Several secondary metabolite gene clusters in the genomes of ten Penicillium spp. raise the risk of multiple mycotoxin occurrence in chestnuts.

Penicillium spp. produce a great variety of secondary metabolites, including several mycotoxins, on food substrates. Chestnuts represent a favorable substrate for Penicillium spp. development. In this study, the genomes of ten Penicillium species, virulent on chestnuts, were sequenced and annotated: P. bialowiezense. P. pancosmium, P. manginii, P. discolor, P. crustosum, P. palitans, P. viridicatum, P. glandicola, P. taurinense and P. terrarumae. Assembly size ranges from 27.5 to 36.8 Mb and the number of encoded genes ranges from 9,867 to 12,520. The total number of predicted biosynthetic gene clusters (BGCs) in the ten species is 551. The most represented families of BGCs are non ribosomal peptide synthase (191) and polyketide synthase (175), followed by terpene synthases (87). Genome-wide collections of gene phylogenies (phylomes) were reconstructed for each of the newly sequenced Penicillium species allowing for the prediction of orthologous relationships among our species, as well as other 20 annotated Penicillium species available in the public domain. We investigated in silico the presence of BGCs for 10 secondary metabolites, including 5 mycotoxins, whose production was validated in vivo through chemical analyses. Among the clusters present in this set of species we found andrastin A and its related cluster atlantinone A, mycophenolic acid, patulin, penitrem A and the cluster responsible for the synthesis of roquefortine C/glandicoline A/glandicoline B/meleagrin. We confirmed the presence of these clusters in several of the Penicillium species conforming our dataset and verified their capacity to synthesize them in a chestnut-based medium with chemical analysis. Interestingly, we identified mycotoxin clusters in some species for the first time, such as the andrastin A cluster in P. flavigenum and P. taurinense, and the roquefortine C cluster in P. nalgiovense and P. taurinense. Chestnuts proved to be an optimal substrate for species of Penicillium with different mycotoxigenic potential, opening the door to risks related to the occurrence of multiple mycotoxins in the same food matrix.

Percepções de pessoas idosas internadas acerca da transição do cuidado do hospital para casa / Perceptions of hospitalized older adults regarding the transition of care from hospital to home

Resumo Objetivo analisar as percepções de pessoas idosas internadas acerca da transição do cuidado do hospital para casa. Método pesquisa com abordagem qualitativa, descritivo-exploratória, realizada em unidade de internação clínica de hospital público, médio porte, no interior do estado de São Paulo, Brasil. Participaram 22 pessoas idosas, por meio de entrevistas semiestruturadas, conduzidas por questões fundamentadas nos pilares do Care Transition Intervention. Posteriormente, foi realizada observação participante no local do estudo, com registro em diário de campo e transcrição das falas. Seguiram-se análise temática e sistematização dos dados por meio de software específico para análise de dados qualitativos. Resultados a média de idade dos participantes foi de 68 anos (DP±5,4); 16 (77%) possuíam uma ou mais doenças crônicas; 14 (64%) faziam uso de um ou mais medicamentos de uso contínuo. O Código Internacional de Doenças principal de internação foi covid-19. A média de permanência de internação foi de 9 dias (DP±5,7), com máximo de 31 dias e mínimo de dois dias, sendo que quatro (18%) tiveram a forma grave da doença. A partir da percepção das pessoas idosas, emergiram quatro temas de análise: problemas relacionados a medicamentos; preparo para alta hospitalar; continuidade do cuidado; e rede familiar. Conclusão na perspectiva das pessoas idosas, faz-se necessário a organização do plano de cuidados durante a internação por meio de reconciliação medicamentosa, preparo para os cuidados domiciliares, presença da família durante a internação e reconhecimento da Atenção Primária à Saúde na continuidade do cuidado durante a transição do cuidado do hospital para casa.

Abstract Objective To analyze the perceptions of older adults hospitalized regarding the transition of care from hospital to home. Method A qualitative, descriptive-exploratory research was conducted in a clinical inpatient unit of a medium-sized public hospital in the interior of São Paulo state, Brazil. Twenty-two older adults participated in the study through semistructured interviews, guided by questions based on the pillars of the Care Transitions Intervention (CTI). Subsequently, participant observation was conducted at the study site, with recording in a field diary and transcription of speeches. Thematic analysis and data systematization followed through specific software for qualitative data analysis Results The mean age of the participants was 68 years (SD±5.4); 16 (77%) had one or more chronic diseases; 14 (64%) were using one or more continuous medications. The primary International Classification of Diseases code for hospitalization was Covid-19. The average length of hospital stay was 9 days (SD±5.7), with a maximum of 31 days and a minimum of two days, with four (18%) experiencing severe disease. From the perception of older adults, four themes of analysis emerged: medication-related problems; preparation for hospital discharge; continuity of care; and family network. Conclusion From the perspective of older adults, it is necessary to organize the care plan during hospitalization through medication reconciliation, preparation for home care, family presence during hospitalization, and recognition of Primary Health Care in continuity of care during the transition from hospital to home care.

Hospital discharge planning in care transition of patients with chronic noncommunicable diseases.

OBJECTIVE: to analyze care transition in hospital discharge planning for patients with chronic noncommunicable diseases. METHOD: a qualitative study, based on the Care Transitions Intervention theoretical model, with four pillars of intervention, to ensure a safe transition. Twelve professionals participated in a public hospital in the countryside of São Paulo. Data were collected through observation, document analysis and semi-structured interviews. RESULTS: there was a commitment of a multidisciplinary team to comprehensive care and involvement of family members in patient care. The documents facilitated communication between professionals and/or levels of care. However, the lack of time to prepare for discharge can lead to fragmented care, impairing communication and jeopardizing a safe transition. FINAL CONSIDERATIONS: they were shown to be important elements in discharge planning composition, aiming to ensure a safe care transition, team participation with nurses as main actors, early discharge planning and family involvement.

A Quantitative Real-Time PCR Assay for Early Detection and Quantification of Ramularia mali, an Emerging Pathogen of Apple Causing Dry Lenticel Rot.

