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The provision of high-quality palliative care in nursing homes (NHs) requires specific knowledge and skills among health professionals. The aims of the study were to assess quality of care during the dying process and quality of end-of-life of NH residents in the French and Italian parts of Switzerland. 90 residents died during the study period (mean age 88.7 years). Mean of the “End-of-Life in Dementia Scales – Comfort Assessment while Dying” score was 35.7 (theoretical range 14–42). Mean of the “Quality of Dying in LongTerm Care” score was 38.3 (theoretical range 11–55). In conclusion, the quality of dying and quality of end-of-life care in NH studied can be improved improved, in particular on the anticipation level. Die Bereitstellung einer qualitativ hochwertigen Palliativversorgung in Pflegeheimen erfordert spezifische Fähigkeiten. Ziel der Studie war es, die Qualität der Sterbebegleitung von Bewohnern, die in der französisch- und italienischsprachigen Schweiz in Pflegeheimen sterben, zu bewerten. 90 Bewohner starben während der Studiendauer (Durchschnittsalter 88,7 Jahre). Der mittlere Wert der «End-of-Life in Dementia Scales – Comfort Assessment while Dying» lag bei 35,7 (theoretischer Bereich 14–42). Der Mittelwert der Skala «the Quality of Dying in LongTerm Care» lag bei 38,3 (theoretischer Bereich 11–55). Zusammenfassend lässt sich sagen, dass die Qualität der Versorgung am Lebensende in den untersuchten Pflegeheimen verbessert werden kann, insbesondere im Hinblick auf die Antizipation. Assurer des soins palliatifs de haute qualité dans les établissements médico-sociaux (EMS) nécessite des compétences spécifiques. Les objectifs de l'étude étaient d'évaluer la qualité de la fin de vie des résidents qui décèdent dans les EMS en Suisse romande et italienne. 90 résidents sont décédés durant l'étude (âge moyen de 88,7 ans). La moyenne du score de l'échelle «End-of-Life in Dementia Scales – Comfort Assessment while Dying» était de 35,7 (fourchette théorique de 14 à 42). La moyenne du score de l'échelle «Quality of Dying in LongTerm Care» était de 38,3 (fourchette théorique 11–55). En conclusion, la qualité des soins de fin de vie dans les EMS étudiés peuvt être améliorée, notamment en ce qui concerne l'anticipation.

BACKGROUND Blood pressure (BP) control was only 43.7% in the National Health and Nutrition Survey (NHANES) survey in 2017–2018. Scalable, nonclinic-based strategies to control BP are needed. We therefore conducted a pilot trial of a text-messaging intervention in a national network of retail outlet health kiosks with BP devices. All study procedures were conducted remotely. METHODS Eligible individuals (N = 140), based on average BP greater than or equal to 140/90 mm Hg at kiosks during the prior year, were randomized to intervention vs. usual care. Intervention consisted of tailored text messages providing educational information with embedded links to educational videos on topics related to BP control. BP measurements were obtained at kiosks at 3, 6, and 12 months following randomization; control was defined as BP < 140/90 mm Hg. Follow-up at 12 months was curtailed due to SARS-CoV-2. We therefore combined 12-month (N = 62) or carried forward 6-month (N = 61) data as the primary end point. RESULTS Participants were 51.4% male, 70.7% white/Caucasian, had mean age of 52.1 years, and mean baseline BP 145.5/91.8 mm Hg. At the end point, 37.7% intervention vs. 27.4% usual care subjects achieved BP control (difference, 10.3%, 95% confidence interval -6.2%, 26.8%). In an intention-to-treat analysis with multiple imputation of missing data, 12-month BP control was 29.0% vs. 19.8% favoring intervention (difference, 9.2%. 95% confidence interval -7.3%, 25.7%); intervention vs. control differences in adjusted mean BP levels were systolic BP: -5.4 mm Hg (95% confidence interval: -13.5, 2.7) and diastolic BP: +0.6 mm Hg (95% confidence interval: -4.2, 5.4). CONCLUSIONS These pilot results support the potential for a highly scalable text-messaging intervention to improve BP. CLINICAL TRIALS REGISTRATION Trial Number NCT03515681.

