Isolation of acute myeloid leukemia blasts from blood using a microfluidic device.

Acute myeloid leukemia (AML) is the most common form of acute leukemia in adults and associated with poor prognosis. Unfortunately, most of the patients that achieve clinical complete remission after the treatment will ultimately relapse due to the persistence of minimal residual disease (MRD), that is not measurable using conventional technologies in the clinic. Microfluidics is a potential tool to improve the diagnosis by providing early detection of MRD. Herein, different designs of microfluidic devices were developed to promote lateral and vertical mixing of cells in microchannels to increase the contact area of the cells of interest with the inner surface of the device. Possible interactions between the cells and the surface were studied using fluid simulations. For the isolation of leukemic blasts, a positive selection strategy was used, targeting the cells of interest using a panel of specific biomarkers expressed in immature and aberrant blasts. Finally, once the optimisation was complete, the best conditions were used to process patient samples for downstream analysis and benchmarking, including phenotypic and genetic characterisation. The potential of these microfluidic devices to isolate and detect AML blasts may be exploited for the monitoring of AML patients at different stages of the disease.

Applying Lean Healthcare in the hospitalization and patient discharge process: an integrative review / La aplicación de Lean Healthcare en el proceso de hospitalización y alta del paciente: revisión integrativa / A aplicação do Lean Healthcare no processo de hospitalização e alta do paciente: revisão integrativa

ABSTRACT Objectives: to identify scientific evidence regarding the use of Lean Healthcare approach in the hospitalization and patient discharge process. Methods: this is an Integrative Review conducted in the PubMed, LILACS, SCOPUS, CINAHL, Web of Science, and Embase databases. Results: out of 904 records identified, three were included in this review. The studies demonstrated that when applied to discharge planning, the Lean philosophy brings favorable results, promoting improvements in the communication process, as well as assisting in workflow organization, with a reduction in length of stay and improvement in the quality of care. Final Considerations: although the Lean methodology presents positive results, it is considered that the application of the philosophy in healthcare institutions is still not sustainable, as it is often restricted to specific departments or services. Thus, to maximize the success of implementation, the Lean philosophy needs to be incorporated into the organizational culture, representing the greatest challenge.

RESUMEN Objetivos: identificar evidencia científica sobre el uso del enfoque Lean Healthcare en el proceso de hospitalización y alta del paciente. Métodos: se realizó una revisión integrativa en las bases de datos PubMed, LILACS, SCOPUS, CINAHL, Web of Science y Embase. Resultados: de los 904 registros identificados, se incluyeron tres en esta revisión. Los estudios demostraron que, cuando se aplica en la planificación del alta, la filosofía Lean produce resultados favorables al mejorar la comunicación y ayudar a organizar el flujo de trabajo, reducir el tiempo de estancia y mejorar la calidad de la atención. Consideraciones Finales: aunque la metodología Lean muestra resultados positivos, su aplicación en las instituciones de salud no es sostenible, ya que a menudo se limita a algunos departamentos o servicios. Por lo tanto, para maximizar el éxito de la implementación, la filosofía Lean debe ser incorporada a la cultura organizacional, lo que representa el mayor desafio.

RESUMO Objetivos: identificar evidências científicas acerca da utilização do Lean Healthcare no processo de hospitalização e de alta do paciente. Métodos: trata-se de uma Revisão Integrativa realizada nas bases de dados PubMed, LILACS, SCOPUS, CINAHL, Web of Science e Embase. Resultados: dos 904 registros identificados, três foram incluídos nesta revisão. Os estudos demonstraram que, quando aplicada ao planejamento de alta, a filosofia Lean traz resultados favoráveis, promovendo melhorias no processo de comunicação, além de auxiliar na organização do fluxo de trabalho, com redução do tempo de permanência e melhoria na qualidade do cuidado. Considerações Finais: apesar da metodologia Lean apresentar resultados positivos, considera-se que sua aplicação nas instituições de saúde não é sustentável, uma vez que, na maioria das vezes, se restringe apenas a alguns setores e/ou serviços. Assim, para maximizar o sucesso da implementação, a filosofia Lean precisa ser incorporada à cultura organizacional, representando o maior desafio.

Does the mycotoxin ingestion by beef heifers on feedlot change the productive parameters?

In intensive beef cattle production systems, silage, corn, soy bean, and their coproducts are commonly used as feed. However, these ingredients are highly susceptible to contamination by fungi and mycotoxins, which may lead to immunological challenges and reduce animal production. The aim of the present study was to evaluate the effects of mycotoxin contamination of diet on intake, digestibility, and performance of heifers. Twenty non-pregnant (Nellore) heifers (age, >18 months; initial body weight, 348±30 kg) were used and randomly distributed in two treatments: (1) control (non-contaminated diet) and (2) zearalenone-contaminated diet (300 ppb). The diet comprised 70% corn silage and 30% concentrate. Individual dry matter intake and digestibility were estimated using external and internal markers. Heifer body weight was evaluated every week without fasting to calculate performance. The experimental design was completely randomized. Each animal was considered one experimental unit. Assumptions were tested for variance analyses (error normality, independence of errors, and homogeneity of variances) (p<0.05). There were no differences in dry matter intake (p=0.96) and digestibility (p=0.62). Performance (kg/day) did not vary as a function of zearalenone ingestion (p=0.68). Therefore, contamination of diet with 300 ppb zearalenone did not affect the intake, digestibility, and performance of feedlot-finished heifers.

