Search

Introduction and objectives: Catheter ablation (CA) is effective in the treatment of ventricular tachycardia (VT). Although some observational data suggest patients with non-ischemic cardiomyopathy (NICM) have less favorable outcomes when compared to those with an ischemic etiology (ICM), direct comparisons are rarely reported. We aimed to compare the outcomes of VT ablation in a propensity-score matched population of ICM or NICM patients. Methods: Single-center retrospective study of consecutive patients undergoing VT ablation from 2012 to 2023. A propensity score (PS) was used to match ICM and NICM patients in a 1:1 fashion according to age, sex, left ventricular ejection fraction (LVEF), NYHA class, electrical storm (ES) at presentation, and previous endocardial ablation. The outcomes of interest were VT-free survival and all-cause mortality. Results: The PS yielded two groups of 71 patients each (mean age 63±10 years, 92% male, mean LVEF 35±10%, 36% with ES at presentation, and 23% with previous ablation), well matched for baseline characteristics. During a median follow-up of 2.3 (interquartile range IQR 1.3–3.8) years, patients with NICM had a significantly lower VT-free survival (53.5% vs. 69.0%, log-rank p=0.037), although there were no differences regarding all-cause mortality (22.5% vs. 16.9%, log-rank p=0.245). Multivariate analysis identified NICM (HR 2.34 [95% CI 1.32–4.14], p=0.004), NYHA class III/IV (HR 2.11 [95% CI 1.11–4.04], p=0.024), and chronic kidney disease (HR 2.23 [95% CI 1.25–3.96], p=0.006), as independent predictors of VT recurrence. Conclusion: Non-ischemic cardiomyopathy patients were at increased risk of VT recurrence after ablation, although long-term mortality did not differ. Resumo: Introdução e objetivos: A ablação por cateter (CA) é eficaz no tratamento da taquicardia ventricular (TV). Embora dados observacionais sugiram que doentes com miocardiopatia não isquémica (NICM) apresentem piores resultados do que aqueles com etiologia isquémica (ICM), comparações diretas são escassamente reportadas. O objetivo foi comparar os resultados da ablação de TV numa população propensity-matched de doentes com NICM ou ICM. Métodos: Estudo retrospetivo unicêntrico de doentes submetidos ablação de TV, de 2012 a 2023. Usado propensity-score (PS) para emparelhar doentes com NICM e ICM numa proporção 1:1 de acordo com idade, sexo, fração de ejeção ventricular esquerda (FEVE), classe de NYHA, tempestade arrítmica à admissão e ablação endocárdica prévia. Os outcomes de interesse foram sobrevida livre de TV e morte por todas as causas. Resultados: O PS resultou em dois grupos de 71 doentes (idade 63 ± 10 anos, 93% do sexo masculino, FEVE 35 ± 10%, 36% com apresentação em tempestade arrítmica e 23% com ablação prévia). Durante um follow-up de 2,3 (1,3–3,8) anos, os doentes com NICM apresentaram menor sobrevida livre de TV (53,5% versus 69,0%, P log-rank = 0,037), apesar de não haver diferenças significativas em relação à mortalidade (22,5% versus 16,9%, P log-rank = 0,245). A análise multivariada identificou NICM (HR 2,34 [IC 95% 1,32–4,14], P = 0,004), NYHA III ou IV (HR 2,11 [IC 95% 1,11–4,04], P = 0,024) e doença renal crónica (HR 2,23 [IC 95% 1,25–3,96], P = 0,006) como preditores independentes de recidiva de TV. Conclusão: Doentes com NICM apresentam maior risco de recidiva de TV, apesar de não haver diferenças significativas na mortalidade a longo prazo.

