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Poorly controlled acute pain is associated with worsened patient outcomes. Prior studies suggest that acute pain is a common complaint among hospitalized pediatric patients, but recent studies with substantial numbers of patients from US hospitals are lacking. We retrospectively reviewed inpatients at a single academic children's hospital during twelve 24-hour periods in 2021. Outcomes were assessed for patients on non–intensive care unit (ICU) inpatient floors and in ICUs. The primary outcome was any presence of moderate to severe pain. Of 1355 patients on a non-ICU inpatient floor and 485 patients in the ICU, 23.5% and 58.6%, respectively, had ≥1 moderate to severe pain score during the 24-hour analysis period. While the mean pain score was low for the majority of patients, moderate to severe pain is frequent in hospitalized children. Future studies may focus on identification of variables associated with pediatric inpatients at risk of moderate to severe pain as well as improved pain prevention and reduction strategies. [ABSTRACT FROM AUTHOR]

In early childhood, the curricular integration of computational thinking, programming, and robotics topics is ever more pressing. Therefore, preparing teachers and educators to implement this integration in the curriculum is fundamental. In the project «Laboratory of Technologies and Learning of Programming and Robotics in basic and preschool education in Portugal», the proposal of a MOOC was designed to meet this demand. This paper discusses aspects of the architecture of MOOCs, and their typologies, in the context of the challenges that the researchers encountered in the design process of the present MOOC. To do so, the Interaction Equivalency Theorem was considered, which equates the fundamental types of interaction to be considered in course design (learner-instructor; learner-content; learner-learner). Considering that learning design is both a process and a product the design of the MOOC is analysed in terms of its socio-technical context and systemic tensions present in work-based learning. Through a qualitative analysis of an individual interview and of a focus group, the paper describes formal and informal interactions and attempts to define a common vision, consensus, and divergences and contradictions that are part of the learning design process. Finally, the MOOC is presented, and its pedagogical design is substantiated. [ABSTRACT FROM AUTHOR]

The contemporary scenario of large migratory flows reveals world sociocultural, economic and political issues, reflecting on the recognition of the human rights for refugees in search of better living conditions and protection in other states. In this sense, we seek to demonstrate the need for Brazil, as a signatory of international pacts, implementing public policies to guarantee fundamental immigrants' rights. [ABSTRACT FROM AUTHOR]

A personal narrative is presented which explores the author's experience of possessing a metallic sculpture called "Knotty-head" in New York City.

The article presents the author's personal narrative which explores the kind of recognition rendered by the art world to her African American father as an artist and admirer of his mentor, artist Romare Bearden.

Schizolobium parahyba chymotrypsin inhibitor (SPCI) was completely purified as a single polypeptide chain with two disulfide bonds, by TCA precipitation and ion exchange chromatography. This purification method is faster and more efficient than that previously reported: SPCI is stable from pH 2 to 12 at 25 °C, and is highly specific for chymotrypsin at pH 7–12. It weakly inhibits elastase and has no significant inhibitory effect against trypsin and α-amylase. SPCI is a thermostable protein and resists thermolysin digestion up to 70 °C. [Copyright &y& Elsevier]

A mixture of bran cereals, cassava leaf and eggshell powder has been used as an alternative diet supplement to fight malnutrition in low-income communities in Brazil. Due to the high phytic acid content there are some concerns about the bioavailability of nutrients in this mixture (MM). This study investigated the effect of dietary concentrations of protein and NaCl on the bioavailability of MM calcium and phosphorus. Undernourished rats were given deficient diet supplemented with MM, with or without the addition of protein and NaCl. Calcium and phosphorus were found to be bioavailable, since rats fed MM supplemented diet showed higher femur calcium and phosphorus contents than did deficient rats (P < 0.001). Increased dietary protein did not provide for any additional weight gain, while added NaCl did (P < 0.001). Dietary protein had a positive effect on the metabolism of calcium and phosphorus while NaCl favored diet acceptability. [Copyright &y& Elsevier]