Incidência e evitabilidade de eventos adversos no pronto atendimento: estudo retrospectivo / Incidencia y evitabilidad de eventos adversos en unidad de pronta atención: estudio retrospectivo / Incidence and avoidability of adverse events in emergency care: a retrospective study

Resumo Objetivo Analisar a incidência e a evitabilidade de eventos adversos em pacientes adultos internados em uma unidade de pronto atendimento no município do interior mineiro. Métodos Estudo de coorte, com revisão retrospectiva de 296 prontuários por meio do uso de formulários de rastreamento (fase 1) e avaliação (fase 2), preenchidos por profissionais não médicos e médico, respectivamente. Na primeira fase foram avaliados os dados demográficos, condição clínica dos pacientes, potenciais eventos adversos, e a verificação da qualidade das informações registradas nos prontuários. Na segunda fase, identificou-se e caracterizou-se os eventos adversos previamente rastreados. Resultados Observou-se a predominância de pessoas do sexo masculino, da raça branca, com 60 anos ou mais. A incidência de eventos adversos acumulada foi de 4,4% (n=13), sendo todos considerados evitáveis, e caracterizados como de gravidade leve, em sua maioria. De acordo com a natureza, 81,2% dos eventos adversos estavam relacionados ao cuidado em geral. Já em relação aos fatores intrínsecos e extrínsecos, encontrou-se uma média de 1,17 e 1,5 por paciente, respectivamente. Constatou-se que 17 pacientes foram identificados com potencial evento adverso, com 22 incidentes na análise. Conclusão Identificou-se que 100% dos eventos adversos eram evitáveis e a maioria relacionados ao cuidado em geral. Esses achados reforçam a necessidade de se avaliar e compreender a incidência e a evitabilidade dos eventos adversos em unidades de pronto atendimento, o que permite o planejamento e implementação de estratégias que visem o desenvolvimento de ações de controle e resposta a estes eventos, garantindo um atendimento seguro e de qualidade.

Resumen Objetivo Analizar la incidencia y la evitabilidad de eventos adversos en pacientes adultos internados en una unidad de pronta atención en un municipio del interior del estado de Minas Gerais. Métodos Estudio de cohorte, con revisión retrospectiva de 296 historias clínicas mediante el uso de formularios de rastreo (fase 1) y evaluación (fase 2), completados por profesionales no médicos y médicos, respectivamente. En la primera fase se evaluaron los datos demográficos, la condición clínica de los pacientes, los potenciales eventos adversos y la verificación de la calidad de la información registrada en las historias clínicas. En la segunda fase, se identificaron y caracterizaron los eventos adversos previamente rastreados. Resultados Se observó la predominancia de personas de sexo masculino, de raza blanca, de 60 años o más. La incidencia de eventos adversos acumulada fue del 4,4 % (n=13), todos fueron considerados como evitables y caracterizados de gravedad baja, en su mayoría. De acuerdo con la naturaleza, el 81,2 % de los eventos adversos estuvo relacionado con el cuidado en general. Por otro lado, con relación a los factores intrínsecos y extrínsecos, se observó un promedio de 1,17 y 1,5 por paciente, respectivamente. Se constató que 17 pacientes fueron identificados con evento adverso potencial, con 22 incidentes en el análisis. Conclusión Se identificó que el 100 % de los eventos adversos era evitable y la mayoría relacionados con el cuidado en general. Estos resultados refuerzan la necesidad de analizar y comprender la incidencia y la evitabilidad de los eventos adversos en unidades de pronta atención, lo que permite la planificación e implementación de estrategias que busquen la elaboración de acciones de control y respuesta a estos eventos, y así garantizar una atención segura y de calidad.

Abstract Objective To analyze the incidence and avoidability of adverse events in adult patients hospitalized in an emergency care unit in the countryside of Minas Gerais. Methods A cohort study, with a retrospective review of 296 medical records using screening (phase 1) and evaluation (phase 2) forms, completed by non-medical professionals and physicians, respectively. In the first phase, the demographic data, clinical condition of the patients, potential adverse events, and the verification of the quality of the information recorded in the medical records were evaluated. In the second phase, previously tracked adverse events were identified and characterized. Results There was a predominance of men, white, aged 60 or older. The cumulative incidence of adverse events was 4.4% (n=13), all of which were considered preventable, and mostly characterized as mild in severity. According to nature, 81.2% of adverse events were related to care in general. In relation to intrinsic and extrinsic factors, an average of 1.17 and 1.5 per patient, respectively, was found. It was found that a total of 17 patients were identified with potential adverse events, with 22 incidents in the analysis. Conclusion It was identified that 100% of adverse events were preventable and most related to general care. These findings reinforce the need to assess and understand the incidence and preventability of adverse events in emergency care units, which allows for the planning and implementation of strategies aimed at the development of control and response actions to these events, ensuring safe and quality care.

Authentic leadership in the educational system and in nursing education: an integrative review / A liderança autêntica no sistema educacional e no ensino da enfermagem: revisão integrativa

ABSTRACT Objectives: to identify and analyze the knowledge produced in literature about authentic leadership in the educational system, as well as in nursing education. Methods: an integrative review, carried out in the Scopus, Web of Science, CINAHL, MEDLINE/PubMed, ERIC, LILACS databases. Articles that addressed authentic leadership in the educational system from a general perspective and within the nursing scope, as well as teaching practices of this leadership model, were eligible. Results: twenty-three articles met the inclusion criteria, most published in 2019, highlighting studies in the context of teaching, with a predominance in the nursing course and which were synthesized into three thematic categories. Final Considerations: it was found that the higher the levels of authentic leadership in the educational system, the higher the rates of other positive factors related to it, such as trust, involvement, academic optimism, responsibility, creativity, among others.

RESUMEN Objetivos: identificar y analizar el conocimiento producido en la literatura sobre el liderazgo auténtico en el sistema educativo, así como en la formación de enfermería. Métodos: una revisión integradora, realizada en bases de datos Scopus, Web of Science, CINAHL, MEDLINE/PubMed, ERIC, LILACS. Fueron elegibles los artículos que abordaran el liderazgo auténtico en el sistema educativo desde una perspectiva general y en el ámbito de la enfermería, así como las prácticas docentes de este modelo de liderazgo. Resultados: 23 artículos cumplieron con los criterios de inclusión, la mayoría publicados en 2019, destacándose estudios en el contexto de la enseñanza, con predominio en el curso de enfermería y que fueron sintetizados en tres categorías temáticas. Consideraciones Finales: se encontró que a mayores niveles de liderazgo auténtico en el sistema educativo, mayores índices de otros factores positivos relacionados con el mismo, como confianza, involucramiento, optimismo académico, responsabilidad, creatividad, entre otros.

