-called ‘pig bronchus’ and a first case of tracheal agenesis with sirenomelia. Tracheal atresia presenting with partial obliteration of its lumen and persistence of a fibromuscular streak resulted in CHAOS. This condition was associated with normal lung lobulation and single, non-VACTERL type malformations. Trio ES revealed a novel variant of MAPK11 in one tracheal agenesis case. Its involvement in tracheooesophageal malformation is herein discussed, but remains hypothetical. Conclusion Tracheal agenesis and tracheal atresia represent different disease entities in terms of morphology, pathogenesis and accompanying anomalies due to a primary developmental and secondary disruptive possibly vascular disturbance, respectively.

Kidney cancer is a common malignancy that constitutes around 5% of all cancer cases. Males are twice as likely to acquire renal cell carcinoma (RCC) compared to females and experience a higher rate of mortality. These disparities indicate that sex hormone (SH)-dependent pathways may have an impact on the aetiology and pathophysiology of RCC. Examination of SH involvement in conventional signalling pathways, as well as genetics and genomics, especially the involvement of ribonucleic acid, reveal further insights into sex-related differences. An understanding of SHs and their influence on kidney cancer is essential to offer patients individualized medicine that would better meet their needs in terms of prevention, diagnosis and treatment. This review presents the understanding of sex-related differences in the clinical manifestation of kidney cancer patients and the underlying biological processes.

BackgroundA better understanding of the consequences of the Coronavirus Disease 2019 (COVID-19) pandemic on lifestyle of patients with Chagas disease (ChD) is of paramount importance to facilitate the implementation of intervention strategies tailored to this specific population.ObjectiveThe present study aimed to evaluate the level of physical activity (PA) in Chagas disease (ChD) patients during the Coronavirus Disease 2019 (COVID-19) pandemic and its main associated factors.MethodsThis is a cross-sectional study with 187 patients of both sexes, aged ≥18 years, followed in a national infectious disease center (Rio de Janeiro, Brazil). The level of PA was determined by the International Physical Activity Questionnaire short version and expressed in terms of total volume of physical activity (PA) (MET-minutes per week). Individuals were classified as physically active following the 2020 World Health Organization PA guideline. The exposure variables were age, sex, race, marital status, schooling, income per capita, number of rooms per domicile, number of residents per domicile, body mass index, clinical form of ChD, COVID-19 antibodies, comorbidities, self-reported anxiety, self-reported depression, self-reported fear, and self-reported sadness. The association between the exposure variables with total PA (as a continuous variable) was determined using univariate and multivariate linear regression models.ResultsMean age was 61.1 ± 11.6 years. Most (62%) were women and self-declared their race as mixed (50.8%). The percentage of physically active individuals according to was 52%. The variables independently associated with total PA levels were non-white race (Exp β = 1.39; 95% CI 1.02 to 1.90), dyslipidemia (Exp β = 0.73; 95% CI 0.56 to 0.95) and self-reported depression during quarantine (Exp β = 0.71; 95% CI 0.52 to 0.96).ConclusionNon-white race was positively associated with total levels of PA, while dyslipidemia, and self-reported depression during quarantine were negatively associated with total levels of PA. The identification of associated factors can facilitate the development of tailored strategies to increase PA levels ChD patients.

ABSTRACT BACKGROUND: Brazilian medical schools equitably divide their medical education assessments into five content areas: internal medicine, surgery, pediatrics, obstetrics and gynecology, and public health. However, this division does not follow international patterns and may threaten the examinations’ reliability and validity. OBJECTIVE: To assess the reliability indices of the content areas of serial, cross-institutional progress test examinations. DESIGN AND SETTINGS: This was an analytical, observational, and cross-sectional study conducted at nine public medical schools (mainly from the state of São Paulo) with progress test examinations conducted between 2017 and 2023. METHODS: The examinations covered the areas of basic sciences, internal medicine, surgery, pediatrics, obstetrics and gynecology, and public health. We calculated reliability indices using Cronbach’s α, which indicates the internal consistency of a test. We used simple linear regressions to analyze temporal trends. RESULTS: The results showed that the Cronbach’s α for basic sciences and internal medicine presented lower values, whereas gynecology, obstetrics, and public health presented higher values. After changes in the number of items and the exclusion of basic sciences as a separate content area, internal medicine ranked highest in 2023. Individually, all content areas except pediatrics remained stable over time. CONCLUSIONS: Maintaining an equitable division in assessment content may lead to suboptimal results in terms of assessment reliability, especially for internal medicine. Therefore, content sampling of medical knowledge for general assessments should be reappraised.