Purpose: Twenty percent of children may develop chronic post-surgical pain (CPSP), but studies investigating pediatric CPSP are limited in scope. In an exploratory patient survey, we sought to assess CPSP prevalence among children of all ages, across a wide range of surgeries, and over an extended period of time after surgery. Methods: We conducted a survey study, including patients < 19 years of age at the time of their surgery at a single-center, quaternary care academic pediatric hospital. Pediatric patients who underwent surgery from May 2014 to August 2019 were included. Via electronic survey, patients/caregivers were asked whether the child had any pain related to their last surgery at the pediatric hospital. Patients/caregivers who answered yes were asked 11 additional questions about the child's pain and pain-related quality of life. The primary outcome was CPSP prevalence; secondary outcomes were pain scores, quality-of-life scores, and the associations of CPSP with time since surgery, preoperative pain, and patient age. Results: The response rate of completed surveys was 4.0%. 30% of respondents reported CPSP; the median pain score was 4.0 on an 11 point scale (0 to 10). Responses to quality of life questions indicated CPSP negatively impacted many children's lives. Preoperative pain was associated with an odds ratio for CPSP of 1.09 [95% confidence interval (CI): 0.58, 2.04], each year after surgery with an odds ratio of 0.94 (95% CI 0.80, 1.10), and each year of age at surgery with an odds ratio of 1.07 (95% CI 1.02, 1.12). Conclusion: While limited by a low response rate, results from this exploratory survey suggest that CPSP is a considerable problem for children who undergo surgery across many specialties, with marked effects on patient well-being even years after surgery. [ABSTRACT FROM AUTHOR]

There is growing evidence to support the perioperative use of nonopioid analgesic medications in the pediatric population,1 but the use of, and attitude toward, these agents among pediatric anesthesiologists is unknown. The most commonly utilized agents included acetaminophen, NSAIDs, dexmedetomidine, dexamethasone, and ketamine. We additionally observed that anesthesiologists who had undergone additional pain or regional anesthesia training utilized some agents at increased frequency, suggesting that general pediatric anesthesiologists are not utilizing nonopioid analgesics at every opportunity. [Extracted from the article]

Background: Children undergoing cleft palate repair present challenges to postoperative management due to several factors that can complicate recovery. Utilization of multimodal analgesic protocols can improve outcomes in this population. We report experience designing and implementing an enhanced recovery after surgery (ERAS) pathway for cleft palate repair to optimize postoperative recovery. Aims: The primary aim was to implement an ERAS pathway with >70% bundle adherence to achieve a 30% reduction in postoperative opioid consumption within 12 months. Our secondary aims assessed intraoperative opioid consumption, length of stay, timeliness of oral intake, and respiratory recovery. Methods: A multidisciplinary team of perioperative providers developed an ERAS pathway for cleft palate patients. Key drivers included patient and provider education, formal pathway creation and implementation, multimodal pain therapy, and target‐based care. Interventions included maxillary nerve blockade and enhanced intra‐ and postoperative medication regimens. Outcomes were displayed as statistical process control charts. Results: Pathway compliance was 77.0%. Patients during the intervention period (n = 39) experienced a 49% reduction in postoperative opioid consumption (p <.0001) relative to our historical cohort (n = 63), with a mean difference of −0.33 ± 0.11 mg/kg (95% CI −0.55 to −0.12 mg/kg). Intraoperative opioid consumption was reduced by 36% (p =.002), with a mean difference of −0.27 ± 0.09 mg/kg (95% CI −0.45 to −0.09 mg/kg). Additionally, patients in the intervention group had a 45% reduction in time to first oral intake (p =.02) relative to our historical cohort, with a mean difference of −3.81 ± 1.56 h (95% CI −6.9 to −0.70). There was no difference in PACU or hospital length of stay, but there was a significant reduction in variance of all secondary outcomes. Conclusion: Opioid reduction and improved timeliness of oral intake is possible with an ERAS protocol for cleft palate repair, but our protocol did not alter PACU or hospital length of stay. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate depression and its relationship with functional capacity in the elderly living in long-stay institutions for the Elderly (ILPIs) of Maceió / AL. This was a correlative and comparative study among the participants, which consider the variables: criterion (depression) and background (functional capacity and indicators). 103 seniors attended eight ILPIs, 48 (46.6%) men and 55 (53.4%) women aged 60 up to 101 years (M = 76.2, SD = 10.1). Participants answered questions about: (1) Geriatric Depression Scale Yesavage, long version, (2) and Katz Index; (3) socio-demographic questionnaire. There were r Pearson correlation analysis and linear regression. It was found that 65% of the elderly had depressive symptoms and 56.4% had dependency related to functional capacity, with greater decline in women. It refers also that functional capacity was presented as a predictor of depressive symptoms and revealed a high incidence of these, in addition to functional disability in institutionalized elderly, pointing functional limitations as an indicator of depressive symptoms in these. We emphasize the importance of early detection of depression and the need for prevention of worsening of their symptoms. [ABSTRACT FROM AUTHOR]