Ramularia mali is an emerging pathogen of apple (Malus domestica) causing dry lenticel rot. No preventive measures have been adopted due to the lack of knowledge about the life cycle and epidemiology of this pathogen. In a preliminary survey to identify the agents of dry lenticel rot of apple, R. mali was constantly associated with the disease. Using isolates from this survey, a SYBR Green quantitative PCR (qPCR) assay was developed, using calmodulin as target gene, for the detection and quantification of R. mali in apple fruit. The qPCR assay was validated in terms of specificity, sensitivity, repeatability, and reproducibility following the international European and Mediterranean Plant Protection Organization standard PM 7/98. The primers amplified a region of 237 bp specific to R. mali. The specificity was validated with 20 fungal species commonly found on apple, and 36 strains of R. mali and closely related species of the R. eucalypti species complex. Positive amplifications were obtained only with DNA of R. mali and no cross-reaction was detected with the other fungal species. Sensitivity was assessed with serial dilutions of target DNA and the limit of detection was 100 fg. No influence of host DNA was observed when target DNA was diluted on the DNA of Ambrosia and Golden Delicious apple. The assay permitted to detect and quantify R. mali in symptomatic and asymptomatic fruit. The presence of R. mali on asymptomatic Ambrosia and Golden Delicious apple fruit was demonstrated, and the presence of the pathogen was reported for the first time on Jeromine, Gala, Opal, and Story Inored fruit. This assay could be useful in clarifying the life cycle of this pathogen in order to build up an effective disease management strategy. Furthermore, the early detection of the pathogen on asymptomatic apple fruit could be used to forecast the development of dry lenticel rot, supporting the packinghouse operators in deciding the storage length of apple lots.

Hospital discharge planning in care transition of patients with chronic noncommunicable diseases / Planificación del alta hospitalaria en la transición asistencial de pacientes con enfermedades crónicas no transmisibles / Planejamento de alta hospitalar na transição do cuidado de pacientes com doenças crônicas não transmissíveis

ABSTRACT Objective: to analyze care transition in hospital discharge planning for patients with chronic noncommunicable diseases. Method: a qualitative study, based on the Care Transitions Intervention theoretical model, with four pillars of intervention, to ensure a safe transition. Twelve professionals participated in a public hospital in the countryside of São Paulo. Data were collected through observation, document analysis and semi-structured interviews. Results: there was a commitment of a multidisciplinary team to comprehensive care and involvement of family members in patient care. The documents facilitated communication between professionals and/or levels of care. However, the lack of time to prepare for discharge can lead to fragmented care, impairing communication and jeopardizing a safe transition. Final considerations: they were shown to be important elements in discharge planning composition, aiming to ensure a safe care transition, team participation with nurses as main actors, early discharge planning and family involvement.

RESUMEN Objetivo: analizar la transición de la atención en la planificación del alta hospitalaria de pacientes con enfermedades crónicas no transmisibles. Método: estudio cualitativo, basado en el modelo teórico Care Transitions Intervention, con cuatro pilares de intervención, para garantizar una transición segura. Doce profesionales participaron en un hospital público del interior de São Paulo. Los datos fueron recolectados a través de observación, análisis de documentos y entrevistas semiestructuradas. Resultados: el equipo multidisciplinario se comprometió a brindar una atención integral e involucrar a los familiares en el cuidado del paciente. Los documentos facilitaron la comunicación entre profesionales y/o niveles de atención. Sin embargo, la falta de tiempo para prepararse para el alta puede dar lugar a una atención fragmentada, perjudicando la comunicación y poniendo en peligro la transición segura. Consideraciones finales: se mostraron elementos importantes en la composición de la planificación del alta, con el objetivo de garantizar una transición segura de la atención, la participación del equipo con los enfermeros como protagonistas, la planificación del alta temprana y la participación de la familia.

RESUMO Objetivo: analisar a transição do cuidado no planejamento de alta hospitalar de pacientes com doenças crônicas não transmissíveis. Método: estudo qualitativo, fundamentado no modelo teórico Care Transitions Intervention, com quatro pilares de intervenção, para garantir uma transição segura. Participaram 12 profissionais, em hospital público, no interior paulista. Os dados foram coletados por meio de observação, análise documental e entrevistas semiestruturadas. Resultados: houve comprometimento da equipe multiprofissional para a integralidade da assistência e envolvimento de familiares nos cuidados ao paciente. Os documentos facilitaram a comunicação entre profissionais e/ou níveis de atenção. Todavia, a falta de tempo hábil para preparação da alta pode ocasionar um cuidado fragmentado, prejudicando a comunicação e colocando em risco a transição segura. Considerações finais: evidenciaram-se como elementos importantes na composição do planejamento de alta, visando garantir a transição do cuidado segura, participação da equipe com protagonismo do enfermeiro, planejamento precoce de alta e envolvimento da família.

Transição do cuidado de pessoas idosas do hospital para casa / Transición del cuidado de adultos mayores del hospital a su casa / Care transition of older adults from hospital to home

Resumo Objetivo Analisar a qualidade da Transição do Cuidado de idosos que receberam alta do hospital para casa. Métodos Estudo observacional transversal, realizado com 156 idosos, após internação em hospital público, localizado no município de Piracicaba, estado de São Paulo. Os dados foram coletados em prontuário eletrônico do paciente e por ligações telefônicas com idosos, seus familiares e/ou cuidadores, até quatro semanas após alta hospitalar. Foram utilizados questionário com dados sociodemográficos e instrumento Care Transitions Measure, versão validada para o Brasil. Resultados A duração média da última internação foi de 8,27 dias causada, majoritariamente (72,44 %) por COVID-19 e 75% dos idosos apresentaram entre 1 e 3 comorbidades, sendo a hipertensão arterial sistêmica (57,7%) a mais frequente. A média de escore do CTM 15 - Brasil foi 68,6. O Fator 1 - Preparação para o autogerenciamento obteve o maior escore (70,5) e o Fator 4 - Plano de Cuidados, o menor (59,14). Houve correlação positiva entre os 4 fatores do Care Transitions Measure, também entre estes fatores e do número de medicamentos utilizados para tratamento dos idosos, de acordo com a Classificação Anatômica Terapêutica Química. Conclusão Evidenciou-se a qualidade da Transição do Cuidado no hospital, próxima do valor considerado satisfatório, sendo dois dos quatro fatores com pontuação maior que 70; entretanto há necessidade de adoção de estratégias para melhorar o processo de alta do hospital para casa, principalmente, no que se refere a preferências asseguradas e plano de cuidado dos idosos.

