Evidence gaps in orthognathic surgery, a Delphi study protocol

Aim: To assess the research gaps identified in a recent mapping review of orthognathic surgery through their evaluation by clinical experts, leading to a clinically relevant list of research gaps. This will guide future investigations of the topic, focusing on the outcomes of blood loss, infection, and relapse. Methods: The Delphi technique will be used to appraise the identified research gaps. The expert panel will include maxillofacial surgeons who regularly perform orthognathic surgery. Potential participants will be identified through various methods, including contact information from articles in the mapping review, nominations from peers, and social media platforms. Two rounds of surveys will be undertaken with Likert-type and open-ended questions to assess the clinical relevance of research gaps. For the second round, participants will receive a report of the results of the first round. Questions will be modified depending on the answers obtained in the first round. A consensus of 60% will be considered valid. Conclusions: Through this Delphi study, in a collaborative effort between researchers and clinical experts, a comprehensive understanding of the clinical relevance of research gaps in orthognathic surgery will be achieved. The outcomes will guide future investigations, ultimately improving the outcomes and practices in this field.

Desigualdades sociales en la mortalidad maternal, República Dominicana, 2016 / Social inequalities in maternal mortality, Dominican Republic, 2016

Esta investigación pretende cuantificar las diferencias en la razón de mortalidad materna en las provincias de la República Dominicana, considerando las distintas condiciones sociales a la que estas mujeres están expuestas. Se utilizó la información proveniente de registro de estadísticas vitales. Se calculó la asociación entre la razón de mortalidad materna y ciertos indicadores socioeconómicos seleccionados. Se calcularon las métricas de desigualdad tomando en cuenta los indicadores socioeconómicos que se hallaron significativamente asociados con la razón de mortalidad materna, resultando esta dos veces mayor en los territorios más desfavorecidos socialmente, comparados con los territorios que se encontraron en mejores condiciones sociales.

This research aims to quantify the differences in the ma-ternal mortality rate in the provinces of the Dominican Republic, considering the different social conditions to which these women are exposed. Information from the vital statistics registry was used. The association be-tween the maternal mortality rate and certain selected socioeconomic indicators was calculated. The inequality metrics were calculated considering the socioeconomic indicators that were found to be significantly associated with the maternal mortality rate, resulting in two times higher in the most socially disadvantaged territories, compared to the territories that were found in better social conditions.

Sensory processing and engagement: a systematic review / Processamento sensorial e engajamento: uma revisão sistemática

Abstract The ability of children to organize themselves sensorially in a school environment to remain engaged in their routine activities has been minimally explored by occupational therapists. This study aimed to identify research on sensory processing and engagement carried out by occupational therapists over the past decade. Moreover, it seeks to analyze the depth and quality of discussions regarding the relationship between sensory processing and children's engagement in their occupations. A systematic review was conducted utilizing the descriptors: sensory processing, engagement, and occupational therapy. These descriptors were combined through the AND operator in the VHL, PubMed, and Web of Science databases. Included articles, whether in English or other languages, defined and measured sensory processing; highlighted a relationship between child sensory processing and occupational engagement; were published within the past 10 years (2008 to 2018); underwent peer-review; are available in full; involved participants aged 0 to 7 years; and were authored by occupational therapists. The review process was performed by two authors using predefined data fields, which included study quality indicators. The results identified a mere nine articles on this specific theme. An assessment based on the OT Seeker scale revealed scores of moderate magnitude. This suggests a pressing need for occupational therapists to invest in the expansion of discerning research, aiming to elevate scientific evidence regarding the relationship between sensory processing and occupational engagement.

Resumo A capacidade das crianças de se organizarem sensorialmente em ambiente escolar para se manterem engajadas em suas atividades rotineiras tem sido pouco explorada por terapeutas ocupacionais. Este estudo teve como objetivo identificar pesquisas sobre processamento sensorial e engajamento realizadas por terapeutas ocupacionais na última década, bem como avaliar a qualidade das discussões sobre a relação entre processamento sensorial e engajamento de crianças em suas ocupações. Trata-se de uma revisão sistemática realizada a partir da busca dos descritores: processamento sensorial, engajamento e terapia ocupacional, combinados segundo o operador AND, nas plataformas BVS, PubMed e Web of Science. Os artigos incluídos, tanto em inglês e como em outras línguas, definiram e mediram processamento sensorial; apontaram relação entre processamento sensorial e engajamento ocupacional infantil; foram publicados nos últimos 10 anos (de 2008 a 2018); revisados ​​por pares; estão disponíveis na íntegra; envolveram participantes com idade entre 0 e 7 anos, e foram escritos por terapeutas ocupacionais. As revisões foram realizadas por duas autoras usando campos de dados predefinidos, incluindo indicadores de qualidade do estudo. Os resultados identificaram apenas nove artigos sobre esse tema específico. A análise da classificação, com base na escala OT Seeker, revelou escores de magnitude moderada, o que sugere a necessidade de terapeutas ocupacionais investirem na ampliação de pesquisas criteriosas a fim de aumentar os níveis de evidência científica sobre a relação entre processamento sensorial e engajamento ocupacional.

