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Abstract Complex non-local behavior makes designing high efficiency and multifunctional metasurfaces a significant challenge. While using libraries of meta-atoms provide a simple and fast implementation methodology, pillar to pillar interaction often imposes performance limitations. On the other extreme, inverse design based on topology optimization leverages non-local coupling to achieve high efficiency, but leads to complex and difficult to fabricate structures. In this paper, we demonstrate numerically and experimentally a shape optimization method that enables high efficiency metasurfaces while providing direct control of the structure complexity through a Fourier decomposition of the surface gradient. The proposed method provides a path towards manufacturability of inverse-designed high efficiency metasurfaces.

Abstract Background Hope is an important resource that helps patients and families thrive during difficult times. Although several studies have highlighted the importance of hope in different contexts, its specific manifestations in the realm of advanced chronic illness need further exploration. In this study, we sought to elucidate the intricate interplay between the construct of hope and the lived experience of advanced chronic illness within patient-caregiver dyads. Our objectives were (a) to explore the dyadic experience of hope as a changing dynamic over time for patients living with advanced chronic illness and their informal caregivers and (b) to evaluate variations of hope and symptom burden across time. Methods We conducted a longitudinal mixed-methods study with a convergent design between December 2020 and April 2021. Patients living with advanced chronic illness and informal caregivers participated as a dyad (n = 8). The Herth Hope Index scale was used to measure dyads' level of hope and the Edmonton Symptom Assessment System was used to measure patients’ symptom burden. Descriptive statistics were undertaken. A thematic analysis as described by Braun and Clarke was conducted to analyze dyadic interview data. Dyads' experience of hope was described by using the six dimensions of hope in the Model of Hope of Dufault and Martocchio. Results Dyadic scores of hope and patients' symptom burden were stable over time. The constructs of hope in dyads included “Living one day at the time,” “Having inner force/strength,” and “Maintaining good health.” Changes in patterns of hope were captured for each dyad in their transition over time. Data converged for all dyads except one. Conclusions The findings of our study show a constant presence of hope even in the face of adversity. Healthcare professionals must find ways to promote hope in dyads of patients living with advanced chronic diseases. Nurses play a pivotal role; dyadic interviews should be promoted to create a safe space for both patients and informal caregivers in order to share experiences. More research is needed to address patients' and informal caregivers' hope in chronic illness because current hope-based interventions primarily target cancer diagnoses.

Esta pesquisa investigou as experiências de streamers LGBTIN+ na plataforma Twitch.tv, concentrando-se no serviço de live streaming de jogos online. O estudo, de natureza exploratória, inicialmente aborda a interação do e-leisure (lazer digital) com a comunidade LGBTIN+, examinando como as tecnologias digitais, enquanto espaços de lazer, expandem as interações e representações sociais desse público diversificado. A partir da observação das relações entre jogadores/jogadoras, dos formatos que se estabelecem nos jogos e os intercâmbios com a audiência e os patrocinadores, foram selecionados/selecionadas 10 streamers LGBTQIN+. Utilizou-se o método snowball e a aplicação de entrevistas semiestruturadas. As entrevistas exploraram experiências nos jogos e na plataforma Twitch.tv e interações e representações LGBTQIN+. Na análise dos dados, a partir da Análise de Conteúdo proposta por Bardin (1977), os resultados indicaram quatro categorias de análise. Por meio das categorias encontrou-se que os espaços de e-leisure, especialmente a live streaming de jogos, oferecem à comunidade LGBTIN+ uma ampliação das interações sociais, possibilitando a expressão de identidades, a promoção da representatividade e criação de oportunidades para geração de renda. Contudo, é essencial destacar que esses ambientes também podem ser cenários para manifestações de ódio e discriminação, sendo que o algoritmo da plataforma aparenta favorecer homens brancos heterossexuais. As experiências compartilhadas pelos/pelas streamers alinham-se com estudos anteriores, ressaltando a necessidade de mais representatividade e visibilidade para esses profissionais. A complexidade da dinâmica entre lazer e trabalho também foi evidenciada, revelando uma tensão entre o prazer pessoal e as demandas profissionais enfrentadas pelos/pelas streamers, de forma que alguns estudos contribuíram para uma compreensão mais profunda acerca dessa dualidade. A conclusão do estudo destaca a imperativa necessidade de investigações mais aprofundadas sobre políticas trabalhistas nas plataformas digitais. Além disso, enfatiza a importância de examinar como as plataformas de live streaming de jogos podem apoiar as minorias que enfrentam opressão na sociedade livecontemporânea. Por fim, esse trabalho oferece uma contribuição para o entendimento das interseções entre lazer, trabalho, representatividade e discriminação na esfera digital.

BACKGROUND AND OBJECTIVES: Health literacy is a topic that has been gaining traction in recent years, both on the policy and research agendas of many countries, however there is no evidence about temporomandibular disorders (TMD) and this topic. The objective was to evaluate the association between the level of functional literacy and the understanding of the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) through self-report and to associate the time of TMD complaint with the levels of functional literacy. METHODS: This is an observational, cross-sectional study, comprising 56 patients from the Temporomandibular Disorders (TMD) clinic at São Leopoldo Mandic College. The DC/TMD questionnaire – axis I, a sociodemographic questionnaire, and tests of the Indicador de Alfabetismo Funcional (Functional Literacy Indicator - INAF) were applied. RESULTS: The outcomes showed that 85.7% of the sample were females and 14.3% males, mainly white (60.7%), with a schooling degree, predominantly from the 3rd grade of high school and professionally active. It was found that 22.5% of the sample were functionally illiterate and 77.5% were functionally literate, 30.6% of whom had elementary level schooling. There was a significant association between the schooling level and combined INAF (p=0.005), as well as between combined INAF and duration of complaint in intervals for jaw pain (p=0.037) when Chi-square tests were used. There is evidence to establish that the mean duration of headache complaints (in months) between literacy groups are different (p=0.001) when using the Student´s t-test. With these results, it is possible to suggest that lower levels of functional literacy are related to a poorly detailed perception of TMD complaints regarding the duration of the complaint and, mainly, to the association of headache with a complaint of TMD. CONCLUSION: Lower levels of functional literacy are related to a poorly detailed perception of TMD complaints regarding the duration of the complaint and, mainly, to the association of headache with a complaint of temporomandibular disorders.