Resumen Objetivo Analizar la calidad de la transición del cuidado de adultos mayores que recibieron alta del hospital a su casa. Métodos Estudio observacional transversal, realizado con 156 adultos mayores, después de estar internados en un hospital público ubicado en el municipio de Piracicaba, estado de São Paulo. Los datos fueron recopilados de la historia clínica del paciente y mediante llamados telefónicos a los adultos mayores, sus familiares o cuidadores, hasta cuatro semanas después del alta hospitalaria. Se utilizó un cuestionario con datos sociodemográficos y el instrumento Care Transitions Measure, versión validada para Brasil. Resultados La duración promedio de la última internación fue de 8,27 días, causada principalmente por COVID-19 (72,44 %) y el 75 % de los adultos mayores presentó entre una y tres comorbilidades, con hipertensión arterial sistémica como la más frecuente (57,7 %). El promedio de puntuación del CTM 15 - Brasil fue de 68,6. El Factor 1: Preparación para la autogestión obtuvo la mayor puntuación (70,5) y el Factor 4: Plan de cuidados, el menor (59,14). Se observó correlación positiva entre los cuatro factores del Care Transitions Measure, también entre estos factores del y número de medicamentos utilizados para el tratamiento de los adultos mayores, de acuerdo con la Clasificación Anatómica Terapéutica Química. Conclusión Se evidenció la calidad de la transición del cuidado en el hospital, cercana al valor considerado satisfactorio, donde dos de los cuatro factores obtuvieron puntuación superior a 70. Sin embargo, existe la necesidad de adoptar estrategias para mejorar el proceso del alta del hospital a la casa, principalmente respecto a las preferencias aseguradas y al plan de cuidado de los adultos mayores.

Abstract Objective To analyze the quality of care transition of older adults who were discharged from hospital to home. Methods This is a cross-sectional observational study, conducted with 156 older adults after public hospital admission, located in the municipality of Piracicaba, state of São Paulo. Data were collected in patients' electronic medical records and by telephone calls with older adults, their relatives and/or caregivers, up to four weeks after hospital discharge. We used a questionnaire with sociodemographic data and the Care Transitions Measure, version validated for Brazil. Results The mean duration of the last hospitalization was 8.27 days, mostly caused (72.44%) by COVID-19 and 75% of older adults had between 1 and 3 comorbidities, with hypertension (57.7%) being the most frequent. The mean CTM-15 score was 68.6. Factor 1, Management preparation, obtained the highest score (70.5), and Factor 4, Care plan, the lowest (59.14). There was a positive correlation between the 4 factors of Care Transitions Measure, also among these factors is the number of drugs used to treat older adults, according to the Anatomical Chemical Therapeutic Classification. Conclusion We evidenced the quality of the transition of care in the hospital close to the value considered satisfactory, with two of the four factors with a score greater than 70; however, there is a need to adopt strategies to improve the discharge process from hospital to home, especially with regard to preferences imported and care plan for older adults.

A construção de um protocolo de transição do cuidado de idosos do hospital para casa na perspectiva de quem cuida e de quem é cuidado / Construction of a protocol for care transition of older adults from hospital to home from the perspective of who cares and who is cared for

Objetivou-se desenvolver e propor o Protocolo de Transição do Cuidado (TC) do hospital para casa, direcionado aos idosos. Foram utilizados, como referencial conceitual, os princípios do Care Transitions Intervention (CTI). Trata-se de um estudo de abordagem qualitativa, do tipo Pesquisa Convergente-Assistencial (PCA). Participaram da pesquisa 22 idosos e 28 profissionais de saúde, de uma enfermaria clínica, em hospital público, no interior paulista, atendendo aos aspectos éticos. A coleta de dados foi realizada em cinco etapas, com técnicas de observação participante, rodas de conversa, entrevistas semiestruturadas (com idosos e profissionais da saúde) e grupos convergentes. Os dados das quatro primeiras etapas foram coletados de forma simultânea e subsidiaram a etapa cinco, com elaboração do protocolo. Para análise e interpretação dos resultados seguiu-se a recomendação da PCA, em quatro processos: apreensão, síntese, teorização e transferência. No processo de apreensão, para sistematizar os dados da análise temática, utilizou-se o software Atlas.ti Qualitative Datas Analysis. Na síntese dos resultados, construiu-se a matriz temática, que subsidiou o processo de teorização. O agrupamento de dados similares possibilitou verificar a saturação dos elementos. No processo de teorização elaborou-se protocolo, embasado à luz da Prática Baseada em Evidências (PBE). No processo de transferência, o protocolo foi contextualizado no cenário do estudo, por meio de um plano de ação. No resultado das primeiras quatro etapas emergiram seis temas: significado de TC; problemas relacionados a medicamentos (PRM) nas TC de idosos do hospital para casa; rede de apoio familiar e TC de idosos do hospital para casa; rede de atenção à saúde e continuidade do cuidado; processo assistencial e TC de idosos do hospital para casa; ausência de protocolo de TC. Na etapa cinco, o plano de cuidado foi considerado como fio condutor para elaboração do protocolo, em que o idoso e sua família são o foco principal. O desenvolvimento do protocolo deste estudo corroborou a qualificação do processo assistencial no local em que foi realizado. Para implantação do protocolo será necessário um acompanhamento sistemático do plano de ação, pela equipe multidisciplinar e gestores da instituição. Novas pesquisas poderão ser realizadas após a sua implantação, para medir a efetividade e impacto deste protocolo nas transições de idosos do hospital para casa. Esta pesquisa foi influenciada pela Pandemia de COVID-19 e há evidências do seu impacto no contexto em que foi desenvolvida

