Nursing and design in the creation of health products: approaching areas and solving problems / Enfermería y diseño en la creación de productos en salud: áreas de aproximación y solución de problemas / Enfermagem e design na criação de produtos para a saúde: aproximando áreas e resolvendo problemas

ABSTRACT Objective: to describe a methodological proposal for product development in the health area through the perspective of design. Method: Theoretical and methodological reflection, based on the experience and knowledge of the authors in studies related to technological production and innovation in nursing. Results: the methodological proposal consists of the following steps: 1) Briefing; 2) data collection; 3) analysis of the problem; 4) concept; 5) generation of alternatives; 6) selection of the best alternative; 7) refining the solution; 8) prototype; 9) tests; 10) modifications; and 11) implementation. The design proposal is shown as a method of investigation and seeks to equip health professionals and related areas for the elaboration of studies with the potential to develop products, at all stages. Conclusion: the approximation of knowledge and practices in the area of design with that of nursing enables the identification of problems and their resolution with creativity and empathy, contributing to innovation and knowledge production.

RESUMEN Objetivo: describir una propuesta metodológica para el desarrollo de productos sanitarios desde la perspectiva del diseño. Método: reflexión teórica y metodológica, a partir de la experiencia y conocimiento de los autores en estudios relacionados con la producción e innovación tecnológica en enfermería. Resultados: la propuesta metodológica está compuesta por los pasos: 1) Briefing; 2) recopilación de datos; 3) análisis de problemas; 4) concepto; 5) generación de alternativas; 6) selección de la mejor alternativa; 7) refinamiento de la solución; 8) prototipo; 9) pruebas; 10) modificaciones; y, 11) implementación. La propuesta de diseño se muestra como un método de investigación y busca equipar a los profesionales de la salud y áreas afines para realizar estudios con potencial para desarrollar productos, en todas sus etapas. Conclusión: la aproximación de saberes y prácticas en el área de diseño con la de enfermería posibilita la identificación de problemas y su resolución con creatividad y empatía, contribuyendo a la innovación y producción de conocimiento.

RESUMO Objetivo: descrever proposta metodológica de desenvolvimento de produtos à área da saúde através da perspectiva do design. Método: reflexão teórica e metodológica, a partir da experiência e conhecimento das autoras em estudos relativos à produção tecnológica e inovação em enfermagem. Resultados: a proposta metodológica é composta pelas etapas: 1) Briefing; 2) levantamento de dados; 3) análise do problema; 4) conceito; 5) geração de alternativas; 6) seleção da melhor alternativa; 7) refino da solução; 8) protótipo; 9) testes; 10) modificações; e, 11) implementação. A proposta do design se mostra como um método de investigação e busca instrumentalizar os profissionais da saúde e áreas afins para elaboração de estudos com potencial de desenvolver produtos, em todas as etapas. Conclusão: a aproximação dos saberes e práticas da área do design com a da enfermagem possibilita a identificação de problemas e sua resolução com criatividade e empatia, contribuindo para inovação e produção de conhecimento.

Prevenção de lesões por pressão na pronação de pacientes Covid-19: construção de uma narrativa gráfica / Prevention of pressure injuries in the pronation of Covid-19 patients: construction of a graphic narrative / Prevención de lesiones por presión en la pronación de pacientes Covid-19: construcción de una narrativa gráfica

Objetivo:construir e validar o conteúdo de uma narrativa gráfica sobre a prevenção de Lesão por Pressão na posição prona em pacientes acometidos pelo Coronavírus. Método: estudo metodológico descritivo. Para a construção da narrativa gráfica, foi realizada a revisão de escopo. A validação de conteúdo da narrativa foi realizada por enfermeiros atuantes em unidades de terapia intensiva respiratória estomaterapeutas de Santa Catarina, os quais responderam a um formulário no Googleforms® com opções de resposta de discordo a concordo. A análise de dados foi realizada por meio do Índice de Validade de Conteúdo, considerando adequado > 0,80%. Resultados: os cuidados elencados para compor a narrativa foram: avaliação da pele; manutenção da pele limpa e hidratada; utilização de dispositivos de redistribuição de pressão; utilização de espumas de silicone, filmes transparentes, spray formador de barreira e silicone sobre as proeminências ósseas, sob dispositivos médicos e em face. A posição recomendada é a do nadador, reposicionando o paciente a cada duas horas. Conclusão: a narrativa gráfica foi validada para enfermeiros experts cujo destaque está para os cuidados preventivos no sentido de promover o engajamento da equipe de Enfermagem frente à importância da prevenção da Lesão por Pressão no cuidado ao paciente com Coronavírus e pronado.

