Predictive accuracy of time series models applied to economic data: the European countries retail trade.

Modeling and accurately forecasting trend and seasonal patterns of a time series is a crucial activity in economics. The main propose of this study is to evaluate and compare the performance of three traditional forecasting methods, namely the ARIMA models and their extensions, the classical decomposition time series associated with multiple linear regression models with correlated errors, and the Holt-Winters method. These methodologies are applied to retail time series from seven different European countries that present strong trend and seasonal fluctuations. In general, the results indicate that all the forecasting models somehow follow the seasonal pattern exhibited in the data. Based on mean squared error (MSE), root mean squared error (RMSE), mean absolute percentage error (MAPE), mean absolute scaled error (MASE) and U-Theil statistic, the results demonstrate the superiority of the ARIMA model over the other two forecasting approaches. Holt-Winters method also produces accurate forecasts, so it is considered a viable alternative to ARIMA. The performance of the forecasting methods in terms of coverage rates matches the results for accuracy measures.

To be or not to be fragrant: floral scent of some bat-pollinated cacti.

Floral scent is a key olfactory cue in both diurnal and nocturnal pollination systems. In the case of nocturnal systems, such as bat-pollinated flowers, odour seems to play a more important role than visual cues. Cactaceae include many bat-pollinated species; however, few studies have investigated the olfactory cues in this family. We analysed and compared the chemical composition of the floral bouquet of three chiropterophilous cactus species, among which are a pair of congeners that differ considerably in scent intensity. Our research presents novel findings regarding the floral scent chemistry of chiropterophilous cactus species. We documented the first case of a bat-pollinated cactus whose flowers lack perceptible floral scent and in which no volatile compounds were detected in our chemical analyses. Additionally, we provide a comprehensive analysis of the chemical composition of the floral bouquet of the other two bat-pollinated species, revealing a resemblance among closely related species within the same genus. We highlight the need for further studies using biotests to investigate the mechanisms through which bats find flowers lacking scent.

Influence of Thickness and Translucency of Lithium Disilicate Ceramic on the Degree of Conversion of Resin Cements with Different Initiators.

INTRODUCTION: The degree of conversion (DC) of resin cements can be affected by ceramics, and by the type of resin cement. The purpose was to evaluate the influence of thickness and translucencies of lithium disilicate ceramic on the DC of resin cements: two light-cure (Variolink LC; NX3 LC) and one dual-cure (NX3 Dual). METHODS: IPS e.max Press ceramic (A2) discs were prepared in 4 thicknesses (0.3, 0.5, 1.0, and 1.5 mm) and in 3 translucencies: HT (high translucency), LT (low translucency), and MO (medium opacity). Subsequently, 234 samples of resin cement (5 x 1 mm) were light-cured through those ceramic discs. The DC was assessed by Fourier Transform Infrared Spectroscopy (FTIR). RESULTS: Ceramic thicknesses decreased DC of NX3 Dual through HT-1.0 and HT 1.5 (p=0.005). Between translucencies, only MO-0.3 affected Variolink LC DC (p=0.018). There was difference among light- and dual-cured resin cements (p=0.001). CONCLUSION: Increasing thickness and opacity lead to a decrease in the DC of all resin cements, with a significantly lower DC value in NX3 Dual (HT-1.0; HT-1.5), and in Variolink LC (MO- 0.3). Light- and dual-cured resin cements were different among each other. NX3 Dual achieved a significantly lower value than its counterpart NX3 LC.

The Presence and Profile of Neurological Conditions and Associated Psychiatric Comorbidities in U.S. Resettled Refugees: A Retrospective Single Center Study.

