The said and the not said in the nature of crime

Objective: To identify the microstructures used in the incident reports generated after the deaths of women to name the criminal practices, thus identifying possible improbability, prejudices and antipathies. Methods: Conceptual organization by categories and discourse analysis were used with the assumption that naming to apprehend is different from naming to punish. To do so, using the following clippings: geographic (São Paulo-Brazil), temporal (January-December 2020) chosen due to the socio-environmental conditions imposed by the advance of SARS-CoV-2 in 2020, which boosted the significant increase in the cases of femicide in Brazil, a documental reading was carried out in the 167 bulletins of occurrences provided by the State Department of Public Security Results: It is possible to observe the use of different terms for crimes committed against women, even if their characteristics point to the crime of femicide. Of the 167 documents analyzed, two did not have femicide as an outcome of the crime. In one, victim and perpetrator did not have any type of relationship, being classified as simple homicide. Simple homicide is the act of intentionally killing another person, with the intention of committing the crime;crimes without qualifiers can increase privileges or decrease punishment. The other document had the unfolding field blank, not bringing any information. Conclusions: Naming to apprehend is different from naming to punish. The credible naming avoids recurrent under-notifications and deletions that harm the search and access to information. Knowing this, we believe in the need to name femicide, representing it accurately. © 2022, Universidade Federal de Santa Catarina. All rights reserved.

NeuroLytes: Developing Clinical Reasoning for Medical Students on the Neurology Clerkship

Objective: Evaluate the role of virtual case-based discussions lead by neurology residents at supplementing the standard didactic series in the neurology clerkship. Background: COVID-19 created a new barrier to medical education by reducing trainee participation in patient care. Neurophobia is still present in up to 50% of medical students. To encourage critical thinking, we developed a series of virtual case-based resident-led discussions ('NeuroLytes'), simulating neurological cases. Design/Methods: Second and third year medical students were enrolled in NeuroLytes during their neurology clerkship. Each rotation was divided into two groups (one group participating earlier). Each group received a virtual case discussion weekly (migraine and multiple sclerosis (MS)). Both groups completed surveys regarding perception of the experience and a quiz of 10 questions regarding case knowledge, followed by 7 questions regarding confidence on clinical reasoning. Results: 108 students participated in NeuroLytes. Over 96% of students that discussed both cases had a score ≥7/10 in knowledge questions compared with 72.9% of students that did not attend any cases (p=0.005). Over 80% of students that participated in NeuroLytes felt confident in identifying clinical findings of neurological diseases compared to 52.2% of students who had not (p=0.026). Students who participated in NeuroLytes also felt more comfortable building a preliminary differential diagnosis after receiving an initial patient history (90.3% compared to 69.6%, p=0.052). Conclusions: Medical students participating in NeuroLytes reported perceived improvement in formulating differentials and identifying common neurological diseases. Virtual case-based discussions could be an effective supplemental learning tool for developing clinical reasoning.

Spread of Gamma (P.1) Sub-Lineages Carrying Spike Mutations Close to the Furin Cleavage Site and Deletions in the N-Terminal Domain Drives Ongoing Transmission of SARS-CoV-2 in Amazonas, Brazil

The Amazonas was one of the most heavily affected Brazilian states by the COVID-19 epidemic. Despite a large number of infected people, particularly during the second wave associated with the spread of the Variant of Concern (VOC) Gamma (lineage P.1), SARS-CoV-2 continues to circulate in the Amazonas. To understand how SARS-CoV-2 persisted in a human population with a high immunity barrier, we generated 1,188 SARS-CoV-2 whole-genome sequences from individuals diagnosed in the Amazonas state from 1st January to 6th July 2021, of which 38 were vaccine breakthrough infections. Our study reveals a sharp increase in the relative prevalence of Gamma plus (P.1+) variants, designated Pango Lineages P.1.3 to P.1.6, harboring two types of additional Spike changes: deletions in the N-terminal (NTD) domain (particularly Delta 144 or Delta 41-144) associated with resistance to anti-NTD neutralizing antibodies or mutations at the S1/S2 junction (N679K or P681H) that probably enhance the binding affinity to the furin cleavage site, as suggested by our molecular dynamics simulations. As lineages P.1.4 (S:N679K) and P.1.6 (S:P681H) expanded (Re > 1) from March to July 2021, the lineage P.1 declined (Re < 1) and the median Ct value of SARS-CoV-2 positive cases in Amazonas significantly decreases. Still, we did not find an increased incidence of P.1 variants among breakthrough cases of fully vaccinated patients (71%) in comparison to unvaccinated individuals (93%). This evidence supports that the ongoing endemic transmission of SARS-CoV-2 in the Amazonas is driven by the spread of new local Gamma/P.1 sublineages that are more transmissible, although not more efficient to evade vaccine-elicited immunity than the parental VOC. Finally, as SARS-CoV-2 continues to spread in human populations with a declining density of susceptible hosts, the risk of selecting more infectious variants or antibody evasion mutations is expected to increase. IMPORTANCE The continuous evolution of SARS-CoV-2 is an expected phenomenon that will continue to happen due to the high number of cases worldwide. The present study analyzed how a Variant of Concern (VOC) could still circulate in a population hardly affected by two COVID-19 waves and with vaccination in progress. Our results showed that the answer behind that was a new generation of Gamma-like viruses, which emerged locally carrying mutations that made it more transmissible and more capable of spreading, partially evading prior immunity triggered by natural infections or vaccines. With thousands of new cases daily, the current pandemics scenario suggests that SARS-CoV-2 will continue to evolve and efforts to reduce the number of infected subjects, including global equitable access to COVID-19 vaccines, are mandatory. Thus, until the end of pandemics, the SARS-CoV-2 genomic surveillance will be an essential tool to better understand the drivers of the viral evolutionary process.