This article points out the contributions of Pierre Bourdieu and Jean-Claude Passeron, which are the starting point for problematizing the way social and cultural inequality has repercussions for the higher education context in Brazil. This article is divided into three parts. In the first part, the authors' reflections on the reproduction of social and cultural structures in school and university are discussed, as well as the articulation of the concepts of habitus and field, which help to specify the object of this research. In the second part, a contrast between the mentioned authors and Bernard Lahire’s work is presented. His work is based on the theory of the plural actor and focused on Bourdieu's concepts and on the analysis of educational attainment. In the third part, there is a comparison between those reflections and the data collected through some qualitative research carried out with public school students who have managed to achieve higher education and are now enrolled in prestigious courses. Thus, aiming at contributing to the understanding of how groups of disadvantaged young students achieve educational attainment, this work shows elements that can be a reference for the development of lasting, inclusive and consequent policies for public education.

Background: The number of older people dying in long-term care facilities is increasing; however, care at the end of life can be suboptimal. Interventions to improve palliative care delivery within these settings have been shown to be effective in improving care, but little is known about their implementation. Aim: The aim of this study was to describe the nature of implementation strategies and to identify facilitators and/or barriers to implementing palliative care interventions in long-term care facilities. Design: Scoping review with a thematic synthesis, following the ENTREQ guidelines. Data sources: Published literature was identified from electronic databases, including MEDLINE, EMBASE, PsycINFO and CINAHL. Controlled, non-controlled and qualitative studies and evaluations of interventions to improve palliative care in long-term care facilities were included. Studies that met the inclusion criteria were sourced and data extracted on the study characteristics, the implementation of the intervention, and facilitators and/or barriers to implementation. Results: The review identified 8902 abstracts, from which 61 studies were included in the review. A matrix of implementation was developed with four implementation strategies (facilitation, education/training, internal engagement and external engagement) and three implementation stages (conditions to introduce the intervention, embedding the intervention within day-to-day practice and sustaining ongoing change). Conclusion: Incorporating an implementation strategy into the development and delivery of an intervention is integral in embedding change in practice. The review has shown that the four implementation strategies identified varied considerably across interventions; however, similar facilitators and barriers were encountered across the studies identified. Further research is needed to understand the extent to which different implementation strategies can facilitate the uptake of palliative care interventions in long-term care facilities.

ObjectivesTo examine the rate and characteristics of hospitalisation in the last month of life and place of death among nursing home residents and to identify related care processes, facility factors and residents’ characteristics.SettingA cross-sectional study (2015) of deceased residents in 322 nursing homes in six European countries.ParticipantsThe nursing home manager (N=1634), physician (N=1132) and primary nurse (N=1384) completed questionnaires.Outcome measuresHospitalisation and place of death were analysed using generalised linear and logistic mixed models. Multivariate analyses were conducted to determine associated factors.ResultsTwelve to 26% of residents were hospitalised in the last month of life, up to 19% died in-hospital (pConclusionsAlthough participating countries vary in hospitalisation and in-hospital death rates, between 12% (Italy) and 26% (Belgium) of nursing home residents were hospitalised in the last month of life. Close monitoring of acute changes in health status and adequate equipment seem critical to avoiding unnecessary hospitalisations. Strategies to increase discussion of preferences need to be developed. Our findings can be used by policy-makers at governmental and nursing home level.

O objetivo deste trabalho é conhecer a trajetória de estudantes de média e baixa renda com êxito escolar na escola pública, contribuindo para a explicação do fenômeno no contexto da formação superior. Partimos do pressuposto de que os estudantes de origem popular, oriundos do ensino fundamental e médio público, com defasagem de capitais (cultural, econômico, social e político), são considerados de exceção quando, superando as dificuldades de sua classe de origem, recorrentes em um país marcado por enormes disparidades socioeconômicas e culturais e, por conseguinte, grandes desigualdades de oportunidades educacionais, acessam o ensino superior. Essa questão é investigada através de uma pesquisa qualitativa apoiada na coleta de dados acerca das experiências dos estudantes a partir da aplicação de entrevistas semiestruturadas e observação de campo, que evidenciam os elementos sociais e culturais que agem na formação de suas disposições. Observa-se que as disposições e as socializações desses jovens são dinâmicas, resultando em uma diversidade de trajetórias escolares, cujos pontos de aproximação estão ancorados no investimento familiar e em seu capital subjetivo.