About sixty thousand new cases of Hepatitis C virus (HCV) infection are recorded in Brazil each year. These cases are currently treated with pegylated interferon (PEG-IFN) and ribavirin (RBV) with an overall success rate of 50%. New compounds for anti-HCV therapy targeted to the HCV NS3 protease are being developed and some already form the components of licensed therapies. Mapping NS3 protease resistance mutations to protease inhibitors or anti-viral drug candidates is important to direct anti-HCV drug treatment. Methods: Sequence analysis of the HCV NS3 protease was conducted in a group of 68 chronically infected patients harboring the HCV genotype 1. The patients were sampled before, during and after a course of PEG-IFN-RBV treatment. Results: Resistance mutations to the protease inhibitors, Boceprevir and Telaprevir were identified in HCV isolated from three patients (4.4%); the viral sequences contained at least one of the following mutations: V36L, T54S and V55A. In one sustained virological responder, the T54S mutation appeared during the course of PEG-IFN and RBV therapy. In contrast, V36L and V55A mutations were identified in virus isolated from one relapsing patient before, during, and after treatment, whereas the T54S mutation was identified in virus isolated from one non-responding patient, before and during the treatment course. Conclusions: The incidence and persistence of protease resistance mutations occurring in HCV from chronically infected patients in Brazil should be considered when using protease inhibitors to treat HCV disease. In addition, patients treated with the current therapy (PEG-IFN and RBV) that are relapsing or are non-responders should be considered candidates for protease inhibitor therapy. [ABSTRACT FROM AUTHOR]

Abstract: In this Letter, we report scanning force microscopy images with sufficient lateral resolution to microscopically identify the distinct ice-like structures on mica at finite humidity. The pattern calculated by Odelius et al. (1997) for bilayers, e.g. a 2D ice-like structure that coincides with the unit cell of mica, was observed at molecular clusters edges and an ice-like with a hexagonal structure at its center. Other regions showing structures with a periodicity of 0.76±0.07nm, possibly associated with a rhombohedral structure, and 0.63±0.06nm a cubic structure, may be described as regions with compactly bonded intermixed structures. [Copyright &y& Elsevier]