Abstract Anticoagulation therapy has undergone significant evolution, marked by the emergence of direct oral anticoagulants with distinct advantages. Despite these advancements, challenges persist in managing residual thrombotic and bleeding risks, particularly among vulnerable populations. The pursuit of alternative drugs has honed in on factor XI/XIa inhibitors. This comprehensive review delves into several key aspects regarding this new target: (i) the role of factor XI in the coagulation cascade; (ii) the genetic evidence and pathophysiologic rationale supporting factor XI inhibition as a therapeutic target; (iii) an exploration of the various types of factor XI/XIa inhibitors currently under investigation; (iv) potential applications of these medications, spanning thromboprophylaxis after orthopedic surgery, stroke prevention in atrial fibrillation, secondary prevention after acute coronary syndrome, non-cardioembolic stroke, thromboprophylaxis after foreign material implantation, end-stage renal disease, and patients with cancer; and (v) an overview of ongoing studies, recent findings, and the future trajectory of research into these drugs.

Introduction and objectives: Current epidemiological data on heart failure (HF) in Portugal derives from studies conducted two decades ago. The main aim of this study is to determine HF prevalence in the Portuguese population. Using current standards, this manuscript aims to describe the methodology and research protocol applied. Methods: The Portuguese Heart Failure Prevalence Observational Study (PORTHOS) is a large, three-stage, population-based, nationwide, cross-sectional study. Community-dwelling citizens aged 50 years and older will be randomly selected via stratified multistage sampling. Eligible participants will be invited to attend a screening visit at a mobile clinic for HF symptom assessment, anthropomorphic assessment, N-terminal pro-B-type natriuretic peptide (NT-proBNP) testing, one-lead electrocardiogram (ECG) and a sociodemographic and health-related quality of life questionnaire (EQ-5D). All subjects with NT-proBNP ≥125 pg/mL or with a prior history of HF will undergo a diagnostic confirmatory assessment at the mobile clinic composed of a 12-lead ECG, comprehensive echocardiography, HF questionnaire (KCCQ) and blood sampling. To validate the screening procedure, a control group will undergo the same diagnostic assessment. Echocardiography results will be centrally validated, and HF diagnosis will be established according to the European Society of Cardiology HF guidelines. A random subsample of patients with an equivocal HF with preserved ejection fraction diagnosis based on the application of the Heart Failure Association preserved ejection fraction diagnostic algorithm will be invited to undergo an exercise echocardiography. Conclusions: Through the application of current standards, appropriate methodologies, and a strong research protocol, the PORTHOS study will determine the prevalence of HF in mainland Portugal and enable a comprehensive characterization of HF patients, leading to a better understanding of their clinical profile and health-related quality of life. Resumo: Introdução e objetivos: Os dados epidemiológicos atuais sobre insuficiência cardíaca (IC) em Portugal provêm de estudos realizados há mais de duas décadas. O objetivo principal deste estudo é determinar a prevalência da síndrome de IC na população portuguesa com 50 ou mais anos, sendo, especificamente, objetivo deste artigo descrever as abordagens metodológicas e o protocolo de investigação aplicados. Métodos: O Estudo de Prevalência de Insuficiência Cardíaca em Portugal (PORTHOS) é um estudo observacional transversal de grande dimensão, de base populacional, nacional, constituído por três fases. Serão selecionados aleatoriamente por amostragem estratificada multietapas cidadãos com 50 ou mais anos residentes na comunidade em Portugal. Os participantes elegíveis serão convidados a participar numa visita de triagem, que decorrerá numa clínica móvel, durante a qual serão submetidos a avaliação de sintomas de IC, avaliação antropomórfica, um teste de N-terminal pró-peptídeo natriurético tipo B (NT-proBNP), eletrocardiograma de 1 derivação, questionários sociodemográficos e questionário de qualidade de vida relacionada à saúde (EQ-5D). Todos os participantes com NT-proBNP ≥125 pg/mL ou história prévia de IC serão submetidos a uma avaliação diagnóstica confirmatória composta por eletrocardiograma de 12 derivações, ecocardiografia completa, questionário de IC (KCCQ) e colheita de sangue. Para validar o procedimento de triagem, um grupo controlo passará pela mesma avaliação diagnóstica. Os resultados dos ecocardiogramas realizados serão validados centralmente e o diagnóstico de IC será confirmado de acordo com as recomendações de IC da Sociedade Europeia de Cardiologia. Uma subamostra aleatória de participantes com diagnóstico questionável de IC com fração de ejeção preservada (ICFEp), após a aplicação do algoritmo de diagnóstico de fração de ejeção preservada da Heart Failure Association (HFA-PEFF) será convidada a realizar ecocardiografia de esforço. Conclusão: Através da aplicação das recomendações atuais e abordagens metodológicas adequadas, o estudo PORTHOS irá determinar a prevalência da IC em Portugal Continental e permitir uma caracterização abrangente dos doentes com IC, para melhor compreensão do seu perfil clínico e qualidade de vida relacionada com a saúde.

