Sustained and Localized Drug Depot Release Using Radiation-Activated Scintillating Nanoparticles.

Clinical treatment of cancer commonly incorporates X-ray radiation therapy (XRT), and developing spatially precise radiation-activatable drug delivery strategies may improve XRT efficacy while limiting off-target toxicities associated with systemically administered drugs. Nevertheless, achieving this has been challenging thus far because strategies typically rely on radical species with short lifespans, and the inherent nature of hypoxic and acidic tumor microenvironments may encourage spatially heterogeneous effects. It is hypothesized that the challenge could be bypassed by using scintillating nanoparticles that emit light upon X-ray absorption, locally forming therapeutic drug depots in tumor tissues. Thus a nanoparticle platform (Scintillating nanoparticle Drug Depot; SciDD) that enables the local release of cytotoxic payloads only after activation by XRT is developed, thereby limiting off-target toxicity. As a proof-of-principle, SciDD is used to deliver a microtubule-destabilizing payload MMAE (monomethyl auristatin E). With as little as a 2 Gy local irradiation to tumors, MMAE payloads are released effectively to kill tumor cells. XRT-mediated drug release is demonstrated in multiple mouse cancer models and showed efficacy over XRT alone (p < 0.0001). This work shows that SciDD can act as a local drug depot with spatiotemporally controlled release of cancer therapeutics.

In vitro kinase assay reveals ADP-heptose-dependent ALPK1 autophosphorylation and altered kinase activity of disease-associated ALPK1 mutants.

Alpha-protein kinase 1 (ALPK1) is a pathogen recognition receptor that detects ADP-heptose (ADPH), a lipopolysaccharide biosynthesis intermediate, recently described as a pathogen-associated molecular pattern in Gram-negative bacteria. ADPH binding to ALPK1 activates its kinase domain and triggers TIFA phosphorylation on threonine 9. This leads to the assembly of large TIFA oligomers called TIFAsomes, activation of NF-κB and pro-inflammatory gene expression. Furthermore, mutations in ALPK1 are associated with inflammatory syndromes and cancers. While this kinase is of increasing medical interest, its activity in infectious or non-infectious diseases remains poorly characterized. Here, we use a non-radioactive ALPK1 in vitro kinase assay based on the use of ATPγS and protein thiophosphorylation. We confirm that ALPK1 phosphorylates TIFA T9 and show that T2, T12 and T19 are also weakly phosphorylated by ALPK1. Interestingly, we find that ALPK1 itself is phosphorylated in response to ADPH recognition during Shigella flexneri and Helicobacter pylori infection and that disease-associated ALPK1 mutants exhibit altered kinase activity. In particular, T237M and V1092A mutations associated with ROSAH syndrome and spiradenoma/spiradenocarcinoma respectively, exhibit enhanced ADPH-induced kinase activity and constitutive assembly of TIFAsomes. Altogether, this study provides new insights into the ADPH sensing pathway and disease-associated ALPK1 mutants.

An antisteatosis response regulated by oleic acid through lipid droplet-mediated ERAD enhancement.

Although excessive lipid accumulation is a hallmark of obesity-related pathologies, some lipids are beneficial. Oleic acid (OA), the most abundant monounsaturated fatty acid (FA), promotes health and longevity. Here, we show that OA benefits Caenorhabditis elegans by activating the endoplasmic reticulum (ER)-resident transcription factor SKN-1A (Nrf1/NFE2L1) in a lipid homeostasis response. SKN-1A/Nrf1 is cleared from the ER by the ER-associated degradation (ERAD) machinery and stabilized when proteasome activity is low and canonically maintains proteasome homeostasis. Unexpectedly, OA increases nuclear SKN-1A levels independently of proteasome activity, through lipid droplet-dependent enhancement of ERAD. In turn, SKN-1A reduces steatosis by reshaping the lipid metabolism transcriptome and mediates longevity from OA provided through endogenous accumulation, reduced H3K4 trimethylation, or dietary supplementation. Our findings reveal an unexpected mechanism of FA signal transduction, as well as a lipid homeostasis pathway that provides strategies for opposing steatosis and aging, and may mediate some benefits of the OA-rich Mediterranean diet.

Akkermansia muciniphila upregulates genes involved in maintaining the intestinal barrier function via ADP-heptose-dependent activation of the ALPK1/TIFA pathway.

