Women's body representations across the life course: A comparative study in Southern Brazil.

The aim of this study is to observe how women of different ages represent their bodies and the changes they undergo across their life course. The research is based on the theory of social representations, idealized by Serge Moscovici. A total of 201 women between 25 and 88 years old from southern Brazil participated in the research. The methodological instrument consists of a questionnaire containing free associations, sentence completion and selection of images. The processing and classification of the data were done by the software Evoc (2000) and content analysis. The results showed differences between the age groups. Younger women represented the body according to aesthetic references and manifested the desire to monitor the body. Older women related the body more frequently with notions of health, social relationships, and leisure. The memories of a younger body and anticipations of an older one reflected the conventions about ageing. The study also shows that concerns about bodily limitations and age-related diseases were frequent in all age groups and may guide behaviour and attitudes towards the body. The study can inform policymakers on the needs and expectations of a growing ageing sector of the population in Brazil and worldwide.

The Effectiveness of Pilates Training Interventions on Older Adults' Balance: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

BACKGROUND AND OBJECTIVES: Pilates training intervention programs have gained attention as a potential approach to enhancing balance in older adults, thereby reducing the risk of falls. In light of these considerations, this systematic review and meta-analysis aimed to critically evaluate the existing evidence and determine the effect of Pilates training intervention programs on older adults' balance. MATERIALS AND METHODS: The literature was searched through the PubMed, Web of Science, and Scopus databases from inception until July 2023. The primary keywords used for the literature search included "elderly" or "older adults" and "pilates training" and "balance". RESULTS: The systematic review through qualitative analysis showed robust evidence about the efficacy of Pilates intervention programs in improving older adults' balance. The pooled meta-analysis of static and dynamic balance showed that eight (53%) out of a total fifteen analyzed interventions presented a significant effect of Pilates in improving the participants' balance, without between-study heterogeneity. In addition, the meta-analysis regarding dynamic balance showed that six (67%) out of nine analyzed interventions presented a significant effect of Pilates in improving the participants' balance, without heterogeneity between studies. Similarly, the meta-analysis regarding static balance showed that four (50%) out of eight analyzed studies presented significant effects on the older adults' balance, where moderate between-study heterogeneity was found. Sensitivity analysis showed that three studies reduced the between-study heterogeneity (19, 17.6, and 17%), regressing from moderate to low heterogeneity, p < 0.05. CONCLUSIONS: This systematic review and meta-analysis underscores the potential of Pilates training as a valuable intervention to enhance balance in the elderly population.

Percutaneous Tibial Nerve Stimulation in Chronic Post-Surgical Anorectal Pain: A Case Report.

Introduction: Anorectal pain is a symptom with a negative impact on quality of life and it can sometimes develop into a chronic pain syndrome. Structural anorectal pain is treated according to the underlying pathology. In situations of chronic post-surgical pain that is refractory to conventional therapeutic approaches, percutaneous tibial nerve stimulation (PTNS) is an option. PTNS is a neurostimulation technique used in the treatment of lower urinary tract dysfunction. There has been increasing evidence of its benefits for improving other conditions, such as chronic pelvic pain (CPP) and faecal incontinence (FI). Case Presentation: We report a case of a 45-year-old woman with chronic post-surgical anorectal pain (CPAP) treated with PTNS. The patient reported a consistent and dramatic decrease in both the frequency and intensity of pain, assessed by the Brief Pain Inventory (BPI). A decrease in the pain interference with mood, normal work, and walking/mobility was also noted, as evaluated by BPI and EQ-5D-3L questionnaires. Discussion: Neuromodulation treatments have been reported as effective for anorectal pain, but reports on the use of PTNS are rare. The tibial nerve is easily accessible and provides an optimal site for neurostimulation without the need of an operating room or anaesthesia. The overall improvement observed in this case of chronic anorectal pain suggests a potential new area of research for PTNS.

