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Objective: this paper aims to describe the first phase of a project whose general goal was to develop a consensus-based set of advanced practice nurse competencies applicable to Latin American countries and, based on these competencies, produce an advanced practice nurse curricular prototype adapted to Latin American countries. The project was framed in a competency-based approach to advanced practice nursing education. The specific aims of the first phase of the project described in this paper were: 1) to identify a set of potential advanced practice nurse competencies that would serve as the template for Core Advanced Practice Nurse Competencies in Latin American countries and 2) to establish consensus for Core Advanced Practice Nurse Competencies in Latin American countries. Method: advanced practice nurse competencies were derived from a comprehensive review of published competencies and informed the development of a survey designed to assess the relevance of advanced practice nurse competencies in Latin American countries. The survey was distributed to nurse leaders and nurse educators. Data were analyzed using descriptive statistics. Results: consensus for Core Competencies was established. Conclusion: the Core Advanced Practice Nurse Competencies presented can provide a structured framework to build educational programs aligned to the needs of the regional environment. [ABSTRACT FROM AUTHOR]

Introduction: Plant-based meats (PBM) are an emerging set of food technologies that could reduce the environmental impacts of food systems by mitigating consumer demand for animal products. However, scaling up the production and consumption of plant-based meats requires overcoming multiple technological, regulatory, political, and market barriers. An evidence-based prioritization of needs and actions may help actors (e.g., investors, funders, policymakers) who wish to help scale PBM achieve desired outcomes with limited resources. Research question: What actions could most effectively help to scale up the production and/or consumption of plant-based meat in Brazil? Methods: We selected Brazil as a case study of a country with a significant animal agriculture sector and a burgeoning PBM sector. We constructed a panel of nine experts and employed the Delphi technique during two rounds of an online survey to iteratively assess the degree of consensus and disagreement around the relative priority of 14 possible actions (identified from relevant literature) that could help to scale up the production and/or consumption of PBM in Brazil. We used the Importance, Neglect, and Tractability framework. Results: The panelists collectively concluded that the top priority action for scaling up both the production and the consumption of plant-based meat in Brazil was to reduce the price of products for consumers. For most priority actions, there was greater consensus among panelists in the second round of the survey. Discussion: Our findings contribute to an improved understanding of (a) which actions may be of highest priority for investors, funders, and policymakers, (b) synergies and differences between priority actions to scale up the production versus consumption of PBM in Brazil, (c) the relative merits of focusing on scaling up PBM production versus consumption, and (d) the strengths and limitations of assessing expert opinion on alternative protein futures using the Delphi technique. [ABSTRACT FROM AUTHOR]

Background: Hidradenitis suppurativa (HS) is a chronic skin condition. Its complexity and impact on patients highlight the need for multidisciplinary care that can address the physical, psychological, and social aspects. Centers of excellence can ideally provide the necessary infrastructure, resources, and expertise to effectively treat HS. However, there are still no consolidated models of centers of excellence in HS, and establishing their foundations is an intricate research challenge. Purposely, design and co-creation as innovation techniques are helpful approaches to this type of research.Methods: In this study, we conducted a co-creation with consensus among HS specialists to propose the criteria and requirements to establish outpatient centers of excellence of HS in Brazil. We followed a linear process with mixed methods in 6 stages.Results: The process resulted in 10 categories for establishing outpatient centers, including their respective requirements, rationale, and classification. The categories include onboarding and welcoming; infrastructure and procedures; infusion therapy; flows and referrals; staffing; disease management; metrics during diagnosis; metrics during treatment; awareness and advocacy; research and education.Discussion: The idealized outpatient centers can play a role in the complete multidisciplinary treatment for HS and advancing the science of healthcare services by providing a focus for research, training, and translation of findings into practice. [ABSTRACT FROM AUTHOR]

Background: Endometrial cancer is of increasing concern in several countries, including Brazil, in part because of an ageing population, declines in fertility, and the increasing prevalence of obesity. Although endometrial tumors had lagged behind other cancer types in terms of treatment improvements, molecular characterization of these tumors is paving the way for novel therapies and an expansion of the therapeutic arsenal. We aimed to help medical oncologists who manage patients with recurrent or metastatic endometrial cancer in the Brazilian healthcare setting. Methods: The panel, composed of 20 medical oncologists, convened in November 2021 to address 50 multiple-choice questions on molecular testing and treatment choices. We classified the level of agreement among panelists as (1) consensus (=75% choosing the same answer), (2) majority vote (50% to <75%), or (3) less than majority vote (<50%). Results: Consensus was present for 25 of the 50 questions, whereas majority vote was present for an additional 23 questions. Key recommendations include molecular testing for every patient with recurrent/metastatic endometrial cancer; choice of first-line treatment according to microsatellite instability and HER2, with the addition of programmed death ligand 1 (PD-L1) and hormone receptors (HRs) for second-line therapy; carboplatin and paclitaxel as the preferred option in first-line treatment of HER2-negative disease, with the addition of trastuzumab in HER2-positive disease; pembrolizumab plus lenvatinib as a key option in second line, regardless of HER2, PD-L1 or HRs; and various recommendations regarding treatment choice for patients with distinct comorbidities. Conclusion: Despite the existing gaps in the current literature, the vast majority of issues addressed by the panel provided a level of agreement sufficient to inform clinical practice in Brazil and in other countries with similar healthcare environments. [ABSTRACT FROM AUTHOR]