The commensal bacteria that make up the gut microbiota impact the health of their host on multiple levels. In particular, the interactions taking place between the microbe-associated molecule patterns (MAMPs) and pattern recognition receptors (PRRs), expressed by intestinal epithelial cells (IECs), are crucial for maintaining intestinal homeostasis. While numerous studies showed that TLRs and NLRs are involved in the control of gut homeostasis by commensal bacteria, the role of additional innate immune receptors remains unclear. Here, we seek for novel MAMP-PRR interactions involved in the beneficial effect of the commensal bacterium Akkermansia muciniphila on intestinal homeostasis. We show that A. muciniphila strongly activates NF-κB in IECs by releasing one or more potent activating metabolites into the microenvironment. By using drugs, chemical and gene-editing tools, we found that the released metabolite(s) enter(s) epithelial cells and activate(s) NF-κB via an ALPK1, TIFA and TRAF6-dependent pathway. Furthermore, we show that the released molecule has the biological characteristics of the ALPK1 ligand ADP-heptose. Finally, we show that A. muciniphila induces the expression of the MUC2, BIRC3 and TNFAIP3 genes involved in the maintenance of the intestinal barrier function and that this process is dependent on TIFA. Altogether, our data strongly suggest that the commensal A. muciniphila promotes intestinal homeostasis by activating the ALPK1/TIFA/TRAF6 axis, an innate immune pathway exclusively described so far in the context of Gram-negative bacterial infections.

UV 254 nm is more efficient than UV 222 nm in inactivating SARS-CoV-2 present in human saliva.

Ultraviolet (UV) light can inactivate SARS-CoV-2. However, the practicality of UV light is limited by the carcinogenic potential of mercury vapor-based UV lamps. Recent advances in the development of krypton chlorine (KrCl) excimer lamps hold promise, as these emit a shorter peak wavelength (222 nm), which is highly absorbed by the skin's stratum corneum and can filter out higher wavelengths. In this sense, UV 222 nm irradiation for the inactivation of virus particles in the air and surfaces is a potentially safer option as a germicidal technology. However, these same physical properties make it harder to reach microbes present in complex solutions, such as saliva, a critical source of SARS-CoV-2 transmission. We provide the first evaluation for using a commercial filtered KrCl excimer light source to inactivate SARS-CoV-2 in saliva spread on a surface. A conventional germicidal lamp (UV 254 nm) was also evaluated under the same condition. Using plaque-forming units (PFU) and Median Tissue Culture Infectious Dose (TCID50) per milliliter we found that 99.99% viral clearance (LD99.99) was obtained with 106.3 mJ/cm2 of UV 222 nm for virus in DMEM and 2417 mJ/cm2 for virus in saliva. Additionally, our results showed that the UV 254 nm had a greater capacity to inactivate the virus in both vehicles. Effective (after discounting light absorption) LD99.99 of UV 222 nm on the virus in saliva was ∼30 times higher than the value obtained with virus in saline solution (PBS), we speculated that saliva might be protecting the virus from surface irradiation in ways other than just by intensity attenuation of UV 222 nm. Due to differences between UV 222/254 nm capacities to interact and be absorbed by molecules in complex solutions, a higher dose of 222 nm will be necessary to reduce viral load in surfaces with contaminated saliva.

Flexible translucent persistent luminescent films based on Sr2MgSi2O7:Eu2+,Dy3+ cellulose ether composites.

Persistent luminescent materials are present in several recent studies on new applications and novel properties. In this work, we demonstrate, for the first time, the production of translucent flexible persistent composites based on Sr2MgSi2O7:Eu2+,Dy3+ (SMSO) into cellulose ether matrix film. The composite was successfully prepared through a new optimized route of co-precipitation and microwave-assisted annealing followed by (3-aminopropyl)triethoxysilane (APTES) coating and dispersion in hydroxypropyl methylcellulose (HPMC). The SMSO@APTES/HPMC films show persistent luminescence emission at 475 nm (blue) and high transmittance in the visible range. To understand the fine distribution of the nanoparticles in the matrix, we have investigated their structure and dispersion by using Synchrotron Radiation X-ray fluorescence mapping and Scanning Transmission X-ray Microscopy. This innovative composite could bring new perspectives for the class of persistent luminescence materials, enhancing technologies in progress throwing light on new applications never perceived.

Metagenome-Assembled Genomes from Monte Cristo Cave (Diamantina, Brazil) Reveal Prokaryotic Lineages As Functional Models for Life on Mars.

Microbial communities have been explored in various terrestrial subsurface ecosystems, showing metabolic potentials that could generate noteworthy morphological and molecular biosignatures. Recent advancements in bioinformatic tools have allowed for descriptions of novel and yet-to-be cultivated microbial lineages in different ecosystems due to the genome reconstruction approach from metagenomic data. Using shotgun metagenomic data, we obtained metagenome-assembled genomes related to cultivated and yet-to-be cultivated prokaryotic lineages from a silica and iron-rich cave (Monte Cristo) in Minas Gerais State, Brazil. The Monte Cristo Cave has been shown to possess a high diversity of genes involved with different biogeochemical cycles, including reductive and oxidative pathways related to carbon, sulfur, nitrogen, and iron. Three genomes were selected for pangenomic analysis, assigned as Truepera sp., Ca. Methylomirabilis sp., and Ca. Koribacter sp. based on their lifestyles (radiation resistance, anaerobic methane oxidation, and potential iron oxidation). These bacteria exhibit genes involved with multiple DNA repair strategies, starvation, and stress response. Because these groups have few reference genomes deposited in databases, our study adds important genomic information about these lineages. The combination of techniques applied in this study allowed us to unveil the potential relationships between microbial genomes and their ecological processes with the cave mineralogy and highlight the lineages involved with anaerobic methane oxidation, iron oxidation, and radiation resistance as functional models for the search for extant life-forms outside our planet in silica- and iron-rich environments and potentially on Mars.