BACKGROUND AND OBJECTIVES: Temporomandibular disorder (TMD) has complex symptoms that involve the orofacial region, such as otalgia. Considering the difficult differential diagnoses for associating otological symptoms with TMD. The aim of this study was to verify the diagnosis of TMD in patients with otalgia. METHODS: This is a cross-sectional and descriptive study, where 75 patients diagnosed with otalgia were evaluated. The European Academy of Craniomandibular Disorders’s (EACD) screening questionnaire was initially applied, and those who answered affirmatively to at least one question were evaluated by the Research Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), with a final sample of 50 patients. Data were tabulated and ANOVA verified whether there was a statistical difference between TMD subtypes classified by DC/TMD, considering confidence intervals with 95% significance. RESULTS: The mean age of the participants was 39.9±14.1 years, with a predominance of females (76%) (p<

Background/Objectives: Cytokine storm in severe COVID-19 is responsible for irreversible tissue damage and death. Soluble mediators from the TNF superfamily, their correlation with clinical outcome, and the use of TNF receptors as a potent predictor for clinical outcome were evaluated. Methods: Severe COVID-19 patients had the levels of soluble mediators from the TNF superfamily quantified and categorized according to the clinical outcome (death versus survival). Statistical modeling was performed to predict clinical outcomes. Results: COVID-19 patients have elevated serum levels from the TNF superfamily. Regardless of sex and age, the sTNFRI levels were observed to be significantly higher in deceased patients from the first weeks following the onset of symptoms. We analyzed hematological parameters and inflammatory markers, and there was a difference between the groups for the following factors: erythrocytes, hemoglobin, hematocrit, leukocytes, neutrophils, band cells, lymphocytes, monocytes, CRP, IL-8, IFN-γ, IL-10, IL-6, IL-4, IL-2, leptin MIF sCD40L, and sTNFRI (p < 0.05). A post hoc analysis showed an inferential capacity over 70% for some hematological markers, CRP, and inflammatory mediators in deceased patients. sTNFRI was strongly associated with death, and the sTNFRI/sTNFRII ratio differed between outcomes (p < 0.001; power above 90%), highlighting the impact of these proteins on clinical results. The final logistic model, including sTNFRI/sTNFRII and CRP, indicated high sensitivity, specificity, accuracy, and an eight-fold higher odds ratio for an unfavorable outcome. Conclusions: The joint use of the sTNFRI/sTNFRII ratio with CRP proves to be a promising tool to assist in the clinical management of patients hospitalized for COVID-19.

Abstract Objective To analyze the serum levels of TNF-alpha and its TNF-R1 and TNF-R2 receptors in the blood of patients with low-impact fractures due to osteoporosis, comparing between genders and with healthy patients. Methods The present study was conducted with a blood sample of 62 patients, divided into patients with osteoporosis and healthy patients. The results were obtained using the ELISA method. Cytokine concentrations were determined based on the absorbance values obtained. Results Serum TNF-alpha levels were undetectable in female patients, while in males they were found only in one patient, with no significant difference. Similar results were found in the analyses of TNF-R1 and TNF-R2 levels, a significant increase in levels of TNF-alpha receptors in the groups of patients with osteoporosis compared with the control groupinbothsexes.There wasnosignificant difference between the sexes in the dosage of both receptors within the group with osteoporosis. There was also a positive and significant correlation in the levels of TNF-R1 and TNF-R2 only in women. Conclusion The significant increase in TNF-R1 and TNF-R2 levels in women with osteoporosis suggest that the release and expression of these receptors may be contributing differently to the development of osteoporosis in men and women.

ABSTRACT Objective: This study aimed to compare the levels of HIF1-α, VEGF, TNF-α, and IL-10 in the peri-implant crevicular fluid of patients with and without peri-implantitis. Methods: Forty patients, comprising 16 with and 24 without peri-implantitis were selected. Results: Patients with peri-implantitis exhibited significantly higher HIF-1α levels than those without peri-implantitis (p=0.0005). TNF-α revealed significant positive correlations with IL-10 (p=0.0008) and VEGF (p=0.0246), whereas HIF-1α and IL-10 levels (p=0.0041) demonstrated a negative and significative correlation in the peri-implantitis group. Conclusion: This study, for the first time demonstrates the balance of HIF-1α, TNFα, IL-10, and VEGF in peri-implantitis. It shows an elevated HIF-1α levels in patients with peri-implantitis, which could have stemmed from persistent inflammation- triggered hypoxia. Furthermore, the positive correlation between TNF-α and VEGF suggests intensified proinflammatory activity in peri-implantitis. Nevertheless, further studies are essential to understand these immune dynamics in peri-implantitis.