Context: Intravenous cardiovascular recording of conscious animals is susceptible to outlier’s presence, due to freely movement and manipulations. These outliers can interfere on heart rate variability results, indicating erroneous results of sympathetic or parasympathetic modulation.Objective: Develop an automated computational approach to minimize the presence of outliers in cardiovascular recorded signals.Method: An application was developed according to the problem addressed based on free-use web frameworks.Results: The use of the proposed application detected and minimized respectively 1% and 0.97% of points outliers in signals of systolic arterial pressure (SAP) and pulse interval (PI) from a representative blood pressure recording. As until then the work of minimization of outliers was carried out manually; the use of the new application considerably reduced time spend analyzing the data.Conclusion: The proposed algorithm can detect and minimize interferent points, reducing chances of an erroneous interpretation about the cardiovascular modulation by the autonomic nervous system. The method can also significantly reduce the time of manual point-to-point screening performed by researchers.

Introduction The coronavirus disease 2019 (COVID-19) pandemic continues to be a global threat, with tremendous resources invested into identifying risk factors for severe COVID-19 illness. The objective of this study was to analyze the characteristics and outcomes of male compared to female adults with COVID-19 who required hospitalization within US academic centers. Methods Using the Vizient clinical database, discharge records of adults with a diagnosis of COVID-19 between March 1, 2020 and November 30, 2020 were reviewed. Outcome measures included demographics, characteristics, length of hospital stay, rate of respiratory intubation and mechanical ventilation, and rate of in-hospital mortality of male vs female according to age, race/ethnicity, and presence of preexisting comorbidities. Results Among adults with COVID-19, 161,206 were male while 146,804 were female. Adult males with COVID-19 were more likely to have hypertension (62.1% vs 59.6%, p Conclusion This large analysis of 308,010 COVID-19 adults hospitalized at US academic centers showed that males have a higher rate of respiratory intubation and longer length of hospital stay compared to females and have a higher death rate even when compared across age groups, race/ethnicity, payers, and comorbidity.

Context. Certain treatments are potentially inappropriate when administered to nursing homes residents at the end of life and should be carefully considered. An international comparison of potentially inappropriate treatments allows insight into common issues and country-specific challenges of end-of-life care in nursing homes and helps direct health-care policy in this area.Objectives. To estimate the prevalence of potentially inappropriate treatments in the last week of life in nursing home residents and analyze the differences in prevalence between countries.Methods. A cross-sectional study of deceased residents in nursing homes (2015) in six European countries: Belgium (Flanders), England, Finland, Italy, The Netherlands, and Poland. Potentially inappropriate treatments included enteral administration of nutrition, parental administration of nutrition, artificial fluids, resuscitation, artificial ventilation, blood transfusion, chemotherapy/radiotherapy, dialysis, surgery, antibiotics, statins, antidiabetics, new oral anticoagulants. Nurses were questioned about whether these treatments were administered in the last week of life.Results. We included 1384 deceased residents from 322 nursing homes. In most countries, potentially inappropriate treatments were rarely used, with a maximum of 18.3% of residents receiving at least one treatment in Poland. Exceptions were antibiotics in all countries (between 11.3% in Belgium and 45% in Poland), artificial nutrition and hydration in Poland (54.3%) and Italy (41%) and antidiabetics in Poland (19.7%).Conclusion. Although the prevalence of potentially inappropriate treatments in the last week of life was generally low, antibiotics were frequently prescribed in all countries. In Poland and Italy, the prevalence of artificial administration of food/fluids in the last week of life was high, possibly reflecting country differences in legislation, care organization and culture, and the palliative care competences of staff. (C) 2020 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

O objetivo deste trabalho é conhecer a trajetória de estudantes de origem popular com êxito escolar, contribuindo para a explicação do fenômeno no contexto da formação superior. Partimos do pressuposto de que os estudantes de origem popular, oriundos do ensino médio público, com defasagem de capitais (cultural, econômico, social e político), são considerados de exceção quando, superando as dificuldades de sua classe de origem, recorrentes em um país marcado por enormes disparidades socioeconômicas e culturais e, por conseguinte, grandes desigualdades de oportunidades educacionais, acessam o ensino superior. Essa questão é investigada através de uma pesquisa qualitativa apoiada na coleta de dados acerca das experiências dos estudantes a partir da aplicação de entrevistas semiestruturadas e observação de campo, que evidencia os elementos sociais que agem na formação de suas disposições.