Refugees are a vulnerable, growing population who confront a myriad of traumas leading to their forced migration. Although psychiatric illnesses of resettled refugees are well-documented, there is a paucity of studies characterizing their neurological disease profiles. This study aimed to characterize the frequency and range of neurological disorders in a sample of resettled refugees receiving care at a community health center in Massachusetts, U.S.A. We performed a retrospective medical record review of adult (≥ 18 years) resettled refugees between May 2001 and December 2012 at a community health center in Northeast Massachusetts. Sociodemographic and clinical characteristics pertaining to neuropsychiatric health were collected from medical records using a standardized data extraction tool. Group comparisons between those with and without neurological illness and associated sociodemographic and psychiatric characteristics were evaluated using χ2 and independent samples two-tailed t-tests. In our sample (n = 779), 53.3% (n = 415) were male and 48.8% (n = 380) were from the African continent. The mean age was 33.2 ± 12.4 years (range 18-85). 36.8% were diagnosed with at least one neurological disorder and 18.1% with more than one neurological illness. The most common diagnoses were headaches (28.3%), sleep disorders (11.2%), cognitive impairment/ dementia (5.5%), and head trauma (5.5%). Exploratory analyses revealed that participants with neurological illness were more likely to be older (p < .001), female (p = .002), and diagnosed with co-morbid psychiatric diagnoses (p < .001) than those without neurological illness. Neurological disorders frequently co-occur with psychiatric comorbidities among U.S. resettled adult refugees. Standard refugee health assessments should incorporate screening and treatment for neurological illnesses.

The potential of mRNA expression evaluation in predicting HER2 positivity in gastroesophageal cancer.

Gastroesophageal cancer (GEC) is an aggressive disease characterized by a high frequency of metastasis and poor overall survival rates. GEC presents HER2 overexpression in 5 to 25% of tumors eligible for HER2-targeted therapy. HER2 evaluation requires protein levels and copy number alteration analyses by immunohistochemistry (IHC) and in situ hybridization (FISH or SISH), respectively. These are semiquantitative methodologies that need an expert and well-trained pathologist. Therefore, the use of new surrogate methods for HER2 evaluation in cancer, such as gene expression analysis, might improve GEC HER2 classification. We evaluated HER2 positivity in GEC through conventional IHC and SISH analyses and investigated the potential application of HER2 mRNA expression by quantitative PCR to categorize GEC samples as HER2-positive or HER2-negative. Among 270 GEC samples, 10.9% were HER2-positive by IHC and SISH analyses. HER2 mRNA was overexpressed in HER2-positive GEC samples and presented high accuracy in distinguishing those tumors from HER2-negative GEC. Nevertheless, HER2 mRNA analysis was not capable of classifying HER2-equivocal GEC samples into HER2-positive or -negative according to SISH data. Quantitative PCR analysis showed HER2 overexpression in HER2-positive GEC samples. Nevertheless, HER2 mRNA analysis failed to classify HER2-equivocal GEC according to SISH data.

Ex vivo UV-vis and FTIR photoacoustic spectroscopy of natural nanoemulsions from cellulose nanocrystals and saponins topically applied into the skin: Diffusion rates and physicochemical evaluation.

Nanoemulsions are increasingly gaining importance in the development of topically applied medicine and cosmetic products because their small droplets favor the penetration rates of active compounds into the body. In this scenario, the measurements of their diffusion rates as well as eventual physicochemical changes in the target tissues are of utmost importance. It is also recognized that the use of natural surfactants can avoid allergic reactions as frequently observed for synthetic products. The natural saponins extracted from Sapindus Saponaria have the property of forming foam and are exploited as biocompatible and biodegradable, while cellulose nanocrystals are known to increase the stability of a formulation avoiding the coalescence of drops at the interface. Therefore, nanoemulsions combining natural saponins and cellulose nanocrystals are promising systems that may facilitate greater diffusion rates of molecules into the skin, being candidates to substitute synthetic formulations. This study applied the Photoacoustic Spectroscopy technique to measure the diffusion rates and the physicochemical properties of nanoemulsified formulations containing saponins and cellulose nanocrystals topically applied to the skin. The ex vivo study combined the first-time photoacoustic measurements performed in both ultraviolet-visible and mid-infrared spectral regions. The toxicity of these formulations in L929 cells was also evaluated. The results showed that the formulations were able to propagate throughout the skin to a depth of approximately 756 µm, reaching the dermal side. The non-observation of absorbing band shifting or new bands in the FTIR spectra suggests that there were no structural changes in the skin as well as in the formulations after the nanoemulsions administration. The cytotoxicity results showed that the increase of cellulose nanocrystals concentration decreased cellular toxicity. In conclusion, the results demonstrated the advantage of combining photoacoustic methods in the ultraviolet-visible and mid-infrared spectral regions to analyze drug diffusion and interaction with the skin tissues. Both methods complement each other, allowing the confirmation of the nanoemulsion diffusion through the skin and also suggesting there were no detectable physicochemical changes in the tissues. Formulations stabilized with saponins and cellulose nanocrystals showed great potential for the development of topically administered cosmetics and drugs.