Objective:build and validate the content of a graphic narrative on the prevention of Pressure Injury in the prone position in patients affected by the Coronavirus. Method: descriptive methodological study. For the construction of the graphic narrative, a scope review was carried out. Narrative content validation was performed by nurses working in stomatherapists in respiratory intensive care units in Santa Catarina, who responded to a form on Googleforms® with response options from disagree to agree. Data analysis was performed using the Content Validity Index, considering appropriate > 0.80%. Results: the care listed to compose the narrative were: skin assessment; keeping the skin clean and hydrated; use of pressure redistribution devices; use of silicone foams, transparent films, barrier-forming spray and silicone on bony prominences, under medical devices and on the face. The recommended position is that of the swimmer, repositioning the patient every two hours. Conclusion: the graphic narrative was valid for expert nurses whose emphasis is on preventive care in order to promote the engagement of the Nursing team in the face of the importance of Pressure Injury prevention in the care of patients with Coronavirus and prone.

Objetivo:construir y validar el contenido de una narrativa gráfica sobre la prevención de Lesión por Presión en la posición prona en pacientes afectados por el Coronavirus. Método: estudio metodológico descriptivo. Para la construcción de la narrativa gráfica, se realizó la revisión del alcance. La validación de contenido de la narrativa fue realizada por enfermeros que trabajan en unidades de terapia intensiva respiratoria estomaterapeutas de Santa Catarina, quienes respondieron a un formulario en Googleforms® con opciones de respuesta de desacuerdo a acuerdo. El análisis de los datos se realizó por medio del Índice de Validez de Contenido, considerando adecuado > 0,80 %. Resultados: las precauciones enumeradas para componer esta narrativa fueron: evaluación de la piel; mantenimiento de la piel limpia e hidratada; utilización de dispositivos de redistribución de presión; utilización de espumas de silicona, películas transparentes, espray formador de barrera y silicona sobre las prominencias óseas, bajo dispositivos médicos y en la cara. La posición recomendada es la del nadador, reposicionando al paciente cada dos horas. Conclusión: la narrativa gráfica fue válida para enfermeros expertos cuyo énfasis está para los cuidados preventivos en el sentido de promover el compromiso del equipe de Enfermería frente a la importancia de la prevención de la Lesión por Presión en el cuidado al paciente con Coronavirus y propensos

Mínimo produto viável para aplicativo de apoio: gestão do cuidado de enfermagem à pele do idoso / Mínimo producto viable para el aplicativo de apoyo: gestión de la atención de enfermería a la piel del anciano / Minimum viable product for support application: nursing care management of the aged skin

RESUMO Objetivo: adescrever as etapas de construção de um Mínimo Produto Viável para aplicativo de apoio à decisão a enfermeiros para prevenção, diagnóstico de enfermagem e tratamento de lesão por fricção/pressão em idosos. Método: estudo qualitativo com produção tecnológica pelo método Lean Startup. Realizou-se investigação qualitativa em um município do Sul do Brasil e revisão integrativa para definição de conteúdo. Produto desenvolvido em formato Hyper Text Markup Language, por meio da ferramenta Net Beans. Aplicado Teste de Usabilidade. Resultados: participaram 25 enfermeiros. As funcionalidades foram organizadas em mapa de navegação contendo caixas de seleção para fatores de risco e plano de cuidados, diagnósticos de enfermagem, estadiamento das lesões e sugestões de tratamento. Após teste de usabilidade, identificou-se necessidade de ajustes no conteúdo e funcionalidades, que foram corrigidos, originando versão final. Conclusão: o modelo constitui uma proposta factível à tomada de decisão de enfermagem, permitindo julgamento crítico, fundamentado em achados clínicos.