Introdução: A dor anorectal é um sintoma com um impacto negativo na qualidade de vida, podendo, por vezes, desenvolver-se numa síndrome de dor crónica. A dor ano rectal de etiologia estrutural trata-se de acordo com a patologia subjacente. No entanto, em situações de dor crónica pós-cirúrgica refratária a abordagens terapêuticas convencionais, a estimulação percutânea do nervo tibial (percutaneous tibial nerve stimulation − PTNS) é uma opção de tratamento. A PTNS é uma técnica de neuroestimulação, estando descritos benefícios da sua aplicação no tratamento da urgência, frequência, incontinência e retenção urinária. Evidência crescente mostra, ainda, resultados promissores noutras condições, como a dor crónica pélvica e a incontinência fecal. Caso Clínico: Descrevemos um caso de uma mulher de 45 anos, com dor crónica anorectal pós-cirúrgica tratada com PTNS. Ao longo do período de seguimento, a doente reportou uma diminuição consistente e significativa na frequência e na intensidade da dor, tal como avaliado pelo Brief Pain Inventory (BPI). Adicionalmente, foi notória uma melhoria significativa de parâmetros relacionados com a qualidade de vida, avaliados pelos questionários BPI e EQ-5D-3L. Discussão: A evidência atual mostra que técnicas baseadas em neuromodulação têm sido eficazes no tratamento da dor anorectal, apesar dos estudos com PTNS ainda serem escassos. O nervo tibial é uma estrutura facilmente acessível e constitui um local óptimo para aplicação de neuroestimulação. A PTNS é uma opção terapêutica pouco invasiva, que não necessita de idas ao bloco operatório, nem de apoio de anestesia. O benefício observado do uso da PTNS neste caso sugere uma nova área de estudo e de potencial aplicabilidade para a técnica.

Digital home-based multidisciplinary cardiac rehabilitation: How to counteract physical inactivity during the COVID-19 pandemic.

Introduction and Objectives: Center-based cardiac rehabilitation (CR) programs have been forced to close due to COVID-19. Alternative delivery models to maintain access to CR programs and to avoid physical inactivity should be considered. The aim of this study was to assess physical activity (PA) levels after completing a home-based digital CR program. Methods: A total of 116 cardiovascular disease (CVD) patients (62.6±8.9 years, 95 male) who had been attending a face-to-face CR program were recruited and assessed (baseline and at three months) on the following parameters: PA, sedentary behavior, adherence, cardiovascular and non-cardiovascular symptoms, feelings toward the pandemic, dietary habits, risk factor control, safety and adverse events. The intervention consisted of a multidisciplinary digital CR program, including regular patient assessment, and exercise, educational and psychological group sessions. Results: Ninety-eight CVD patients successfully completed all the online assessments (15.5% drop-out rate). A favorable main effect of time was an increase in moderate to vigorous PA and a decrease in sedentary time at three months. Almost half of the participants completed at least one online exercise training session per week and attended at least one of the online educational sessions. No major adverse events were reported and only one minor event occurred. Conclusion: During the pandemic, levels of moderate to vigorous PA improved after three months of home-based CR in CVD patients with previous experience in a face-to-face CR model. Diversified CR programs with a greater variety of content tailored to individual preferences are needed to meet the motivational and clinical requirements of CVD patients.

Introdução e objetivos: Os programas convencionais de reabilitação cardíaca (RC) foram forçados a encerrar devido à Covid-19. Modelos alternativos para que os doentes tenham acesso a um programa de RC evitando a inatividade física devem ser considerados. O objetivo deste estudo foi avaliar os níveis de atividade física (AF) de um programa digital de RC em casa. Métodos: Foram recrutados e avaliados (inicialmente e aos três meses) 116 doentes cardiovasculares (CV) (62,6±8,9 anos, 95 homens) que frequentavam um programa presencial de RC, nos seguintes parâmetros: AF, comportamento sedentário, adesão, sintomas CV e não CV, sentimentos face à pandemia, hábitos alimentares, fatores de risco, segurança e eventos adversos. A intervenção consistiu num programa digital multidisciplinar de RC, inclusive acompanhamento regular, sessões de exercício, de ensino e de psicologia em grupo. Resultados: Completaram com sucesso todas as avaliações online (15,5% drop-out) 98 pessoas com doença CV. Houve um efeito favorável no aumento da AF moderada a vigorosa e diminuição do tempo sedentário aos três meses. Quase metade da amostra fez, pelo menos, mais de uma sessão de exercício físico online por semana e assistiu a pelo menos uma das sessões educacionais online. Não se verificaram eventos major e registou-se apenas um minor. Conclusão: Em tempo de pandemia, os níveis de AF moderada a vigorosa melhoraram após três meses em doentes CV que frequentavam previamente um modelo presencial de RC. São necessários mais programas de RC com maior variedade de conteúdos adaptados à preferência individual para dar resposta às necessidades motivacionais e clínicas dos doentes CV.

Toward Modeling Psychomotor Performance in Karate Combats Using Computer Vision Pose Estimation.