Effect of Canopy Gaps on Growth and Water Use Efficiency of Seedling of Vulnerable Species, Hopea sangal Korth

Aims: Hopea sangal Korth. is listed as vulnerable species and recently its remnant habitat was rediscovered in the degraded forest near the springs area in East Java. In the forest, the regeneration of the seedling and saplings understory is affected by the heterogeneity in environmental factors especially various light levels due to the canopy gaps. H. sangal is considered a shade-tolerant species, hence the establishment of the seedling in its natural habitat occurs under the closed canopy. This study aimed to understand the Water Use Efficiency (WUE) and Relative Growth Rate (RGR) of Hopea sangal Korth seedling grown in two different levels of tree canopy shades. Study Design: This research was using a completely randomized design, with 9 replications. Place and Duration of Study: This study was conducted in the Purwodadi Botanic Garden, East Java, between March � July. Methodology: We used seedling of H. sangal collected from the field in Pasuruan which were planted in plastic pots and acclimatized to obtain seedling of a similar size. The microclimate was measured weekly using solarimetri and sling psychrometer at 08.00; 10:00; 12:00; 14:00 and 16:00. RGR was measured by harvesting the seedling and whole plant WUE was measured using the gravimetric method. Results: We observed the light level during the periodic opening of the canopy gap was significantly different at a specific time (8-12 am), with the highest light intensity at 10.00 of 333.57 祄ol photon m-2s-1. The canopy shades differences did not affect the WUE of seedling (P = 0.333), meanwhile, there was a significant difference in the seedling RGR (P = 0.025). The seedling that were grown under a higher gap and received higher light intensity periodically during a day had higher RGR than those under a closed canopy. The WUE has a positive relationship with the RGR of seedling (R2 = 0.5; P < 0.05). Conclusions: This study suggested that the H. sangal is one of the shade-tolerant species capable of responding to gap-opening sunlight. The study also showed RGR of the seedling positively correlated with the WUE of plants, indicating that the seedling could use the water supply efficiently to grow rapidly.

MicroCT evaluation for CAD/CAM occlusal veneer fit using two materials and three cement space settings

Abstract This study was aimed to evaluate the fit of occlusal veneer restoration for two CAD/CAM materials with different cement space settings, using microCT scans. Sixty resin dies were made and divided into two groups (n=30) according to the materials, (I): Hybrid all-ceramic, and (II): zirconia-reinforced lithium silicate glass-ceramic. Each group was subdivided into three subgroups (n=10) according to the cement space parameters (30, 40, and 50 µm). Occlusal veneers for the six subgroups were milled. A circle with 20 different sections was placed at the center of every scanned specimen to measure four different locations (Occlusal, Axial, Marginal, and Absolute marginal discrepancy). Data were analyzed using two-way ANOVA at a 0.05 level of significance. There was no statistically significant effect of material type on the mean values of internal and marginal gaps for the three cement space parameters (P>0.05). There were no statistically significant differences in the occlusal and axial gap between the cement space parameters, furthermore, there were statistically significant differences in marginal gap distances and absolute marginal discrepancies (P>0.05). Hybrid all-ceramic showed smaller marginal and internal discrepancies than zirconia-reinforced lithium silicate glass-ceramic without statistically significant differences, and, for both materials, 50 µm cement space significantly improved the marginal fit and absolute marginal discrepancy.

Resumo Este estudo teve como objetivo avaliar o ajuste da restauração de facetas oclusais para dois materiais CAD/CAM com diferentes configurações de espaço de cimento, usando microCT. Foram feitos sessenta moldes de resina e divididos em dois grupos (n=30) de acordo com os materiais, (I): cerâmica pura híbrida, e (II): cerâmica de vidro de silicato de lítio reforçada com zircónia. Cada grupo foi subdividido em três subgrupos (n=10), de acordo com os parâmetros do espaço de cimento (30, 40, e 50 µm). As facetas oclusais para os seis subgrupos foram fresadas. Um círculo com 20 secções diferentes foi colocado no centro de cada amostra digitalizada para medir quatro locais diferentes (Oclusal, Axial, Marginal, e discrepância marginal absoluta). Os dados foram analisados utilizando ANOVA bidireccional a um nível de significância de 0,05. Não houve efeito estatisticamente significativo do tipo de material nos valores médios das aberturas internas e marginais para os três parâmetros do espaço de cimento (P>0,05). Não houve diferenças estatisticamente significativas no intervalo oclusal e axial entre os parâmetros do espaço de cimento, além disso, houve diferenças estatisticamente significativas nas distâncias do intervalo marginal e discrepâncias marginais absolutas (P>0,05). A cerâmica pura híbrida mostrou discrepâncias marginais e internas menores do que a cerâmica de vidro de silicato de lítio reforçada com zircónia sem diferenças estatisticamente significativas, e, para ambos os materiais, 50 µm de espaço de cimento melhoraram significativamente o ajuste marginal e a discrepância marginal absoluta.

Las brechas de género en la investigación científica del Perú / Gender gaps in Peruvian scientifc research / Lacunas de gênero na pesquisa científica peruana

Los estudios de tipo bibliométricos han mostrado las grandes diferencias en producción científica entre continentes, países o instituciones; sin embargo, un análisis más minucioso de las publicaciones científicas ha identifcado patrones de desigualdad con respecto a sus autores, siendo una ellas las referidas al género. Identificar las brechas de género en la investigación científica viene adquiriendo cada vez mayor interés por la desigualdad social y económica que representa, debido a que detrás ellas existen causales culturales o formativas que impiden la inserción, participación y el avance de las mujeres en los espacios de ciencia, tecnología e innovación

Bibliometric studies have shown the large differences in scientific differences in scientific production between continents, countries or institutions. countries or institutions; however, a more thorough analysis of scientific of scientific publications has identified patterns of inequality with respect to their with respect to their authors, one of them being those related to gender. Identifying gender gaps in scientific research has become of increasing interest for the of growing interest due to the social and economic inequality it represents, because behind economic inequality that it represents, because behind them there are cultural or formative that impede the insertion, participation and advancement of women in the and advancement of women in the areas of science, technology and innovation