RESUMO Objetivos: identificar e analisar o conhecimento produzido na literatura acerca da liderança autêntica no sistema educacional, assim como na educação em enfermagem. Métodos: revisão integrativa, realizada nas bases de dados Scopus, Web of Science, CINAHL, MEDLINE/PubMed, ERIC, LILACS. Foram elegíveis artigos que abordassem sobre a liderança autêntica no sistema educacional de uma perspectiva geral e no âmbito da enfermagem, assim como as práticas de ensino desse modelo de liderança. Resultados: 23 artigos atenderam aos critérios de inclusão, a maioria publicada em 2019, sobressaindo-se estudos no contexto no ensino, com predomínio no curso de enfermagem e que foram sintetizados em três categorias temáticas. Considerações Finais: constatou-se que, quanto maiores os níveis da liderança autêntica no sistema educacional, mais elevados serão os índices de outros fatores positivos a ela relacionadas, como confiança, envolvimento, otimismo acadêmico, responsabilidade, criatividades, entre outros.

Satisfação no trabalho de técnicos de enfermagem do atendimento pré-hospitalar: um estudo observacional analítico / Job satisfaction of nursing technicians in pre-hospital care: an analytical observational study / Satisfacción laboral de los técnicos de enfermería en la atención prehospitalaria: un estudio analítico observacional

Objetivo: avaliar a satisfação no trabalho dos técnicos de enfermagem atuantes no Serviço de Atendimento Móvel de Urgência e sua relação com variáveis relacionadas aos aspectos profissionais e demográficos. Método: estudo observacional analítico, com 155 técnicos de enfermagem do Serviço de Atendimento Móvel de Urgência. Empregaram-se o Job Satisfaction Survey e testes estatísticos não paramétricos para analisar a correlação e a associação entre as dimensões do instrumento com as variáveis sociodemográficas e profissionais, com nível de significância de p<0,05. Resultados: os profissionais estão nem insatisfeitos nem satisfeitos em relação ao seu trabalho. Identificaram-se correlações fracas entre alguns domínios do instrumento com as variáveis idade e tempo na unidade. Houve associações entre a satisfação no trabalho com as variáveis: sexo, graduação, escala e tipo de vínculo. Conclusão: evidenciou-se que a satisfação no trabalho dos técnicos de enfermagem atuantes no atendimento pré-hospitalar está associada às variáveis sexo, graduação, escala de serviço e tipo de vínculo.

Objective: to assess job satisfaction among nursing technicians working in a Mobile Emergency Care Service and its relationship with professional and demographic variables. Method: in this analytical observational study of 155 nursing technicians from the Mobile Emergency Care Service, the Job Satisfaction Survey and non-parametric statistical tests were used to examine correlations and associations between the dimensions of the instrument and sociodemographic and professional variables, to a p < 0.05 level of significance. Results: the technicians were neither dissatisfied nor satisfied with their work. Weak correlations were identified between some domains of the instrument, age and time in the unit. Job satisfaction was associated with sex, graduation, scale of service and type of employment relationship. Conclusion: job satisfaction among nursing technicians working in pre-hospital care was found to be associated with sex, graduation, scale of service and type of employment relationship.

Objetivo: evaluar la satisfacción no trabajo de los técnicos de enfermería que trabajan en el Servicio de Atención Móvil de Urgencias y su relación con variables relacionadas con los aspectos profesionales y demográficos. Método: estudio analítico observacional junto a 155 técnicos de enfermería del Servicio de Atención Móvil de Urgencias. Se utilizaron la Encuesta de Satisfacción Laboral y pruebas estadísticas no paramétricas para analizar la correlación y la asociación entre las dimensiones del instrumento y las variables sociodemográficas y profesionales, con el nivel de significancia de p <0.05. Resultados: los profesionales no están insatisfechos ni satisfechos con respecto a su trabajo. Se identificaron correlaciones débiles entre algunos dominios del instrumento con las variables edad y tiempo en la unidad. Hubo asociaciones entre la satisfacción laboral con las variables: sexo, graduación, escala y tipo de vínculo laboral. Conclusión:se evidenció que la satisfacción laboral de los técnicos de enfermería que laboran en la atención prehospitalaria se asocia con las variables sexo, grado, escala de servicio y tipo de vínculo.

Lateral subtalar dislocation associated with a lateral malleolus and a nutcracker cuboid fracture: Case report of a rare pattern of lesion.

INTRODUCTION AND IMPORTANCE: Combined fracture of the lateral malleolus and cuboid due to a lateral subtalar dislocation is an uncommon injury. Literature is scarce on this trauma association. To the best of our knowledge, this represents a new lesion pattern. Hereby we describe its mechanism, management and outcomes. CASE PRESENTATION: We report a case of a 58-year-old woman, who fell from the stairs and presented with pain and an acute deformity of the left foot and ankle. Plain radiographs and CT scan revealed a lateral subtalar dislocation with a lateral malleolus and cuboid fractures. After a failed closed reduction, the patient underwent an open reduction and fixation of the talonavicular joint. An external fixator was applied to address the cuboid fracture. The lateral malleolus was treated conservatively with 5.5 weeks of immobilization. At 38 months of follow-up, the patient scored 87% on the AOFAS ankle-hindfoot scale and returned to normal daily activity. Radiographs demonstrate signs of posttraumatic arthritis at the subtalar and talonavicular joints. CLINICAL DISCUSSION: After reduction of the lateral subtalar dislocation, addressing the nutcracker cuboid fracture was essential, since it can contribute to a flatfoot deformity. Although the patient progressed to posttraumatic arthritis, the sequelae are usually well tolerated and a good outcome was achieved. CONCLUSION: The rarity of this pattern of lesion is related to the necessary multidirectional forces. Correct management of the associated fractures is essential. Our study demonstrates a new lesion pattern of lateral subtalar dislocations, its mechanism, management and outcomes.