Photoacoustic for thermal diffusivity determination of fish scale: A methodology for environmental integrity monitoring.

In this work the thermal diffusivity (D) of Astyanax lacustris fish scale is investigated aiming to use it for environmental integrity certification. The D values were obtained by a relatively simple procedure by a photoacoustic method. The chosen fish species is from wide occurrence in Brasil's basins. It has short migration, and it has also been used as environmental bioindicator. The results obtained in 195 scales sampled from three different streams in the Midwest region in Brazil gives an average value of D ~ 4 × 10-3 cm2/s. ANCOVA analysis demonstrated that D values are able to differentiate among the three basins and indicates that it is dependent on the scales thickness and water conductivity. This last one is strongly affected by biotic and abiotic actions, so that D values measured by photoacoustic method can be used for interpreting the environmental integrity from where the fishes were sampled.

Cytokines and inflammatory mediators: Markers involved in interstitial damage to the pancreas in two dengue fever cases associated with acute pancreatitis.

Dengue viral (DENV) infections can lead to acute pancreatitis and associated tissue damage. This study examined the pancreas from two fatal cases of DENV for histopathological changes as well as for the detection of cytokines, and other inflammatory mediators. Tissue sections were prepared for examination by ultrastructural and histopathological techniques. Sections from the pancreas of non-infected individuals were prepared in parallel as a control. The presence of viral replication in macrophages was detected by co-staining for the proteins NS3 and CD68 by immunofluorescence. Immunohistochemistry was used to detect cells that expressed cytokines and inflammatory mediators to characterize the inflammatory response. Edema, acinar necrosis and fibrosis areas associated with a mononuclear infiltrate were found in infected tissues. The major site of virus replication appeared to be macrophages based on their exclusive presentation of the viral protein NS3. Pancreatic tissues from the infected individuals also displayed increased levels of high mobility group box-1, caspase-3, gelatinase B and tumor necrosis factor alpha compared to controls. The presence of virus replicating macrophages in the pancreas was associated with multiple changes in tissue structure that included elevated levels of cytokines and inflammatory markers that may differentiate acute pancreatitis due to DENV infections from other causes.

The potential of mRNA expression evaluation in predicting HER2 positivity in gastroesophageal cancer

Gastroesophageal cancer (GEC) is an aggressive disease characterized by a high frequency of metastasis and poor overall survival rates. GEC presents HER2 overexpression in 5 to 25% of tumors eligible for HER2-targeted therapy. HER2 evaluation requires protein levels and copy number alteration analyses by immunohistochemistry (IHC) and in situ hybridization (FISH or SISH), respectively. These are semiquantitative methodologies that need an expert and well-trained pathologist. Therefore, the use of new surrogate methods for HER2 evaluation in cancer, such as gene expression analysis, might improve GEC HER2 classification. We evaluated HER2 positivity in GEC through conventional IHC and SISH analyses and investigated the potential application of HER2 mRNA expression by quantitative PCR to categorize GEC samples as HER2-positive or HER2-negative. Among 270 GEC samples, 10.9% were HER2-positive by IHC and SISH analyses. HER2 mRNA was overexpressed in HER2-positive GEC samples and presented high accuracy in distinguishing those tumors from HER2-negative GEC. Nevertheless, HER2 mRNA analysis was not capable of classifying HER2-equivocal GEC samples into HER2-positive or -negative according to SISH data. Quantitative PCR analysis showed HER2 overexpression in HER2-positive GEC samples. Nevertheless, HER2 mRNA analysis failed to classify HER2-equivocal GEC according to SISH data.

