Advancing the scholarship and practice of stakeholder engagement in working landscapes: a co-produced research agenda.

Participatory approaches to science and decision making, including stakeholder engagement, are increasingly common for managing complex socio-ecological challenges in working landscapes. However, critical questions about stakeholder engagement in this space remain. These include normative, political, and ethical questions concerning who participates, who benefits and loses, what good can be accomplished, and for what, whom, and by who. First, opportunities for addressing justice, equity, diversity, and inclusion interests through engagement, while implied in key conceptual frameworks, remain underexplored in scholarly work and collaborative practice alike. A second line of inquiry relates to research-practice gaps. While both the practice of doing engagement work and scholarly research on the efficacy of engagement is on the rise, there is little concerted interplay among 'on-the-ground' practitioners and scholarly researchers. This means scientific research often misses or ignores insight grounded in practical and experiential knowledge, while practitioners are disconnected from potentially useful scientific research on stakeholder engagement. A third set of questions concerns gaps in empirical understanding of the efficacy of engagement processes and includes inquiry into how different engagement contexts and process features affect a range of behavioral, cognitive, and decision-making outcomes. Because of these gaps, a cohesive and actionable research agenda for stakeholder engagement research and practice in working landscapes remains elusive. In this review article, we present a co-produced research agenda for stakeholder engagement in working landscapes. The co-production process involved professionally facilitated and iterative dialogue among a diverse and international group of over 160 scholars and practitioners through a yearlong virtual workshop series. The resulting research agenda is organized under six cross-cutting themes: (1) Justice, Equity, Diversity, and Inclusion; (2) Ethics; (3) Research and Practice; (4) Context; (5) Process; and (6) Outcomes and Measurement. This research agenda identifies critical research needs and opportunities relevant for researchers, practitioners, and policymakers alike. We argue that addressing these research opportunities is necessary to advance knowledge and practice of stakeholder engagement and to support more just and effective engagement processes in working landscapes. Supplementary Information: The online version contains supplementary material available at 10.1007/s42532-022-00132-8.

Revisiting Biological Nitrogen Fixation Dynamics in Soybeans.

Biological nitrogen (N) fixation is the most relevant process in soybeans (Glycine max L.) to satisfy plant N demand and sustain seed protein formation. Past studies describing N fixation for field-grown soybeans mainly focused on a single point time measurement (mainly toward the end of the season) and on the partial N budget (fixed-N minus seed N removal), overlooking the seasonal pattern of this process. Therefore, this study synthesized field datasets involving multiple temporal measurements during the crop growing season to characterize N fixation dynamics using both fixed-N (kg ha-1) and N derived from the atmosphere [Ndfa (%)] to define: (i) time to the maximum rate of N fixation (ß2), (ii) time to the maximum Ndfa (α2), and (iii) the cumulative fixed-N. The main outcomes of this study are that (1) the maximum rate of N fixation was around the beginning of pod formation (R3 stage), (2) time to the maximum Ndfa (%) was after full pod formation (R4), and (3) cumulative fixation was positively associated with the seasonal vapor-pressure deficit (VPD) and growth cycle length but negatively associated with soil clay content, and (4) time to the maximum N fixation rate (ß2) was positively impacted by season length and negatively impacted by high temperatures during vegetative growth (but positively for VPD, during the same period). Overall, variation in the timing of the maximum rate of N fixation occurred within a much narrower range of growth stages (R3) than the timing of the maximum Ndfa (%), which varied broadly from flowering (R1) to seed filing (R5-R6) depending on the evaluated studies. From a phenotyping standpoint, N fixation determinations after the R4 growth stage would most likely permit capturing both maximum fixed-N rate and maximum Ndfa (%). Further investigations that more closely screen the interplay between N fixation with soil-plant-environment factors should be pursued.

Neoplastic sigmoid-uterine fistula. An exceptional complication of large intestine cancer.