This text seeks to analyze the privatization guidelines both globally and at the local level and their deployment in public basic education in Brazil. For that, a bibliographic and documentary study was used, using only public domain. It is possible to diagnose the double movement of endo and exoprivatization carried out in the educational panorama of Brazil, especially through the insertion of large business groups, as well as the reforms undertaken to put into operation the privatization agenda of public basic education. It is observed that the insertion of the private sector into the spaces of human formation reverberate metamorphoses, including that of the social function of the school institution, since it incorporates a link with the business and financial logic and, consequently, will facilitate a loss of the public sense of education as a social right.

Objective: Venture capital has garnered global interest, attracting policymakers, investors, and entrepreneurs. However, its implementation in emerging nations, particularly in the challenging seed-stage segment, requires adaptive strategies from investors. This article investigates whether these adaptations lead to performance differences among various VC investor types. Methods: We examine the impact of different investor types on the performance of seed-stage ventures in Brazil, comparing our findings to existing literature on the United States. Analyzing investments in the Brazilian seed-stage VC market from 2000 to September 2022, we evaluate outcomes for ventures supported by IVCs, CVCs, Angels, and Accelerators. Results: The results reveal significant disparities in the performance of these entities in Brazil compared to the United States. Conclusions: We conclude that these differences likely stem from unique Brazilian market dynamics that have shaped investor profiles and operational approaches distinct from those in developed nations.

No dia 1º de abril de 1964, um golpe de Estado retirou João Goulart da presidência da República. O objetivo foi depor o presidente, mas não impor um regime autoritário. No entanto, nos oito dias seguintes, militares e diversas organizações da sociedade, a imprensa em particular, defenderam punições aos chamados “comunistas”. O resultado foi o Ato Institucional do dia 9 de abril, abrindo caminho para o estabelecimento da ditadura no país. Utilizando a imprensa como fonte privilegiada e recorrendo a uma abordagem microanalítica, a pesquisa aponta a conivência da imprensa, das instituições políticas e de diversas organizações sociais na construção do autoritarismo militar.

Proliferating cells need to cope with extensive cytoskeletal and nuclear remodeling as they prepare to divide. These events are tightly regulated by the nuclear translocation of the cyclin B1-CDK1 complex, that is partly dependent on nuclear tension. Standard experimental approaches do not allow the manipulation of forces acting on cells in a time-resolved manner. Here, we describe a protocol that enables dynamic mechanical manipulation of single cells with high spatial and temporal resolution and its application in the context of cell division. In addition, we also outline a method for the manipulation of substrate stiffness using polyacrylamide hydrogels. Finally, we describe a static cell confinement setup, which can be used to study the impact of prolonged mechanical stimulation in populations of cells.Key features• Protocol for microfabrication of confinement devices.• Single-cell dynamic confinement coupled with high-resolution microscopy.• Static cell confinement protocol that can be combined with super-resolution STED microscopy.• Analysis of the mechanical control of mitotic entry in a time-resolved manner.Graphical overview