Estudos bibliométricos têm mostrado as grandes diferenças na produção científica entre continentes, países diferenças na produção científica entre continentes, países ou instituições. países ou instituições; no entanto, uma análise mais completa das publicações científicas tem publicações científicas identificaram padrões de desigualdade em relação a seus autores. com respeito a seus autores, sendo um deles gênero. A identificação de lacunas de gênero na pesquisa científica é de interesse crescente para a de crescente interesse devido à desigualdade social e econômica que representa, porque por trás do desigualdade econômica que ela representa, porque por trás delas há culturais ou formativas causas culturais ou formativas que impedem a inserção, participação e participação e avanço da mulher nas áreas de ciência, tecnologia e inovação

Postos de trabalho ocupados por fisioterapeutas: uma menor demanda para a atenção básica / Workplaces occupied by physiotherapists: less demand for primary care

Resumo Tendo em vista o olhar ampliado de saúde proposto pelo SUS, a abordagem dada ao processo do adoecimento exigiu um prisma voltado à visão biopsicossocial, e não mais ao modelo biomédico, o que levou a um reordenamento na formação dos profissionais de saúde. Assim, as Diretrizes Curriculares Nacionais foram instituídas norteando os projetos pedagógicos dos cursos rumo ao modelo biopsicossocial, de forma que a Classificação Internacional de Funcionalidade, Incapacidade e Saúde contribui para esse cenário por meio de sua abordagem multidimensional e não reducionista. Entretanto, historicamente, a fisioterapia tem forte influência do modelo biomédico, distanciando-a da atenção básica (AB). Este é um estudo exploratório, descritivo e quantitativo, com fonte de dados secundários obtidos por meio do Cadastro Nacional dos Estabelecimentos de Saúde do Brasil, e cujo objetivo foi verificar, dentro de um intervalo de dez anos, em qual nível de assistência à saúde está concentrada a maior parte dos fisioterapeutas e sua representatividade na AB. Os achados indicaram que a AB representa o cenário minoritário dos postos de trabalho ocupados pelos fisioterapeutas, refletindo a hegemonia do modelo biomédico e reforçando o caráter reabilitador dado historicamente à profissão.

Abstract In view of the expanded view of health proposed by the Unified Health System (SUS), the approach given to the illness process required a prism focused on the biopsychosocial view and no longer on the biomedical model, which led to a reorganization in the training of health professionals. Thus, the National Curriculum Guidelines were established guiding the pedagogical projects of the courses towards the biopsychosocial model, so that the International Classification of Functionality, Disability and Health contributes to this scenario through its multidimensional and non-reductionist approach. However, physiotherapy has historically been strongly influenced by the biomedical model, distancing it from primary care (PC). This is an exploratory, descriptive and quantitative study, with secondary data source obtained through the National Register of Health Establishments in Brazil, whose objective was to verify, within a 10-year interval, at which level of health care most physiotherapists and their representation in PC are concentrated. The findings indicated that PC represents the minority scenario of jobs occupied by physical therapists, reflecting the hegemony of the biomedical model and reinforcing the rehabilitation character historically given to the profession.

Situação de saúde mental de comunidades tradicionais: marcadores sociais em análise / Mental health status in traditional communities: Social markers under analysis / L'état de santé mentale dans les communautés traditionelles: les marqueurs sociaux à l'étude / Situación de la salud mental en comunidades tradicionales: marcadores sociales en análisis

Objetiva-se analisar a situação de saúde mental de 48 municípios nordestinos que registram a presença de comunidades quilombolas e de assentamentos de reforma agrária em seus territórios, considerando as condições de vida, a oferta de serviços de saúde e o perfil de morbimortalidade em saúde mental. São articulados aspectos de gênero, classe e raça para compreender a produção de iniquidades em saúde nesses territórios. Trata-se de um estudo descritivo, realizado a partir de análise quantitativa com dados secundários coletados de diferentes bases disponíveis em domínio público. Observa-se o entrecruzamento e a combinação de fatores que influenciam a situação de saúde mental de municípios com populações do campo e da floresta: a precariedade nas condições de vida e trabalho, retaguarda insuficiente de serviços de atenção psicossocial e desigualdades étnico-raciais e de gênero da morbimortalidade psiquiátrica.

This descriptive study sought to analyze the mental health status of 48 Northeastern municipalities in Brazil with quilombola communities and agrarian reform settlements in their territories, considering the living conditions, health service supply and the profile of morbidity and mortality in mental health. Gender, class and race aspects are articulated to understand the production of health inequities in these territories. By means of a quantitative analysis based on secondary data collected from different open databases, the research unveiled the intersection and combination of factors that influence the mental health status of municipalities with rural and forest populations: the precariousness of living and working conditions, insufficient support from psychosocial care services, and ethnic-racial and gender inequalities in psychiatric morbidity and mortality.

Cette recherche descriptive visait à analyser l'état de santé mentale dans 48 municipalités du Nord-Est brésilien ayant des communautés quilombolas et des établissements de réforme agraire sur leur territoire, en tenant compte des conditions de vie, de l'offre de services de santé et du profil de morbidité et de mortalité en matière de santé mentale. Les aspects de genre, de classe et de race sont articulés pour comprendre la production d'inégalités en matière de santé dans ces territoires. À partir d'une analyse quantitative basée sur des données secondaires recueillies dans différentes bases de données dans le domaine public, on dévoile l'intersection et la combinaison de facteurs qui influencent l'état de santé mentale dans les communes à population rurale et forestière : la précarité des conditions de vie et de travail, le soutien insuffisant des services de soins psychosociaux et les inégalités ethniques, raciales et de genre en matière de morbidité et de mortalité psychiatriques.