Technological advances enable the design of systems that interact more closely with humans in a multitude of previously unsuspected fields. Martial arts are not outside the application of these techniques. From the point of view of the modeling of human movement in relation to the learning of complex motor skills, martial arts are of interest because they are articulated around a system of movements that are predefined, or at least, bounded, and governed by the laws of Physics. Their execution must be learned after continuous practice over time. Literature suggests that artificial intelligence algorithms, such as those used for computer vision, can model the movements performed. Thus, they can be compared with a good execution as well as analyze their temporal evolution during learning. We are exploring the application of this approach to model psychomotor performance in Karate combats (called kumites), which are characterized by the explosiveness of their movements. In addition, modeling psychomotor performance in a kumite requires the modeling of the joint interaction of two participants, while most current research efforts in human movement computing focus on the modeling of movements performed individually. Thus, in this work, we explore how to apply a pose estimation algorithm to extract the features of some predefined movements of Ippon Kihon kumite (a one-step conventional assault) and compare classification metrics with four data mining algorithms, obtaining high values with them.

Estresse ocupacional relacionado à assistência de enfermagem em terapia intensiva / Estrés ocupacional relacionado con la atención de enfermería en cuidados intensivos / Occupational stress related to nursing care in intensive care

Objetivo estimar a prevalência de estresse ocupacional entre profissionais de enfermagem que atuam em Unidade de Terapia Intensiva e identificar sua associação com variáveis sociodemográficas, profissionais e relacionadas à assistência de enfermagem. Método estudo transversal, realizado em um hospital de ensino de Salvador, Bahia, Brasil, com 54 profissionais. Os dados foram coletados entre fevereiro e março de 2020 por meio da Escala Bianchi de Stress e analisados pelo Programa Stata. Resultados a prevalência de estresse ocupacional em nível médio ou alto foi de 57,4%. Maiores níveis de estresse foram associados significativamente ao menor tempo de formação (p-valor=0,05), ser enfermeiro (p-valor=0,00), enfrentar a morte do paciente (p-valor=0,01), atender aos familiares dos pacientes críticos (p-valor=0,00) e atender às necessidades dos familiares (p-valor=0,00). Conclusão a elevada prevalência de estresse ocupacional, bem como os fatores associados identificados, foram informações essenciais para implementação de estratégias preventivas.

Objetivo estimar la prevalencia del estrés ocupacional entre los profesionales de enfermería que trabajan en la Unidad de Cuidados Intensivos e identificar su asociación con variables sociodemográficas, profesionales y de cuidados de enfermería. Método estudio transversal, realizado en un hospital de enseñanza en Salvador, Bahía, Brasil, con 54 profesionales. Los datos fueron recopilados entre febrero y marzo de 2020 utilizando la Escala de Estrés de Bianchi y analizados por el Programa Stata. Resultados la prevalencia del estrés ocupacional a nivel medio o alto fue del 57,4%. Los niveles de estrés más altos se asociaron significativamente con un tiempo de entrenamiento más corto (p-valor-0,05), ser una enfermera (p-valor-0,00), enfrentar la muerte del paciente (p-valor-0,01), atender a los familiares de los pacientes en estado crítico (p-value-0,00) y satisfacer las necesidades de los miembros de la familia (p-valor-0,00). Conclusión la alta prevalencia del estrés ocupacional, así como los factores asociados identificados, fueron información esencial para la aplicación de estrategias preventivas.

Objective to estimate the prevalence of occupational stress among nursing professionals working in the Intensive Care Unit and to identify its association with sociodemographic, professional and nursing care-related variables. Method cross-sectional study, conducted in a teaching hospital in Salvador, Bahia, Brazil, with 54 professionals. Data were collected between February and March 2020 using the Bianchi Stress Scale and analyzed by the Stata Program. Results the prevalence of occupational stress at medium or high level was 57.4%. Higher stress levels were significantly associated with shorter training time (p-value=0.05), being a nurse (p-value=0.00), facing patient death (p-value=0.01), attending to critically ill patients' relatives (p-value=0.00) and meeting the needs of family members (p-value=0.00). Conclusion the high prevalence of occupational stress, as well as the associated factors identified, were essential information for the implementation of preventive strategies.