Cutaneous mammary loxoscelism: An unknown cause of breast inflammation: A case report and review of the literature.

Envenomation due to a Loxosceles spider bite is a rare event in France and no case concerning the breast has yet been reported. We report the case of a 48-year-old woman who presented at Saint-Etienne University Hospital with a pulsatile pain in her left breast two days after feeling a fleeting bite. An abscess was diagnosed and antibiotics were prescribed. A few days later, a necrotic zone appeared around the areola and 75 percent of the surrounding skin was inflamed. The patient reported a persistent fever and a burning pain in her breast. Loxoscelism was finally concluded and surgical debridement was undertaken, followed by supervised wound therapy and local skin care. Complete healing was achieved after 4 weeks of treatment. The diagnosis of loxoscelism is generally presumptive, as the bite is usually painless and the spider rarely captured. Its diagnosis should be considered when an abscess responds poorly to antibiotics.

Apical hypertrophic cardiomyopathy: A case series at a Brazilian referral center with a maximal follow-up of 15 years.

BACKGROUND: Apical hypertrophic cardiomyopathy (AHCM) is a rare cardiomyopathy, in which hypertrophy occurs predominantly in the ventricular apex, and in some cases with a high risk of sudden cardiac death. OBJECTIVE: The aim of this paper is to present a case series of patients with AHCM and describe their main clinical, echocardiographic and electrocardiographic characteristics, the recommendation for an implantable cardioverter-defibrillator (ICD) and the frequency of sudden cardiac death (SCD). METHODS: A retrospective case series was conducted at the referral center of a federal teaching hospital, between the years 2005 to 2020, involving patients with an echocardiographic diagnosis of AHCM. The parameters of the American College of Cardiology and the European Society of Cardiology were used to assess the risk of SCD. RESULTS: A total of 11 individuals were assessed with a mean age of 55.3 years, mean follow-up of 41.2 months, most of whom were symptomatic at diagnosis (72.7%). The most frequent symptom was dyspnea (27.3%). A family history of SCD was described in 45.5% of cases. Due to a high risk of SCD, four patients received ICDs. One patient presented sudden cardiac death after having refused the ICD. CONCLUSIONS: Symptoms and alterations in the imaging exams are significant factors in the clinical and prognostic assessment of patients with AHCM.

MET overexpression and intratumor heterogeneity in esophageal squamous cell carcinoma.

Esophageal squamous cell carcinoma (ESCC) is among the ten most frequent and deadly cancers, without effective therapies for most patients. More recently, drugs targeting deregulated growth factor signaling receptors have been developed, such as HGF-MET targeted therapy. We assessed MET and HGF genetic alterations and gene and protein expression profiles in ESCC patients from the Brazilian National Cancer Institute and publicly available datasets, as well as the intratumor heterogeneity of the alterations found. Our analyses showed that HGF and MET genetic alterations, both copy number and mutations, are not common in ESCC, affecting 5 and 6% of the cases, respectively. HGF showed a variable mRNA expression profile between datasets, with no alterations (GSE20347), downregulation (GSE45670), and upregulation in ESCC (our dataset and GSE75241). On the other hand, MET was found consistently upregulated in ESCC compared to non-tumor surrounding tissue, with median fold-changes of 5.96 (GSE20347), 3.83 (GSE45670), 6.02 (GSE75241), and 5.0 (our dataset). Among our patients, 84% of the tumors showed at least a two-fold increase in MET expression. This observation was corroborated by protein levels, with 55% of cases exhibiting positivity in 100% of the tumor cells. Intratumor heterogeneity was evaluated in at least four tumor biopsies from five patients and two cases showed a consistent increase in MET expression (at least two-fold) in all tumor samples. Our data suggested that HGF-MET signaling pathway was likely to be overactivated in ESCC, representing a potential therapeutic target, but eligibility for this therapy should consider intratumor heterogeneity.