ABSTRACT Objective: To assess sleep quality and the association of trait and state anxiety in patients with diabetes mellitus. Method: A cross-sectional, quantitative, and analytical study was conducted between January and April 2022, at the reference center for hypertension and diabetes in Rio Verde, Goiás, with 81 patients. The Pittsburgh Sleep Quality Index and State-Trait Anxiety Inventory were used for data collection. Analyses included the Student’s t-test and multivariate logistic regression analysis. Results: Of patients, 64.2% reported poor sleep quality. There were significant differences in trait anxiety levels between patients with good and poor sleep quality. Trait anxiety was associated with sleep quality, with an increase in the trait anxiety score increasing the chances of poor sleep quality. Conclusion: A significant proportion of the sample had poor sleep quality, and trait anxiety was found to be associated with this condition.

Abstract Introduction Nutrition is vital in health and sports performance by improving anthropometric-related parameters and dietary habits, especially in the youngest ages. The Mediterranean diet (MD) has been highly recognized for its positive health effects and low adverse environmental impact. Objectives We aimed to characterize adherence to the MD and analyze its association with anthropometric parameters in young soccer players. Methodology In the present study, 132 male young soccer players from under 9 to under 15 categories (aged 7 to 15 years) from a Portuguese football club participated. The Mediterranean Diet Quality Index for Children and Adolescents (KIDMED) questionnaire was applied to assess adherence to the MD. Anthropometric-related parameters, including body mass, height, triceps skinfold thickness (TSKF), suprailiac skinfold thickness (SISKF), body mass index (BMI) and body fat percentage (%BF), were determined. The differences between groups were performed accordingly to normal and non-normal distribution. Spearman’s correlations were performed to analyze the hypothetical correlation between KIDMED and BMI. Results Players reached an average KIDMED score of 8.36 ± 1.92, showing that 68.2% (n = 90) reached high adherence to the MD, 31.1% (n = 41) had moderate adherence to the MD, and 0.78% (n = 1) had poor adherence to the MD. When the analysis was made for age group and BMI classification, no significant differences were observed in adherence to the MD. Considering the main characteristics of the MD, 50.8% consumed fruit (vs. 49,2%), 52.3% consumed vegetables (vs. 47,7%), and only 20% consumed oleaginous dried fruits (vs. 80%). Dairy consumption throughout the day was 49,2% (vs. no: 50,8%). Conclusion Data from the present study showed that many soccer players adhered to the MD, and no differences were observed for age group or BMI classification.

RESUMO Descrever a elaboração de uma estratégia educativa com potencial de criar um espaço de diálogo entre adolescentes, profissionais da saúde e educadores. O trabalho foi realizado em quatro escolas públicas do município de Belo Horizonte (MG), Participaram 67 alunos matriculados no oitavo ano do Ensino Fundamental, quatro professores e 6 profissionais de saúde de unidades básicas próximas às escolas. Na primeira etapa, os alunos responderam a um questionário semiestruturado e, a seguir, participaram de oficinas psicossociais. O estudo chama atenção para a potencialidade das estratégias educativas pautadas no diálogo, no vínculo, na escuta e no acolhimento, para que os adolescentes encontrem espaços de conversação que possibilitem a construção do conhecimento sobre sua saúde sexual, afetiva e reprodutiva, garantindo, assim, que eles possam exercer a sexualidade de maneira mais segura, responsável e consciente.

IntroductionSingle nucleotide variations (SNVs) are specific genetic variations that commonly occur in a population and often do not manifest phenotypically. However, depending on their location and the type of nucleotide exchanged, an SNV can alter or inhibit the function of the gene in which it occurs. Immunoglobulin G (IgG) receptor genes have exhibited several polymorphisms, including rs1801274, which is found in the FcgRIIa gene. The replacement of A with T results in a Histidine (H) to Arginine (R) substitution, altering the affinity of the IgG receptor for IgG subtypes and C-reactive protein (CRP). In this study, we analyzed rs1801274 and its functional implications concerning L. Infantum uptake and cytokine production.MethodsWe genotyped 201 individuals from an endemic area for visceral leishmaniasis to assess the presence of rs1801274 using Taqman probes for a candidate gene study. Additionally, we included seventy individuals from a non-endemic area for a functional study. Subsequently, we isolated and cultivated one-week adherent mononuclear cells (AMCs) derived from the peripheral blood of participants residing in the non-endemic region in the presence of L. infantum promastigotes, with and without antigen-specific IgG and/or CRP. We analyzed the rate of phagocytosis and the production of nitric oxide (NO), tumor necrosis factor (TNF)-a, interleukin (IL)-10, IL-12 p70, IL-1b, IL- 6, and IL-8 in the culture supernatants.Results and discussionIn participants from the endemic region, the A/G (H/R isoform) heterozygous genotype was significantly associated with susceptibility to the disease. Furthermore, SNVs induced a change in the phagocytosis rate in an opsonin-dependent manner. Opsonization with IgG increased the production of IL-10, TNF-a, and IL-6 in AMCs with the H/R isoform, followed by a decrease in NO production. The results presented here suggest that the rs1801274 polymorphism is linked to a higher susceptibility to visceral leishmaniasis.

As entrevistas concedidas pelo ator Carlos Vereza fazem parte da minha Tese de Doutorado, defendida em 2019. É importante ressaltar que tais entrevistas foram realizadas na modalidade aberta, que prioriza a informalidade entre entrevistado e entrevistador, e que foram transcritas obedecendo a fala literal do entrevistado, numa tentativa de garantir a máxima fidelidade documental. Nelas, o ator Carlos Vereza revela o processo de recriação de Graciliano Ramos na adaptação fílmica Memórias do cárcere, de Nelson Pereira dos Santos. A interpretação de Vereza constrói uma imagem íntegra e unificada do homem que sofre a violência do cárcere. Esta é simbolizada pelo definhamento dos prisioneiros e na decadência física de Vereza, que não mediu esforços para incorporar a figura de Graciliano Ramos.