Incidência e caracterização das flebites notificadas eletronicamente em um hospital de ensino / Incidencia y caracterización de la flebitis notificada electrónicamente en un hospital de enseñanza / Incidence and characterization of electronically notified phlebitis in a teaching hospital

Objetivo: analisar a incidência e as notificações de flebite em um hospital de ensino. Método: estudo observacional retrospectivo, realizado em Salvador, Bahia, Brasil. Os dados foram coletados com base nas notificações de incidentes relacionados à assistência à saúde, ocorridas no período de janeiro/2016 a dezembro/2017. Realizou-se análise descritiva. Resultados: foram notificados 277 casos de flebite, com incidência variando entre 1,45% e 26,09% no período do estudo. A maioria das flebites ocorreu em indivíduos adultos (63,27%); raça negra (66,06%); e com baixo nível de escolaridade (53,43%). O uso prolongado de medicamentos e/ou uso de medicamento irritante (52%) foram citados como principais causas do evento; 95,31% foram classificados como não graves. Conclusão: a incidência de flebite variou no período de estudo, e as notificações em um hospital de ensino apontaram para danos à saúde da maioria dos pacientes com flebites notificadas.

Objetivo: analizar la incidencia y las notificaciones de flebitis en un hospital de enseñanza. Método: estudio retrospectivo de observación, realizado en Salvador, Bahía, Brasil. Los datos se reunieron sobre la base de los reportes de incidentes relacionados con la asistencia de la salud, que ocurrieron entre enero/2016 y diciembre/2017. Se realizó un análisis descriptivo. Resultados: se notificaron 277 casos de flebitis, con una incidencia que oscila entre el 1,45% y el 26,09% en el período de estudio. La mayoría de las flebitis ocurrieron en individuos adultos (63,27%); de raza negra (66,06%); y con bajo nivel de escolaridad (53,43%). El uso prolongado de medicamentos y/o el uso de medicamentos irritantes (52%) fueron citados como las principales causas del evento; el 95,31% se clasificó como no grave. Conclusión: la incidencia de la flebitis varió durante el período de estudio, y los reportes en un hospital de enseñanza señalaron el daño a la salud de la mayoría de los pacientes con flebitis reportados.

Objective: to analyze the incidence and notifications of phlebitis in a teaching hospital. Method: retrospective observational study, held in Salvador, Bahia, Brazil. The data was collected based on the notifications of incidents related to health assistance, which occurred in the period from January/2016 to December/2017. A descriptive analysis was conducted. Results: 277 cases of phlebitis were notified, with incidence ranging from 1.45% to 26.09% in the study period. Most phlebitis occurred in adult individuals (63.27%); black race (66.06%); and with low schooling level (53.43%). Prolonged use of medication and/or use of irritant medication (52%) were cited as the main causes of the event; 95.31% were classified as non-serious. Conclusion: the incidence of phlebitis varied during the study period, and the reports at a teaching hospital pointed to damage to the health of most patients with phlebitis reported.

Intelligent Framework for Learning Physics with Aikido (Martial Art) and Registered Sensors.

Physics is considered a tough academic subject by learners. To leverage engagement in the learning of this STEM area, teachers try to come up with creative ideas about the design of their classroom lessons. Sports-related activities can foster intuitive knowledge about physics (gravity, speed, acceleration, etc.). In this context, martial arts also provide a novel way of visualizing these ideas when performing the predefined motions needed to master the associated techniques. The recent availability of cheap monitoring hardware (accelerometers, cameras, etc.) allows an easy tracking of the aforementioned movements, which in the case of aikido, usually involve genuine circular motions. In this paper, we begin by reporting a user study among high-school students showing that the physics concept of moment of inertia can be understood by watching live exhibitions of specific aikido techniques. Based on these findings, we later present Phy + Aik, a tool for educators that enables the production of innovative visual educational material consisting of high-quality videos (and live demonstrations) synchronized/tagged with the inertial data collected by sensors and visual tracking devices. We think that a similar approach, where sensors are automatically registered within an intelligent framework, can be explored to teach other difficult-to-learn STEM concepts.

Egressos de residência em enfermagem e o mercado de trabalho / Nursing residence graduates and the job market

Objetivo: descrever as características sociodemográficas e profissionais dos egressos dos programas de Residência em Enfermagem. Método: trata-se de estudo quantitativo, descritivo, exploratório, transversal, envolvendo 32 egressas de Residência em Enfermagem, por meio de entrevista semiestruturada. Analisaram-se os dados por meio de planilha eletrônica com valores e frequências relativas e absolutas e os resultados apresentados em tabelas. Resultados: evidenciou-se que as egressas apresentam um perfil jovem, são solteiras e de origem fora da capital, com a Terapia Intensiva como área de concentração escolhida e, após a conclusão do curso, buscaram continuar o seu processo formativo em programas de pós-graduação. Conclusão: contribuiu-se, pelo curso de Residência, para a formação de profissionais mais preparados para responder às demandas dos serviços de saúde, além de possibilitar e ampliar as oportunidades de ingresso no mercado de trabalho, ampliando possibilidades e perspectivas para a continuidade do aprendizado. Acredita-se que este estudo significa um caminho para a realização de outras pesquisas que busquem reflexão acerca da avaliação dos programas, especialmente sobre a formação e o mercado de trabalho.(AU)