Incidence and preventability of adverse events in adult patients admitted to a Brazilian teaching hospital.

OBJECTIVE: To analyze the incidence and preventability of adverse events related to health care in adult patients admitted to a Brazilian teaching hospital. METHODS: A retrospective cohort study, in which the incidence and preventability of adverse events related to health care were based on a two-stage retrospective review of 368 medical records (nurses and pharmacist review of medical records, followed by physicians review of triggered medical records) of adult patients whose hospitalizations occurred during 2015 in a high-complexity public teaching hospital located in Brazil. Data were collected from February 2018 to February 2019. RESULTS: A total of 266 adverse events were observed in 124 patients. The incidence of adverse events related to health care was 33.7% (95% CI 0.29-0.39), and the incidence density was 4.97 adverse events per 100 patient-days. Adverse events were responsible for 701 additional days of hospitalization, and the estimated length of additional hospital stay attributable to them was, on average, 6.8 days per event. The most common types of events were related to general care (60; 22.6%), medications (50; 18.8%), nosocomial infection (35; 13.2%), any other type (11; 4.1%), and diagnoses (2; 0.8%). Regarding the severity of adverse events, it was found that 168 (63.2%) were mild, 55 (20.7%) were moderate, and 43 (16.2%) were severe. In addition, it was estimated that 155 (58.3%) events were preventable. The length of a patient's hospital stay was identified as a risk factor for the occurrence of adverse events (RR 1.20; 95% CI 1.04-1.39). CONCLUSIONS: Through knowledge of the incidence, nature, severity, preventability, and risk factors for the occurrence of adverse events, it is possible to create the opportunities to prioritize the implementation of strategies for mitigating specific events based on reliable data and concrete information.

Enhanced optical asymmetry in supramolecular chiroplasmonic assemblies with long-range order.

Chiral assemblies of plasmonic nanoparticles are known for strong circular dichroism but not for high optical asymmetry, which is limited by the unfavorable combination of electrical and magnetic field components compounded by strong scattering. Here, we show that these limitations can be overcome by the long-range organization of nanoparticles in a manner similar to the liquid crystals and found in helical assemblies of gold nanorods with human islet amyloid polypeptides. A strong, polarization-dependent spectral shift and the reduced scattering of energy states with antiparallel orientation of dipoles activated in assembled helices increased optical asymmetry g-factors by a factor of more than 4600. The liquid crystal-like color variations and the nanorod-accelerated fibrillation enable drug screening in complex biological media. Improvement of long-range order can also provide structural guidance for the design of materials with high optical asymmetry.

Assessment of the incidence and preventability of adverse events in hospitals: an integrative review.

OBJECTIVE: To highlight the scientific production related to the use of the retrospective chart review methods to assess the incidence and preventability of adverse events in hospitals. METHOD: An integrative review in the MEDLINE, LILACS, SCOPUS, Web of Science and EMBASE databases conducted in May 2019 with the following guiding question: What is known about the retrospective chart review methods to assess the incidence and preventability of adverse events in hospitals? Subsequently, the categorization, synthesis, and classification of the evidence levels of the included publications were performed. RESULTS: In the 13 selected studies, the instruments adopted to assess the occurrence of adverse events were the Harvard Medical Practice Study, the Canadian Adverse Event Study, the Quality in Australian Health Care Study, and the Global Trigger Tool. Incidence ranged from 5.7 to 14.2%, while preventability ranged from 31 to 83%. CONCLUSION: Differences in incidence and preventability were found, showing different results in the quality of care provided, the information registered in medical records, the screening criteria used, and the assessments of the reviewers.

A liderança exemplar na perspectiva de enfermeiros do atendimento pré-hospitalar: estudo descritivo / Liderazgo ejemplar en la perspectiva de enfermeros de la atención prehospitalaria: estudio descriptivo / The exemplary leadership from the perspective of pre-hospital care nurses: a descriptive study

OBJETIVO: Identificar e analisar os aspectos relacionados às práticas da liderança exemplar na perspectiva de enfermeiros do Serviço de Atendimento Móvel de Urgência (SAMU), distinguindo a autopercepção desses profissionais enquanto líderes e caracterizando a percepção da liderança exercida por enfermeiros integrantes de suas equipes. MÉTODO: Estudo descritivo, realizado com enfermeiros do SAMU Regional dos 26 municípios de um Departamento Regional de Saúde do interior de São Paulo. A coleta de dados ocorreu mediante aplicação das versões EU e OBSERVADOR do Leadership Practices Inventory (LPI). RESULTADOS: Considerando as versões do LPI, as avaliações dos participantes atinentes ao comportamento do líder apresentaram diferenças mínimas em comparação com suas autoavaliações. Contudo, os respondentes se autoavaliaram positivamente na maior parte das práticas que delineiam a liderança exemplar. CONCLUSÃO: As práticas da liderança exemplar mostraram-se presentes no comportamento dos enfermeiros que atuavam no SAMU, despontando como competências imprescindíveis aos enfermeiros do atendimento pré-hospitalar.