Neoplastic sigmoid-uterine fistula is an extremely rare condition because the uterus is a thick and muscular organ. A 74-year-old woman was admitted to the First Aid Station suffering from abdominal pain and foul smelling vaginal discharge. Gynaecological examination showed fecal drainage from the cervical orifice, while the uterus was regular in size but very firm and painful. Ovaries and fallopian tubes were not palpable owing to abdominal tenderness. Ultrasounds reveled inhomogeneous thickening of uterine cavity, without detecting fistula. Contrast Medium CT (CMCT) showed Douglas' recto-uterine pouch occluded. The sigmoid wall was very thin exception a site where a fistula was suspected. At the surgery severe adhesions of the sigma-rectum with the posterior uterine wall were observed. After adhesiolysis, 18 cm colon-sigma-rectum was removed. Total hysterectomy with salpingooophorectomy was performed. Lymphadenectomy ended the procedure. Anatomical specimen confirmed sigmoid-uterine fistula. At histology a mildly differentiated adenocarcinoma of sigma-rectum was shown. Postoperative course was uneventful. Such a case of neoplastic sigmoiduterine fistula has not been reported so far.

Percepción del paciente hospitalizado respecto a la atención de enfermería en un hospital público / The hospitalized patient's perception of the nursing attention in a public hospital / Percepção do paciente hospitalizado referente à atenção de enfermagem num hospital público

Objetivo: Determinar y asociar la percepción del paciente hospitalizado respecto a la atención de enfermería con las variables sociodemográficas y estancia hospitalaria en el servicio de medicina de un hospital público. Método: Estudio cuantitativo, descriptivo y transversal con 50 pacientes de ambos sexos mayores de 18 años atendidos en un servicio de medicina. Para la recolección de datos se utilizó el cuestionario de perfil social y el cuestionario de percepción del paciente de la atención de enfermería. Resultados: Se observó predominio del sexo femenino, edad entre 40 y 49 años, solteros, con secundaria completa y con menos de 5 días de estancia hospitalaria. La atención de enfermería fue categorizada como medianamente favorable. Los componentes Técnico e Interpersonal fueron categorizados como medianamente favorables y el componente Confort desfavorable. Se observó que la mujer percibe mejor la atención de enfermería. Conclusión: Los resultados apuntaron la necesidad de un proceso reflexivo por parte del personal de enfermería para mejorar la atención, la percepción del paciente y brindar un cuidado de calidad.

Objective: To determine and associate the perception of the hospitalized patient regarding the nursing attention, using social and demographical variables and hospital stay in the medical service of a public hospital. Method: Quantitative, descriptive and transversal study with 50 patients of both sexes over 18 being treated by a medical service. Data were collected through a social profile questionnaire and a patient questionnaire on their perception of nursing attention. Results: There was a prevalence of females, aged between 40 and 49 years old, single, with high-school education and admitted to the hospital for less than 5 days. Nursing attention was categorized as broadly favorable. The Technical and Interpersonal components were categorized as fairly favorable, while Comfort was unfavorable. It was observed that women perceive the nursing attention better than men. Conclusion: The results pointed towards the need for a reflexive process for the nursing staff to improve attention and the patient's perception of this, as well as to offer better quality care.

Objetivo: Determinar e associar a percepção do paciente hospitalizado referente à atenção de enfermagem com as variáveis sócio-demográficas e 'a permanência hospitalar no serviço de medicina de um hospital público. Método: Estudo quantitativo, descritivo e transversal com 50 pacientes de ambos os sexos com mais de 18 anos atendidos num serviço de medicina. Para a recolha de dados utilizou-se o questionário de perfil social e o questionário de percepção do paciente na atenção de enfermagem. Resultados: Observou-se o predomínio do sexo feminino, idade entre 40 e 49 anos, solteiros, com estudos secundários completos e com menos de 5 dias de permanência hospitalar. A atenção de enfermagem foi categorizada como medianamente favorável. Os componentes técnico e interpessoal foram categorizados como medianamente favoráveis e o componente conforto desfavorável. Na associação observou-se que a mulher percebe melhor a atenção de enfermagem. Conclusão: Os resultados dirigiram-se à necessidade de um processo reflexivo por parte do enfermagem para melhorar a atenção, à percepção do paciente e oferecer um cuidado de qualidade.