Objective: to describe the sociodemographic and professional characteristics of the graduates of Nursing Residency programs. Method: this is a descriptive, descriptive, exploratory, cross-sectional study involving 32 Nursing Residency graduates, through a semi-structured interview. Data was analyzed by spreadsheet with relative and absolute values and frequencies and the results presented in tables. Results: it was evidenced that the graduates present a young profile, are single and of origin outside the capital, with Intensive Therapy as chosen concentration area and, after completing the course, sought to continue their formative process in post- University graduate. Conclusion: it was contributed, through the Residency course, to the training of professionals better prepared to respond to the demands of the health services, besides enabling and expanding the opportunities of entering the job market, expanding possibilities and perspectives for the continuity of learning . It is believed that this study represents a way to carry out other research that seeks reflection on the evaluation of programs, especially on training and the job market. (AU)

Objetivo: describir las características sociodemográficas y profesionales de los egresados de los programas de Residencia en Enfermería. Método: se trata de estudio cuantitativo, descriptivo, exploratorio, transversal, involucrando 32 egresas de Residencia en Enfermería, por medio de una entrevista semiestructurada. Se analizaron los datos por medio de planilla electrónica con valores y frecuencias relativas y absolutas y los resultados presentados en tablas. Resultados: se evidenció que las egresadas presentan un perfil joven, son solteras y de origen fuera de la capital, con la Terapia Intensiva como área de concentración elegida y, tras la conclusión del curso, buscaron continuar su proceso formativo en programas de postgrado. Conclusión: se contribuyó, por el curso de Residencia, a la formación de profesionales más preparados para responder a las demandas de los servicios de salud, además de posibilitar y ampliar las oportunidades de ingreso en el mercado de trabajo, ampliando posibilidades y perspectivas para la continuidad del aprendizaje. Se cree que este estudio significa un camino para la realización de otras investigaciones que busquen reflexión acerca de la evaluación de los programas, especialmente sobre la formación y el mercado de trabajo.(AU)

Mapeamento da oferta de cursos e vagas dos programas de residência em enfermagem na bahia / Mapeo de la oferta de cursos y vacantes de los programas de residencia en enfermería en la bahia / Mapping of offers of courses and vacancies in nursing residence programs in bahia

Objetivo mapear a oferta de cursos e vagas dos programas de residência multiprofissional e em área profissional da saúde em enfermagem na Bahia. Método estudo documental, quantitativo, cujas fontes de dados foram 15 editais de processo seletivo para programas de residência em enfermagem que descreveram as variáveis ano, número de programa, áreas de concentração, vagas, instituições de ensino superior vinculadas e modalidades dos programas. A coleta deu-se de 15 a 19 de janeiro de 2018. Resultados foram identificadas 566 vagas distribuídas entre 19 áreas de concentração e ofertadas por oito instituições de ensino. No ano de 2014 houve a maior oferta de vagas 107 (18,9%), em 2015 houve queda considerável de 57,9% no número dessas vagas. Conclusão os programas de residência multiprofissional expandiram-se em decorrência de reformulações das políticas de saúde e dos incentivos à formação de recursos humanos especializados, no entanto vem ocorrendo redução na oferta de vagas.

Objetivo mapear la oferta de cursos y vacantes de programas de residencia multiprofesional y en área profesional de la salud en enfermería en la Bahía, Brasil. Método estudio documental, cuantitativo, cuyas fuentes de datos fueron 15 ediciones de proceso selectivo para programas de residencia en enfermería que describieron las variables año, número de programa, áreas de concentración, vacantes, instituciones de enseñanza superior vinculada y modalidad de los programas. Recolección de 15 a 19 de enero de 2018. Resultados se identificaron 566 vacantes distribuidas entre 19 áreas de concentración y ofrecidas por ocho instituciones de enseñanza. En 2014, hubo mayor oferta de vacantes 107 (18,9%); en 2015, descenso considerable de 57,9% en el número de vacantes. Conclusión los programas de residencia multiprofesional se expandieron como consecuencia de reformulaciones de políticas de salud e incentivos a la formación de recursos humanos especializados, sin embargo, hubo reducción en la oferta de vacantes.