Resumo Fundamento: As diretrizes da Sociedade Europeia de Cardiologia recomendam um nível de colesterol LDL (LDL-C) < 55 mg/dL para pacientes com doença cardiovascular estabelecida. Embora a fórmula de Friedewald ainda seja amplamente utilizada para estimar o LDL-C, a fórmula mais recente de Martin-Hopkins mostrou maior precisão. Objetivos: Nosso objetivo foi avaliar: A) a proporção de pacientes que atingiram a meta de LDL-C e as terapias utilizadas em um centro terciário; B) o impacto da utilização do método de Martin-Hopkins em vez do método de Friedewald na proporção de pacientes controlados. Métodos: Estudo transversal monocêntrico, incluindo pacientes consecutivos pós-infarto do miocárdio, acompanhados por 20 cardiologistas, em um hospital terciário. Os dados foram coletados retrospectivamente de consultas clínicas realizadas após abril de 2022. Para cada paciente, os níveis de LDL-C e o atingimento das metas foram estimados a partir de um perfil lipídico ambulatorial, utilizando as fórmulas de Friedewald e Martin-Hopkins. Um valor-p bicaudal < 0,05 foi considerado estatisticamente significativo para todos os testes. Resultados: Foram incluídos 400 pacientes (com 67 ± 13 anos, 77% do sexo masculino). Utilizando a fórmula de Friedewald, a mediana de LDL-C sob terapia foi de 64 (50-81) mg/dL, e 31% tinham LDL-C dentro da meta. Estatinas de alta intensidade foram usadas em 64% dos pacientes, 37% estavam em uso de ezetimiba e 0,5% estavam em uso de inibidores de PCSK9. A terapia combinada de estatina de alta intensidade + ezetimiba foi utilizada em 102 pacientes (26%). A aplicação do método de Martin-Hopkins reclassificaria um total de 31 pacientes (7,8%). Entre aqueles considerados controlados pela fórmula de Friedewald, 27 (21,6%) teriam LDL-C estimado por Martin-Hopkins acima da meta. Conclusões: Menos de um terço dos pacientes pós-infarto do miocárdio apresentaram LDL-C dentro da meta. A aplicação da fórmula de Martin-Hopkins reclassificaria um quinto dos pacientes presumivelmente controlados no grupo de pacientes não controlados.

This paper concerns a viscoelastic Kirchhoff-type equation with the dispersive term, internal damping, and logarithmic nonlinearity. We prove the local existence of a weak solution via a modified lemma of contraction of the Banach fixed-point theorem. Although the uniqueness of a weak solution is still an open problem, we proved uniqueness locally for specifically suitable exponents. Furthermore, we established a result for local existence without guaranteeing uniqueness, stating a contraction lemma.

This study investigated the integration of computer-aided design (CAD) and additive manufacturing (AM) in prototype production, particularly in the automotive industry. It explores how these technologies redefine prototyping practices, with a focus on design flexibility, material efficiency, and production speed. Adopting the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, this study encompasses a systematic review of 28 scholarly articles. It undertakes a comprehensive analysis to identify key themes, trends, and gaps in the existing research on CAD and AM integration in automotive prototyping. This study revealed the significant advantages of CAD and AM in prototype manufacturing, including improved design capabilities, efficient material usage, and the creation of complex geometries. It also addresses ongoing challenges, such as technology integration costs, scalability, and sustainability. Furthermore, this study foresees future developments by focusing on enhancing CAD and AM technologies to meet evolving market demands and optimize performance. This study makes a unique contribution to the literature by providing a detailed overview of the integration of CAD and AM in the context of automotive prototyping. This study incorporates valuable insights into the current practices and challenges and future prospects, potentially leading to more advanced, sustainable, and customer-oriented prototyping methods in the automotive sector.