The objective was to develop and propose a Care Transition Protocol (CT) from hospital to home aimed at older adults. The Care Transitions Intervention (CTI) principles were used as a conceptual framework. This is a study with a qualitative approach, of the Convergent Care Research (CCR) type. We included 22 older adults and 28 health professionals from a clinical ward in a public hospital in the countryside of São Paulo, meeting ethical aspects. Data collection was carried out in five stages, using participant observation techniques, conversation circles, semi-structured interviews (with older adults and health professionals) and convergent groups. Data from the first four stages were collected simultaneously and subsidized stage five, with protocol elaboration. For analysis and interpretation of results, the CCR recommendation was followed, in four processes: gathering, synthesis, theorization and transference. In the gathering process, to systematize data from thematic analysis, Atlas.ti Qualitative Data Analysis was used. In the synthesis of results, a thematic matrix was constructed, which supported the theorizing process. Similar data cluster made it possible to verify their saturation. In the theorizing process, a protocol was elaborated, based on Evidence-Based Practice (EBP). In the transfer process, the protocol was contextualized in the study scenario through an action plan. As a result of the first four steps, six themes emerged: meaning of CT; drug-related problems (DRP) in hospital-to-home CT of older adults; family support network and CT of older adults from hospital to home; health care network and continuity of care; care process and CT of older adults from hospital to home; absence of CT protocol. In step five, the care plan was considered as guideline for elaborating the protocol, in which older adults and their family are the main actors. The study's protocol development of the protocol of this study corroborated with the qualification of the care process in the place where it was carried out. In order to implement the protocol, it will be necessary to systematically monitor the action plan by the institution's multidisciplinary team and managers. Further research may be carried out after its implementation, to measure the effectiveness and impact of this protocol in transition of older adults from hospital to home. This research was influenced by the COVID-19 pandemic and there is evidence of its impact in the context in which it was developed

Transição do cuidado de idosos do hospital para casa: vivência da enfermagem / Transición del cuidado de adultos mayores del hospital a la casa: vivencia de enfermería / Transition of elder care from hospital to home: nursing experience

Resumo Objetivo Compreender como ocorre a transição do cuidado do hospital para casa de idosos na vivência de técnicos de enfermagem que atuam em uma unidade de internação clínica. Métodos Pesquisa observacional, descritiva, transversal, com abordagem qualitativa, composta por 15 técnicos de enfermagem que prestam assistência direta aos idosos internados em um hospital público, médio porte, no interior do estado de São Paulo. Realizadas quatro Rodas de Conversas Dialógicas, conduzidas por questões fundamentadas nos pilares do Care Transition Intervention e os principais componentes do modelo de Transição do Cuidado Ideal, com duração média de 30 minutos. Posteriormente realizada observação participante no local de atuação desses profissionais. Após transcrição das falas, seguiu-se análise temática e sistematização dos dados utilizando-se o Atlas.ti Qualitative Datas Analysis. Resultados Os técnicos de enfermagem demonstraram desconhecimento sobre o significado de transição do cuidado, contudo na prática vivenciam aspectos importantes que permeiam o seu conceito, como continuidade do cuidado, planejamento de alta e reconciliação medicamentosa. O fortalecimento da comunicação com os serviços da rede de atenção à saúde, a importância da família e educação em saúde foram eixos nas discussões referentes às transições de idosos do hospital para casa junto com estes profissionais. Conclusão Os profissionais apontaram para potencialidades no desenvolvimento de transições seguras na sua prática assistencial, consonantes com os pilares do Care Transition Intervention e componentes do modelo de Transição do Cuidado Ideal, desde que alinhadas a diretrizes assistenciais da instituição.

Resumen Objetivo Entender cómo ocurre la transición del cuidado del hospital a la casa de adultos mayores en la vivencia de técnicos de enfermería que actúan en una unidad de internación clínica. Métodos Investigación de observación, descriptiva, transversal, con enfoque cualitativo, compuesta por 15 técnicos de enfermería que brindan atención directa a adultos mayores internados en un hospital público, de tamaño mediano, en el interior del estado de São Paulo. Se realizaron cuatro Rondas de Conversaciones Dialógicas, conducidas por cuestiones fundamentadas en los pilares del Care Transition Intervention y los principales componentes del modelo de Transición del Cuidado Ideal, con una duración promedio de 30 minutos. Posteriormente se realizó la observación del participante en el lugar de actuación de esos profesionales. Después de la transcripción de los relatos, se siguió al análisis temático y a la sistematización de los datos utilizando el Atlas.ti Qualitative Datas Analysis. Resultados Los técnicos de enfermería demostraron una falta de conocimiento del significado de transición del cuidado, sin embargo, en la práctica vivencian aspectos importantes que penetran en su concepto, como continuidad del cuidado, planificación del alta y reconciliación medicamentosa. El fortalecimiento de la comunicación con los servicios de la red de atención a la salud, la importancia de la familia y la educación en salud fueron ejes en las discusiones referentes a la transición de adultos mayores del hospital a la casa junto con estos profesionales. Conclusión Los profesionales apuntaron las potencialidades en el desarrollo de transiciones seguras en su práctica asistencial, consonantes con los pilares del Care Transition Intervention y componentes del modelo de Transición del Cuidado Ideal, siempre y cuando estén alineadas a directivas asistenciales de la institución.

Abstract Objective To understand how the transition of care from hospital to home of older adults occurs in the experience of nursing technicians who work in a clinical inpatient unit. Methods This is an observational, descriptive, cross-sectional research, with a qualitative approach, composed of 15 nursing technicians who provide direct care to older adults hospitalized in a medium-sized public hospital in the countryside of the state of São Paulo. Four Dialogical Conversation Circles were held, guided by questions based on the Care Transition Intervention pillars and the Ideal Care Transition model main components, with an average duration of 30 minutes. Subsequently, participant observation was carried out in the place where these professionals work. After transcription of speeches, thematic analysis and data systematization followed using the Atlas.ti Qualitative Data Analysis. Results Nursing technicians showed a lack of knowledge about the meaning of care transition; however, in practice, they experience important aspects that permeate their concept, such as continuity of care, discharge planning and medication reconciliation. The strengthening of communication with the health care network services, the importance of family and health education were axes in the discussions regarding the transitions of older adults from hospital to home together with these professionals. Conclusion Professionals pointed to potentialities in the development of safe transitions in their care practice, in line with the Care Transition Intervention pillars and Ideal Care Transition model components, as long as they are aligned with the institution's care guidelines.