Objective map the offer of courses and vacancies in multiprofessional residency programs and in the professional health area in nursing in Bahia. Method documentary, quantitative study, whose data sources were 15 selective process edicts for nursing residency programs that described the variables year, number of program, concentration areas, vacancies, linked higher education institutions, and program modality. The collection took place from January 15 to 19, 2018. Results 566 vacancies were identified distributed among 19 concentration areas and areas offered by eight educational institutions. In 2014, there was the greatest number of vacancies, 107 (18.9%); in 2015 there was a considerable fall of 57.9% in the number of these vacancies. Conclusion multiprofessional residency programs have expanded due to reformulations of health policies and incentives to the formation of specialized human resources; however, there has been a reduction in the availability of vacancies.

18F-FDG-PET/CT angiography in the diagnosis of infective endocarditis and cardiac device infection in adult patients with congenital heart disease and prosthetic material.

OBJECTIVES: Infective endocarditis (IE) and cardiac device infection (CDI) are a major complication in the growing number of patients with congenital heart disease (CHD) reaching adulthood. We aimed to evaluate the added value of 18F-FDG-PET/CT angiography (PET/CTA) in the diagnosis of IE-CDI in adults with CHD and intravascular or intracardiac prosthetic material, in whom echocardiography (ECHO) and modified Duke Criteria (DC) have limitations because of the patients' complex anatomy. METHODS: A prospective study was conducted in a referral center with multidisciplinary IE and CHD Units. PET/CTA and ECHO findings were compared in consecutive adult (≥18years) patients with CHD who have prosthetic material and suspected IE-CDI. The initial diagnosis using the DC and the diagnosis with the additional PET/CTA data (DC+PET/CTA) were compared with the final diagnostic consensus established by an expert team at three months. RESULTS: Between November-2012 and April-2017, 25 patients (15 men; median age 40years) were included. Cases were initially classified as definite in 8 (32%), possible in 14 (56%) and rejected in 3 (12%). DC+PET/CTA allowed reclassification of 12/14 (86%) cases initially identified as possible IE. The sensitivity, specificity, PPV, NPV, and accuracy of DC at IE suspicion were 39.1%/83.3%/90.4%/25.5%/61.2%, respectively. The diagnostic performance increased significantly with addition of PET/CTA data: 87%/83.3%/95.4%/61.5%/85.1%, respectively. PET/CTA also provided an alternative diagnosis in 3 patients with rejected IE, and detected pulmonary embolisms in 3 patients. CONCLUSIONS: PET/CTA was a useful diagnostic tool in the complex group of adult patients with CHD who have cardiac or intravascular prosthetic material and suspected IE or CDI, providing added diagnostic value to the modified DC (increased sensitivity) and improving case classification.

Clinical aspects of pancreatogenic diabetes secondary to hereditary pancreatitis.

BACKGROUND: Hereditary pancreatitis is a rare inherited form of pancreatitis, characterized by recurrent episodes of acute pancreatitis with early onset and/or chronic pancreatitis, and presenting brittle diabetes, composed of episodes of nonketotic hyperglycemia and severe hypoglycemia. The existing literature regarding this form of diabetes is scarce. In this report, clinical features of pancreatogenic diabetes secondary to hereditary pancreatitis are presented along with recommendations for appropriate medical treatment. RESULTS: Clinical data from five patients of a family with pancreatogenic diabetes secondary to hereditary pancreatitis were analyzed. The average time between hereditary pancreatitis and diabetes diagnosis was 80 ± 24 months (range: 60-180 months) with a mean age of 25.6 ± 14.7 years (range: 8-42 years), four patients used antidiabetic agents for 46 ± 45 months and all progressed to insulin therapy with a mean dose of 0.71 ± 0.63 IU/kg (range: 0.3-1.76 IU/kg). The glycemic control had a high variability with average capillary blood glucose of 217.00 ± 69.44 mg/dl (range: 145-306 mg/dl) and the average HbA1c was 9.9 ± 1.9% (range: 7.6-11.6%). No ketoacidosis episodes occurred and there were several episodes of hospitalization for severe hypoglycemia. CONCLUSIONS: Diabetes mellitus secondary to hereditary pancreatitis presents with early onset, diverse clinical presentation and with extremely labile glycemic control. Diabetes treatment varies according to the presentation and insulin is frequently necessary for glycemic control.

Hydrophilic Polymer Brush Layers on Stainless Steel Using Multilayered ATRP Initiator Layer.