O artigo tem por objetivo contribuir para a reflexão sobre o golpe civil-militar de 1964 a partir da abordagem metodológica de redução de escala, alternando da análise nacional para a local, em especial, para a cidade Juiz de Fora, no estado de Minas Gerais. Recorrendo a diversos jornais, livros de memórias e ao relatório final da Comissão Municipal da Verdade de Juiz de Fora, o artigo trata do cotidiano repressivo na cidade durante os primeiros dias do golpe de Estado, da perseguição aos líderes sindicais – em particular a Clodsmidt Riani –, da maneira como a imprensa local apoiou o movimento golpista e, por fim, da festiva recepção ao general Olímpio Mourão Filho e a suas tropas militares quando retornaram da Guanabara para Juiz de Fora.

Abstract This study aims to understand healthcare professionals’ thoughts and motivations about optimal management and treatment of patients with chronic obstructive pulmonary disease (COPD). We conducted a DELPHI survey through an online questionnaire distributed to 220 panellists from six European countries and a discrete choice experiment to describe the relationship between selected clinical criteria and the initial COPD treatment of choice. One hundred twenty-seven panellists (general practitioners [GPs] and pulmonologists) completed the survey. Despite the familiarity and use (89.8%) of the GOLD classification for initial treatment selection, a frequent use of LAMA/LABA/ICS was noted. In fact, panellists agreed that inhaled corticosteroids (ICS) are over-prescribed in the primary care setting. Our study showed that GPs felt less confident than pulmonologists with ICS withdrawal. This mismatch observed between best practice and behaviour indicates the need to increase awareness and efforts to improve the adherence to guidelines in clinical practice.

Abstract Purpose Chronic mitral regurgitation promotes left atrial (LA) remodeling. However, the significance of LA dysfunction in the setting of ventricular functional mitral regurgitation (FMR) has not been fully investigated. Our aim was to assess the prognostic impact of peak atrial longitudinal strain (PALS), a surrogate of LA function, in patients with FMR and reduced left ventricular ejection fraction (LVEF). Methods Patients with at least mild ventricular FMR and LVEF

The Spanish Guideline on the Management of Asthma, better known by its acronym in Spanish GEMA, has been available for more than 20 years. Twenty-one scientific societies or related groups both from Spain and internationally have participated in the preparation and development of the updated edition of GEMA, which in fact has been currently positioned as the reference guide on asthma in the Spanish language worldwide.Its objective is to prevent and improve the clinical situation of people with asthma by increasing the knowledge of healthcare professionals involved in their care. Its purpose is to convert scientific evidence into simple and easy-to-follow practical recommendations. Therefore, it is not a monograph that brings together all the scientific knowledge about the disease, but rather a brief document with the essentials, designed to be applied quickly in routine clinical practice. The guidelines are necessarily multidisciplinary, developed to be useful and an indispensable tool for physicians of different specialties, as well as nurses and pharmacists.Probably the most outstanding aspects of the guide are the recommendations to: establish the diagnosis of asthma using a sequential algorithm based on objective diagnostic tests; the follow-up of patients, preferably based on the strategy of achieving and maintaining control of the disease; treatment according to the level of severity of asthma, using six steps from least to greatest need of pharmaceutical drugs, and the treatment algorithm for the indication of biologics in patients with severe uncontrolled asthma based on phenotypes. And now, in addition to that, there is a novelty for easy use and follow-up through a computer application based on the chatbot-type conversational artificial intelligence (ia-GEMA). Resumen: La Guía Española para el Manejo del Asma, mejor conocida por su acrónimo en español, GEMA, está a nuestra disposición desde hace más de veinte años. Veintiuna sociedades científicas o grupos relacionados, tanto de España como de otros países, han participado en la preparación y desarrollo de la edición actualizada de GEMA que, de hecho, se ha posicionado en la actualidad a nivel mundial como la guía de referencia sobre asma en lengua española.Su objetivo es prevenir y mejorar la situación clínica de las personas con asma, aumentando el conocimiento de los profesionales sanitarios involucrados en su cuidado. Su propósito es convertir la evidencia científica en recomendaciones prácticas sencillas y fáciles de seguir. Por lo tanto, no se trata de una monografía que reúna todo el conocimiento científico sobre la enfermedad, sino más bien de un documento conciso con lo esencial, diseñado para ser aplicado rápidamente en la práctica clínica de rutina. Las recomendaciones son necesariamente multidisciplinares, están desarrolladas para ser útiles y una herramienta indispensable para médicos de diferentes especialidades, así como para profesionales de enfermería y farmacia.Seguramente, los aspectos más destacados de la guía son las recomendaciones para: establecer el diagnóstico del asma utilizando un algoritmo secuencial basado en pruebas diagnósticas objetivas; el seguimiento de los pacientes, preferentemente basado en la estrategia de lograr y mantener el control de la enfermedad; el tratamiento según el nivel de gravedad del asma utilizando seis escalones, desde la menor hasta la mayor necesidad de medicamentos, y el algoritmo de tratamiento basado en fenotipos para la indicación de biológicos en pacientes con asma grave no controlada. A esto se suma ahora una novedad para su fácil uso y seguimiento a través de una aplicación informática basada en la inteligencia artificial conversacional de tipo chatbot (ia-GEMA).