RESUMEN Objetivo: Describir las etapas de construcción de un Producto Mínimo Viable para la aplicación de apoyo a la decisión de los enfermeros para la prevención, el diagnóstico de la enfermedad y el tratamiento de la úlcera por presión/fricción en los ancianos. Método: estudio cualitativo con producción tecnológica por el método Lean Startup. Se realizó una investigación cualitativa en un municipio del sur de Brasil y una revisión integradora para definir el contenido. Producto desarrollado en formato Hyper Text Markup Language, a través de la herramienta Net Beans. Prueba de usabilidad aplicada. Resultados: participaron 25 enfermeras. Las funcionalidades se organizaron en un mapa de navegación que contenía casillas de selección para los factores de riesgo y el plan de atención, los diagnósticos de enfermería, la estadificación de las lesiones y las sugerencias de tratamiento. Tras las pruebas de usabilidad, identificamos la necesidad de realizar ajustes en el contenido y las funcionalidades, que se corrigieron, dando lugar a la versión final. Conclusión: el modelo constituye una propuesta factible para la toma de decisiones de enfermería, permitiendo un juicio crítico, basado en los hallazgos clínicos.

ABSTRACT Objective: to describe the construction steps of a Minimum Viable Product for a decision support application for nurses for prevention, nursing diagnosis, and treatment of friction injury/pressure injury in the elderly people. Method: qualitative study with technological production by the Lean Startup method. Qualitative research was conducted in a municipality in southern Brazil and integrative review for content definition. Product developed in Hyper Text Markup Language format, through the Net Beans tool. Usability Test applied. Results: 25 nurses participated. The functionalities were organized into a navigation map containing selection boxes for risk factors and care plan, nursing diagnoses, injury staging and treatment suggestions. After usability testing, it was identified the need for adjustments in content and functionalities, which were corrected, resulting in a final version. Conclusion: the model constitutes a feasible proposal for nursing decision making, allowing critical judgment, based on clinical findings.

Moonlighting Function of Phytochelatin Synthase1 in Extracellular Defense against Fungal Pathogens.

Phytochelatin synthase (PCS) is a key component of heavy metal detoxification in plants. PCS catalyzes both the synthesis of the peptide phytochelatin from glutathione and the degradation of glutathione conjugates via peptidase activity. Here, we describe a role for PCS in disease resistance against plant pathogenic fungi. The pen4 mutant, which is allelic to cadmium insensitive1 (cad1/pcs1) mutants, was recovered from a screen for Arabidopsis mutants with reduced resistance to the nonadapted barley fungal pathogen Blumeria graminis f. sp. hordei PCS1, which is found in the cytoplasm of cells of healthy plants, translocates upon pathogen attack and colocalizes with the PEN2 myrosinase on the surface of immobilized mitochondria. pcs1 and pen2 mutant plants exhibit similar metabolic defects in the accumulation of pathogen-inducible indole glucosinolate-derived compounds, suggesting that PEN2 and PCS1 act in the same metabolic pathway. The function of PCS1 in this pathway is independent of phytochelatin synthesis and deglycination of glutathione conjugates, as catalytic-site mutants of PCS1 are still functional in indole glucosinolate metabolism. In uncovering a peptidase-independent function for PCS1, we reveal this enzyme to be a moonlighting protein important for plant responses to both biotic and abiotic stresses.

Relacionamento interpessoal em um centro de atenção psicossocial: articulando educação, design e saúde / Relación interpersonal en un centro de atención psicosocial: articulación de educación, diseño y salud / Interpersonal relationship in a psychosocial care center: articulating education, design and health

Objetivo: descrever a prática de intervenção educativa desenvolvida junto a uma equipe multiprofissional em um Centro de Atenção Psicossocial sobre relacionamento interpessoal, inserindo técnicas da área do design thinking para estimular o processo de reflexão. Método: relato de experiência de atividade educativa, em que foram realizados três encontros sequenciais, nos meses de outubro e novembro de 2018, junto a oito profissionais. Resultados: a equipe estava com dificuldade de relacionamento, prejudicando e dificultando o atendimento multiprofissional ao usuário do serviço de atenção psicossocial. As técnicas estimularam a reflexão do grupo a respeito de sua realidade, possibilitando melhorar o relacionamento interpessoal e refletindo positivamente no cuidado prestado ao usuário. Considerações finais: com essa prática foi possível perceber a importância de se articular conhecimentos de outras áreas, como a do design, reforçando os benefícios da busca pela interdisciplinaridade.