Thin polymer coatings (in tens of nanometers to a micron thick) are desired on industrial surfaces such as stainless steel. In this thickness range coatings are difficult to produce using conventional methods. In this context, surface-initiated controlled polymerization method can offer a promising tool to produce thin polymer coatings via bottom-up approach. Furthermore, the industrial surfaces are chemically heterogeneous and exhibit surface features in the form of grain boundaries and grain surfaces. Therefore, the thin coatings must be equally effective on both the grain surfaces and the grain boundary regions. This study illustrates a novel "periodic rejuvenation of surface initiation" process using surface-initiated ATRP technique to amplify the graft density of poly(oligoethylene glycol)methacrylate (POEGMA) brush layers on stainless steel 316L surface. The optimized conditions demonstrate a controlled, macroscopically homogeneous, and stable POEGMA brush layer covering both the grain surface and the grain boundary region. Various relevant parameters-surface cleaning methods, controllability of thickness, graft density, homogeneity and stability-were studied using techniques such as ellipsometer, X-ray photoelectron spectroscopy, scanning electron microscopy-energy-dispersive X-ray, surface zeta potential, and infrared reflection-adsorption spectroscopy.

Hereditary Pancreatitis Associated With the N29T Mutation of the PRSS1 Gene in a Brazilian Family: A Case-Control Study.

Hereditary pancreatitis (HP) is an autosomal-dominant disease with incomplete penetrance manifesting as early-onset chronic relapsing pancreatitis. A mutation in the PRSS1 gene is present in greater than 70% of HP kindreds and leads to a gain-of-function characterized by the increased autocatalytic conversion of trypsinogen to active trypsin, promoting autodigestion and damage to acinar cells. Other genetic defects observed in the pathogenic mechanism of pancreatitis include mutations in the genes encoding SPINK1, CTRC, and CPA1. There are few reports of HP in Latin America, and no families have been investigated in Brazil. A case-control observational study was conducted at Clementino Fraga Filho University Hospital in Brazil. Patients with suspected HP and healthy controls were enrolled in this study, and a detailed questionnaire was administered to patients with HP. PRSS1 and SPINK1 genes were analyzed by DNA sequencing, and a family that fit the HP diagnostic criteria was identified. The neutral polymorphism c.88-352A > G in the SPINK1 gene was found to be prevalent in the individuals studied, but no important alterations were found in this gene. Ten out of 16 individuals in this family carried the N29T mutation in the PRSS1 gene, with 2 clinically unaffected mutation carriers. The median age of HP onset was 6 years. Pancreatic exocrine failure occurred in 6 patients, 5 of whom also had diabetes mellitus. Surgical procedures were performed on 3 affected members, and no cases of pancreatic cancer have been reported thus far. This study identified the first PRSS1 gene mutation in a Brazilian family with HP.

Improving the Diagnosis of Infective Endocarditis in Prosthetic Valves and Intracardiac Devices With 18F-Fluordeoxyglucose Positron Emission Tomography/Computed Tomography Angiography: Initial Results at an Infective Endocarditis Referral Center.

BACKGROUND: The diagnosis of infective endocarditis (IE) in prosthetic valves and intracardiac devices is challenging because both the modified Duke criteria (DC) and echocardiography have limitations in this population. The added value of (18)F-fluorodeoxyglucose ((18)F-FDG) positron emission tomography (PET)/computed tomography (CT) and (18)F-FDG PET/CT angiography (PET/CTA) was evaluated in this complex scenario at a referral center with a multidisciplinary IE unit. METHODS AND RESULTS: Ninety-two patients admitted to our hospital with suspected prosthetic valve or cardiac device IE between November 2012 and November 2014 were prospectively included. All patients underwent echocardiography and PET/CT, and 76 had cardiac CTA. PET/CT and echocardiography findings were evaluated and compared, with concordant results in 54% of cases (κ=0.23). Initial diagnoses with DC at admission, PET/CT, and DC+PET/CT were compared with the final diagnostic consensus reached by the IE Unit. DC+PET/CT enabled reclassification of 90% of cases initially classified as possible IE with DC and provided a conclusive diagnosis (definite/rejected) in 95% of cases. Sensitivity, specificity, and positive and negative predictive values were 52%, 94.7%, 92.9%, and 59.7% for DC; 87%, 92.1%, 93.6%, and 84.3% for PET/CT; and 90.7%, 89.5%, 92%, and 87.9% for DC+PET/CT. Use of PET/CTA yielded even better diagnostic performance values than PET/nonenhanced CT (91%, 90.6%, 92.8%, and 88.3% versus 86.4%, 87.5%, 90.2%, and 82.9%) and substantially reduced the rate of doubtful cases from 20% to 8% (P<0.001). DC+PET/CTA reclassified an additional 20% of cases classified as possible IE with DC+PET/nonenhanced CT. In addition, PET/CTA enabled detection of a significantly larger number of anatomic lesions associated with active endocarditis than PET/nonenhanced CT (P=0.006) or echocardiography (P<0.001). CONCLUSIONS: (18)F-FDG PET/CT improves the diagnostic accuracy of the modified DC in patients with suspected IE and prosthetic valves or cardiac devices. PET/CTA yielded the highest diagnostic performance and provided additional diagnostic benefits.