Educating traineesthrough social media-The Resident and Fellow Section Social Media Initiative

Objective: To describe the use of social media by the Resident and Fellow Section (RFS) of Neurology to expand and engage readers in research and educational content. Background: Social media is used by medical journals to disseminate health research [1], a practice more common since the COVID-19 pandemic. Delivering educational materials and engaging readership through social media may also be used to educate trainees. Design/Methods: In January 2019, the RFS developed and implemented a strategy for disseminating educational materials through Instagram. The initiative expanded to Facebook and Twitter in January 2020 and February 2020, respectively. Each post highlighted a recent RFS publication, summarized the key teaching point, and included key images and/or videos when appropriate. In June 2020, posts were expanded to include interactive quizzes to maximize audience engagement. Posts were shared in the American Academy of Neurology's (AAN) social media accounts. Reach and readership engagement were measured by tracking social media account users and average engagement. Results: From January 2019 to October 2020, 70 posts were delivered across three social media platforms: 54 were Teaching (Video) NeuroImages, 6 Pearls and Oy-sters, 7 e-Pearls, 2 Mystery Cases, and 1 Child Neurology post. Over this time, social media followers increased on all platforms: 312.5% on Instagram, 12.9% on Twitter, 10% on Facebook. On Twitter, there was an increase in impressions (74.5%), engagements (121%), and post link clicks (38.7%). On Facebook, there was a 34.6% increase in total engagements. Overall, teaching Video NeuroImages produced the highest level of engagement. Posts with polls and/or quizzes were well received by audience on all platforms and also received high levels of participation. Conclusions: The RFS successfully used social media to increase visibility of trainee publications and deliver educational content. Content with interactivity (e.g., quizzes) and that included patient videos tended to produce the most engagement.

Neuro Lytes as a novel, virtual,case-based didacticstargeted at medicalstudents undergoing Neurology clerkship

Objective: To demonstrate that interactive virtual case-based discussions contribute to the education and satisfaction of medical students as an adjunct to standard educational practices. Background: Due to the COVID-19 pandemic, medical students have had their time engaging with patients dramatically decreased. In an attempt to compensate for this deficit in education, many novel teaching methods have been utilized such as the use of interactive virtual case discussions. Design/Methods: We designed four interactive case discussions (NeuroLytes), each focusing on a particular neurologic disorder. These discussions were held weekly, led by neurology residents, and targeted at medical students during their neurology clerkship. Satisfaction surveys were distributed to medical students who participated in NeuroLytes in order to assess their subjective perception of these sessions as well as their overall perspective on how education was impacted by COVID-19. Results: Seventy-six medical students participated in NeuroLytes and responded to the perception survey. Students identified that their learning experience after the pandemic was most affected by decreased interaction with patients (85.5%), other students (73.6%), residents (46.1%), attendings (53.9%), as well as decreased motivation to study (52.6%). Students also felt their ability to learn the neurological exam, take a history, and reason clinically would be most affected (51.5%, 69.7%, and 42.4% respectively). Satisfaction with NeuroLytes has been reported as high-86% strongly agreed or agreed that NeuroLytes should continue. Additionally, there was a significant increase in student rating of teaching sessions prior (median of 4/5) and after (median of 4.3/5) NeuroLytes (p=0.01). Similarly, there was a significant increase in student rating of overall educational experience on the clerkship as a median of 3.5 before and 3.9 after (p=0.02). Conclusions: Interactive virtual case-based discussions (NeuroLytes) appear to be a successful educational method and may be implemented in neurology clerkships as an add-on to standard teaching, especially during the COVID-19 pandemic.

Nursing and visibility in the COVID-19 pandemic: Social media monitoring

Objective: analyze the publications of Twitter users directed to the campaign of valuation of Nursing, driven by the terms #LuteComoUmaEnfermeira and #EnfermagemEuValorizo. Method: quantitative research, based on digital methods. The search was realized using the hashtags #LuteComoUmaEnfermeira and #EnfermagemEuValorizo for tweets extraction. 2,613 tweets were selected for analysis. Results: 22.5% of publications are located in the Brazilian Southeast region and 9.3% in the Northeast region. There were more than 18,000 interactions (likes and shares), and the authors of the posts reach an estimated audience of about 7 million people). The content of the posts mainly related to the regulation of working hours, Personal Protective Equipment, the fight against COVID-19, the defense of the majority female workforce and the fight for rights. Conclusion: the realization of the virtual campaign had important visibility in the national territory and presented great visibility to the profession in number and reach on the Internet. © 2021 Universidade Federal da Bahia. All rights reserved.