Myocardial remodeling includes inappropriate collagen deposition in the interstitium. Erythropoietin (EPO) may have cardioprotective effects. We aimed to assess the role of EPO on myocardial remodeling during the chronic phase. We studied 60 Wistar rats divided into the following groups: control (CT), control + EPO (CT + EPO), myocardial infarction + EPO (MI + EPO), and myocardial infarction (MI). The interstitial collagen volume fraction (ICVF) was quantified and echocardiography was performed. We quantified asymmetric dimethylarginine and glutathione by ELISA, and used real-time PCR to assess apoptosis and inflammation. Western blotting was used to evaluate inflammatory proteins and tissue inhibitors of metalloproteinases (TIMPs), and TUNEL staining was used to detect apoptosis. For matrix metalloproteinases (MMPs), we performed zymography. Parametric and nonparametric analyses were performed according to normality testing. ICVF was greater in MI groups (p < 0.001) and was attenuated by EPO (p = 0.05). The MMP-2 did not show any difference between groups. The TIMP-1 and TIMP-2 did not have difference between groups. The MI groups had worse fraction shortening (p < 0.001), without EPO protection (p = 0.666). The MI groups had increased left ventricle diastolic dimension (p < 0.001) without EPO attenuation (p = 0.79). EPO did not act on oxidative stress. Apoptosis and inflammation were not modulated by EPO. We concluded that EPO attenuated interstitial collagen accumulation, but did not protect from heart dilation or dysfunction.

Over the past 15 years the Potenza Valley Survey project investigated Iron Age to Medieval settlement dynamics in the Central Adriatic Potenza Valley. Part of this research focuses on the Roman abandoned towns of Potentia and Trea by performing an integrated geoarchaeological study of their townscape. This largely noninvasive research consists of remote sensing analysis, geophysical surveys (magnetometry, electrical resistivity, and ground-penetrating radar), and geomorphological fieldwork such as microtopographic measurements and hand augering. The chosen techniques depend on the nature of each town and are integrated with more traditionally achieved research data. This paper presents the main interdisciplinary results of work on these two Roman towns and highlights the importance of obtaining complementary data and performing hand augering as a stratigraphic control of the remote sensing and geophysical results. Insights into the character and layout of the cities, the structural influence on the surrounding area, and the human-environment interactions and dynamics through time of both Roman cities could be achieved. Moreover, the results offer guidelines for conservation strategies of these abandoned towns and their suburbium, which are necessary to protect them from present-day threats such as agriculture and tourism. In this way the paper offers an insight in the tremendous potential of well-integrated geoarchaeological investigations of partly or fully abandoned urban contexts in the Mediterranean area and beyond.

Este artigo faz um apanhado das principais contribuições de pesquisas nacionais que descrevem e problematizam trajetórias escolares e/ou universitárias de sucesso de jovens oriundos de meios populares no Brasil, no período compreendido entre os anos 1990 e 2018. Tratado comumente no âmbito da Sociologia da Educação, esse tema é revisitado aqui a partir de diferentes abordagens e perspectivas, que se complementam, formando um painel da situação, que culmina com a mais recente expansão do sistema de ensino superior através da implementação de políticas públicas e programas assistenciais (vivida entre 2000 e 2016). A esse último período, é dedicado um estudo que abarca especificamente a transição de jovens do ensino médio público para formações universitárias consideradas de prestígio, em que se consideram suas características, mas também suas percepções do sucesso escolar. Além disso, em razão das especificidades da população analisada, das particularidades da própria pesquisa de campo empreendida, bem como pelo fato de esse tema afetar diretamente a igualdade de chances e, por conseguinte, a mobilidade social brasileira, propomos que este seja tratado como um tema sensível pelas Ciências Humanas e Sociais, abordagem discutida ao final do texto. Palavras-chave: Sucesso escolar; estudantes de origem popular; Terrenos sensíveis.