Úlcera rectal solitaria como causa infrecuente de rectorragia / Solitary rectal ulcer syndrome as a rare cause of rectal bleeding

La úlcera rectal solitaria es un trastorno crónico, benigno, excepcional en pediatría, caracterizado por un conjunto de síntomas, como tenesmo, dolor perianal y prolapso rectal ocasional, con unos hallazgos anatomopatológicos típicos. La histología pone de manifiesto un engrosamiento de la mucosa y la muscularis mucosae, la elongación y distorsión de las glándulas, un edema de la lámina propia y, a veces, una ulceración de la lesión. Las lesiones se localizan con frecuencia en la pared anterior del recto, y la ulceración no siempre está presente. El diagnóstico suele ser tardío, dada la inespecificidad y la variabilidad clínica, y se basa en los estudios endoscópicos e histológicos. Aunque se trata de una entidad bien conocida en la edad adulta, resulta inusual en pediatría. Presentamos el caso de un adolescente de 16 años diagnosticado 4 años después del inicio de los síntomas(AU)

Solitary rectal ulcer syndrome is a rare condition in children, with benign chronic curse that is characterised by a complex of clinical and histological features. It usually appears with rectal bleeding, tenesmus and perinial pain, occasional rectal prolapsed and typical anatomopathological findings. Histologically, the presence of thickening of the mucous portion and muscularis mucosae, elongation and distortion of the glands and edema of the lamina propria and occasionally, ulceration of the lesion. The lesions are most often located on the anterior wall of the rectum, and ulceration is not always present. The diagnosis is usually delayed due to the nonspecific and clinical variability and is based on samples obtained by colonoscopy and biopsy. Although this entity is well recognized in adults, there are few pediatric cases reported in literature. We reporta 16 year-old boy case who was diagnosed 4 years after the onset of the symptoms(AU)

Aberrant TTF-1 expression in papillary high-grade urothelial neoplasm: case report and literature review.

We herein report the case of a 48-year-old man who developed synchronous advanced tumors in the lung and the bladder. The most striking feature of our case is that the otherwise typical bladder urothelial carcinoma showed focal areas (comprising less than 5% of the tumor mass) of nuclear positivity for TTF-1 (thyroid transcription factor-1). The different pattern of cytokeratin expression led us to consider them two independent primary tumors. Several recent reports have indicated that the type of clone used can influence the results of TTF-1 staining and can explain positivity in extrapulmonary and extrathyroid tumors.

Neutral endopeptidase and angiotensin I converting enzyme insertion/deletion gene polymorphism in humans.

Neutral endopeptidase (NEP) hydrolyses angiotensins (Ang) I and II and generates angiotensin-(1-7) [Ang-(1-7)]. In humans, the insertion/deletion (I/D) angiotensin-I converting enzyme (ACE) gene polymorphism determined plasma ACE levels by 40%. In rats, a similar polymorphism determines ACE levels which are inversely associated to NEP activity. The objective of this study is to evaluate the relationship between ACE expression and plasma NEP activity in normotensive subjects and in hypertensive patients. In total, 58 consecutive patients with hypertension, evaluated in our Hypertension Clinic, were compared according to their ACE I/D genotypes with 54 control subjects in terms of both plasma ACE activity and NEP activities. Plasma ACE activity was elevated 51 and 70% in both DD ACE groups (normotensives and hypertensives) compared with their respective ID and II ACE groups (P<0.001). A significant effect of the ACE polymorphism and of the hypertensive status on ACE activity was observed (P<0.001). In normotensive DD ACE subjects, NEP activity was 0.30+/-0.02 U/ml, whereas in the normotensive II ACE and in the normotensive ID ACE subjects NEP activity was increased 65 and 48%, respectively (P<0.001). In the hypertensive DD ACE patients, NEP activity was 0.47+/-0.03 U/mg. An effect of the I/D ACE genotypes on NEP activity (P<0.04) and an interaction effect between the I/D ACE genotype and the hypertensive status were also observed (P<0.001). These results are consistent with a normal and inverse relationship between the ACE polymorphism and NEP activity in normotensive humans (as is also observed in rats). This normal relationship is not observed in hypertensive patients.

Methicillin-resistant Staphylococcus aureus bacteraemia in Western Australian teaching hospitals, 1997-1999: risk factors, outcomes and implications for management.