Introduction: The Urgeiriça mines were once the main uranium producer in Portugal. The aim of this study was to estimate the benefit of low-dose chest computed tomography (LDCT) for lung cancer screening in former miners that were considered as being at high-risk. Methods: A subgroup of former miners of the Uranium National Company exposed to uranium and with a smoking load greater than 20 pack-years, agreed to perform a LDCT. The Fleischner Society Guidelines were used to classify the nodules and establish follow-up. Results: Initially, 265 former employees of the Uranium National Company were included. The mean time of employment was 15 (0 - 45) years. The non-smokers represented 50.9% and 30.2% were ever smokers; the remaining chose not to respond. One diagnosis of lung cancer was initially made. In the second phase, a subgroup of 66 former miner underwent a LDCT, 37 of whom presented pulmonary nodules. Most computed tomography (CT) scans revealed one single nodule (n = 13) and the mean size was 5 (1 - 16) mm. A suspicious 16 mm spiculated nodule was evaluated with PET/CT, and percutaneous and surgical biopsies, ultimately revealing a benign lesion. Conclusion: The data highlights the importance of lung cancer screening in high-risk populations. This was, to the best of our knowledge, the first study performed in Portugal and can act as a bridge towards a wider implementation in the country.

Oxidation of PUFAs in LDLs trapped in the arterial intima plays a critical role in atherosclerosis. Though there have been many studies on the atherogenicity of oxidized derivatives of PUFA-esters of cholesterol, the effects of cholesteryl hemiesters (ChEs), the oxidation end products of these esters, have not been studied. Through lipidomics analyses, we identified and quantified two ChE types in the plasma of CVD patients and identified four ChE types in human endarterectomy specimens. Cholesteryl hemiazelate (ChA), the ChE of azelaic acid (n-nonane-1,9-dioic acid), was the most prevalent ChE identified in both cases. Importantly, human monocytes, monocyte-derived macrophages, and neutrophils exhibit inflammatory features when exposed to subtoxic concentrations of ChA in vitro. ChA increases the secretion of proinflammatory cytokines such as interleukin-1β and interleukin-6 and modulates the surface-marker profile of monocytes and monocyte-derived macrophage. In vivo, when zebrafish larvae were fed with a ChA-enriched diet, they exhibited neutrophil and macrophage accumulation in the vasculature in a caspase 1- and cathepsin B-dependent manner. ChA also triggered lipid accumulation at the bifurcation sites of the vasculature of the zebrafish larvae and negatively impacted their life expectancy. We conclude that ChA behaves as an endogenous damage-associated molecular pattern with inflammatory and proatherogenic properties.