Construction and validation of a matrix for normative evaluation of the integrated health system of the borders.

OBJECTIVE: to build and validate a matrix for normative evaluation of the Integrated Health System of Borders. METHOD: a methodological study, composed by the construction of an evaluation matrix elaborated in three stages: elaboration of the logical model, containing the triad of structure, process and result; definition of evaluative questions and appearance and content validation of the matrix. Appearance and content validation were performed simultaneously by seven judges. For data collection, an online questionnaire and the Delphi technique were used and, for analysis, the Content Validity Index and Content Validity Ratio. RESULTS: the evaluation matrix containing 24 questions was submitted to two evaluations for its appearance and content validation. In the first, the overall mean Content Validity Index was 99.40% and the Content Validity Ratio was 0.90. In the second, the Content Validity Index was 100% and the Content Validity Ratio, 1.0; there were no new proposals and the matrix was made up of 24 questions. The matrix was considered intelligible in terms of appearance validation. CONCLUSION: the evaluation matrix of the Integrated Health System of the Borders is validated in terms of appearance and content for analyzing the performance of public actions and policies in border regions.

CRISPR-Cas9-Based Discovery of the Verrucosidin Biosynthesis Gene Cluster in Penicillium polonicum.

Penicillium polonicum, commonly found on food matrices, is a mycotoxigenic species able to produce a neurotoxin called verrucosidin. This methylated α-pyrone polyketide inhibits oxidative phosphorylation in mitochondria and thereby causes neurological diseases. Despite the importance of verrucosidin as a toxin, its biosynthetic genes have not been characterized yet. By similarity analysis with the polyketide synthase (PKS) genes for the α-pyrones aurovertin (AurA) and citreoviridin (CtvA), 16 PKS genes for putative α-pyrones were identified in the P. polonicum genome. A single PKS gene, verA, was found to be transcribed under verrucosidin-producing growth conditions. The annotated functions of the genes neighboring verA correspond to those required for verrucosidin biosynthesis. To prove the involvement of verA in verrucosidin biosynthesis, the clustered regularly interspaced short palindrome repeats (CRISPR) technology was applied to P. polonicum. In vitro reconstituted CRISPR-Cas9 was used to induce targeted gene deletions in P. polonicum. This approach allowed identifying and characterizing the verrucosidin biosynthetic gene cluster. VerA deletion mutants were no longer able to produce verrucosidin, whereas they were displaying morphological characteristics comparable with the wild-type strain. The available CRISPR-Cas9 technology allows characterizing the biosynthetic potential of P. polonicum as a valuable source of novel compounds.

Construction and validation of a matrix for normative evaluation of the integrated health system of the borders / Construção e validação de matriz para avaliação normativa do sistema integrado de saúde das fronteiras / Construcción y validación de una matriz para evaluar la normativa del Sistema Integrado de Salud de las Fronteras

Objective: to build and validate a matrix for normative evaluation of the Integrated Health System of Borders. Method: a methodological study, composed by the construction of an evaluation matrix elaborated in three stages: elaboration of the logical model, containing the triad of structure, process and result; definition of evaluative questions and appearance and content validation of the matrix. Appearance and content validation were performed simultaneously by seven judges. For data collection, an online questionnaire and the Delphi technique were used and, for analysis, the Content Validity Index and Content Validity Ratio. Results: the evaluation matrix containing 24 questions was submitted to two evaluations for its appearance and content validation. In the first, the overall mean Content Validity Index was 99.40% and the Content Validity Ratio was 0.90. In the second, the Content Validity Index was 100% and the Content Validity Ratio, 1.0; there were no new proposals and the matrix was made up of 24 questions. The matrix was considered intelligible in terms of appearance validation. Conclusion: the evaluation matrix of the Integrated Health System of the Borders is validated in terms of appearance and content for analyzing the performance of public actions and policies in border regions.

Objetivo: construir e validar uma matriz para avaliação normativa do Sistema Integrado de Saúde das Fronteiras. Método: estudo metodológico, composto pela construção de uma matriz avaliativa elaborado em três etapas: elaboração do modelo lógico, contendo a tríade estrutura, processo e resultado; definição de questões avaliativas e validação aparente e de conteúdo da matriz. A validação aparente e de conteúdo foi realizada simultaneamente por sete juízes. Para a coleta de dados utilizou-se questionário on-line e a técnica Delphi, e para análise, o Índice de Validade de Conteúdo e Razão de Validade de Conteúdo. Resultados: a matriz de avaliação contendo 24 questões foi submetida a duas avaliações para a sua validação aparente e de conteúdo. Na primeira, o Índice de Validade de Conteúdo médio geral foi de 99,40% e a Razão de Validade de Conteúdo de 0,90. Na segunda, o Índice de Validade de Conteúdo foi de 100% e a Razão de Validade de Conteúdo de 1.0, não houve novas proposições e a matriz foi constituída de 24 questões. A matriz foi considerada inteligível quanto à validação de aparência. Conclusão: a matriz avaliativa do Sistema Integrado de Saúde das Fronteiras encontra-se validada quanto à aparência e conteúdo para análise do desempenho de ações e políticas públicas em regiões de fronteira.