ABSTRACT Tailgut cysts are rare congenital lesions that are remnants of the embryonic hindgut. This abnormality presents with non-specific symptoms or no symptoms; therefore, misdiagnosis is common. Here, we present four cases of tailgut cysts that were successfully removed using a robotic surgical approach. A 42-year-old woman with tenesmus, pain in the right gluteal region, and discomfort in the rectal region during evacuation was referred to our medical center. Another patient was a 28-year-old woman who presented with the same symptoms to our general practitioner. Both patients underwent upper abdominal and pelvic magnetic resonance imaging that revealed a tailgut cyst. Further, a 36-year-old woman was referred with coccyx and hypogastric pain. Magnetic resonance imaging revealed two pararectal cystic formations. She underwent robot-assisted surgery, and after analysis by a pathologist, the conclusion was that the tailgut cyst was associated with scarring fibrosis. A 55-year-old woman with posterior epigastric pelvic pain associated with heartburn underwent robot-assisted surgery to resect a retroperitoneal tumor. These cases highlighted the importance of tailgut cysts in the differential diagnosis of rectal lesions. Surgical treatment is preferred because malignant transformations can occur. The difference between laparoscopic and robotic approaches is the better visualization and stability of the latter, inducing less tissue damage. Robotic resection is a safe procedure, especially in patients with a narrow pelvis, because it reduces tissue damage.

Abstract Few studies on the distribution of oral diseases in older people are available in the literature. This study aimed to investigate the prevalence and demographic characteristics of oral and maxillofacial lesions in geriatric patients (age ≥ 60 years). A retrospective descriptive cross-sectional study was performed. Biopsy records were obtained from archives of three Brazilian oral pathology centers over a 20-year period. Data on sex, age, anatomical site, skin color, and histopathological diagnosis were collected and analyzed. Pearson’s chi-square test was used to evaluate differences in the frequency of the different oral and maxillofacial lesion groups. A total of 7,476 biopsy records of older patients were analyzed. Most cases were diagnosed in patients aged 60 to 69 years (n = 4,487; 60.0%). Females were more affected (n = 4,403; 58.9%) with a female-to-male ratio of 1:0.7 (p < 0.001). The tongue (n = 1,196; 16.4%), lower lip (n = 1,005; 13.8%), and buccal mucosa (n = 997; 13.7%) were the most common anatomical sites. Reactive and inflammatory lesions (n = 3,840; 51.3%) were the most prevalent non-neoplastic pathologies (p < 0.001), followed by cysts (n = 475; 6.4%). Malignant neoplasms were more frequent (n = 1,353; 18.1%) than benign neoplasms (n = 512; 6.8%). Fibrous/fibroepithelial hyperplasia (n = 2,042; 53.2%) (p < 0.001) and squamous cell carcinoma (n = 1,191; 88.03%) (p < 0.001) were the most common oral lesions in older adults. Biopsy data allow the accurate characterization of the prevalence of oral and maxillofacial lesions, supporting the development of public health policies that can enable the prevention, early diagnosis, and appropriate treatment of these lesions. Also, they bring valuable information that helps dentists and geriatricians diagnose these diseases.

RESUMO O metilfenidato não é disponibilizado pelo Sistema Único de Saúde (SUS), pois não faz parte da Relação Nacional de Medicamentos Essenciais. Todavia, o metilfenidato 10 mg é disponibilizado pela rede pública em Maringá-PR de acordo com a Política da Assistência Farmacêutica do município. Objetivou-se analisar as características das prescrições médicas de metilfenidato para crianças em ambulatório de neuropediatria vinculado ao SUS no município. Estudo transversal observacional retrospectivo de caráter quantitativo, realizado por meio da coleta de dados dos prontuários cadastrados no Sistema Gestor da rede pública de saúde do município, pelo ambulatório de neuropediatria na Unidade Básica de Saúde, Zona 7, entre janeiro de 2017 e novembro de 2019. Analisaram-se os dados por frequência relativa e absoluta. Emitiram-se 339 prescrições pelo neuropediatra responsável do ambulatório para 107 pacientes de 6 a 11 anos. Notou-se distribuição geográfica desigual das crianças atendidas conforme bairro da cidade, o que denota influência socioeconômica na prescrição de medicamentos. Ressaltam-se picos de prescrições coincidindo com o período do ano letivo escolar. Concluiu-se que o acompanhamento especializado adequado é premissa para o tratamento, não dispensando a rede longitudinal de assistência. Ademais, evidencia-se o impacto das condições socioeconômicas, tanto na prescrição como na aquisição do medicamento.