Background: Studies evaluating physical activity (PA) levels in individuals with Chagas disease (CD) are still scarce. The present study aimed to evaluate PA levels in CD individuals and examine their association with Chagas heart disease (ChHD). Methods: We included patients with CD regularly followed in a reference center for treatment of infectious diseases. PA levels were assessed using the short version of the International Physical Activity Questionnaire (IPAQ). ChHD was determined following the Brazilian Consensus on Chagas Disease. The association between ChHD and levels of PA (total, walking, moderate, and vigorous) as a continuous variable was fitted using generalized linear models. Logistic regression models were fitted to evaluate the association between ChHD and meeting WHO’s PA recommendations. Results: Among the 361 participants included in the analysis (60.7 ± 10.7 years; 56.2 % women), 58.1 % (n = 210) complied with the WHO’s PA recommendations. After adjustments for potential confounders, regression analyses revealed that ChHD without heart failure was significantly associated with reduced vigorous PA (Exp β 0.32 95 % CI 0.10 to 0.98). ChHD with heart failure had significantly lower levels of total (Exp β 0.61 95 % CI 0.44 to 0.84) and moderate (Exp β 0.59 95 % CI 0.39 to 0.89) PA. ChHD with heart failure had a lower odd of meeting the PA recommendation in comparison to those with no cardiac involvement (OR 0.48 95 % CI 0.24 to 0.97). Conclusions: We found low levels of PA among individuals with CD. Presence of ChHD (mainly with HF) was associated with decreased levels of PA.

Ocean surface pCO2 estimates are of great interest for the calculation of air–sea CO2 fluxes, oceanic uptake of anthropogenic CO2, and eventually the Global Carbon Budget. They are accessible from direct observations, which are discrete in space and time and thus always sparse, or from biogeochemical models, which only approximate reality. Here, a combined method for the extrapolation of pCO2 observations is presented that uses (1) model-based patterns of variability from an empirical orthogonal function (EOF) analysis of variability with (2) observational data to constrain EOF pattern amplitudes in (3) an ensemble approach, which locally adjusts the spatial scale of the mapping to the density of the observations. Thus, data-constrained, gap- and discontinuity-free mapped fields including local error estimates are obtained without the need for or dependence on ancillary data (e.g. satellite sea surface temperature maps). This extrapolation approach is generic in that it can be applied to any oceanic or coastal region covered by a suitable model and observations. It is used here to establish a regional pCO2 climatology of the Baltic Sea (Bittig et al., 2023: https://doi.org/10.1594/PANGAEA.961119), largely based on ICOS-DE ship of opportunity (SOOP) Finnmaid surface pCO2 observations between Lübeck-Travemünde (Germany) and Helsinki (Finland). The climatology can serve as improved input for atmosphere–ocean CO2 flux estimation in this coastal environment.

Wireless communications with greater transmission capacities are possible in the millimeter wave (mmWave) region. However, to overcome the significant propagation losses in this frequency band, it is necessary to employ more efficient and intelligent antennas based on MIMO and beam-steering phased array technologies. This paper demonstrates the fabrication of a beam steerable array antenna using a $4\times 4$ Butler matrix at 60 GHz employing the metallic nanowire membrane (MnM) substrate. This substrate has the advantage of interconnecting two metallization layers by vias fabricated through its nanopores. Experimental characterization of the fabricated samples shows that the MnM platform represents a high-potential candidate for millimeter-wave front-ends supporting the beam-steering technique.

Abstract Objective Pregnancy after bariatric surgery is a reality of the 21st century and therefore is essential that all obstetricians know how to manage it. The most prevalent nutritional deficiency is iron deficiency and, consequently, anemia. Although bariatric surgery and pregnancy are already risk factors for anemia, we evaluated in our study if there were any other risk factors and actions to improve hemoglobin levels in this population. Methods We performed a retrospective cohort study, and performed frequency measurements and analyzes of odds ratio, X2 and Fisher exact test to evaluate the risk factors. Results We evaluated 44 pregnancies after bariatric surgery, with an incidence of anemia of 62%, and the only identifiable risk factor for anemia was being black. As for the treatment, the iron salt used for oral supplementation did not associate with anemia risk, and in 27% of the patients, the adjustment of the oral dosage was enough for improvement in hemoglobin levels, but in 36% supplementation with intravenous iron was necessary. Conclusion Being black is a risk factor for anemia. The type of iron salt does not correlate with the incidence of anemia, and for the treatment and improvement of iron dosages, it seems an effective increase in iron intake.

ABSTRACT Objective This study aimed to evaluate the prevalence of hypertensive disorders during pregnancy among Brazilian women with preterm births and to compare the epidemiological characteristics and perinatal outcomes among preterm births of women with and without hypertension. Methods This was a secondary cross-sectional analysis of the Brazilian Multicenter Study on Preterm Birth. During the study period, all women with preterm births were included and further split into two groups according to the occurrence of any hypertensive disorder during pregnancy. Prevalence ratios were calculated for each variable. Maternal characteristics, prenatal care, and gestational and perinatal outcomes were compared between the two groups using χ2 and t-tests. Results A total of 4,150 women with preterm births were included, and 1,169 (28.2%) were identified as having hypertensive disorders. Advanced maternal age (prevalence ratio (PR) 2.49) and obesity (PR= 2.64) were more common in the hypertensive group. The gestational outcomes were worse in women with hypertension. Early preterm births were also more frequent in women with hypertension. Conclusion Hypertensive disorders of pregnancy were frequent among women with preterm births, and provider-initiated preterm births were the leading causes of premature births in this group. The factors significantly associated with hypertensive disorders among women with preterm births were obesity, excessive weight gain, and higher maternal age.