Objective: to describe the practice of educational intervention developed with a multiprofessional team in a Psychosocial Care Center about interpersonal relationships, including design thinking techniques to stimulate the reflection process. Method: experience report of educational activity, in which three sequential meetings were held, in the months of October and November 2018, with eight professionals. Results: the team was having relationship difficulties, impairing and hindering multiprofessional care to users of psychosocial care services. The techniques stimulated the group's reflection about its reality, enabling to improve the interpersonal relationship and reflecting positively on the care provided to the user. Final considerations: with this practice it was possible to realize the importance of articulating knowledge from other areas, such as design, reinforcing the benefits of the search for interdisciplinarity.

Objetivo: describir la práctica de la intervención educativa desarrollada con un equipo multiprofesional en un centro de atención psicosocial sobre las relaciones interpersonales, incluidas las técnicas de pensamiento de diseño para estimular el proceso de reflexión. Método: informe de experiencia de la actividad educativa, en el que se realizaron tres reuniones secuenciales, en los meses de octubre y noviembre de 2018, con ocho profesionales. Resultados: el equipo estaba teniendo dificultades de relación, perjudicando y obstaculizando la atención multiprofesional a los usuarios de los servicios de atención psicosocial. Las técnicas estimularon la reflexión del grupo sobre su realidad, permitiendo mejorar la relación interpersonal y reflexionando positivamente sobre la atención brindada al usuario. Consideraciones finales: con esta práctica fue posible darse cuenta de la importancia de articular el conocimiento de otras áreas, como el diseño, reforzando los beneficios de la búsqueda de la interdisciplinariedad.

A regulon conserved in monocot and dicot plants defines a functional module in antifungal plant immunity.

At least two components that modulate plant resistance against the fungal powdery mildew disease are ancient and have been conserved since the time of the monocot-dicot split (≈ 200 Mya). These components are the seven transmembrane domain containing MLO/MLO2 protein and the syntaxin ROR2/PEN1, which act antagonistically and have been identified in the monocot barley (Hordeum vulgare) and the dicot Arabidopsis thaliana, respectively. Additionally, syntaxin-interacting N-ethylmaleimide sensitive factor adaptor protein receptor proteins (VAMP721/722 and SNAP33/34) as well as a myrosinase (PEN2) and an ABC transporter (PEN3) contribute to antifungal resistance in both barley and/or Arabidopsis. Here, we show that these genetically defined defense components share a similar set of coexpressed genes in the two plant species, comprising a statistically significant overrepresentation of gene products involved in regulation of transcription, posttranslational modification, and signaling. Most of the coexpressed Arabidopsis genes possess a common cis-regulatory element that may dictate their coordinated expression. We exploited gene coexpression to uncover numerous components in Arabidopsis involved in antifungal defense. Together, our data provide evidence for an evolutionarily conserved regulon composed of core components and clade/species-specific innovations that functions as a module in plant innate immunity.

Arabidopsis PEN3/PDR8, an ATP binding cassette transporter, contributes to nonhost resistance to inappropriate pathogens that enter by direct penetration.

Arabidopsis thaliana is a host to the powdery mildew Erysiphe cichoracearum and nonhost to Blumeria graminis f. sp hordei, the powdery mildew pathogenic on barley (Hordeum vulgare). Screening for Arabidopsis mutants deficient in resistance to barley powdery mildew identified PENETRATION3 (PEN3). pen3 plants permitted both increased invasion into epidermal cells and initiation of hyphae by B. g. hordei, suggesting that PEN3 contributes to defenses at the cell wall and intracellularly. pen3 mutants were compromised in resistance to the necrotroph Plectosphaerella cucumerina and to two additional inappropriate biotrophs, pea powdery mildew (Erysiphe pisi) and potato late blight (Phytophthora infestans). Unexpectedly, pen3 mutants were resistant to E. cichoracearum. This resistance was salicylic acid-dependent and correlated with chlorotic patches. Consistent with this observation, salicylic acid pathway genes were hyperinduced in pen3 relative to the wild type. The phenotypes conferred by pen3 result from the loss of function of PLEIOTROPIC DRUG RESISTANCE8 (PDR8), a highly expressed putative ATP binding cassette transporter. PEN3/PDR8 tagged with green fluorescent protein localized to the plasma membrane in uninfected cells. In infected leaves, the protein concentrated at infection sites. PEN3/PDR8 may be involved in exporting toxic materials to attempted invasion sites, and intracellular accumulation of these toxins in pen3 may secondarily activate the salicylic acid pathway.

Pre- and postinvasion defenses both contribute to nonhost resistance in Arabidopsis.