Objetivo: construir y validar una matriz para evaluar la normativa del Sistema Integrado de Salud de las Fronteras. Método: estudio metodológico, compuesto por la construcción de una matriz de evaluación elaborado en tres etapas: elaboración del modelo lógico, que contiene tres componentes: estructura, proceso y resultado, definición de cuestiones evaluativas y validación de aspecto y de contenido de la matriz. Siete jueces realizaron la validación de aspecto y de contenido en forma simultánea. Para la recolección de datos se utilizó un cuestionario online y la técnica Delphi y, para el análisis, el Índice de Validez de Contenido y la Relación de Validez de Contenido. Resultados: se sometió la matriz de evaluación con 24 preguntas a dos evaluaciones para su validación de aspecto y de contenido. En la primera, el Índice de Validez de Contenido medio general fue del 99,40% y la Relación de Validez de Contenido fue de 0,90. En la segunda, el Índice de Validez de Contenido fue del 100% y la Relación de Validez de Contenido fue de 1,0; no hubo nuevas propuestas y la matriz quedó constituida por 24 preguntas. Se consideró la matriz inteligible respecto a la validación de aspecto. Conclusión: la matriz de evaluación del Sistema Integrado de Salud de las Fronteras se encuentra validada en cuanto a aspecto y contenido para el análisis del desempeño de acciones y políticas públicas en regiones de frontera.

Elaborated regulation of griseofulvin biosynthesis in Penicillium griseofulvum and its role on conidiation and virulence.

Penicilium griseofulvum, the causal agent of apple blue mold, is able to produce in vitro and on apple a broad spectrum of secondary metabolites (SM), including patulin, roquefortine C and griseofulvin. Among them, griseofulvin is known for its antifungal and antiproliferative activity, and has received interest in many sectors, from medicine to agriculture. The biosynthesis of SM is finely regulated by filamentous fungi and can involve global regulators and pathway specific regulators, which are usually encoded by genes present in the same gene cluster as the backbone gene and tailoring enzymes. In the griseofulvin gene cluster, two putative transcription factors were previously identified, encoded by genes gsfR1 and gsfR2, and their role has been investigated in the present work. Analysis of P. griseofulvum knockout mutants lacking either gene suggest that gsfR2 forms part of a different pathway and gsfR1 exhibits many spectra of action, acting as regulator of griseofulvin and patulin biosynthesis and influencing conidia production and virulence on apple. The analysis of gsfR1 promoter revealed that the regulation of griseofulvin biosynthesis is also controlled by global regulators in response to many environmental stimuli, such as carbon and nitrogen. The influence of carbon and nitrogen on griseofulvin production was further investigated and verified, revealing a complex network of response and confirming the central role of gsfR1 in many processes in P. griseofulvum.

Effect of Drying Temperatures and Exposure Times on Aspergillus flavus Growth and Aflatoxin Production on Artificially Inoculated Hazelnuts.

ABSTRACT: Aspergillus flavus may colonize hazelnuts and produce aflatoxins in the field and during storage. The main purpose of this study was to investigate the influence of drying temperature and exposure times on the viability of A. flavus and its ability to produce aflatoxins during the drying process and storage. Hazelnuts were inoculated with A. flavus and dried at different temperatures to reach 6% moisture content and a water activity (aw) of 0.71, a commercial requirement to avoid fungal development and aflatoxin contamination. Hazelnuts were dried at 30, 35, 40, 45, and 50°C and subsequently stored at 25°C for 14 days. After drying at 30, 35, and 40°C, increased amounts of A. flavus were evident, with the highest concentration occurring after drying at 35°C ([6.1 ± 2.4] × 106A. flavus CFU/g). At these temperatures, aflatoxins were detected only at 30 and 35°C. Aflatoxins, however, were present at higher levels after drying at 30°C, with concentrations of 1.93 ± 0.77 µg/g for aflatoxin B1 (AFB1) and 0.11 ± 0.04 µg/g for aflatoxin B2 (AFB2). After 14 days of storage, the highest A. flavus concentration and the highest levels of mycotoxins were detected in samples treated at 35°C ([8.2 ± 2.1] × 107A. flavus CFU/g and 9.30 ± 1.58 µg/g and 0.89 ± 0.08 µg/g for AFB1 and AFB2, respectively). In hazelnuts dried at 45 or 50°C, no aflatoxins were found either after drying or storage, and a reduction of A. flavus viable conidia was observed, suggesting that a shorter and warmer drying is essential to guarantee nut safety. The lowest temperature that guarantees the lack of aflatoxins should be selected to maintain the organoleptic quality of hazelnuts. Therefore, 45°C should be the recommended drying temperature to limit A. flavus growth and aflatoxin contamination on hazelnuts.

Drug-Related Problems in the transitional care of the elderly from hospital to home.

OBJECTIVE: To identify the knowledge produced on Medication-Related Problems in the transitional care of the elderly from hospital to home. METHOD: Integrative review of the literature data, organized in six stages: guiding question; establishment of inclusion and exclusion criteria; extraction of data; analyze; interpretation of results; and presentation of the review. Articles were considered among 2002 and 2017, in Portuguese, English, and Spanish, in the databases LILACS, MEDLINE, CINAHL and EMBASE. RESULTS: 10 studies were selected and analyzed. They were categorized by subject and identified in three themes: Medication Discrepancy and Reconciliation (40%); Adhesion to Medication (30%); and Adverse Drug Events (30%). FINAL CONSIDERATIONS: Drug-Related Problems in the transitional care of the elderly from hospital to home, were presented as a relevant theme for nursing, involving complex issues related to care. Drug reconciliation was evidenced as a coherent and effective strategy in home care transitions for the elderly.

Drug-Related Problems in the transitional care of the elderly from hospital to home / Problemas Relacionados com los Medicamentos en la transición de ancianos del hospital para casa / Problemas relacionados a medicamentos na transição de idosos do hospital para casa

ABSTRACT Objective: To identify the knowledge produced on Medication-Related Problems in the transitional care of the elderly from hospital to home. Method: Integrative review of the literature data, organized in six stages: guiding question; establishment of inclusion and exclusion criteria; extraction of data; analyze; interpretation of results; and presentation of the review. Articles were considered among 2002 and 2017, in Portuguese, English, and Spanish, in the databases LILACS, MEDLINE, CINAHL and EMBASE. Results: 10 studies were selected and analyzed. They were categorized by subject and identified in three themes: Medication Discrepancy and Reconciliation (40%); Adhesion to Medication (30%); and Adverse Drug Events (30%). Final considerations: Drug-Related Problems in the transitional care of the elderly from hospital to home, were presented as a relevant theme for nursing, involving complex issues related to care. Drug reconciliation was evidenced as a coherent and effective strategy in home care transitions for the elderly.