The aim of this study was to document the evolution of methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia at teaching hospitals in Perth, Western Australia (WA), and determine the risk factors and outcomes of the disease. We performed a retrospective case series analysis of all laboratory-confirmed episodes of S. aureus bacteraemia at Perth teaching hospitals between 1 July 1997 and 30 June 1999 by linking laboratory data with hospitalization data from the state's Hospital Morbidity Data System. Episodes of S. aureus bacteraemia were stratified according to methicillin susceptibility and the relationship between methicillin resistance and key factors or outcomes was determined. Almost 11% of episodes of S. aureus bacteraemia (55/509) were caused by MRSA. On age-adjusted multivariate analysis, Aboriginality (RR 6.71, 95% CI 3.20-14.10, P<0.001), geriatric unit admission (RR 5.74, 95% CI 2.01-16.37, P=0.001), female sex (RR 1.88, 95% CI 1.03-3.42, P=0.04) and healthcare-associated disease (RR 1.93, 95% CI 1.01-3.70, P=0.05) were independently associated with MRSA bacteraemia. Outcomes among those with MRSA bacteraemia included death in 15 patients and re-admission for an MRSA-related complication in five. Empirical use of vancomycin needs consideration in at-risk patients in whom Gram-positive bacteraemia is suspected clinically, with prompt review of therapy once antibiotic susceptibility results are known. The rates of re-admission after discharge for MRSA bacteraemia could be used as a clinical indicator to monitor the quality of care in hospitals.

Identificación de la sobreexpresión del encogen c-erb B2 O HER-2/neu en cáncer de mama / Identification of the sobreexpression of they shrink c-erb B2 or HER-2/neu in cancer of breast

En un análisis de 160 casos de cáncer de mama en mujeres, estudiados en Lima, hemos encontrado una incidencia de reacción positiva a c-erb B2 (2 o 3 +) del 54.37 por ciento. Este porcentaje es más alto que el usualmente reportado a la literatura. La comparación de la sobreexpresión del c-erb B2 con positividad para receptores de estrógenos y progesterona no arrojó una relación inversa como se ha registrado en la literatura. Tampoco se halló una relación directamente proporcional entre la sobreexpresión de la proteína c-erb B2 y la presencia de la proteína Ki 67 o alguna forma de correlato con el índice de Nottingham. Se encontró un grado de paralelismo entre la sobreexpressión del c-erb B2 y la presencia de la proteína p53, aunque este no alcanzó un valor estadístico significativo (p mayor que 0.05). Se discute, brevemente el significado de los resultados obtenidos.

Increasing asthma awareness among physicians: impact on patient management and satisfaction.

Our objective was to investigate the impact of increased asthma awareness among primary care physicians on the asthma control and satisfaction of their patients. Physicians attended an asthma education session with emphasis on patient-physician partnership followed by 4 month monitored follow-up of patients aged 5-44 years with mild to moderate asthma. Findings were compared with a group of patients whose physician attended the session but did not participate in the follow-up and two other control groups. The study included pediatricians and general practitioners of Maccabi Healthcare Services and their patients. Asthma symptoms were rated by patients and physicians. Data on drug prescription and use were derived from the Maccabi central database. Patient response and satisfaction and physician satisfaction were evaluated by telephone interviews. Mean asthma symptom score improved from 2.0 to 1.1 in the study group of patients (p < 0.001). The use of reliever drugs decreased concomitantly with a rise in controller drugs in all patients. An improvement in asthma status was reported by 64% of the study patients and 39% of non-participating patients (p = 0.007). Fifty-eight percent of the patients rated their competence to deal with asthma as high before the intervention compared to 62% of the participating and 55% of the non-participating patients after the intervention (p = 0.002). Most physicians claimed that simply increasing their awareness on asthma led to beneficial results in their patients. Physician education followed by monitored follow-up enhanced asthma control and patient satisfaction. Nevertheless, physician education alone appears to have a significant isolated impact on asthma control.

[Juvenile myoclonic epilepsy in chromosome 6p12: clinical and genetic advances]. / Epilepsia mioclónica juvenil del cromosoma 6p12: avances clínicos y genéticos.

Amongst idiopathic generalized epilepsies, juvenile myoclonic epilepsy (JME) is the most common, accounting for 12% to 30% of all epilepsies in the Western world. Classic JME consists of awakening myoclonias, grand mal convulsions and EEG 4 to 6 Hz polyspike waves that appear in adolescence. Probands and affected family members do not have pyknoleptic 3Hz spike and wave absences. However, in 10 to 30% of patients, rare or spanioleptic polyspike wave absences appear. In 1988,1995,1996,we mapped classic JME to a 7 cM locus in chromosome 6p12 11, called EJM1, using families from Los Angeles and Belize. In 2001,we studied one large family from Belize and 21 new families from Los Angeles and Mexico Cities, aided by a BAC/PAC based physical map and 6 new dinucleotide repeats, to narrow EJM1 to an interval between D6S272 and D6S1573. In 2002, we found myoclonin, the putative gene for typical JME in 6p12. At the congress, we will reveal the identity of the myoclonin gene, its putative function and discuss the significance of this discovery in the JME population at large.