El objetivo de este artículo es analizar la situación de la salud mental en 48 municipios del Nordeste de Brasil que tienen comunidades quilombolas y asentamientos de reforma agraria en sus territorios, en cuanto a las condiciones de vida, la oferta de servicios de salud y el perfil de morbimortalidad en salud mental. Se articulan los aspectos de género, clase y raza para comprender la producción de las desigualdades sanitarias en estos territorios. Se trata de un estudio descriptivo, que aplicó el análisis cuantitativo a los datos secundarios recogidos de diferentes bases de datos disponibles en el dominio público. Se observan el entrecruzamiento y la combinación de factores que influyen en la situación de la salud mental en los municipios con poblaciones rurales y de la floresta: la precariedad en las condiciones laborales y de vida, el insuficiente apoyo de los servicios de atención psicosocial y las desigualdades étnico-raciales y de género en la morbimortalidad psiquiátrica.

Anterior aesthetic restoration with ultrathin porcelain veneers on asymmetric faces assisted by a four-dimensional smile design: a case report and literature review / 口腔疾病防治

Objective@#To explore the application effect of a four-dimensional smile design as the leading and facial streamline as the reference system in the aesthetic restoration of anterior teeth.@*Methods@# A case of scattered space in anterior teeth was treated with a four-dimensional smile design and digital aesthetic restoration with ultrathin porcelain veneer. The digital information of the patients was obtained through oral and facial scanning, and a four-dimensional smile design and prediction were carried out. After the treatment plan was jointly determined by doctors and patients, minimally invasive abutment preparation was carried out, and ultrathin porcelain veneer was made and bonded in place. After the operation, the esthetic degree and marginal fit were observed and reexamined one year after the repair.@* Results @#The edges of the ultrathin ceramic veneers were naturally tight, and the color was coordinated, with satisfying pink and white esthetics. The face was more harmonious and natural when smiling. One year after the restoration, the facial aesthetics were wonderful, the abutment teeth and periodontal tissues were healthy, and the patients were satisfied. The results of the literature review showed that the fitting of temporal facial scanning and intraoral scanning data can accurately predict four-dimensional smile aesthetics, simulate the real state of the dynamic smile and pronunciation process, and combine it with facial streamlines to design a natural and coordinated personalized smile for patients with asymmetric faces. However, for patients with occlusal changes, unstable occlusion or temporomandibular joint disorder, it is necessary to add data fitting, such as electronic facial arch and cone beam CT, to more accurately simulate postoperative mandibular movement.@*Conclusion@# With a four-dimensional smile design as the leading and facial streamline as the reference system, the whole process digital design assisted the restoration of asymmetric anterior teeth with ultrathin porcelain veneer and had a good effect. The postoperative smiling of patients is harmonious and beautiful, which is in line with the expected effect. Patient participation and satisfaction are high; thus, this method is worthy of clinical promotion.

¿Cómo comen los argentinos? Consumos, brechas y calidad de dieta / How do argentines eat? Consumption, gaps and diet quality

Resumen El objetivo del trabajo fue analizar los consumos alimentarios de la población argentina, identificar sus principales brechas alimentarias, determinar su magnitud e intensidad y analizar la calidad de dieta resultante. Se trabajó con la base de datos de la Encuesta Nacional de Gastos de los Hogares (ENGHo) 2017/2018. Se extrajeron y analizaron registros de compras de 383 alimentos y bebidas; los consumos se expresaron en energía y nutrientes (tabla SARA) y se calcularon medidas de Índice de Densidad de Nutrientes (IDN) y brechas alimentarias con relación a las recomendaciones de una dieta saludable (brecha promedio, magnitud de hogares con brechas e intensidad de la brecha). El patrón alimentario hallado refleja consumos bajos en alimentos protectores y preventivos de enfermedades crónicas y monotonía de la dieta. Las brechas reflejan déficits (promedio 60%) en hortalizas no feculentas, frutas, legumbres, granos y cereales integrales y leche, yogur y quesos. Harinas y otros productos feculentos, alimentos ocasionales y carnes registran brechas excedentarias en hogares de todos los niveles de ingreso, excepto el 1° quintil en carnes y en alimentos ocasionales. Solo 11% de los hogares presenta una calidad de dieta alta. Todos los resultados hallados son peores en los quintiles de ingresos más bajos y en hogares con presencia de niños, niñas y adolescentes. Las principales conclusiones se refieren a la monotonía alimentaria, las amplias brechas, su magnitud e intensidad en los alimentos de mejor densidad nutricional y su expresión en una calidad de dieta apenas intermedia. El exceso y desequilibrio en la ingesta de alimentos fuente de hidratos de carbono, con un balance desfavorable hacia legumbres, granos y cereales integrales, así como el exceso de alimentos ocasionales y la necesidad de disminuir los altos consumos de carnes en amplios sectores de la población.

Abstract The objective of this research was to analyze the food consumption of the Argentine population, identify its main food gaps, determine its magnitude and intensity and analyze the resulting quality of diet. We analyzed the database of the National Household Expenditure Survey (ENGHo) 2017/2018. Purchase records of 383 food and beverages were extracted and analyzed; consumptions were expressed in energy and nutrients (SARA table) and Nutrient Density (IDN) measures and food gaps were calculated in relation to the recommendations of a healthy diet (average gap, magnitude of households with gaps and intensity of the gap). The dietary pattern found reflects low intakes of protective and preventive foods for chronic diseases and monotony of the diet. The gaps reflect deficits (average 60% ) in non-starchy vegetables, fruits, legumes, grains and whole grains, milk, yogurt and cheeses. Flour and other starchy products, occasional foods and meats register surplus gaps in households of all income levels, except for the 1st quintile in meats and occasional foods. Only 11% of households have a high quality of diet. All the results found are worse in the lowest income quintiles and in households with children and adolescents. The main conclusions refer to food monotony, wide gaps, its magnitude and intensity in foods with the best nutritional density and its expression in a barely intermediate quality of diet. The excess and imbalance in the intake of carbohydrates source foods, with an unfavourable balance towards legumes, grains and whole grains, as well as the excess of occasional foods and the need to reduce the high consumption of meat in large sectors of the population.