Nonhost resistance describes the immunity of an entire plant species against nonadapted pathogen species. We report that Arabidopsis PEN2 restricts pathogen entry of two ascomycete powdery mildew fungi that in nature colonize grass and pea species. The PEN2 glycosyl hydrolase localizes to peroxisomes and acts as a component of an inducible preinvasion resistance mechanism. Postinvasion fungal growth is blocked by a separate resistance layer requiring the EDS1-PAD4-SAG101 signaling complex, which is known to function in basal and resistance (R) gene-triggered immunity. Concurrent impairment of pre- and postinvasion resistance renders Arabidopsis a host for both nonadapted fungi.

Host and non-host pathogens elicit different jasmonate/ethylene responses in Arabidopsis.

Arabidopsis does not support the growth and asexual reproduction of the barley pathogen, Blumeria graminis f. sp. hordei Bgh). A majority of germlings fail to penetrate the epidermal cell wall and papillae. To gain additional insight into this interaction, we determined whether the salicylic acid (SA) or jasmonate (JA)/ethylene (ET) defence pathways played a role in blocking barley powdery mildew infections. Only the eds1 mutant and NahG transgenics supported a modest increase in penetration success by the barley powdery mildew. We also compared the global gene expression patterns of Arabidopsis inoculated with the non-host barley powdery mildew to those inoculated with a virulent, host powdery mildew, Erysiphe cichoracearum. Genes repressed by inoculations with non-host and host powdery mildews relative to non-inoculated control plants accounted for two-thirds of the differentially expressed genes. A majority of these genes encoded components of photosynthesis and general metabolism. Consistent with this observation, Arabidopsis growth was inhibited following inoculation with Bgh, suggesting a shift in resource allocation from growth to defence. A number of defence-associated genes were induced during both interactions. These genes likely are components of basal defence responses, which do not effectively block host powdery mildew infections. In addition, genes encoding defensins, anti-microbial peptides whose expression is under the control of the JA/ET signalling pathway, were induced exclusively by non-host pathogens. Ectopic activation of JA/ET signalling protected Arabidopsis against two biotrophic host pathogens. Taken together, these data suggest that biotrophic host pathogens must either suppress or fail to elicit the JA/ET signal transduction pathway.

SNARE-protein-mediated disease resistance at the plant cell wall.

Failure of pathogenic fungi to breach the plant cell wall constitutes a major component of immunity of non-host plant species--species outside the pathogen host range--and accounts for a proportion of aborted infection attempts on 'susceptible' host plants (basal resistance). Neither form of penetration resistance is understood at the molecular level. We developed a screen for penetration (pen) mutants of Arabidopsis, which are disabled in non-host penetration resistance against barley powdery mildew, Blumeria graminis f. sp. hordei, and we isolated the PEN1 gene. We also isolated barley ROR2 (ref. 2), which is required for basal penetration resistance against B. g. hordei. The genes encode functionally homologous syntaxins, demonstrating a mechanistic link between non-host resistance and basal penetration resistance in monocotyledons and dicotyledons. We show that resistance in barley requires a SNAP-25 (synaptosome-associated protein, molecular mass 25 kDa) homologue capable of forming a binary SNAP receptor (SNARE) complex with ROR2. Genetic control of vesicle behaviour at penetration sites, and plasma membrane location of PEN1/ROR2, is consistent with a proposed involvement of SNARE-complex-mediated exocytosis and/or homotypic vesicle fusion events in resistance. Functions associated with SNARE-dependent penetration resistance are dispensable for immunity mediated by race-specific resistance (R) genes, highlighting fundamental differences between these two resistance forms.

Loss of a callose synthase results in salicylic acid-dependent disease resistance.

Plants attacked by pathogens rapidly deposit callose, a beta-1,3-glucan, at wound sites. Traditionally, this deposition is thought to reinforce the cell wall and is regarded as a defense response. Surprisingly, here we found that powdery mildew resistant 4 (pmr4), a mutant lacking pathogen-induced callose, became resistant to pathogens, rather than more susceptible. This resistance was due to mutation of a callose synthase, resulting in a loss of the induced callose response. Double-mutant analysis indicated that blocking the salicylic acid (SA) defense signaling pathway was sufficient to restore susceptibility to pmr4 mutants. Thus, callose or callose synthase negatively regulates the SA pathway.