Epilepsia mioclónica juvenil en el cromosoma 6p12: avances clínicos y genéticos / Juvenile myoclonic epilepsy in chromosome 6p12: clinical and genetic advances

Entre las epilepsias generalizadas idiopáticas, la epilepsia mioclónica juvenil (EMJ) es la más frecuente y representa el 12-30 por ciento de todas las epilepsias del mundo occidental. La EMJ `clásica' consiste de mioclonía al despertar, crisis convulsivas de gran mal y electroencefalogramas (EEG) con polipunta-ondas de 4 a 6 Hz, que se presentan en la adolescencia. Los probandos y los miembros afectados de la familia no presentan ausencias punta-onda picnolépticas de 3 Hz. Sin embargo, el 10-30 por ciento de los pacientes presentan ausencias polipunta-onda escasas o raras. En 1988, 1995 y 1996 realizamos el mapeo genético de la EMJ `clásica' en un locus de 7 cM en el cromosoma 6p12-11, llamado EMJ1, mediante el empleo de familias de Los Ángeles y Belice. En 2001, estudiamos una familia numerosa de Belice y 21 familias nuevas de Los Ángeles y de Ciudad de México, con la ayuda de un mapa físico basado en recursos BAC/PAC y seis repeticiones dinucleotídicas, para reducir el cromosoma EMJ1 a un intervalo entre los marcadores D6S272 y D6S1573. En 2002, hallamos mioclonín, gen putativo de la EMJ típica en el cromosoma 6p12. En el congreso revelaremos la identidad del gen mioclonín, su función putativa y discutiremos la significación de este descubrimiento en la población con EMJ en general (AU)

[Aortic valve multiple papillary fibroelastoma complicated with a cerebrovascular accident: Report of one case]. / Fibroelastoma papilar múltiple de válvula aórtica complicado de accidente vascular encefálico embólico. Caso clínico.

The echocardiographic identification of cardiac tumors as cause of embolic episodes is infrequent, and the finding of multiple papillary fibroelastoma is even less common. We report a 70 years old female with a history of a rheumatic mitral valve lesion, subjected to a commissurotomy in 1970. She was admitted with a cerebrovascular accident and the transesophageal echocardiogram revealed the presence of a multiple papillary fibroelastoma in the aortic valve. The patient was operated and the tumor excised, the pathological analysis confirmed the diagnosis. The patient was discharged in good conditions and after 8 months of follow up, she has no neurological abnormality and is in functional class I.

Uso de forceps terapéuticos con técnica modificada: estudio de 514 casos / Use of therapeutic forceps with modified technique: study of 514 cases

Se estudiaron en el Servicio de Obstetricia y Ginecología del Hospital San Juan de Dios, entre los años 1996, 1997 y 1998, 514 pacientes cuyo parto se verificó mediante fórceps terapéutico. En ese período hubo 17.678 partos con 839 nacimientos con fórceps (4,74 por ciento). De ellos, se seleccionaron 514 con indicación de terminación médica del parto por vía vaginal. En la mayoría de los casos correspondió a sufrimiento fetal, distocia persistente de posición y expulsivo prolongado. Se usó el fórceps de Kielland. Se describe un procedimiento consistente en la aplicación de una rama en el occipucio fetal, traccionando y rotando suavemente durante la contracción uterina con lo que se logra una mayor flexión cefálica, descenso y rotación a una posición anterior para hacer una aplicación biparietomalar baja con traumatismo materno y fetal menos severo que con las maniobras clásicas. Se exponen resultados referentes a la madre y al recién nacido (RN) en los que destaca que el sufrimiento fetal estuvo presente como indicación en 297 pacientes (57,7 por ciento). El Apgar bajo 7 al minuto lo tuvieron 110 RN (21,4 por ciento) y a los 5 minutos sólo lo presentaron 5 (0,97 por ciento). Hubo dos mortineonatos (0,38 por ciento) en los que en uno se diagnosticó una cardiopatía congénita no confirmada y en el otro una retención prolongada de hombros con severa hipoxia. Se presentó un caso de rotura uterina en un útero malformado. Se analizan además resultados concernientes a complicaciones maternas, tales como lesiones cervicales, vaginales, complicaciones del RN y otras