Role of perioperative nursing in anesthesia: a national overview / Papel de la enfermería perioperatoria en la anestesia: panorama nacional / Papel da Enfermagem perioperatória na anestesia: panorama nacional

Abstract Objectives: To assess the actions performed by the operating room nurse during anesthesia and their behavior for patient safety regarding the reporting on adverse events, and to analyze their knowledge about anesthetic practices. Method: This is a cross-sectional study carried out using an electronic questionnaire consisting of socio-demographic, professional practice, knowledge in anesthesia, patient safety, and professional practice questions, conducted from January to March 2019 with operating room nurses. Results: One hundred nurses participated, 89 (89%) being women, with a mean age of 41.09 years (SD = 9.36), time of undergraduate completion of 14.33 years (SD = 8.34). The average attendance was 4.69 operating rooms (SD = 2.07) per nurse, with an emphasis on action before induction (49; 49%). Professionals reported performance of simultaneous activities (72; 72%) and insufficient number of employees (57; 57%) as difficulties of their daily practice. Among the participants, 77 (77%) correctly cited the periods of general anesthesia and 80.4% always reported the occurrence of an adverse event. Conclusion: Nurses identified their role in anesthesia, with limitations for assistance from multiple activities and lack of professionals.

RESUMEN Objetivos: Evaluar las acciones realizadas por los enfermeros en el quirófano durante la anestesia y sus conductas para la seguridad del paciente en la notificación de eventos adversos, analizando sus conocimientos sobre prácticas anestésicas. Método: Estudio transversal realizado con un cuestionario electrónico compuesto por preguntas sociodemográficas, práctica profesional, conocimientos en anestesia, seguridad del paciente y cuestiones de ejercicio profesional, realizado de enero a marzo de 2019 con enfermeros de quirófano. Resultados: Participaron 100 enfermeros, 89 (89%) mujeres, con una edad media de 41,09 años (DE = 9,36), tiempo de formación de 14,33 años (DE = 8,34). La asistencia media fue de 4.69 quirófanos (DE = 2.07) por enfermero, con énfasis en la actuación antes de la inducción (49; 49%). Los profesionales informaron como limitación de su práctica diaria la ejecución de actividades simultáneas (72; 72%) y la insuficiencia de empleados (57; 57%). Entre los participantes, 77 (77%) citaron correctamente los períodos de anestesia general y el 80,4% siempre reportaron la ocurrencia de un evento adverso. Conclusión: Los enfermeros identificaron su papel en la anestesia, con limitaciones en la atención por múltiples actividades y falta de profesionales.

RESUMO Objetivos: Avaliar as ações executadas pelo enfermeiro de centro cirúrgico durante a anestesia e suas condutas para segurança do paciente quanto à notificação de eventos adversos, analisar o seu conhecimento sobre as práticas anestésicas. Método: Estudo transversal realizado com questionário eletrônico composto por perguntas sócio-demográficas, prática profissional, conhecimento em anestesia, segurança do paciente e questões de exercício profissional, conduzido de janeiro a março de 2019 com enfermeiros de centro cirúrgico. Resultados: Participaram 100 enfermeiros, sendo 89 (89%) do sexo feminino, com média de idade de 41,09 anos (DP = 9,36), tempo de formação de 14,33 anos (DP = 8,34). A média de atendimento foi de 4,69 salas operatórias (DP = 2,07) por enfermeiro, com destaque para a atuação antes da indução (49; 49%). Os profissionais relataram como limitação de sua prática diária a execução de atividades simultâneas (72; 72%) e funcionários insuficientes (57; 57%). Entre os participantes, 77 (77%) citaram corretamente os períodos da anestesia geral e 80,4% sempre notificavam a ocorrência de um evento adverso. Conclusão: Os enfermeiros identificaram seu papel na anestesia, com limitações para assistência devido a múltiplas atividades e carência de profissionais.

speciesLink: rich data and novel tools for digital assessments of biodiversity / speciesLink: dados valiosos e ferramentas inovadoras para avaliações digitais da biodiversidade

Abstract speciesLink is a large-scale biodiversity information portal that exists thanks to a broad collaborative network of people and institutions. CRIA's involvement with the scientific community of Brazil and other countries is responsible for the significant results achieved, currently reaching more than 15 million primary biodiversity data records, 95% of which are associated with preserved specimens and about 25% with high-quality digital images. The network provides data on over 200,000 species, of which over 110,000 occur in Brazil. This article describes thematic networks within speciesLink, as well as some of the most useful tools developed. The importance and contributions of speciesLink are outlined, as are concerns about securing stable budgetary support for such biodiversity data e-infrastructures. Here we review the value of speciesLink as a major source of biodiversity information for research, education, informed decision-making, policy development, and bioeconomy.

Resumo speciesLink é um portal de informações em larga escala sobre biodiversidade, que existe graças a uma ampla rede colaborativa de pessoas e instituições. O envolvimento do CRIA com a comunidade científica do Brasil e de outros países é responsável pelos resultados expressivos alcançados, atingindo atualmente mais de 15 milhões de registros de dados primários de biodiversidade, sendo 95% associados a espécimes preservados e cerca de 25% a imagens digitais de alta qualidade. A rede fornece dados sobre mais de 200.000 espécies, das quais mais de 110.000 ocorrem no Brasil. Este artigo descreve as redes temáticas do speciesLink, bem como algumas das ferramentas mais úteis desenvolvidas. A importância e as contribuições do speciesLink são destacadas, assim como as preocupações em garantir um apoio financeiro estável para e-infraestruturas de dados sobre biodiversidade. Aqui revisamos o valor do speciesLink como uma das principais fontes de informação sobre biodiversidade para pesquisa, educação, tomada de decisão, desenvolvimento de políticas e bioeconomia.