Background: Vascular access is a minor procedure that is associated with reported pain and fear in pediatric patients, often resulting in procedural incompliance. Virtual reality has been shown to be effective in adult populations for reducing pain and anxiety in various medical settings, although large studies are lacking in pediatrics. Aims: The primary aim was to determine whether pain would be reduced in pediatric patients using virtual reality undergoing vascular access. The four secondary aims measured patient fear, procedural compliance, satisfaction, and adverse events. Methods: A prospective, randomized, controlled trial was completed at a pediatric hospital, enrolling children 7‐18 years old undergoing vascular access in a variety of clinical settings, randomized to virtual reality or standard of care. Pain scores were measured using a numeric pain faces scale. The secondary outcomes of patient fear, procedural compliance, satisfaction, and adverse events were measured with the Child Fear Scale, modified Induction Compliance Checklist, and satisfaction surveys, respectively. Chi‐squared, t tests, and regression models were used to analyze the results. Results: The analysis included 106 patients in the virtual reality group and 114 in the control. There were no significant differences in postprocedure pain (VR group estimated 0.11 points lower, 95% confidence interval: 0.50 points lower to 0.28 points greater, P =.59), postprocedure fear (VR group estimated 0.05 points lower, 95% confidence interval: 0.23 points lower to 0.13 points greater), or compliance (adjusted odds ratio 2.31, 95% confidence interval: 0.96‐5.56). Children in the virtual reality group were satisfied with the intervention. There were no adverse events. Conclusion: This study demonstrates no reduction in pain while using Virtual reality (VR) across a heterogeneous pediatric inpatient population undergoing vascular access. [ABSTRACT FROM AUTHOR]

Abstract: The bioavailability of β-carotene from cassava (Manihot esculenta Crantz) leaves was assayed in vitamin A deficient Wistar rats (Rattus norvegicus). Rats were separated into three groups and fed with a modified AIN-93G – vitamin A deficient – diet. Deficient rat received this diet without any additional vitamin A source. Controls received the diet with 7200 μg of synthetic β-carotene (control), while experimentals (test) received 19.5 g of cassava leaves powder per kg of diet. The cassava leaves with β-carotene promotes similar growth and tissue weight in rats to the synthetic β-carotene. The relative bioavailability, estimated as the Retinol Accumulation Factor (RAF), was 16.5 and 27.5 for control and test groups, respectively, indicating that control and test rats should have an intake of 16.5 μg or 27.5 μg of β-carotene from synthetic form or cassava leaves powder for each 1 μg of hepatic retinol stored, respectively. The cassava leaves β-carotene bioavailability was lower than the synthetic β-carotene probably because the β-carotene from the leaf matrix may be bounded to protein complex or inside organelles, which impair carotenoid absorption. Our findings showed that beside the hepatic retinol recovery, cassava leaf β-carotene could maintain rat growth and avoid vitamin A deficient symptoms. [Copyright &y& Elsevier]

One of the major dietary sources of vitamin A in the human diet is provitamin A carotenoids. However, the activity of these carotenoids as a vitamin A source is uncertain due to concerns about the bioavailability of the carotenoids from vegetables. This study evaluated the bioavailability of provitamin A carotenoids from native Brazilian dark-green vegetables. Vitamin A–depleted rats were fed a basal diet (AIN-93G) in which the synthetic vitamin A content was replaced by non conventional leaves. At the end of the 30 day-repletion period, 1 μg of retinol accumulated in the liver after the intake of 43.1, 95.3 or 178.9 μg β-carotene from Sonchus oleraceus (So), Amaranthus viridis (Av) and Xanthosoma sagittifolium (Xs) leaves, respectively. The relative bioavailability of β-carotene from the leaves was 36 %, 16%, and 9% for So, Av, and Xs leaf, respectively. The results showed that the carotenoids from the three dark-green leaves were absorbed, converted to retinol, and stored in the liver of rats. Because they are pest-resistant and widely distributed vegetables, they may be an inexpensive alternative source of vitamin A to reduce vitamin A deficiency. [Copyright &y& Elsevier]

In this work, tip sliding at the water/substrate interfacial region was used to investigate the pattern observed during image acquisition with atomic resolution in atomic force microscopy. The process responsible for the pattern formation is the oscillatory movement of the tip in the direction that is normal to scanning induced by a change in the water interfacial dielectric permittivity from [variant_greek_epsilon]≈4 at the interface to [variant_greek_epsilon]≈80 (bulk value) that results in a variation of the measured force acting on the tip of ≈30 pN. [ABSTRACT FROM AUTHOR]