RESUMEN Objetivo: identificar el conocimiento producido sobre Problemas Relacionados con los Medicamentos en la transición de ancianos del hospital a casa. Método: la revisión integrativa de la literatura, organizada en seis etapas: pregunta orientadora; establecimiento de criterios de inclusión y exclusión; extracción de datos; análisis; interpretación de los resultados; y presentación de la revisión. Se consideraron los artículos entre 2002 y 2017, en portugués, inglés y español, en las bases de datos LILACS, MEDLINE, CINAHL y EMBASE. Resultados: se seleccionaron y analizaron 10 estudios. Se clasificaron por tema y se identificaron tres temas: Discrepancia y Reconciliación de Medicamentos (40%); Adhesión al Medicamento (30%); y Eventos Adversos a los Medicamentos (30%). Consideraciones finales: los Problemas Relacionados con los Medicamentos en la transición de ancianos del hospital a casa, se presentó como un tema relevante para la enfermería, involucrando cuestiones complejas relacionadas con el cuidado. La reconciliación de medicamentos fue evidenciada como estrategia coherente y eficaz en las transiciones de cuidado del anciano a casa.

RESUMO Objetivo: identificar o conhecimento produzido sobre Problemas Relacionados a Medicamentos na transição de idosos do hospital para casa. Método: revisão integrativa da literatura, organizada em seis etapas: pergunta norteadora; estabelecimento de critérios de inclusão e exclusão; extração dos dados; análise; interpretação dos resultados; e apresentação da revisão. Consideraram-se artigos entre 2002 e 2017, nos idiomas português, inglês e espanhol, nas bases de dados LILACS, MEDLINE, CINAHL e EMBASE. Resultados: foram selecionados e analisados 10 estudos. Categorizaram-se por assunto e identificaram-se três temas: Discrepância e Reconciliação de Medicamentos (40%); Adesão ao Medicamento (30%); e Eventos Adversos a Medicamentos (30%). Considerações finais: os Problemas Relacionados a Medicamentos na transição de idosos do hospital para casa, apresentou-se como um tema relevante para a Enfermagem, envolvendo questões complexas relacionadas ao cuidado. A reconciliação de medicamentos foi evidenciada como estratégia coerente e eficaz nas transições de cuidado do idoso para casa.

Absenteísmo na equipe de enfermagem em serviços de emergência: implicações na assistência / Absentismo en el equipo de enfermería en los servicios de emergencia: implicaciones en la atención / Absenteeism in the nursing team in emergency services: implications in care

Resumo Objetivo Neste estudo o objetivo foi analisar a percepção da equipe de enfermagem sobre as condições geradoras de absenteísmo e suas implicações para a assistência em unidades de urgência e emergência. Métodos Estudo qualitativo, realizado por meio de entrevistas individuais, semiestruturadas, conduzidas a partir de um roteiro norteador composto das dimensões Processo de Gestão de Recursos Humanos; Condição de Trabalho em Equipe e Qualidade do Cuidado Prestado, com 30 profissionais da equipe de enfermagem, sendo esses enfermeiros, auxiliares e técnicos de enfermagem atuantes em cinco unidades de urgência e emergência, no município de Ribeirão Preto, São Paulo. Para análise dos dados, utilizou-se a análise de conteúdo, modalidade temática. Resultados Os participantes relataram que a estrutura física inadequada, equipamentos e materiais de má qualidade, questões salariais, déficit de recursos humanos e comunicação ineficaz são potenciais condições geradoras de absenteísmo e influenciam a qualidade da assistência prestada. Conclusão Os gestores têm papel fundamental de criar condições que assegurem ao trabalhador da enfermagem o seu crescimento profissional, satisfação com o trabalho, gerando menor absenteísmo e fortalecendo o seu compromisso com cuidado de qualidade à população assistida pelo Sistema Único de Saúde. Portanto, considera-se este estudo uma ferramenta para a compreensão da percepção da equipe de enfermagem sobre as condições geradoras de absenteísmo em serviços de urgência e emergência.

Resumen Objetivo El objetivo del estudio fue analizar la percepción del equipo de enfermería acerca de las condiciones que generan el absentismo y sus implicaciones para la asistencia en unidades de urgencia y de emergencia. Métodos Estudio cualitativo, realizado por medio de entrevistas individuales, semi estructuradas, conducidas a partir de una guía de ruta compuesta por las dimensiones: Proceso de Gestión de Recursos Humanos; Condición de Trabajo en Equipo y Calidad de la Asistencia Médica Prestada, con 30 profesionales del equipo de enfermería, siendo estos enfermeros, auxiliares y técnicos de enfermería, actuantes en cinco unidades de urgencia y emergencia, en el municipio de Ribeirão Preto, São Paulo. Para el análisis de los datos, se utilizó el análisis de contenido, modalidad temática. Resultados Los participantes informaron que la infraestructura física inadecuada, equipos y materiales de mala calidad, cuestiones salariales, escasez de recursos humanos y comunicación ineficaz son posibles condiciones generadoras de absentismo e influyen en la calidad de la atención prestada. Conclusión Los directores poseen un papel clave en la creación de condiciones que aseguren al trabajador de enfermería su crecimiento profesional, satisfacción en el trabajo, generando un menor absentismo y fortaleciendo su compromiso con la atención de calidad a la población atendida por el Sistema Único de Salud. Por lo tanto, se considera este estudio una herramienta para entender la percepción del equipo de enfermería acerca de las condiciones generadoras de absentismo en servicios de urgencia y emergencia.