Momentos de "des-existir" e espaços vazios de "des-existência" / Moments of "de-existing" and empty spaces of "de-existence" / Momentos de "des-existir" y espacios vacíos de "des-existencia"

A utilização do conceito des-existir, usado por mim neste e em outros trabalhos, resulta de uma necessidade de nomear e delimitar situações em geral transitórias limitadas à esfera psíquica. Diferencia-se do conceito de matar, verbo ativo que implica na ação de um sujeito, seja em termos físicos ou metafóricos. Assim como diferencia-se também do conceito de morrer, ligado a algo mais definitivo em termos naturais ou figurados. Des-existir refere-se a uma situação momentânea, temporária e às vezes prolongada, em que o sujeito entra em processo de falência como sujeito psíquico por desinvestimento. Pode ser des-existido em diferentes graus de apagamento em um espectro que se estende entre a situação ativa de sujeito e a condição passiva de objeto da pulsão de morte (AU)

I employ the idea of de-existing, in this and other papers, as a result from an urge to name and delimit usually transient situations limited to the psychic sphere. It differs from the idea of killing, active verb that implies the action of a subject, in physical or metaphorical terms. As well as it also differs from the idea of dying, connected to something more definitive in natural or figurative terms. De-existing refers to a momentary, temporary situation, sometimes long-lasting, in which, due to disinvestment, the subject goes into a process of failure as psychic subject. It may be de-existed in different levels of effacement in a spectrum that extends between the active situation as subject and the passive condition of object of the death drive (AU)

El uso del concepto des-existir, que utilizo en este y otros trabajos, resulta de una necesidad de nombrar y delimitar en general situaciones transitorias limitadas a la esfera psíquica. Se diferencia del concepto de matar, verbo activo que implica la acción de un sujeto, ya sea en términos físicos o metafóricos. Además, también se diferencia del concepto de morir, ligado a algo más definitivo en términos naturales o figurativos. El des-existir se refiere a una situación momentánea, temporal y en ocasiones prolongada en la que el sujeto entra en proceso de desplome como sujeto psíquico debido a la desinversión. Puede ser des-existido en diferentes grados de desvanecimiento en un espectro que se extiende entre la situación activa del sujeto y la condición pasiva de objeto de la pulsión de muerte (AU)

Prescription audit led rational drug use management in medical institutions by GAPS method / 中华医院管理杂志

Based on the GAPS(goal, analyze, problem, solution) management model, the authors analyzed the problems existing in the practice of prescription audit and the strategies of continuous optimization. Multi-disciplinary team(MDT) and evidence-based practice were applied to help the continuous optimization of prescription audit practice and promote the rational drug use management of medical institutions. Through the establishment of accurate control process, the personalized management of prescription dosage of chronic diseases, perioperative drugs, special grade antibiotics and auxiliary drugs was realized. The practice of prescription audit based on the GAPS management model, on the one hand, could improve the quality and efficiency of prescription audit, gradually improve the qualified rate of prescription, strengthen clinical use intervention and promote rational drug use; On the other hand, it could reflect the value of pharmacists′ professional technicians, provide patients with more high-quality pharmaceutical care, and gradually realize the prescription audit mode of " improving quality, controlling cost and increasing efficiency" .

Amphibians of Serra das Torres Natural Monument: a reservoir of biodiversity in the Atlantic Forest of southeastern Brazil / Anfíbios do Monumento Natural Serra das Torres: um reservatório da biodiversidade da Mata Atlântica no sudeste do Brasil

Abstract The Brazilian Atlantic Forest holds a major part of the country's amphibian species richness and high rates of endemism. In this study, we conducted surveys using the Rapid Assessment (RA) method to sample the amphibian fauna of the Serra das Torres Natural Monument (MONAST), an Atlantic Forest remnant in southeastern Brazil. We sampled actively with a 6-10-person team to collect standard samples from 09:00 to 12:00 hours for the daytime period, and from 18:00 to 22:00 hours for the crepuscular/nighttime period, with a total of approximately 1,320 hours of sampling effort. We supplemented these data with 720 hours of passive sampling, using pitfall traps with drift fences (30 bucket-days). We recorded 54 amphibian species (two gymnophionans and 52 anurans), and the species richness estimated by the Bootstrap method indicates that a slightly larger number of species (n = 60) may occur in the study area. The most speciose family was Hylidae (n = 21), followed by Brachycephalidae (n = 8). Overall, 25% of the species (n = 13) were recorded only once (singletons) and 15% (n = 8) only twice (doubletons). Most amphibians recorded in this study (71%, n = 37 species) were restricted to the Atlantic Forest biome, two species (Euparkerella robusta and Luetkenotyphlus fredi) are endemic to the Espírito Santo state, and one of them, the leaf litter species E. robusta, is endemic to the MONAST. Euparkerella robusta is currently listed as Vulnerable by the IUCN and is classified as Critically Endangered in the Espírito Santo State red list, while L. fredi has yet to be evaluated due to its recent description. Thoropa lutzi is currently listed as Endangered (EN) by both the IUCN and in the State list. Nine species are listed as Data Deficient (DD) and populations of 13 species are considered to be declining by the IUCN. We extend the geographical distribution of two anuran species (Hylodes babax and Phasmahyla lisbella) and fill an important gap in the distribution of Siphonops hardyi. Amphibians associated with the forest floor represented 42% of the species richness from MONAST, and 43% of these species inhabit the leaf litter exclusively. Our study revealed that Serra das Torres preserves a considerable diversity of Atlantic Forest amphibians, which reinforces the need for the conservation of this forest remnant.