Towards emotion detection in educational scenarios from facial expressions and body movements through multimodal approaches.

We report current findings when considering video recordings of facial expressions and body movements to provide affective personalized support in an educational context from an enriched multimodal emotion detection approach. In particular, we describe an annotation methodology to tag facial expression and body movements that conform to changes in the affective states of learners while dealing with cognitive tasks in a learning process. The ultimate goal is to combine these annotations with additional affective information collected during experimental learning sessions from different sources such as qualitative, self-reported, physiological, and behavioral information. These data altogether are to train data mining algorithms that serve to automatically identify changes in the learners' affective states when dealing with cognitive tasks which help to provide emotional personalized support.

Subclinical hypothyroidism represents an additional risk factor for coronary artery calcification, especially in subjects with intermediate and high cardiovascular risk scores.

OBJECTIVE: Several studies have suggested an association between subclinical hypothyroidism (SCH) and increased cardiovascular risk. The aim of this study was to evaluate the presence of coronary artery disease (CAD) in asymptomatic patients with SCH by measuring the coronary artery calcium score (CACS). DESIGN: A total of 222 asymptomatic subjects (103 SCH and 119 euthyroid (EU)), who were between the ages of 35 and 65 years and had no previous history of CAD, were enrolled for this cross-sectional analysis. METHODS: The criteria for SCH included a confirmed normal serum free thyroxine and high TSH levels. Lipid profile, Framingham risk score (FRS) and CACS analyses were performed for all subjects. RESULTS: The SCH and EU groups were comparable with respect to age, gender, BMI and frequency of diabetes, systemic arterial hypertension, hypercholesterolaemia and smoking. There was no difference in the median CACS between the SCH and EU groups. However, in the subgroup of subjects with intermediate/high FRS (AR10y ≥10%), CACS was higher in the SCH subjects compared with EU subjects (EU vs SCH, 0.0 (57.0) vs 23.0 (161.5); P=0.045). Multivariate analysis revealed that the risk for CACS >100 was independently associated with male gender, age >55 years, and the presence of simultaneous SCH and AR10y ≥10% (OR=87.5 (CI=2.1-3500); P=0.001). Serum TSH was positively correlated with CACS, especially in intermediate/high FRS subjects (rs=0.301, P=0.045). CONCLUSIONS: It was demonstrated that SCH represents an additional risk factor for CAD, notably in intermediate and high FRS subjects.

Involving users to improve the collaborative logical framework.

In order to support collaboration in web-based learning, there is a need for an intelligent support that facilitates its management during the design, development, and analysis of the collaborative learning experience and supports both students and instructors. At aDeNu research group we have proposed the Collaborative Logical Framework (CLF) to create effective scenarios that support learning through interaction, exploration, discussion, and collaborative knowledge construction. This approach draws on artificial intelligence techniques to support and foster an effective involvement of students to collaborate. At the same time, the instructors' workload is reduced as some of their tasks-especially those related to the monitoring of the students behavior-are automated. After introducing the CLF approach, in this paper, we present two formative evaluations with users carried out to improve the design of this collaborative tool and thus enrich the personalized support provided. In the first one, we analyze, following the layered evaluation approach, the results of an observational study with 56 participants. In the second one, we tested the infrastructure to gather emotional data when carrying out another observational study with 17 participants.

Influence of pH on the build-up of poly-L-lysine/heparin multilayers.

The effect of pH on the build-up of polyelectrolyte multilayers, PEMs, composed by poly-L-lysine and heparin onto two different substrates, silica and gold, has been studied by means of ellipsometry and quartz crystal microbalance with dissipation, QCM-D. Ellipsometry results indicate that the dry mass grows exponentially with the number of layers, and that this amount is larger as the pH values are raised. From QCM-D data the viscoelastic properties of the multilayered structure have been obtained. These data reflect that PEMs become more viscoelastic as the pH values are increased for silica substrates, while for gold the highest viscoelastic behavior is obtained at neutral pH and the elastic behavior becomes dominant as the pH is further increased or decreased. By combining these two surface techniques it has been also possible to determine the solvent content in the multilayers and reach a deeper understanding of the internal structure.