OBJETIVO: Identificar y analizar los aspectos relacionados a las prácticas de liderazgo ejemplar en la perspectiva de enfermeros del Servicio de Asistencia Móvil de Urgencia (SAMU), distinguiendo su autopercepción como líderes y caracterizando la percepción del liderazgo ejercida por enfermeros integrantes de sus equipos. MÉTODO: Estudio descriptivo, realizado con enfermeros del SAMU Regional de los 26 municipios de un Departamento Regional de Salud del interior de São Paulo. Los datos se recolectaron mediante la aplicación de las versiones YO y OBSERVADOR del Leadership Practices Inventory (LPI). RESULTADOS: Considerando las versiones del LPI, las valoraciones de los participantes atinentes al comportamiento del líder presentaron diferencias mínimas en comparación a sus autovaloraciones. Sin embargo, los respondientes se autoevaluaron positivamente en la mayoría de las prácticas que delinean el liderazgo ejemplar. CONCLUSIÓN: Las prácticas del liderazgo ejemplar se mostraron presentes en el comportamiento de los enfermeros que actuaban en el SAMU, destacándose como competencias imprescindibles en los enfermeros de la atención prehospitalaria.

OBJECTIVE: Identify and analyze the aspects related to the practices of exemplary leadership from the perspective of nurses of the Mobile Emergency Services (SAMU), distinguishing the self-perception of these professionals as leaders and characterizing the perception of leadership exercised by nurses in their teams. METHOD: This is a descriptive study, carried out with nurses from SAMU Regional of the 26 municipalities of a Regional Health Department of the interior of São Paulo. The data collection occurred through the application of the SELF and OBSERVER versions of Leadership Practices Inventory (LPI). RESULTS: Considering the LPI versions, the participants' evaluations regarding the leader's behavior presented minimal differences compared to their self-evaluations. However, respondents rated themselves positively in most of the practices that delineate exemplary leadership. CONCLUSION: The practices of exemplary leadership were present in the behavior of the nurses who worked at SAMU, emerging as essential skills for nurses in pre-hospital care.

Emergence of complexity in hierarchically organized chiral particles.

The structural complexity of composite biomaterials and biomineralized particles arises from the hierarchical ordering of inorganic building blocks over multiple scales. Although empirical observations of complex nanoassemblies are abundant, the physicochemical mechanisms leading to their geometrical complexity are still puzzling, especially for nonuniformly sized components. We report the self-assembly of hierarchically organized particles (HOPs) from polydisperse gold thiolate nanoplatelets with cysteine surface ligands. Graph theory methods indicate that these HOPs, which feature twisted spikes and other morphologies, display higher complexity than their biological counterparts. Their intricate organization emerges from competing chirality-dependent assembly restrictions that render assembly pathways primarily dependent on nanoparticle symmetry rather than size. These findings and HOP phase diagrams open a pathway to a large family of colloids with complex architectures and unusual chiroptical and chemical properties.

Liderança Coaching no contexto do Serviço de Atendimento Móvel de Urgência / Liderazgo Coaching en el contexto del Servicio Móvil de Urgencia / Coaching Leadership in the context of the Mobile Emergency Care Service

RESUMO Objetivo: Analisar a Liderança Coaching exercida pelos coordenadores de enfermagem nas unidades do Serviço de Atendimento Móvel de Urgência, na percepção dos coordenadores e técnicos de enfermagem, além da sua correlação com três variáveis sociodemográficas. Método: Estudo descritivo e analítico realizado com coordenadores de enfermagem e técnicos de enfermagem das unidades do serviço pré-hospitalar, utilizando os questionários da Liderança Coaching e o teste de Spearman para análise das correlações. Resultados: Participaram 11 coordenadores de enfermagem e 155 técnicos de enfermagem. Verificou-se o exercício da Liderança Coaching na percepção de duas categorias profissionais: "dar e receber feedback", que foi o domínio com maior média para os coordenadores (21,45; DP=2,84); e "comunicação" (20,43; DP=5,57) para os técnicos. Ademais, na autopercepção da Liderança Coaching dos coordenadores, evidenciou-se uma correlação indireta entre os domínios "dar e receber feedback" (Spearman −0,720; p-valor 0,012) e "escore total da escala" (Spearman −0,652 e p-valor 0,029) em relação ao "tempo de formação". Conclusão: Os resultados da pesquisa sinalizam contribuições significativas para as práticas de enfermagem e denotam o impacto dessa competência na equipe de enfermagem do serviço pré-hospitalar, no ambiente de trabalho e no cuidado prestado ao paciente.

RESUMEN Objetivo: Analizar el Liderazgo Coaching ejercido por los coordinadores de enfermería en las unidades del Servicio de Atención Móvil de Urgencia, según la percepción de los coordinadores y técnicos de enfermería, y su correlación con tres variables sociodemográficas. Método: Se trata de un estudio descriptivo y analítico realizado con coordinadores y técnicos de enfermería de unidades de servicio prehospitalario, realizado con los cuestionarios de Liderazgo Coaching y el test de Spearman para el análisis de las correlaciones. Resultados: Participaron 11 coordinadores de enfermería y 155 técnicos. Se comprobó el ejercicio del Liderazgo Coaching en la percepción de dos categorías profesionales: "dar y recibir feedback", dominio con promedio mayor para los coordinadores (21,45; DP=2,84); y "comunicación" (20,43; DP=5,57) para los técnicos. Además, en la autopercepción del Liderazgo Coaching de los coordinadores, se observó una correlación indirecta entre los dominios "dar y recibir feedback" (Spearman −0,720; p-valor 0,012) y "puntuación total de la escala" (Spearman −0,652 y p-valor 0,029) con relación al "tiempo de capacitación". Conclusión: Los resultados de la investigación señalan la existencia de contribuciones significativas para las prácticas de enfermería y denotan el impacto de dicha competencia en el equipo de enfermería del servicio prehospitalario, en el ambiente de trabajo y en el cuidado prestado al paciente.