Resumo A Mata Atlântica brasileira guarda importante porção da riqueza de anfíbios e altas taxas de endemismos. Neste estudo, nós realizamos pesquisas usando o Método de Avaliação Rápida (RA) com o objetivo de inventariar a fauna de anfíbios de um remanescente da Mata Atlântica no sudeste do Brasil, o Monumento Natural Serra das Torres (MONAST). Amostramos ativamente com uma equipe de 6 a 10 pessoas para coletar amostras padronizadas entre 09:00 e 12:00 horas durante o peíodo diurno e entre 18:00 e 22:00 duranto período crepuscular/noturno, totalizando aproximadamente 1320 horas de esforço amostral. Complementamos estes dados com 720 horas de amostragem passiva usando armadilhas de queda com cercas-guia (30 dias de balde). Registramos 54 espécies de anfíbios (dois gimnofionos e 52 anuros) e a riqueza de espécies estimada pelo Bootstrap indicou um número relativamente maior de espécies (n = 60). A família mais especiosa foi Hylidae (n = 21), seguida por Brachycephalidae (n = 8). No geral, 25% das espécies (n = 13) foram registradas apenas uma vez - singletons e 15% (n = 8) apenas duas vezes (doubletons). A maioria dos anfíbios registrados neste estudo (71%, n = 37 espécies) esteve restrita ao bioma Mata Atlântica, duas espécies (Euparkerella robusta e Luetkenotyphlus fredi) são endêmicas do estado do Espírito Santo, sendo uma delas, a espécie de serapilheira E. robusta, endêmica do MONAST. Euparkerella robusta está atualmente listada como Vulnerável pela IUCN e classificada como Criticamente Ameaçada na lista vermelha do estado do Espírito Santo, enquanto L. fredi ainda não foi avaliada devido a sua descrição ser muito recente. Thoropa lutzi está atualmente listada como Ameaçada (EN) pela IUCN e na lista estadual. Nove espécies estão listadas como Deficiente de Dados (DD) e as populações de 13 espécies são consideradas em declínio pela IUCN. Estendemos a distribuição geográfica de duas espécies de anuros (Hylodes babax e Phasmahyla lisbella) e preenchemos uma importante lacuna na distribuição de Siphonops hardyi. Os anfíbios associados ao chão da floresta representaram 42% das espécies do MONAST e 43% destas espécies habitavam exclusivamente a serapilheira. Nosso estudo revelou que a Serra das Torres preserva diversidade considerável de anfíbios da Mata Atlântica, o que reforça a necessidade de conservação desse remanescente florestal.

Brechas en la atención de personas hipertensas en el Policlínico Julio Antonio Mella, Guanabacoa, 2016-2017 / Gaps in the care of hypertensive people in Julio Antonio Mella Polyclinic, Guanabacoa (2016-2017)

Introducción: Para lograr el control de la hipertensión arterial se requiere de la vigilancia de sus factores de riesgo, del manejo integral de la enfermedad y la eliminación de brechas que atentan contra la calidad del proceso de atención. Objetivo: Identificar las principales brechas que afectan el proceso de atención de las personas hipertensas en un área de salud del municipio Guanabacoa durante el periodo 2016-2017. Métodos: Se realizó una investigación descriptiva transversal, se aplicó un muestreo por conglomerado bietápico. En una primera etapa de los 41 consultorios se seleccionaron 10, y de estos se seleccionaron aleatoriamente las familias, quedando conformada la muestra por 1458 familias. Se entrevistaron 2297 personas mayores de 35 años. Resultados: El 42,5 por ciento de los entrevistados tenía antecedentes de hipertensión arterial, el 3,0 resultó presunto hipertenso, en el 54,5 por ciento no se encontraron evidencias. Existieron dificultades con la atención de estas personas, dado por problemas organizativos, de funcionamiento del sistema y de comportamiento individual. Las principales brechas fueron en el acceso (36,3 por ciento, seguimiento (28,5 por ciento) y control (17,5 por ciento). El 97,6 por ciento tenía indicado tratamiento farmacológico y el 28 por ciento de los no controlados en el momento de la medición de la presión arterial no estaban adheridos. Conclusiones: Las brechas relacionadas con el acceso a los servicios de salud, diagnóstico, seguimiento, tratamiento y control de los hipertensos, cuyo elemento común es la no búsqueda de atención, repercute en la calidad de la atención(AU)

Introduction: To achieve the control of high blood pressure requires the monitoring of its risk factors, the comprehensive management of the disease and the elimination of gaps that hamper the quality of the care process. Objective: Identify the main gaps that affect the care process of hypertensive people in a health area of Guanabacoa municipality during the period 2016-2017. Methods: A cross-sectional descriptive research was conducted, and a two-stage conglomerate sampling was applied. In a first stage of the 41 family doctor´s offices, 10 were selected, and of these families were randomly selected, with the sample being made up of 1458 families. 2297 people over 35 years old were interviewed. Results: 42.5 percent of the interviewees had a history of high blood pressure, 3.0 percent were suspected hypertensives, in 54.5 percent no evidence was found. There were difficulties with the care of these people, given by organizational problems, system functioning and individual behavior. The main gaps were access (36.3 percent), follow-up (28.5 percent) and control (17.5 percent). 97.6 percent had an indicated drug treatment and 28 percent of those not controlled at the time of blood pressure measurement were not attached. Conclusions: Gaps related to access to health, diagnostic, follow-up, treatment and control services for hypertensive in which the common element is care´s non-seeking have an impact on the quality of care(AU)

Gastrointestinal Helminthic Challenges in Sheep and Goats in Afro-Asian Region: A Review