Trata-se de um estudo qualitativo e exploratório que objetiva refletir sobre experiências de travestis e mulheres trans na utilização de banheiros públicos. Utilizamo-nos dos pressupostos da pesquisa documental para a produção de dados. Para tal, consideramos o conteúdo, comentários e curtidas do vídeo intitulado "Uma mulher trans deve frequentar o banheiro feminino?", disponível na plataforma Facebook. Tomamos como lente orientadora de todo o processo interpretativo a análise do discurso. Evidenciamos alguns pontos centrais para debate: a estruturação de um sistema de classificação social que posiciona travestis e mulheres trans em categorias de periculosidade; a relação profícua estabelecida entre os sistemas de categorização e classificação social e as categorias de gênero e sexualidade enquanto organizadores da vida cotidiana e dos espaços sociais; a manutenção dos discursos que asseguram a lógica dicotômica binária e, consequentemente, a patologização das experiências de travestilidade e transexualidade; e a articulação política como estratégia que assegura, nos processos de espacialização, a superação de dinâmicas que naturalizam violências legitimadoras de interdições e segregações. Por fim, observamos como ponto de convergência de todas as análises realizadas as estratégias de manutenção da vida de travestis e mulheres trans, através da desestabilização de sistemas de opressão.

Resumo Partindo do conceito do Complexo Econômico-Industrial da Saúde, o artigo teve como objetivo central realizar uma análise do modelo de política proposto pelas Parcerias para o Desenvolvimento Produtivo (PDPs) e de seus principais resultados, por meio de um balanço crítico do grau de cumprimento dos principais objetivos explícitos da política. A partir da realização de uma extensa revisão bibliográfica de materiais referentes à temática das PDPs, a contribuição central do artigo consiste na realização de uma síntese organizada dos principais argumentos das potencialidades e dos limites associados ao modelo das PDPs diante dos objetivos a que se que propõem, separados pelas categorias de compras públicas, produção nacional de medicamentos, processos de inovação e impactos sociais, trazendo reflexões acerca de possíveis aprimoramentos para que sejam alcançados de forma ainda mais exitosa.

ABSTRACT This research aims to develop a critical-reflexive analysis of entrepreneurship in public administration based on two significant works of Alberto Guerreiro Ramos: ‘The sociological reduction’ and ‘The new science of organizations.’ The research is qualitative, based on bibliographic, documentary data, in-depth interviews, online questionnaires, and direct observation. The results show that the challenges present in the context of study indicate that small municipalities can present fertile ground for the development of entrepreneurial practices. The analyses have also shown that the main deficiencies of the small towns are the managers’ lack of training, the lack of effective articulation with the federal level, the lack of an environment capable of fostering proactivity and participation, the financial crisis, and the necessary behaviors and arrangements. A huge gap for the development of effective businesss practice is the loose coordination of the Union, states and cities, which is a historical feature of the country.

ABSTRACT Roux-en-Y gastric bypass, a procedure proven effective for treating morbid obesity and metabolic disorders, carries the risk of complications such as the formation of internal hernias. These hernias are often difficult to diagnose and can be potentially fatal because they can cause structural obstruction. Most internal hernias occur in the jejunojejunostomy mesentery space, followed by Petersen's space hernias, although herniation at other locations can also occur. Our case report presents an example of a rare internal hernia after laparoscopic Roux-en-Y gastric bypass. A 36-year-old woman presented with an uncommon internal hernia located between the liver and alimentary loop, resulting in the formation of a new space and consequently incarcerating the entire biliopancreatic loop. This type of internal hernia is rare and has not been reported in the literature, indicating that this is the first report of such a case. In this case, we realized that the diagnosis was challenging and imaging examinations could not help determine the etiology of the pain and obstruction. Therefore, videolaparoscopy revealed an uncommon hernia formed by firm adhesion between the hepatic segment III and the alimentary loop mesentery. Our case is an example of an internal hernia that was not detected with a normal computed tomography scan of the abdomen and pelvis. Only diagnostic laparoscopy revealed herniation, effectively preventing further complications for the patient.

Objective: To evaluate the performance of the Berlin Questionnaire, the STOP-Bang Questionnaire, and the Epworth Sleepiness Scale in screening for the disease in adults of different age groups by comparing them with polysomnography. Methods: Cross-sectional study with prospective patient allocation, in which individuals underwent a medical interview, completion of the three screening instruments, and polysomnography. Individuals were categorized into three age groups: 18–39, 40–59, and ≥60 years. The results of the screening instruments were compared to the diagnostic criteria of the International Classification of Sleep Disorders—third edition. Performance was assessed using 2 × 2 contingency tables, estimating sensitivity, specificity, predictive value, likelihood ratio, and accuracy. Receiver Operating Characteristic curves were also constructed and the area under the curve was estimated for each instrument by age group. Results: We obtained a sample with 321 individuals suitable for analysis. The mean age was 50 years, with a predominance of females (56%). The prevalence of the disease in the overall sample was 79%, more prevalent in males in any age group and more frequent in the middle age group. The analyzes revealed that STOP-Bang performed better, both for the overall sample and for all age groups, followed by Berlin Questionnaire and Epworth Sleepiness Scale. Conclusion: In an outpatient setting with individuals with characteristics similar to those in this study, it seems sensible to choose the STOP-Bang as a screening tool for the disease, regardless of age group. Level of evidence according the guide for authors: level 2.

As the largest particle physics laboratory in the world, it is no surprise that CERN has a vast network of thousands of collaborators spread globally. Among CERN’s experiments, ATLAS stands out with over 6,000 active members and 300 associate institutes. This extensive community must go through the standard registering and maintenance procedures within CERN’s human resources database, called Foundation. Simultaneously, the Glance system, among other specific functions, also aims to fulfill the same objectives within the context of different CERN experiments, such as ATLAS, LHCb and ALICE. It achieves that by having its own database. Since members need to exist in the two databases, a lot of data was being duplicated. Manual updates by the ATLAS secretariat became necessary to maintain consistency over members and institutes data, such as names, employment information and authorship status. Today, the Glance system undergoes a transformative process to redefine its relationship with Foundation. The goal is to eliminate duplication of data by establishing a single source of truth. At the same time, the automation of a series of internal processes will be made to ensure synchronization between the two databases at all times, thus removing the need for manual intervention from the ATLAS secretariat. This requires some restructuring to Glance’s database, updates to the code and overall implementation of new tools that facilitate seamless communication with Foundation.