Background: Stereotactic radiosurgery (SRS) has recently gained space as an accepted non-invasive alternative treatment option for drug resistant Glossopharyngeal neuralgia (GPN). The purpose of this systematic review was to provide an overview of the outcomes of SRS treatment in patients with GPN. Methods: A literature review until March 2023 was performed. Data about patient's demographics, complications and recurrence rates, additional treatment post procedure as well as pain outcomes in the short and long term were collected. Studies without reported pain outcomes were excluded. Results: Sixteen studies with a total of 97 patients diagnosed with GPN who had undergone SRS were identified. The mean reported maximal radiation dose ranged from 70 to 88.7 Gy with the glossopharyngeal meatus (GPM) being the most common target in 12/16 studies. The median time from SRS till pain response was between 2 and 120 days. The mean proportion of patients requiring further treatment after SRS ranged from 11.1 to 57.14% in a time frame between 2 and 36 months post procedure. Favourable pain response rates after SRS (BNI-IIIb) ranged from 60% to 100% and 57.1%–100% in short and long term respectively. Conclusion: SRS for GPN remains a safe alternative to surgery with low complication rates and favourable pain outcomes in both short and long term.

Purpose – Agile methods are increasingly being applied in the contexts of innovation beyond traditional information technology (IT) and physical product development projects, such as when process improvements are being implemented. Nevertheless, this phenomenon is still recent and little addressed in the literature, with few descriptions of empirical cases. This study aims to address this gap. Design/methodology/approach – This multiple case study aims to present and discuss the application of Agile practices embedded in large companies’ innovation value chains, focusing on improvements of business processes. The following research question is pursued: How are large companies applying elements of Agile methods to their innovation processes when implementing incremental improvements in their operational processes? Based on the idea that the Agile-Stage-Gate model is an alternative to this challenge, this study investigates the application of this hybrid model in two large Brazilian companies by presenting their idiosyncrasies, lessons learned, adaptations, challenges and benefits. Findings – Overall, it was observed that the experience with the application of the Agile-Stage-Gate model is positive for these companies, with better customer engagement, easier project control and increased productivity of the project team. Originality/value – For those aiming to implement the Agile-Stage-Gate model, this paper identifies the main adaptations made in order to combine the purist approaches and critical success factors for its implementation.

Abstract Objective Evaluate the different perspectives that involve the choice of long-acting reversible contraceptives (LARCs), the issues related to this process and the consequences of deciding one method in the women's in the primary health care (PHC) center in Sousas, a district in Campinas, SP (Brazil). Methods This is an analytical cross-sectional study, it was performed at the PHC in Sousas. Data were collected through the analysis of medical records and interviews with women who live in Sousas and had the insertion of the copper intrauterine device (IUD) (D) from April 2021 to April 2022 or the etonogestrel implant (I) from May to December 2022. The study was approved by the Research Ethics Committee of the Medical Science School at the State University of Campinas (UNICAMP). Results Reason for choosing this LARC: medical (D: 52%; I: 100%), easy adhesion (D: 71%; I: 67%), effectiveness (D: 55%; I: 100%). Indication by health professionals (D: 65%; I: 100%). And improvement of clinical characteristics: mood (D: 77%; I: 67%), body mass index (BMI; D: 52%; I: 33%), and libido (D: 84%; I: 67%). Conclusion It is suggested that women tend to decide between LARCs when guided by their doctor or PHC health professionals, and they select LARCs because of the ease of use and low failure rates. Therefore, this study highlights how LARCs can positively interfere in the aspects that pervade contraception, such as BMI, libido, and mood.

Abstract Increasing atmospheric CO2 drives ocean acidification globally. In coastal seas, acidification trends can however be either counteracted or enhanced by other processes. Ecosystem effects of acidification are so far small in the Baltic Sea, but changes should be anticipated unless CO2 emissions are curbed. Possible future acidification trends in the Baltic Sea, conditional on CO2 emissions, climate change, and changes in productivity, can be assessed by means of model simulations. There are uncertainties regarding potential consequences for marine organisms, partly because of difficulties to assign critical thresholds, but also because of knowledge gaps regarding species’ capacity to adapt. Increased temporal and spatial monitoring of inorganic carbon system parameters would allow a better understanding of current acidification trends and also improve the capacity to predict possible future changes. An additional benefit is that such measurements also provide quantitative estimates of productivity. The technology required for precise measurements of the inorganic carbon system is readily available today. Regularly updated status evaluations of acidification, and the inorganic carbon system in general, would support management when assessing climate change effects, eutrophication or characteristics of the pelagic habitats. This would, however, have to be based on a spatially and temporally sufficient monitoring program.