Objective: To analyze the Coaching Leadership exercised by nursing coordinators in the Mobile Emergency Care Service units, in the coordinators and nursing technicians' perception, in addition to its correlation with three sociodemographic variables. Method: Descriptive and analytical study carried out on nursing coordinators and nursing technicians from the pre-hospital care units, using the Coaching Leadership questionnaires and the Spearman correlation test to analyze the results. Results: 11 nursing coordinators and 155 nursing technicians participated in the study. The Coaching Leadership exercise was observed in the perception of two professional categories: "giving and receiving feedback", which was the domain with the highest average for the coordinators (21.45; SD=2.84); and "communication" (20.43; SD=5.57) for technicians. Furthermore, in the coordinators' self-perception of the Coaching Leadership, there was an indirect correlation between the domains "giving and receiving feedback" (Spearman −0.720; p-value 0.012) and "total scale score" (Spearman −0.652 and p-value 0.029) with regard to "training time". Conclusion: The research results indicate significant contributions to nursing practices and denote this competence impact on the pre-hospital care nursing staff, in the work environment, and in the care provided to the patient.

Leadership and job satisfaction in the Mobile Emergency Care Service context / Liderança e satisfação no trabalho no contexto do Serviço de Atendimento Móvel de Urgência / Liderazgo y satisfacción laboral en el contexto del Servicio Móvil de Atención de Emergencia

Objective: to evaluate the correlation between the practice of Coaching Leadership performed by nursing coordinators and job satisfaction, in the self-perception of coordinators and the perception of nursing technicians of the Mobile Emergency Care Service. Method: a descriptive, correlational study that used the Questionnaire on Self-Perception of the Nurse in the Exercise of Leadership to measure the self-perception of leadership of the eleven nursing coordinators and the Questionnaire on Nursing Technician Perception in the Exercise of Leadership to verify the perception of 155 nurse technicians. The Job Satisfaction Questionnaire assessed job satisfaction in both categories. Correlations among instrument domains were determined using the Spearman test (p<0.05) and the association was analyzed. Results: the Coaching Leadership exercise correlated with job satisfaction (p-value=0.001), both in the self-perception of nursing coordinators, with high correlation (Spearman coefficient - (0.835), and in the perception of nursing technicians, with moderate association (Spearman coefficient - 0.678). Conclusion: coaching Leadership showed a positive correlation with job satisfaction, marked by mutual trust, continuous interaction between nurse and nursing technicians, and the pursuit of professional and personal development.

Objetivo: avaliar a correlação entre a prática de Liderança Coaching exercida pelos coordenadores de enfermagem e a satisfação no trabalho, na autopercepção dos coordenadores e na percepção dos técnicos de enfermagem do Serviço de Atendimento Móvel de Urgências. Método: estudo descritivo, correlacional, que utilizou o Questionário de Autopercepção do Enfermeiro no Exercício da Liderança para mensurar a autopercepção da liderança dos onze coordenadores de enfermagem e o Questionário de Percepção do Técnico/Auxiliar de Enfermagem no Exercício da Liderança para verificar a percepção dos 155 técnicos. Já o Job Satisfaction Survey avaliou a satisfação no trabalho de ambas as categorias. Foram determinadas as correlações entre os domínios dos instrumentos por intermédio do teste de Spearman (p<0,05), sendo analisado o seu poder de associação. Resultados: o exercício da Liderança Coaching correlacionou-se com a satisfação no trabalho (p-valor=0,001), tanto na autopercepção dos coordenadores de enfermagem, com alta correlação (coeficiente de Spearman - 0,835), quanto na percepção dos técnicos de enfermagem, com moderada associação, (coeficiente de Spearman - 0,678). Conclusão: a Liderança Coaching apresentou correlação positiva com a satisfação no trabalho, marcada pela confiança mútua, interação contínua entre líder (enfermeiro) e liderados (técnicos de enfermagem) e a busca do desenvolvimento profissional e pessoal.

Objetivo: evaluar la correlación entre la práctica del Coaching de Liderazgo ejercida por los coordinadores de enfermería y la satisfacción laboral, en la autopercepción de los coordinadores y en la percepción de los técnicos de enfermería del Servicio Móvil de Atención de Emergencia. Método: estudio descriptivo y correlacional que utilizó el Cuestionario de Autopercepción del Enfermero en el Ejercicio de Liderazgo para medir la autopercepción de liderazgo de los once coordinadores de enfermería y el Cuestionario de Percepción de Técnico/Asistente de Enfermería en el Ejercicio de Liderazgo para verificar la percepción de 155 técnicos. Por otra parte, el Job Satisfaction Survey evaluó la satisfacción laboral en ambas categorías. Las correlaciones entre los dominios de los instrumentos se determinaron mediante la prueba de Spearman (p<0,05), y se analizó su poder de asociación. Resultados: El ejercicio de Coaching de Liderazgo se correlacionó con la satisfacción laboral (p-valor=0,001), tanto en la autopercepción de los coordinadores de enfermería, con una alta correlación (coeficiente de Spearman - 0,835), como en la percepción de los técnicos de enfermería, con asociación moderada (coeficiente de Spearman - 0,678). Conclusión: el Coaching de Liderazgo se correlacionó positivamente con la satisfacción en el trabajo, marcada por la confianza mutua, la interacción continua entre el líder (enfermero) y dirigidos (personal de enfermería) y la búsqueda de desarrollo profesional y personal.

Charismatic leadership among nursing professionals: an integrative review / Liderazgo carismático entre profesionales de enfermería: revisión integrativa / Liderança carismática entre os profissionais de enfermagem: revisão integrativa

ABSTRACT Objective: Analyze the literature for knowledge about charismatic leadership among nursing professionals. Method: This is an integrative review of the literature that searched for studies published in English, Portuguese and Spanish until 2016 in the following electronic databases: LILACS, Pubmed, SCOPUS, Web of Science, and CINAHL. Results: Three studies were selected from a total of twenty-one studies; they were arranged in two categories: validation of a charismatic leadership instrument and effects of charismatic leadership on followers' initiative-oriented behavior. Conclusion: Charismatic leadership is considered an important skill for nursing professionals as they generate a positive influence on followers, especially in times of crisis and changes. Considering the relevance of this style of leadership, the need to develop further studies on this subject is reinforced, given the low number of studies found in the literature.