The ATLAS experiment is a particle physics experiment situated at the Large Hadron Collider (LHC) at CERN. It involves almost 6000 members from approximately 300 institutes spread all over the globe and more than 100 papers published every year. This dynamic environment brings some challenges such as how to ensure publication deadlines, communication between the groups involved, and the continuity of workflows. The solution found for those challenges was automation, which was achieved through the Glance project, more specifically through the Glance Analysis systems, developed to support the analysis and publications life cycle in 2011. Now, after twelve years, in order to satisfy the experiments’ most recent needs, the systems need code refactoring and database remodelling. The goal is to have only one system to accommodate all the analysis and publications workflows, the so-called ATLAS Publication Tracking system, an evolution of the current Analysis systems. This project includes a database remodelling that reflects the hierarchical relation between analyses and publications; a code base that supports non-standard workflows; the expansion of the current API so all the authorized ATLAS members can access ATLAS publication data programmatically; a service-oriented architecture for integration with external software, such as GitLab; the creation of an automatic test environment, which assures the quality of the systems on each update. The ATLAS Publication Tracking system is a long-term project being developed with an iterative and incremental approach, which ensures that the most valuable tools are implemented with priority while allowing a smooth transition between the old systems and the new one.

Objectives: Upper respiratory tract infections in children generally have significant morbidity and mortality. There is little data available about functional immaturity of the immune system and the child's susceptibility to infections at the beginning of their lives, thus, justifying a more specific immunological analysis. Method: Analysis of hemograms and innate and adaptive immune responses in 95 children between age 1 to 6 years with episodes of recurrent respiratory infections (test group n = 39) and without these episodes (control group n = 56) was carried out. The production of reactive oxygen intermediates by peripheral blood cells stimulated by phorbol myristate acetate was analyzed. Additionally, the number of B lymphocytes, auxiliary T lymphocytes, and cytotoxic cells was determined using flow cytometry. Results: Results from both groups did not show statistically significant differences in red blood cells, total leukocytes count, and the differential neutrophils, eosinophils, basophils, lymphocytes, and monocytes count. The analysis of the number of B lymphocytes, auxiliary T lymphocytes (LTCD4), and cytotoxic cells (LTCD8) also did not show any difference between both groups. However, the production of radical oxygen intermediates was significantly reduced in the test group as compared to the control group (p < 0.05). Conclusions: There was no difference in the analysis of hemograms, leukograms, or the number of lymphocytes, LTCD4, LTCD8, or LTCD19. The reduced production of oxygen intermediates in the affected group suggests that these children's microbicide capacity is compromised, which may be related to their recurrent respiratory infections.

Introduction Chronic obstructive pulmonary disease (COPD) is responsible for 2.9 million deaths annually in Europe. Symptom burden and functional decline rise as patients reach advanced stages of the disease enhancing risk of vulnerability and dependency on informal caregivers (ICs).Evidence shows that hope is an important psycho-social-spiritual construct that humans use to cope with symptom burden and adversity. Hope is associated with increased quality of life (QoL) comfort and well-being for patients and ICs. A better understanding of the meaning and experience of hope over time as patients transition through chronic illness may help healthcare professionals to plan and deliver care more appropriately.Methods and analysis This is a longitudinal multicentre mixed-methods study with a convergent design. Quantitative and qualitative data will be collected from dyads of advanced COPD patients and their ICs in two university hospitals at two points in time. The Herth Hope Index, WHO Quality of Life BREF, Functional Assessment of Chronic Illness Therapy-Spiritual Well-being and the French version of the Edmonton Symptom Assessment Scale will be used to collect data. Dyadic interviews will be conducted using a semi-structured interview guide with five questions about hope and their relationship with QoL.Statistical analysis of data will be carried out using R V.4.1.0. To test whether our theoretical model as a whole is supported by the data, structural equation modelling will be used. The comparison between T1 and T2 for level of hope, symptom burden, QoL and spiritual well-being, will be carried out using paired t-tests. The association between symptom burden, QoL, spiritual well-being and hope will be tested using Pearson correlation.Ethics and dissemination This study protocol received ethical approval on 24 May 2022 from the Commission cantonale d'éthique de la recherche sur l'être humain—Canton of Vaud. The identification number is 2021-02477.

Abstract Objective The present study aims to evaluate the influence of hormonal levels of vitamin D, calcitonin, testosterone, estradiol, and parathyroid in patients with fractures attributed to osteoporosis when compared with young patients with fractures resulting from high-impact accidents. Methods Blood samples were collected from 30 elderly patients with osteoporosisattributed fractures (T-score ≤-2.5) (osteoporotic group), and from 30 young patients with fractures resulting from high-impact accidents (control group). Measurement of 1,25-hydroxyvitamin D (Kit Diasorin, Saluggia, Italy), calcitonin (Kit Siemens, Tarrytown, NY, USA), testosterone, estradiol, and parathyroid hormone (Kit Beckman Couter, Indianapolis, IN, United States) was performed using a chemiluminescence technique. Data were inserted into a Microsoft Excel (Microsoft Corp., Armonk, WA, USA) spreadsheet and analyzed using Statview statistical software. Results showing non-normal distribution were analyzed with nonparametric methods. The Mann-Whitney test was applied for group comparison, and a Spearman test correlated hormonal levels. Statistical significance was set at p < 0.05. All analyzes compared gender and subjects with and without osteoporosis. Results Women with osteoporosis had significantly lower levels of estradiol and vitamin D (p = 0.047 and p = 0.0275, respectively). Men with osteoporosis presented significantly higher levels of parathyroid hormone (p = 0.0065). There was no significant difference in testosterone and calcitonin levels. Conclusion Osteoporosis patients presented gender-related hormonal differences. Women had significantly lower levels of estradiol and vitamin D, whereas men had significantly higher parathyroid hormone levels, apparently impacting the disease.