This study, holding as background the conflicts that involve the environment, analyzes the fraternity principle, from the perspective of the theory proposed by Baggio, concluding that the official pattern of environmental litigations composition that exist in Brazil --solidified by the obsolete monopoly of Judiciary-- consolidated on a Law's positivism and on a competitive point of view of the society, does not contemplates the fraternity as a legal value. In other hands, the paper starts to focus the mediation, making clear that this alternative way of contest's solution not only disposes with justness to the environmental conflicted issue but --remarkably by its communicative characteristic acting and shared true-- deeply excited by the fraternity idea. The subject has been researched in the specialized literature, making sure about the precarious systematization of the mediation as management way of environmental conflicts, as well as a lack on the approach of the fraternity as juridical category of potential incidence at the environmental field. In the end, the analysis concludes that the eco mediation may appease the insertion of the fraternity component on arguing related to environmental estates, generally ruled by the radicalization and a vision of world's representationalism, contributing perhaps to the co-operation construction of a new paradigmatical systemic epistemology for conflicts solutions, that insures the emphasized roll to fraternal as imperative of conduct. [ABSTRACT FROM AUTHOR]

Background: Human-animal interactions with mutual benefits in the wild are rare. Such positive interactions seem to require an intricate knowledge from the human side on the animals' behavior and their habitat. In southern Brazil, dolphins and human net-casting fishers have specialized in a cooperative foraging, in which fishers report being able to identify and name dolphins. Here, we evaluate the consensus in their ability to recognize the individual dolphins they interact with. By investigating the reliability of this recognition process, we assess the pros and cons of relying on the fishers' traditional knowledge to further understand the behavior and ecology of dolphins at the individual level. We also assess the potential role of traditional knowledge for the maintenance of this unusual interaction. Methods: We interviewed 38 fishers using a semi-structured questionnaire. During each interview, we evaluate their recognition ability of dolphins by showing high-quality photos of dorsal fins of different dolphins, asking questions about the dolphins' behavior and traits, and about how fishers recognize each dolphin. We also evaluated information about the fishers. Different indices were used to measure the fishers' ability to recognize dolphins via photos, and their consensus on individual identification. These indices were modeled as functions of traits of both dolphins and fishers to investigate which ones influence the recognition process. Results: We found that fishers can primarily recognize dolphins by natural marks in the dorsal fin but there was little consensus in recognition. Fishers also tend to repeat the name of the most "popular" dolphins for different photos, indicating low reliability in individual recognition. We also found that fishers who learned from relatives (vertical learning) how to interact with dolphins tend to be more accurate and have higher consensus in dolphin recognition than those fishers who learned from friends (horizontal learning) or individually. Conclusion: Artisanal fishers have a deep understanding of the dolphins and the system they are inserted in. However, the lack of consensus in identifying individual dolphins herein reported indicates that using their traditional knowledge to further understand dolphin behavior and ecology at the individual level requires caution. Our study also suggests that the transmission of this tradition from parents to sons can be crucial to preserve such a unique human-animal positive interaction in its original form. [ABSTRACT FROM AUTHOR]

Surgical management in epithelial ovarian cancer (EOC) has a significant impact in overall survival and progression-free survival. The Brazilian Society of Surgical Oncology (BSSO) supported a taskforce of experts to reach a consensus: experienced and specialised trained surgeons, in cancer centres, provide the best EOC surgery. Laparoscopic and/or radiological staging prognosticates the possibility of complete cytoreduction (CC0) and helps to reduce unnecessary laparotomies. Surgical techniques were reviewed. Multidisciplinary input is essential for treatment planning. Quality assurance criteria are proposed and require national consensus. Genetic testing is mandatory. This consensus states the final recommendations from BSSO for management of EOC.Tweetable Abstract: Brazilian Society of Surgical Oncology consensus for surgery in epithelial ovarian cancer patients. [ABSTRACT FROM AUTHOR]