Aspectos sociales, sobrecarga y calidad de vida de las madres de niños con microcefalia / Social aspects, work overload, and quality of life among mothers of children with microcephaly / Aspectos sociais, sobrecarga e qualidade de vida de mães de crianças com microcefalia

RESUMEN Introducción: Cuidar completamente de niños con microcefalia es un gran desafío para sus cuidadores. La situación de vulnerabilidad social junto con la complejidad de la atención puede llevar a sobrecarga con pérdida de la calidad de vida. Objetivo: Analizar la relación entre aspectos socioeconómicos, dominio social de la calidad de vida y la sobrecarga de madres cuidadoras de niños con microcefalia. Metodología: Estudio transversal con 105 participantes, mediante aplicación de cuestionarios sociodemográficos, WHOQOL-BREF, sobrecarga del cuidador. Se utilizaron pruebas ANOVA, t de Student, coeficiente de correlación de Pearson (r). Resultados: Población de madres mestizas (65.7%), desempleadas (88.6%), dependientes de la prestación social (76.2%), bajo nivel educativo (50.5%) e insuficiencia financiera (90.5%). El promedio del dominio social se consideró bajo (51.11). Hubo asociación entre beneficio social y puntaje de calidad de vida total (p=0.046). Las madres sufren sobrecarga severa (39%) e intensa (30.4%). Se encontró asociación entre niveles de sobrecarga y variables etnia (p= 0.027), ocupación (p= 0.043) y medios de transporte (p <0.0001). La sobrecarga tiene impacto negativo en la calidad de vida (r= -.463, p <0.0001), percepción de la calidad de vida (r= -.476, p= <0.0001), calidad de vida total (r= -.576, p= <0.0010). Conclusiones: Las madres cuidadoras manifiestan sobrecarga con pérdida de calidad de vida. Los aspectos sociales influyen directamente y pueden potenciar la sobrecarga del cuidado. El personal de enfermería tiene un papel fundamental para crear e implementar líneas de atención con énfasis en promover la salud y alivio de la sobrecarga en el cuidador.

ABSTRACT Introduction: Taking care of children with microcephaly is a great challenge for their care providers because of the associated social vulnerability, work overload, and loss of quality of life. Objective: To analyze the associations related to the social aspects, the quality of life, and the work overload among care providing mothers of children with microcephaly. Methodology: This is a transversal study with 105 participants. Social and demographic questionnaires and WHOQOL-BREF were used. ANOVA tests, Student's t-test, and Pearson's correlation coefficient were calculated. Results: 65.7% were of mixed ethnicity; 88.6% were unemployed; 76.2% were dependent on Social Welfare; 50.5% had a low level of education; and 90.5% were financially insufficient. The social domain average was considered low (51.11). An association was found between social benefits and quality of life (p=0.046). 39% of these mothers suffer from severe work overload while 30.4% suffer from intense work overload. An association was found between the levels of work overload and ethnicity (p= 0.027), occupation (p= 0.043), and transportation means (p <0.0001). Work overload had a negative impact on the quality of life (r= -.463, p <0.0001), the perception of quality of life (r= -.476, p= <0.0001), and total quality of life (r= -.576, p= <0.0010). Conclusions: These care providing mothers suffer work overload with an associated loss of quality of life. Social aspects have a direct influence and can increase work overload. Nursing professionals have a fundamental role in the creation and implementation of attention initiatives aimed at promoting health and relief to this kind of care providing mothers.