Sheep and goats, being hardy and prolific in their growth, play a crucial role in cultural and socioeconomic life of rural poor under privileged people in Afro-Asian countries by providing meat, milk, wool and hide to them. Gastrointestinal helminthic infections are worldwide problem in ruminants. They results considerable loss in them causing mortality and poor production. Various helminthes types like trematodes, cestodes and nematodes are prevalent in different climates and geographical regions depending on rearing systems, intermediate host’s availability and management practices. Epidemiology of helminthic diseases, though variable at times, is determined by various factors like treatment, climate and poverty (socio-economic and traditional practices). The study oversees gastrointestinal helminthic challenges in goats and sheep faced in Afro-Asian region in last decade. Methodology involves exhaustive exercise of screening and massive literature hunt which included published research, both abstracts and full length papers on the subject in last 10 years in addition to authors own observations. The diseases like Fasciolosis, Dicrocoelosis, Amphistomosis in trematodes, Monieziosis, Avitellinosis in cestodes and Haemonchosis, Trichostronglylosis, Oesophagostomosis, Trichuriosis, Strongyloidosis in nematodes were still serious challenges in the region threatening the small ruminant production. Frequent reports on Marshallgia, Ostertagia, Nematodirus, Stilesia, Thysaniezia spp. from this region showed emerging threats. Infections like Camelostrongylus, Graphidiops, Parabronema and Skrjabinema spp. were scarcely distributed. The paper reviews scientific work and developments of last 10 years on occurrence, distribution and epidemiology of common gastrointestinal helminthic infections of sheep and goats in Afro-Asian region with future research prospective in light of newer scientific approaches

Assessing in-situ conservation status of threatened medicinal vascular plants in central China / 中国中药杂志

It is of great significance to carry out scientific investigation of threatened species and assess their in-situ conservation status in order to guide the conservation and management of these species within a region. In this study, we explored and assessed the biodiversity and in-situ conservation status of the threatened medicinal vascular plants(TMVPs) in central China. The results showed that there were 276 TMVPs in central China, including 18 critically endangered(CR), 77 endangered(EN), and 181 vulnerable(VU) species. Of which, 222 TMVPs were distributed in 49 national nature reserves, with an in-situ conservation rate of 80.43%. And the in-situ conservation rate of CR, EN and NR species were 83.33%, 77.92% and 81.22%, respectively. The complementary algorithm was used to select the nine national nature reserves with the highest protection and complementary contribution to the TMVPs. The cumulative protection contribution rate of these nine nature reserves was 81.98%. Fifty-four TMVPs were distributed outside of national nature reserves, while mainly distributed within 10 hotspot counties including Badong county, Hubei province, Sangzhi county, Hunan province, Jianghua Yao Autonomous county, Hunan province and so on. In general, TMVPs are well protected by the national nature reserves in central China. However, there are still some conservation gaps. It is necessary to carry out further field investigation on the species with conservation gaps and identify the gap areas, so as to provide scientific guidance for the optimization of the conservation of TMVPs in this region.

A multicenter study on the gaps and potential barriers in palliative care services

Background and Objective@#Palliative care is a human right. In the local setting, only a few data have been published regarding its practice among healthcare workers. This study aimed to determine the gaps and potential barriers in palliative care services among resident physicians.@*Methodology@#A cross-sectional study design using a 27-item interview-based questionnaire was conducted from July to September 2019 among resident trainees in seven departments of four hospitals in Manila, Philippines. The data gathered were tallied using Microsoft Excel and analyzed using STATA Statistical Software with p-value of 0.05 as statistically significant.@*Results@#A total of 200 physicians participated in the study. Majority of the respondents referred patients to palliative care services, primarily for symptom control and home care upon the diagnosis of a terminal illness. Sixty percent of respondents correctly identified patients eligible for hospice care. The 3 services rated as most important in palliative care were pain control, symptom control and psychological support. Most of the respondents perceived that palliative care is underutilized, and yet they felt that attending doctors know when referral to such is appropriate. The discrepancy is due to their lack of knowledge on the nature of its scope of care and eligibility criteria. The common barriers for referral to palliative care were “no time to refer secondary to rapid demise of the patient”, “difficulty in accurately predicting death”, and “lack of time to discuss issues of dying and hospice care”. These presumed barriers contradicted the respondents’ perceived practices in advance care planning, particularly on confirming the goals of treatment with the patient and family.@*Conclusion@#The prevailing illiteracy on palliative care that poorly translates to actualization is alarming as it deprives many patients of their right to a dignified and quality of life given their limited days. The inexcusable lack of awareness must be the impetus to a massive knowledge drive to impact clinical practice.

Estudio con Microtomografía de Conductos Tratados con Sistemas Reciprocantes y Obturados con Cementos Biocerámicos / Microtomography Study of Root Canals Treated with Reciprocating Systems and Filled with Bioceramic Cements

Objetivo: Comparar la presencia de poros en los tres tercios del conducto radicular luego de la obturación con cementos biocerámicos. Se trataron endodónticamente 20 premolares inferiores unirradiculares, de anatomía oval. Los mismos fueron divididos en dos grupos y se obturaron con dos cementos biocerámicos diferentes. Todas las muestras fueron analizadas con microtomografía de rayos X para comparar la presencia de poros en los tres tercios radiculares, clasificando los mismos en internos, externos y combinados. En las 20 piezas dentarias obturadas y analizadas se encontraron poros. La cantidad de poros detectados no presentó diferencias significativas mediante análisis estadísticos cuantitativos ni cualitativos. Los poros se presentaron más frecuentemente en el tercio cervical, independientemente del cemento sellador. Ambos grupos presentan una buena adaptación a nivel apical, siendo esto imprescindible para la longevidad y éxito del tratamiento endodóntico (AU)