Este artigo objetiva analisar os mapeamentos na interface da segurança alimentar e nutricional e do planejamento territorial. Para isso, consideramos a fome como manifestação da questão social, o retorno do Brasil ao mapa da fome durante a Pandemia de Covid-19, a importância do Estado no planejamento de políticas públicas e a literatura. O exame da literatura demonstrou uma frágil relação entre os campos da cartografia temática, do planejamento e da alimentação. Como procedimento metodológico, realizamos a análise crítica de estudos selecionados, mobilizando definições de desertos alimentares, pântanos e ilhas de abundância. Concluímos que, para a efetivação do direito humano à alimentação adequada, é fundamental um planejamento que contemple a pluralidade da alimentação e relacione aos territórios e suas populações por meio de mapeamentos temáticos intersetoriais.

PurposeWound closure technique is an operative factor that influences early post-operative complications after third molar surgery. This study investigates and compared the effectiveness of two closure techniques, primary closure and healing by second intention of the oblique incision on postsurgical discomfort after mandibular third molar surgery.Materials and methodsThis is a prospective, randomized, double-blind, split mouth controlled trial. Surgical sites were divided into two groups Control group received simple sutures in both alveolar crest incision and oblique incision and intervention group received simple sutures in alveolar crest incision, while the oblique incision healed by second intention. All the patients were instructed to measure pain according to visual analogue scale (VAS) in postoperative period, swelling, mouth opening was assessed at 72h and 7 days after surgery. The wound healing was assessed on day 7.ResultsThirty-five patients, who had bilateral impacted third molars of similar surgical difficulty, were recruited. Thirty-one successfully completed the study. Patients in the second intention group had significantly less pain at 24h (p < 0.27). and 48h (< 0.001), had significantly less swelling (< 0.001) and trismus (< 0.001) and patients submitted to primary closure had a better evaluation of the Landry index (p < 0.001).ConclusionHealing by second intention of the oblique relaxing incision by partial surgical wound closure, in our study, were superior to the primary closure in reduction of post-operative pain, swelling and trismus.Trial registrationThis trial is registered at Brazilian Registry of Clinical Trials-ReBEC -UTN: RBR-5fxbqsf (https://ensaiosclinicos.gov.br/rg/RBR-5fxbqsf).

IntroductionThe use of massage therapy has received increased attention in the treatment of chronic pain. However, barriers can hinder its use in nursing care. This study uses a qualitative methodology to explore professionals' experiences regarding touch massage (TM) and identify barriers and facilitators for the implementation of this intervention.Materials and methodsThis study is part of a larger research program aimed at investigating the impact of TM on the experiences of patients with chronic pain hospitalized in two units of an internal medicine rehabilitation ward. Health care professionals (HCPs) were trained either to provide TM or to use of a massage-machine device according to their units. At the end of the trial, two focus groups were conducted with HCPs from each unit who took part in the training and agreed to discuss their experience: 10 caregivers from the TM group and 6 from the machine group. The focus group discussions were tape-recorded, transcribed and analyzed using thematic content analysis.ResultsFive themes emerged from thematic content analysis: perceived impact on patients, HCPs' affective and cognitive experiences, patient-professionals relationships, organizational tensions, and conceptual tensions. Overall, the HCPs reported better general outcomes with TM than with the machine. They described positive effects on patients, HCPs, and their relationships. Regarding interventions' implementation, the HCPs reported organizational barriers such as patients' case complexity, work overload, and lack of time. Conceptual barriers such as ambivalence around the legitimacy of TM in nursing care were reported. TM was often described as a pleasure care that was considered a complementary approach and was overlooked despite its perceived benefits.ConclusionDespite the perceived benefits of TM reported by the HCPs, ambivalence arose around the legitimacy of this intervention. This result emphasizes the importance of changing HCPs' attitudes regarding a given intervention to facilitate its implementation.

INTRODUCTION: Neonatal palliative care has been increasingly integrated promoting individualized care, centered on maternal and family bonds. Even progress, there are several difficulties in the implementation of conducts. OBJECTIVE: To emphasize the importance and mains difficulties in implementing neonatal palliative care. METHODS: Bibliographic survey in PubMed and Lilacs databases. The descriptor used “neonatal palliative care”, “neonatology” and “difficulties”. Ten articles were selected at the end of review. CONCLUSION: Neonatal palliative care has made great advances; however, its implementation remains a challenge, not only on the part of the family, but also due to the lack of training and qualification of professionals in the field. This shows the importance of continuing education and creating protocols that meet the needs of patients.