RESUMO Introdução: Cuidar completamente das crianças com microcefalia é um grande desafio para os seus cuidadores. A situação de vulnerabilidade social aliada à complexidade do cuidado pode levar à sobrecarga com perda de qualidade de vida. Objetivo: Analisar a relação entre aspectos socioeconómicos, domínio social da qualidade de vida e sobrecarga de mães cuidadoras de crianças com microcefalia. Metodologia: Estudo transversal com 105 participantes, por meio da aplicação de questionários sociodemográficos, WHOQOL-BREF, sobrecarga do cuidador. Foram utilizados os testes ANOVA, t de Student, e coeficiente de correlação de Pearson (r). Resultados: População de mães pardas (65.7%), desempregadas (88.6%), dependentes de benefícios sociais (76.2%), baixa escolaridade (50.5%) e insuficiência financeira (90.5%). A média do domínio social foi considerada baixa (51.11). Houve associação entre benefício social e pontuação total de qualidade de vida (p=0.046). As mães sofrem sobrecarga severa (39%) e intensa (30.4%). Foi encontrada associação entre os níveis de sobrecarga e as variáveis de etnia (p= 0.027), ocupação (p= 0.043) e meio de transporte (p <0.0001). A sobrecarga tem um impacto negativo na qualidade de vida (r= -.463, p <0.0001), percepção de qualidade de vida (r= -.476, p= <0.0001), qualidade de vida total (r= -.576, p= <0.0010). Conclusões: As mães cuidadoras sofrem sobrecarga com perda de qualidade de vida. Os aspectos sociais influenciam diretamente e podem potenciar a sobrecarga do cuidado. A enfermagem tem um papel fundamental na criação e implementação de linhas de cuidados com ênfase na promoção da saúde e no alívio da sobrecarga do cuidador.

Targeted nanostructured lipid carriers for doxorubicin oral delivery.

The treatment with anticancer drugs remains a challenge, as available drugs still entail the risk of deleterious off-target effects. The present study describes folic acid conjugated nanostructured lipid carriers (NLCs) as an effective doxorubicin delivery approach targeted to breast cancer cells. Two distinct NLCs formulations were designed and optimized leading to an encapsulation efficiency over than 65%. Cytotoxic and targeting potential of NLCs were studied in vitro, using MDA-MB-231 cell line. Results showed an enhanced cellular uptake of conjugated NLCs. In vitro release studies, mimicking the path in the body after oral administration, show that all formulations would reach the tumor microenvironment bearing 50% of the encapsulated doxorubicin. Moreover, NLCs demonstrated storage stability at 25 °C for at least 42 days. Overall, results revealed that the developed NLCs enable the possibility of oral administration and are a promising approach for the targeted delivery of doxorubicin to breast cancer cells.

MET overexpression and intratumor heterogeneity in esophageal squamous cell carcinoma

Esophageal squamous cell carcinoma (ESCC) is among the ten most frequent and deadly cancers, without effective therapies for most patients. More recently, drugs targeting deregulated growth factor signaling receptors have been developed, such as HGF-MET targeted therapy. We assessed MET and HGF genetic alterations and gene and protein expression profiles in ESCC patients from the Brazilian National Cancer Institute and publicly available datasets, as well as the intratumor heterogeneity of the alterations found. Our analyses showed that HGF and MET genetic alterations, both copy number and mutations, are not common in ESCC, affecting 5 and 6% of the cases, respectively. HGF showed a variable mRNA expression profile between datasets, with no alterations (GSE20347), downregulation (GSE45670), and upregulation in ESCC (our dataset and GSE75241). On the other hand, MET was found consistently upregulated in ESCC compared to non-tumor surrounding tissue, with median fold-changes of 5.96 (GSE20347), 3.83 (GSE45670), 6.02 (GSE75241), and 5.0 (our dataset). Among our patients, 84% of the tumors showed at least a two-fold increase in MET expression. This observation was corroborated by protein levels, with 55% of cases exhibiting positivity in 100% of the tumor cells. Intratumor heterogeneity was evaluated in at least four tumor biopsies from five patients and two cases showed a consistent increase in MET expression (at least two-fold) in all tumor samples. Our data suggested that HGF-MET signaling pathway was likely to be overactivated in ESCC, representing a potential therapeutic target, but eligibility for this therapy should consider intratumor heterogeneity.