El presente ensayo tiene por objeto actualizar el perfil censor de Juan Navarro de Espinosa desde la perspectiva de las Humanidades Digitales. Ruano de la Haza (1989) ofreció un bosquejo del censor a partir del escrutinio de diez piezas revisadas (de un total de veinte que documenta). Treinta años después, la base de datos CLEMIT incluye más de una decena de nuevas obras censuradas por Navarro de Espinosa y ofrece referencias bibliográficas de reciente aparición que enriquecen notablemente las primeras observaciones de Ruano. Así las cosas, nuestra tarea pasa por estudiar la trayectoria de Navarro a través de CLEMIT, pues así renovaremos nuestra visión sobre las prácticas censorias del fiscal de comedias.

Perception of risk is known to change throughout the lifespan. Previous studies showed that younger adults are more prone to risk behaviours than older adults. Do these age-related differences influence risk perception during a pandemic crisis? Here, we investigated how age influenced predicted risk during the COVID-19 emergency state in Portugal. We show that time-projected estimations (e.g., appraisals based on ‘now’ vs. ‘in two weeks’ time’, or ‘in four weeks’ time’) of both risk behaviour and importance of transmission prevention decrease over time. Importantly, projected risk decreased more steeply for younger than older adults. Our findings suggest that younger adults have a different perception of epidemic-related risk than older adults. This seems to support the view that public health policy making during epidemics should differentially target younger adults.

This paper is concerned with a stability result for a Kirchhoff beam equation with variable exponents and time delay. The exponential and polynomial stability decay are proved based on Komornik's inequality.

Introduction: Sickle cell trait (SCT) has been associated with chronic kidney disease (CKD) in African Americans, although evidence for its impact in Africans and people with HIV is currently lacking. We conducted a cross-sectional study investigating the association between SCT and kidney disease in people of African ancestry with HIV in the UK. Methods: The primary outcome was estimated glomerular filtration rate (eGFR) 50 mg/mmol), and albuminuria (albumin-to-creatinine ratio >3 mg/mmol). Multivariable logistic regression was used to estimate the associations between SCT and kidney disease outcomes. Results: A total of 2895 participants (mean age 48.1 [SD 10.3], 57.2% female) were included, of whom 335 (11.6%) had SCT and 352 (12.2%) had eGFR

The decentralization of social functions to municipalities, also known as municipal decentralization, triggered new contexts of practice in municipal social intervention. Municipalities are now dealing with more work and a focus on working in partnerships, which calls for greater dynamism of the local social action teams. This process has pushed the social workers to practices that alternate between mediation through the construction of access to a universal standard of social rights and the development of social intervention models with specific access to certain contexts and social groups. The objective of this paper is to envision new forms of standardization of social action within the framework of municipal decentralization, combining place-based perspectives with community and structural social work. What can we learn from social workers’ perspectives on the context of social functions in order to envision forms of place-based standardization of municipal social action? We seek to analyze the professional visions of local social action systems reform, discussing new contexts of practice; new place-based functions; and their correlation with political mediation for universal and intermunicipal social rights, instrumental dimensions of concrete work, and dimensions of value attributed to practicing social work. We organized the research according to the phenomenological paradigm, mobilizing the qualitative method and the multiple-case study. Based on evidence from the discourse of all professionals involved in the study, the findings indicate that the transformations of local social action systems, associated with the processes of social functions decentralization, imply greater comprehensiveness of social intervention, the ability to work in partnerships, and new place-based approach matrices, but they also present challenges for social workers in terms of multilevel governance that may favor the standardization of access to better social well-being between municipal territories.

En este trabajo vamos a estudiar la determinación de autoría de una obra asociada recientemente al Fénix de los ingenios: La paciencia en la fortuna. La pieza contiene un número considerable de indicios que la hacen merecedora de pertenecer a Lope, como el hecho de contar con la aprobación de Gracián Dantisco, las alusiones al duque de Lerma, la «traza» de la «lujuria del déspota» o el encomio a la estirpe aragonesa de los Moncada. Sin embargo, también hay indicios documentales externos que apuntan a la autoría de Claramonte, cuya candidatura es sólidamente reforzada por una serie de elementos intratextuales: usus scribendi, métrica e intertextualidad.