Development of a sticker sealed microfluidic device for in situ analytical measurements using synchrotron radiation.

Shedding synchrotron light on microfluidic systems, exploring several contrasts in situ/operando at the nanoscale, like X-ray fluorescence, diffraction, luminescence, and absorption, has the potential to reveal new properties and functionalities of materials across diverse areas, such as green energy, photonics, and nanomedicine. In this work, we present the micro-fabrication and characterization of a multifunctional polyester/glass sealed microfluidic device well-suited to combine with analytical X-ray techniques. The device consists of smooth microchannels patterned on glass, where three gold electrodes are deposited into the channels to serve in situ electrochemistry analysis or standard electrical measurements. It has been efficiently sealed through an ultraviolet-sensitive sticker-like layer based on a polyester film, and The burst pressure determined by pumping water through the microchannel(up to 0.22 MPa). Overall, the device has demonstrated exquisite chemical resistance to organic solvents, and its efficiency in the presence of biological samples (proteins) is remarkable. The device potentialities, and its high transparency to X-rays, have been demonstrated by taking advantage of the X-ray nanoprobe Carnaúba/Sirius/LNLS, by obtaining 2D X-ray nanofluorescence maps on the microchannel filled with water and after an electrochemical nucleation reaction. To wrap up, the microfluidic device characterized here has the potential to be employed in standard laboratory experiments as well as in in situ and in vivo analytical experiments using a wide electromagnetic window, from infrared to X-rays, which could serve experiments in many branches of science.

Contribuições da auditoria para a gestão na atenção hospitalar: revisão integrativa / Audit contributions to management in hospital care: integrative review / Contribuciones de la auditoría a la gestión de la atención hospitalaria: una revisión integradora

Introdução: A auditoria em saúde é considerada um instrumento que permite auxiliar na gestão de serviços de saúde, e, por meio de sua aplicação, é possível obter um diagnóstico situacional para intervir com a finalidade de obter mudanças e melhorias. Objetivo: Analisar o conhecimento científico produzido sobre a auditoria e sua contribuição para a gestão na atenção hospitalar. Método: Revisão Integrativa realizada nas bases de dados LILACS, MEDLINE via PUBMED, SCOPUS, EMBASE e WEB OF SCIENCE no período de 2009 a 2019. Resultados: 18 artigos foram selecionados e agrupados em duas categorias "A auditoria na qualificação de processos gerenciais e assistenciais" que aborda o seu uso no processo educativo, na implantação de protocolos/diretrizes assistenciais, que possibilitam o planejamento e a tomada de decisão por parte do gestor e, a categoria "Auditoria e gestão de custos" que apresenta a contribuição em relação à adequação de custos e otimização dos recursos envolvidos na assistência ao paciente. Conclusão: A auditoria promove suporte na gestão hospitalar, principalmente em intervenções para revisão e melhorias de processos assistenciais favorecendo a ação educativa e reflexiva da prática profissional, bem como, redução de custos.(AU)

Introduction: Introduction: The health audit is considered an instrument that allows to assist in the management of health services, and, through its application, it is possible to obtain a situational diagnosis to intervene in order to obtain changes and improvements. Objective: To analyze the scientific knowledge produced on the audit and its contribution to hospital care management. Method: Integrative Review performed in the databases LILACS, MEDLINE via PUBMED, SCOPUS, EMBASE and WEB OF SCIENCE from 2009 to 2019. Results: 18 articles were selected and grouped into two categories "Audit in the qualification of management and care processes" that addresses its use in the educational process, in the implementation of care protocols/guidelines, that enable planning and decision-making by the manager and, the category "Audit and cost management" that presents the contribution in relation to the adequacy of costs and optimization of the resources involved in patient care. Conclusion: The audit promotes support in hospital management, mainly in interventions to review and imp...(AU)