Macrosomía fetal / Fetal macrosomy

La macrosomía fetal nos hace considerar múltiples aspectos que involucran no sólo determinantes del crecimiento fetal in utero, sino las complicaciones materno fetales que pueden presentarse tanto en el parto como en el puerperio. El excesivo aumento de peso fetal durante el embarazo, no es sinónimo de salud y bienestar fetal, sino por el contrario, puede ser el resultado de la interacción de varios fenómenos patológicos, que derivan en complicaciones obstétricas, perinatales y neonatales, que requieren de conocimientos y destrezas para su resolución inmediata

Fixed, dilated pupils in the ICU: another recoverable cause.

A 41-year-old woman presented unconscious with fixed dilated pupils following a massive overdose of carbamazepine and an unknown quantity of venlafaxine prescribed for the management of bipolar affective disorder. Her course in the intensive care unit was marked by a number of complications related to the overdose including prolonged coma, seizures and cardiac arrest. The patient eventually recovered to leave hospital.

Murray Valley encephalitis in Western Australia in 2000, with evidence of southerly spread.

We describe the epidemiological and clinical features of human Murray Valley encephalitis (MVE) and Kunjin (KUN) virus infections in Western Australia (WA) during March to July 2000. A case series was performed. For laboratory-confirmed cases, travel histories and clinical details were collected from patients, family members, friends or treating physicians. Surveillance data from the sentinel chicken program and climatic conditions were reviewed. Nine encephalitic cases of MVE were recorded. Eight were non-Aboriginal adults (age range, 25 to 79 years; 5 male, 3 female) and 1 was an Aboriginal boy. Four cases acquired infection in the Murchison and Midwest regions of WA from which no human cases of MVE have been reported previously. One of the 9 cases was fatal and 3 had severe neurological sequelae. Five non-encephalitic infections were also recorded, 3 MVE and 2 KUN. Encephalitis caused by MVE virus remains a serious problem with no improvement in clinical outcomes in the last 25 years. Excessive rainfall with widespread flooding in the northern two-thirds of WA provided ideal conditions for mosquito breeding and favoured southerly spread of the virus into new and more heavily populated areas. Surveillance in WA with sentinel chickens and mosquito trapping needs expansion to define the boundaries of MVE virus activity. To enable timely warnings to the public, and to institute mosquito control where feasible, continued surveillance in all Australian areas at risk is indicated.

The outbreak that had to happen: Bordetella pertussis in north-west Western Australia in 1999.

In late 1999, an outbreak of Bordetella pertussis occurred in a small town in North-West Western Australia. We undertook an investigation to describe the outbreak and to identify strategies to minimise the impact of future pertussis outbreaks in Australia. In November, people with respiratory symptoms were reviewed in an emergency pertussis clinic, which provided antibiotic treatment or prophylaxis. We conducted a school survey to enhance case ascertainment and followed up those attending the clinic by telephone. Fifty-nine cases of confirmed or probable B. pertussis infection were identified from 124 households (482 persons). Ages ranged from 5 months to 67 years, with children aged 9 to 11 years comprising 24 cases (41%). Early missed diagnoses and a school camp in September attended by 2 symptomatic children appeared to facilitate spread of infection, with the outbreak peak occurring in November. From immunisation records, childhood vaccine coverage in this sample was estimated at 96 per cent. All 21 cases of pertussis among the group under 10 years of age were at least partially vaccinated. There was only one laboratory confirmed case in the high-risk, under one-year of age category. Even in highly immunised populations periodic pertussis outbreaks are inevitable reflecting a vaccine efficacy of about 80 per cent and waning immunity with increasing age. Prevention of pertussis outbreaks depends not only on high vaccination coverage among young children but also early diagnosis and management of cases and their contacts. Clinicians should consider pertussis in the differential diagnosis of persistent cough illness in people of all ages--even those previously immunised.