RESUMEN Objetivo: Analizar el conocimiento producido sobre liderazgo carismático entre profesionales de enfermería. Método: Revisión integrativa de la literatura, habiéndose realizado búsquedas en las bases de datos electrónicas: LILACS, Pubmed, SCOPUS, Web of Science y CINAHL, consistente en artículos publicados en inglés, portugués y español, hasta el año 2016. Resultados: De un total de veintiún artículos encontrados, fueron seleccionados tres, y divididos en dos categorías: estudio de validación de instrumento de liderazgo carismático y efectos del liderazgo carismático en la conducta de la iniciativa-orientada de los seguidores. Conclusión: Cabe resaltar que el liderazgo carismático es considerado una competencia importante en profesionales de enfermería, y que genera influencia positiva a los seguidores, particularmente en momentos de crisis y de cambios. Ante la relevancia de este tipo de liderazgo, toma fuerza la necesidad de desarrollar más estudios sobre la temática, considerando la escasa cantidad de artículos encontrados.

RESUMO Objetivo: Analisar o conhecimento produzido acerca da liderança carismática entre os profissionais de enfermagem. Método: Trata-se de uma revisão integrativa da literatura por meio de buscas nas seguintes bases de dados eletrônicas: LILACS, Pubmed, SCOPUS, Web of Science e CINAHL, sendo artigos publicados em inglês, português e espanhol, até o ano de 2016. Resultados: De um total de vinte e um artigos encontrados, foram selecionados três e divididos em duas categoriais: estudo de validação de instrumento de liderança carismática e efeitos da liderança carismática no comportamento da iniciativa orientada dos seguidores. Conclusão: Ressalta-se que a liderança carismática é apontada como competência importante para profissionais da enfermagem e gera influências positivas nos seguidores, sobretudo em momentos de crise e de mudanças. Diante da relevância desse estilo de liderança, reforça-se a necessidade do desenvolvimento de mais estudos sobre a temática, tendo em vista a pequena quantidade de artigos encontrados.

A liderança coaching exercida pelos enfermeiros no contexto hospitalar / El liderazgo coaching ejercido por los enfermeros en el ámbito hospitalario / Coaching leadership exercised by nurses in the hospital setting

RESUMO Objetivo: identificar e comparar a autopercepção dos enfermeiros e a percepção de auxiliares/técnicos de enfermagem quanto às práticas de Liderança Coaching. Método: estudo transversal, realizado em 2016, com 69 enfermeiros e 233 auxiliares/técnicos de enfermagem de dois hospitais públicos paulistas. Utilizaram-se dois questionários validados acerca do exercício da liderança Coaching pelo enfermeiro, relacionados à autopercepção do enfermeiro e à percepção do técnico e auxiliar de enfermagem. Resultados: dentre as quatro dimensões da Liderança Coaching, "comunicação" foi a mais reconhecida. No Hospital A, constatou-se semelhança na percepção da prática de liderança exercida pelos enfermeiros entre as duas categorias. No Hospital B, a autopercepção dos enfermeiros acerca do exercício da Liderança Coaching foi maior, quando comparada à percepção dos auxiliares/técnicos, exceto para a dimensão "comunicação". Conclusão: a Liderança Coaching e suas dimensões podem beneficiar as instituições e a enfermagem na melhor gestão de suas equipes.

RESUMEN: Objetivo: Identificar y comparar la autopercepción de enfermeros y la percepción de auxiliares/técnicos de enfermería respecto de las prácticas de liderazgo coaching. Método: Estudio transversal, realizado en 2016 con 69 enfermeros y 233 auxiliares/técnicos de enfermería de dos hospitales públicos paulistas. Se utilizaron dos cuestionarios validados para el ejercicio de dicho liderazgo por parte del enfermero, relacionados con autopercepción del enfermero y autopercepción de técnicos/auxiliares de enfermería. Resultados: De las cuatro dimensiones del liderazgo coaching, la más reconocida fue "comunicación". En el Hospital A, se constató semejanza en la percepción de la práctica de liderazgo ejercido por enfermeros entre ambas categorías. En el B, la autopercepción de enfermeros respecto del ejercicio de liderazgo coaching fue mayor comparada con la percepción de auxiliares/técnicos, excepto para la dimensión "comunicación". Conclusión: El liderazgo coaching y sus dimensiones puede beneficiar a instituciones y a la enfermería permitiendo una mejor gestión de sus equipos.

ABSTRACT Objective: To identify and compare the self-perception of nurses and the perception of nursing aides and nursing technicians towards coaching leadership practices. Method: This was a cross-sectional study carried out in 2016 with 69 nurses and 233 nursing aides and technicians from two public hospitals in the Brazilian state of São Paulo. The researchers administered two validated questionnaires about the exercise of this type of leadership by nurses, addressing the self-perception of nurses and the perception of nursing aides and nursing technicians. Results: Of the four dimensions of coaching leadership, communication was the most recognized. In hospital A, the perceptions of professionals from both categories regarding the practice of leadership exercised by nurses were similar. In hospital B, the self-perception of nurses regarding the exercise of coaching leadership was higher than the perception of nursing aides and nursing technicians, except for the communication dimension. Conclusion: coaching leadership and its dimensions can benefit institutions and nursing professionals by helping improve team management.

Site-selective photoinduced cleavage and profiling of DNA by chiral semiconductor nanoparticles.