RESUMO Objetivo conhecer o perfil clínico e cirúrgico de pacientes que realizaram ceratoplastia em um hospital universitário. Métodos Trata-se de um estudo observacional analítico, do tipo transversal. Foram avaliadas as fichas de descrição cirúrgica dos prontuários dos pacientes transplantados nos anos de 2019 e 2020, a fim de analisar dados sociais e clínicos. Os dados foram tratados por meio do programa Microsoft Office Excel 2017. As variáveis numéricas foram analisadas com auxílio da estatística descritiva no programa Bioestat versão 5.3 (frequência, porcentagem, média). As informações descritivas foram analisadas qualitativamente. Resultados Foram realizados 167 procedimentos nesse período, notando-se faixa etária média de 45 anos, indivíduos do sexo masculino, receptores de tecidos doados no Pará ou provenientes do Estado do Ceará. Os transplantes foram majoritariamente ópticos, eletivos, com botão corneano doador em média de 8mm e receptor de 7,5mm. Quanto às indicações, a maioria era decorrente de distrofias corneanas, seguidas de leucoma e perfuração do globo ocular, com predominância da técnica cirúrgica penetrante, sutura interrompida e anestesia local. Conclusão O conhecimento desses dados é importante para considerar que o perfil clínico e cirúrgico dos pacientes do hospital estudado se aproxima da realidade nacional, sobretudo na indicação clínica.

Este artigo investiga o sagrado na obra “O Livro dos Homens”, de Ronaldo Correia de Brito, a partir do universo simbólico que, embora criado pelo humano, compõe-se de determinadas máximas populares que fornecem sentido à existência. Destacam-se as correlações epistemológicas entre sagrado e literatura, principalmente, na perspectiva dos espaços em que os contos são narrados através do sertão, assim como a partir da cronotopia particularmente brasileira cheia de tradições, imaginários e acervos dentro da literatura brasileira. A multiplicidade de significados de “O Livro dos homens” define a natureza das treze narrativas que compõem o livro, todas atadas ao retrato brutal, mas nem por isso alheio à poeticidade da narrativa. Dessa forma, religião e sagrado constituem em formas de ver o mundo e as manifestações culturais que o ser humano inventa e reinventa para dar sentido à sua existência, portanto, a religião oferece um sistema de símbolos e signos que orienta o modo como os humanos constituem a si mesmos, aos seus semelhantes e às devidas percepções das coisas do mundo que o cercam, de modo semelhante, a arte literária tem seu critério de ser um arquivo, registro e interpretação de imaginários sociais.

In order to evaluate and compare the specific immune response of pregnant women (PW) chronically infected with Toxoplasma gondii, with and without gestational diabetes mellitus (GDM), and the humoral response of their respective newborns (NB), the study was carried out on 81 PW (34 GDM and 47 controls) from whose medical records the results of the oral glucose tolerance test (OGTT) were obtained, and blood samples were collected at the third trimester of pregnancy; also, on 45 NBs (20 GDM and 25 controls) from whom umbilical cord blood samples were obtained. Humoral immunity was analyzed by measuring anti-T. gondii total IgG, IgG subclasses and IgG avidity. To evaluate cellular immunity, peripheral blood mononuclear cells (PBMC) from 32 PW (16 GDM and 16 controls) were cultured, supernatant cytokines were determined, and flow cytometry was performed to analyze the expression at lymphocytes of surface molecules, cytokines and transcription factors. All PW and NBs were positive for total IgG, and the prevalent subclass was IgG1. There was a negative correlation between the OGTT glycemia of PW and the levels of total IgG, IgG1 and IgG avidity. The IgG avidity of the GDM group was significantly lower than the control group. Patients from the GDM group had a higher number of T lymphocytes expressing markers of cell activation and exhaustion (CD28 and PD-1). In the presence of T. gondii soluble antigen (STAg) the amount of CD4+ T cells producing IFN-γ, IL-10 and IL-17 was significantly lower in the GDM group, while there was no difference between groups in the number of CD4+ CD25HighFOXP3+LAP+ functional Treg cells. Additionally, under STAg stimulus, the secretion of IL-17, IL-4, TNF and IL-2 cytokines at PBMCs culture supernatant was lower in the GDM group. In conclusion, there was a correlation between the increase in blood glucose and the decrease in levels of anti-T. gondii antibodies, associated with the decreased IgG avidity in patients who develop GDM. Also, the GDM group had decreased immune responses in Th1, Th2 and Th17 profiles, suggesting an association between GDM and the negative modulation of the humoral and cellular immune responses against T. gondii.

The objective of this study was to estimate (co)variances and genetic parameters and to predict genetic trends for weight at 120 (W120), 210 (W210), 365 (W365), and 450 (W450) days of age in Nelore cattle raised in the northern region of Brazil. The database comprised records of 30,387 animals born between 2000 and 2013 in the Brazilian North. Estimates were calculated by the Restricted Maximum Likelihood (REML) method, in single- and multi-trait analyses in an animal model. Heritability as obtained using single- and multi-trait models for W120 (0.22 and 0.31), W210 (0.20 and 0.34), W365 (0.51 and 0.51), and W450 (0.49 and 0.51) indicated moderate to high magnitudes, with the possibility of genetic selection and incorporation into the herd. Genetic correlations between growth traits were favorable, ranging from 0.78 to 0.96. Genetic trends for W120 and W210 varied largely, from -0.31 to 4.68 and -0.53 to 7.62 kg/year, respectively. Smaller fluctuations were observed in genetic trends for W365 and W450, which ranged from -1.08 to 10.90 and -1.29 to 12.51 kg/year, respectively. Selection for W365 and W450 proved to be the criterion of choice for Nelore herds raised in the region; however, it may compromise adult performance because of higher costs and time for production. A thorough analysis of mattings is recommended to allow the selection of earlier-developing animals.