Abstract Objective In this study, the objective was to analyze how the nursing team perceives the conditions that lead to absenteeism and its implications for care at emergency medical services. Methods Qualitative study, developed through individual, semistructured interviews based on a script composed of the dimensions: Human Resource Management Process; Teamwork Condition and Quality of Care Provided, involving 30 nursing team professionals, including baccalaureate nurse, auxiliary nurses and nursing technicians working at five emergency services in the city of Ribeirão Preto, São Paulo. To analyze the data, thematic content analysis was used. Results The participants reported that the inappropriate physical structure and bad-quality equipment and material, salary issues, lack of human resources and ineffective communication are potential conditions leading to absenteeism and influence the quality of care provided. Conclusion The managers play a fundamental role in creating conditions that guarantee professional growth and job satisfaction to the nursing workers, leading to less absenteeism and strengthening their commitment to care quality for the population attended in the Unified Health System. Therefore, this study is considered as a tool to understand the nursing team's perception of the conditions leading to absenteeism in emergency services.

Cloning, characterization, expression and antifungal activity of an alkaline serine protease of Aureobasidium pullulans PL5 involved in the biological control of postharvest pathogens.

An alkaline protease gene was amplified from genomic DNA and cDNA of the antagonistic yeast-like fungus Aureobasidium pullulans PL5, a biocontrol agent effective against Monilinia laxa on stone fruit and Botrytis cinerea and Penicillium expansum on pome fruits. An open reading frame of 1248 bp encoding a 415-amino acid (aa) protein with a calculated molecular weight (M(r)) of 42.9 kDa and an isoelectric point (pI) of 4.5 was characterized. The cDNAALP5 gene had an 18-amino acid signal peptide, one N-gylcosylation, one histidine active site, and one serine active site. The ALP5 gene with a M(r) of 1351 bp contained two introns. One intron was of 54 bp, while the other was of 50 bp. Protein BLAST and phylogenetic tree analysis of the deduced amino sequences from the cDNAALP5 gene showed that the encoded protein had 100% homology to a protease enzyme (ALP2) of a sea strain of A. pullulans, suggesting that the protein ALP5 was an alkaline serine protease. Expression of ALP5 in Escherichia coli BL21 (DE3), followed by identification with Western-blotting, purification with Ni-NTA and analysis of enzymatic activity, yielded an homogeneous recombinant ALP5 which hydrolysed the substrate casein and inhibited the mycelial growth of the pathogens. At its optimal pH of 10.0 and reaction temperature of 50°C, the recombinant protease exhibited the highest activity towards the substrate casein, though the highest stability was at lower temperatures and pH between 7.0 and 9.0. This study provided the direct evidence that extracellular proteases secreted by the antagonist A. pullulans PL5 played a role in the biocontrol activities against some postharvest pathogens of apple and peach.

[Phenomenological study about the nurse's home care for families of terminally ill patients]. / Estudo fenomenológico sobre a visita domiciliária do enfermeiro à família no processo de terminalidade.

The present study is a qualitative and phenomenological research aimed to understand the phenomenon Nurses working in the FHP (Family Health Program) and home care provided to the family living in a home where terminality of one of its members is being experienced. The study was carried out with healthcare providers who work in the Southeastern Region of the city of Sao Paulo/SP, Brazil. Existential phenomenology was used as the theoretical background. This study made possible the comprehension of what this experience meant to healthcare providers in a moment of being with the family in an existential situation of loss and death, creating a home protection network in order to make this process of terminality of one of the family members as smooth as possible. Even though permeated by care giving filled with humane feelings, thus representing a unique and remarkable experience, it was also a weary and difficult event that triggered labor health problems.

Estudo fenomenológico sobre a visita domiciliária do enfermeiro à família no processo de terminalidade / Estudio fenomenológico sobre la visita a domicilio del enfermero a la familia durante un proceso terminal / Phenomenological study about the nurse's home care for families of terminally ill patients

Pesquisa qualitativa e fenomenológica que teve como proposta compreender o fenômeno: Enfermeiros que atuam no PSF e o cuidado, em domicilio, à família que vivencia, nele, ao término de um dos seus membros. O estudo foi realizado com enfermeiros que atuam na Região Sudeste do município de São Paulo, SP. Utilizou-se como referencial teórico a fenomenologia existencial. Com este estudo foi possível desvelar que essa vivência significou para os enfermeiros um momento para estar-com-a-família em uma situação existencial de perda e morte, construindo no domicílio uma rede de proteção para que o processo de terminalidade de um de seus membros fosse o mais ameno possível. Apesar de ter sido permeada por um cuidado de enfermagem repleto de humanidade, significando uma vivência única e singular, foi também uma experiência difícil, desgastante, representando situações geradoras de agravos a sua saúde enquanto trabalhador.

The present study is a qualitative and phenomenological research aimed to understand the phenomenon Nurses working in the FHP (Family Health Program) and home care provided to the family living in a home where terminality of one of its members is being experienced. The study was carried out with healthcare providers who work in the Southeastern Region of the city of Sao Paulo/SP, Brazil. Existential phenomenology was used as the theoretical background. This study made possible the comprehension of what this experience meant to healthcare providers in a moment of being with the family in an existential situation of loss and death, creating a home protection network in order to make this process of terminality of one of the family members as smooth as possible. Even though permeated by care giving filled with humane feelings, thus representing a unique and remarkable experience, it was also a weary and difficult event that triggered labor health problems.

Investigación cualitativa y fenomenológica que tuvo como propuesta comprender el fenómeno: Enfermeros que actúan en el PSF y el cuidado, a domicilio, a la familia que experimenta, en él, el término de uno de sus miembros. El estudio fue realizado con enfermeros que actúan en la Región Sudeste del municipio de São Paulo, SP. Se utilizó como marco teórico la fenomenología existencial. Con este estudio fue posible revelar que esa vivencia significó, para los enfermeros, un momento para estar con la familia en una situación existencial de pérdida y muerte, construyendo en el domicilio, una red de protección para que el proceso terminal de uno de sus miembros fuese lo más ameno posible. A pesar de haber sido otorgado un cuidado de enfermería repleto de humanidad, significando una experiencia única y singular, fue también una experiencia difícil, desgastante, representando situaciones generadoras de agravios a su salud, en cuanto trabajador.