COVID-19 mortality in an area of northeast Brazil: epidemiological characteristics and prospective spatiotemporal modelling.

This study aimed to analyse the spatial-temporal distribution of COVID-19 mortality in Sergipe, Northeast, Brazil. It was an ecological study utilising spatiotemporal analysis techniques that included all deaths confirmed by COVID-19 in Sergipe, from 2 April to 14 June 2020. Mortality rates were calculated per 100 000 inhabitants and the temporal trends were analysed using a segmented log-linear model. For spatial analysis, the Kernel estimator was used and the crude mortality rates were smoothed by the empirical Bayesian method. The space-time prospective scan statistics applied the Poisson's probability distribution model. There were 391 COVID-19 registered deaths, with the majority among ⩾60 years old (62%) and males (53%). The most prevalent comorbidities were hypertension (40%), diabetes (31%) and cardiovascular disease (15%). An increasing mortality trend across the state was observed, with a higher increase in the countryside. An active spatiotemporal cluster of mortality comprising the metropolitan area and neighbouring cities was identified. The trend of COVID-19 mortality in Sergipe was increasing and the spatial distribution of deaths was heterogeneous with progression towards the countryside. Therefore, the use of spatial analysis techniques may contribute to surveillance and control of COVID-19 pandemic.

Risk clusters of COVID-19 transmission in northeastern Brazil: prospective space-time modelling.

This study aimed to analyse the trend and spatial-temporal clusters of risk of transmission of COVID-19 in northeastern Brazil. We conducted an ecological study using spatial and temporal trend analysis. All confirmed cases of COVID-19 in the Northeast region of Brazil were included, from 7 March to 22 May 2020. We used the segmented log-linear regression model to assess time trends, and the local empirical Bayesian estimator, the global and local Moran indexes for spatial analysis. The prospective space-time scan statistic was performed using the Poisson probability distribution model. There were 113 951 confirmed cases of COVID-19. The average incidence rate was 199.73 cases/100 000 inhabitants. We observed an increasing trend in the incidence rate in all states. Spatial autocorrelation was reported in metropolitan areas, and 178 municipalities were considered a priority, especially in the states of Ceará and Maranhão. We identified 11 spatiotemporal clusters of COVID-19 cases; the primary cluster included 70 municipalities from Ceará state. COVID-19 epidemic is increasing rapidly throughout the Northeast region of Brazil, with dispersion towards countryside. It was identified high risk clusters for COVID-19, especially in the coastal side.

Challenges of In-House Development and Implementation of a CPOE for Oncology.

Hospital Italiano de Buenos Aires (HIBA) is an academic tertiary care hospital highly specialized that has started the process of informatization of chemotherapy protocols. The objective is to describe the development of a computerized physician order entry (CPOE) oriented to the oncology adult patient and the members of the healthcare team that works with him (physicians, pharmacists, nurses and administrative staf) to improve the process and prevent errors at a critical point in the patient's health care: during prescription, preparation and / or administration. The development of this system consisted of several stages: inquiries about the usual work and perception of needs of the potential users; user-centered design; interoperability with the electronic health record (EHR) and development of a final prototype.

Evaluating the Use of a CPOE for Chemotherapy Protocols.

Chemotherapy drugs are one of the most common causes of serious and fatal medication errors, especially during prescribing, where computerized physician order entry (CPOE) take on importance. This study proposes the description of the post-implementation status of a CPOE in a highly specialized hospital between January and June 2018, among patients older than 18 years. Results: a total of 8835 protocols were indicated using the specific CPOE (93% use rate over all protocols) 91% completed the administration, 1.2% were rejected by pharmacy, and 6.8% was canceled. The most frequent cause of rejection by pharmacy and cancellation by oncologist was an inadequate dose. Most of the protocols indicated using the CPOE implemented, with a reject by pharmacy rate of 1.2%, indicates the utility of CPOE as an error prevention strategy.