Gene editing is an important genetic engineering technique that enables gene manipulation at the molecular level. It mainly relies on engineered nucleases of biological origin, whose precise functions cannot be replicated in any currently known abiotic artificial material. Here, we show that chiral cysteine-modified CdTe nanoparticles can specifically recognize and, following photonic excitation, cut at the restriction site GAT'ATC (' indicates the cut site) in double-stranded DNA exceeding 90 base pairs, mimicking a restriction endonuclease. Although photoinduced reactive oxygen species are found to be responsible for the cleavage activity, the sequence selectivity arises from the affinity between cysteine and the conformation of the specific DNA sequence, as confirmed by quantum-chemical calculations. In addition, we demonstrate non-enzymatic sequence-specific DNA incision in living cells and in vivo using these CdTe nanoparticles, which may help in the design of abiotic materials for gene editing and other biological applications.

Two different pathways for assembling bis-urea in benzene and toluene.

The thermodynamic stability of assemblies formed by a bis-urea-based supramolecular polymer, 2,4-bis(2-ethylhexylureido)toluene (EHUT), was investigated in solutions using either benzene or toluene as the solvent. Starting from a higher temperature in which EHUT was soluble in both solvents, molecules spontaneously self-organized into tubular assemblies upon cooling and these assemblies were stable in a wide range of temperatures. However, the systems followed different paths below a specific temperature: while the supramolecular polymer remained stable in toluene, EHUT molecules underwent precipitation in benzene. The causes for these different behaviors were explored by molecular dynamics simulations, which provided support for stronger enthalpic stabilization of the tubular assemblies in toluene as compared to benzene. This stabilization was due mainly to the better interaction energy of trapped toluene molecules instead of benzene ones. For both cases, lowering the temperature makes the solvent penetration inside the tubes less favorable, which reduces the stability of supramolecular structures upon cooling. Graphical abstract Different EHUT solubilities.

Standard Operational Protocols in professional nursing practice: use, weaknesses and potentialities / Protocolos Operacionales Patrón en la práctica profesional de enfermería: utilización, fragilidades y potencialidades / Protocolos Operacionais Padrão na prática profissional da enfermagem: utilização, fragilidades e potencialidades

ABSTRACT Objective: to evaluate the use of Standard Operational Protocols (SOPs) in the professional practice of the nursing team based on the theoretical framework of Donabedian, as well as to identify the weaknesses and potentialities from its implementation. Method: Evaluative research, with quantitative approach performed with nursing professionals working in the Health Units of a city of São Paulo, composed of two stages: document analysis and subsequent application of a questionnaire to nursing professionals. Results: A total of 247 nursing professionals participated and reported changes in the way the interventions were performed. The main weaknesses were the small number of professionals, inadequate physical structure and lack of materials. Among the potentialities were: the standardization of materials and concern of the manager and professional related to patient safety. Conclusion: The reassessment of SOPs is necessary, as well as the adoption of a strategy of permanent education of professionals aiming at improving the quality of care provided.

RESUMEN Objetivo: Evaluar la utilización de los Procedimientos Operacionales Patrón (POP) en la práctica profesional del equipo de enfermería, con base en el referencial teórico de Donabedian, bien como identificar las fragilidades y potencialidades a partir de su implantación. Método: Pesquisa evaluativa, con abordaje cuantitativa realizada con profesionales de enfermería actuantes en las Unidades de Salud de un municipio de São Paulo, compuesta por dos etapas: análisis documental y posterior aplicación de cuestionario a los profesionales de enfermería. Resultados: Participaron 247 profesionales de enfermería que han mencionado cambios en la manera de ejecución de las intervenciones estudiadas. Las principales fragilidades apuntaron para el número reducido de profesionales, inadecuación de la estructura física y ausencia de materiales. Entre las potencialidades se destacaron: la estandarización de los materiales y la preocupación del gestor y del profesional relacionada a la seguridad del paciente. Conclusión: La reevaluación de los POP es necesaria, bien como la adopción de la estrategia de educación permanente de los profesionales visando la mejoría de la cualidad de la asistencia prestada.

RESUMO Objetivo: avaliar a utilização dos Procedimentos Operacionais Padrão (POP) na prática profissional da equipe de enfermagem, com base no referencial teórico de Donabedian, bem como identificar as fragilidades e potencialidades a partir da sua implantação. Método: Pesquisa avaliativa, com abordagem quantitativa realizada com profissionais de enfermagem atuantes nas Unidades de Saúde de um município paulista, composta por duas etapas: análise documental e posterior aplicação de questionário aos profissionais de enfermagem. Resultados: Participaram 247 profissionais de enfermagem que referiram mudanças na forma de execução das intervenções estudadas. As principais fragilidades apontaram para o número reduzido de profissionais, inadequação da estrutura física e ausência de materiais. Entre as potencialidades destacaram-se: a padronização dos materiais e a preocupação do gestor e do profissional relacionada à segurança do paciente. Conclusão: A reavaliação dos POP é necessária, bem como a adoção da estratégia de educação permanente dos profissionais visando à melhoria da qualidade da assistência prestada.

Deslocamento de cabos-eletrodos decorrente de síndrome de Twiddler em portadora de marcapasso bicameral / Lead displacement resulting from Twiddler's Syndrome in a patient with dual chamber pacemaker

Relatamos o caso de uma paciente com implante de marcapasso bicameral há dois meses por bloqueio atrioventricular total, que, dois dias após queda acidental em sua residência com trauma homolateral ao local do implante do marcapasso, apresentou pré-síncope, lipotimias e bradicardia. O eletrocardiograma evidenciava perda total de comando atrioventricular e a radiografia de tórax mostrava tracionamento, deslocamento e enovelamento dos cabos-eletrodos próximo ao gerador. A paciente foi diagnosticada como caso típico de síndrome de Twiddler

We report the case of a patient with a bicameral pacemaker implantation within the last two months due to total atrioventricular block, who presented pre-syncope, lipothymia and bradycardia two days after an accidental fall at home with a homolateral trauma to the pacemaker implantation site. The electrocardiogram showed a total loss of the atrioventricular command and chest x-ray evidence of traction, displacement and folding of the leads near the generator. The patient was diagnosed as a typical Twiddler's Syndrome case