Heart failure (HF) with reduced ejection fraction (HFrEF) is associated with high rates of hospitalization and death. It also has a negative impact on patients’ functional capacity and quality of life, as well as on healthcare costs. In recent years, new HFrEF prognosis-modifying drugs have emerged, leading to intense debate within the international scientific community toward a paradigm shift for the management of HFrEF. In this article, we report the contribution of a Portuguese HF expert panel to the ongoing debate.Based on the most recently published clinical evidence, and the panel members’ clinical judgment, three key principles are highlighted: (i) sacubitril/valsartan should be preferred as first-line therapy for HFrEF, instead of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker; (ii) the four foundation HFrEF drugs are the angiotensin receptor/neprilysin inhibitor, beta-adrenergic blocking agents, mineralocorticoid receptor antagonists, and sodium-glucose co-transporter 2 inhibitors, regardless of the presence of type-2 diabetes mellitus; (iii) these four HFrEF drug classes should be introduced over a short-term period of four to six weeks, guided by a safety protocol, followed by a dose up-titration period of 8 weeks. Resumo: A insuficiência cardíaca (IC) com fração de ejeção reduzida (ICFEr) está associada a níveis elevados de hospitalização e mortalidade. A ICFEr também tem um impacto negativo na capacidade funcional e na qualidade de vida dos doentes, bem como na despesa em saúde. Nos últimos anos, surgiram novos medicamentos modificadores do prognóstico da ICFEr, originando um intenso debate na comunidade científica internacional em relação a uma mudança de paradigma para o tratamento da ICFEr. Neste artigo, relatamos a contribuição de um painel de especialistas portugueses em IC para o debate em curso.Com base na evidência clínica publicada mais recentemente e no julgamento clínico dos membros do painel, três princípios-chave são destacados: (i) sacubitril/valsartan deve ser preferido como terapia de primeira linha para a ICFEr, em vez de um inibidor da enzima de conversão da angiotensina ou um bloqueador do recetor da angiotensina; (ii) os quatro medicamentos básicos para a ICFEr são o inibidor do recetor da angiotensina e da neprilisina, os agentes bloqueadores beta-adrenérgicos, os antagonistas do recetor mineralocorticoide e os inibidores do cotransportador sódio-glucose 2, independentemente da presença de diabetes mellitus tipo 2; (iii) essas quatro classes de medicamentos para a ICFEr devem ser rapidamente introduzidas num período curto de 4-6 semanas, seguindo um protocolo de segurança, e depois tituladas durante as oito semanas seguintes.

Este ensayo incluye la edición anotada de la Danza del caballero peregrino, una obra corta dramática anónima de la segunda mitad del siglo XVII que descansa en el ms. 16725 de la BNE. Previamente se ofrece al lector una breve introducción donde hablamos del argumento, de la relación de la pieza con El caballero peregrino (1601) y del género.

En el trabajo que se presenta a continuación, analizaremos El ignorante discreto, una comedia del siglo xvii atribuida a Adrián Guerrero que solo había sido citada veladamente por algunos eruditos. En consecuencia, examinaremos aspectos ineludibles como el debate crítico, el argumento de la obra, el único testimonio conservado, el género y la métrica. Igualmente, ofreceremos una hipótesis de autoría radicada en los elementos internos del texto, que serán estudiados a la luz de la estilometría.

En este artículo recogemos la edición crítica de la Loa con que empezó Escamilla. Previamente se ofrece al lector una breve introducción donde se habla del argumento, de las circunstancias escénicas y de la atribución a Calderón de la Barca.

Reseña de Pedro Calderón de la Barca, La exaltación de la cruz, ed. Ignacio Arellano, Madrid / Frankfurt am Main, Iberoamericana / Vervuert, 2022, 216 pp. ISBN: 978- 84-9192-260-5 (Iberoamericana) ISBN: 978-3-96869-255-5 (Vervuert)