Introducción: La auditoría de salud se considera un instrumento que ayuda en la gestión de los servicios de salud y, a través de su aplicación, es posible obtener un diagnóstico situacional para intervenir con el fin de obtener cambios y mejoras. Objetivo: Analizar el conocimiento científico producido sobre la auditoría y su contribución a la gestión de la atención hospitalaria. Método: Revisión Integradora realizada en LILACS, MEDLINE a través de las bases de datos PUBMED, SCOPUS, EMBASE y WEB OF SCIENCE de 2009 a 2019. Resultados: Se seleccionaron 18 artículos y se agruparon en dos categorías "Auditoría en la calificación de procesos de gestión y atención" que abordan su uso en el proceso educativo, en la implementación de protocolos / guías de atención, que posibilitan la planificación y toma de decisiones por parte del gerente, y la categoría "Auditoría y gestión de costos" que presenta la contribución en...(AU)

Synthesis of Zinc Oxide Nanoparticles by Ecofriendly Routes: Adsorbent for Copper Removal From Wastewater.

Zinc Oxide nanoparticles have been synthesized by two simple routes using Aloe vera (green synthesis, route I) or Cassava starch (gelatinization, route II). The XRD patterns and Raman spectra show that both synthesis routes lead to single-phase ZnO. XPS results indicate the presence of zinc atoms with oxidation state Zn2+. SEM images of the ZnO nanoparticles synthesized using Cassava starch show the presence of pseudo-spherical nanoparticles and nanosheets, while just pseudo-spherical nanoparticles were observed when Aloe vera was used. The UV-Vis spectra showed a slight difference in the absorption edge of the ZnO particles obtained using Aloe vera (3.18 eV) and Cassava starch (3.24 eV). The ZnO nanoparticles were tested as adsorbents for the removal of copper in wastewater, it is shown that at low Cu2+ ion concentration (~40 mg/L) the nanoparticles synthesized by both routes have the same removal efficiency, however, increasing the absorbate concentration (> 80 mg/L) the ZnO nanoparticles synthesized using Aloe vera have a higher removal efficiency. The synthesized ZnO nanoparticles can be used as effective and environmental-friendly metal trace absorbers in wastewater.

Abnormal co-doping effect on the red persistent luminescence SrS:Eu2+,RE3+ materials.

Persistent luminescence materials are a reality in several applications. However, there is still a lack of efficient red-emitting materials. SrS:Eu2+ phosphor is a potential candidate since its strong nephelauxetic effect shifts Eu2+4f65d1 → 4f7 to red, and its weak bond between strontium and sulphide, due to the soft base-hard acid character, generates a high number of intrinsic defects. SrS:Eu2+,RE3+ materials were efficiently prepared by two rounds of 22 min microwave-assisted solid-state synthesis. The highly crystalline purity and the material organization at the micro-scale were observed with X-ray powder diffraction and scanning electron microscopy, respectively. X-ray absorption spectroscopy revealed a low amount of Eu2+ compared to Eu3+ due to the efficient Eu2+ photo-oxidation by X-ray irradiation in the high storage capability SrS host matrix. Electron paramagnetic resonance spectra confirmed that at least 50% of Eu2+ ions in the material are photo-oxidized during excitation, reinforcing the previously established mechanisms. The RE2+ energy level positioned very close to or into the conduction band led to an abnormal co-doping effect, with similar effects independent of the co-dopant. The high concentration of intrinsic defects in SrS indicates that the soft-hard pair host is an excellent approach to develop efficient persistent luminescence materials.

Structural and optical properties of europium- and titanium-doped Y2 O3 nanoparticles.

Luminescent nanoparticles of Y2 O3 doped with europium (Eu) and/or titanium (Ti) were synthesized using modified sol-gel routes. The crystalline cubic phase was confirmed using X-ray powder diffraction (XRD). Particle morphology and size were evaluated using scanning and transmission electron microscopy. High-resolution transmission electron microscopy showed that the synthesis method affected the average particle size and the Fourier transform of the images showed the lattice plane distances, indicating that the samples presented high crystallinity degree in accordance with the XRD pattern. The Ti valence was investigated using X-ray absorption near edge spectroscopy and the tetravalent form was the dominant oxidizing state in the samples, mainly in Eu and Ti co-doped Y2 O3 . Optical behaviour was investigated through X-ray excited optical luminescence and photoluminescence under ultraviolet-visible (UV-vis) and vacuum ultraviolet (VUV) excitation. Results indicated that Eu3+ is the emitting centre in samples doped with only Eu and with both Eu and Ti with the 5 D0 →7 F2 transition as the most intense, indicating Eu3+ in a noncentrosymmetric site. Finally, in the Eu,Ti-doped Y2 O3 system, Ti3+ (or TiIV ) excitation was observed but no Ti emission was present, indicating a very efficient energy transfer process from Ti to Eu3+ . These results can aid the development of efficient nanomaterials, activated using UV, VUV, or X-rays.

Evaluating Biogenicity on the Geological Record With Synchrotron-Based Techniques.

The biogenicity problem of geological materials is one of the most challenging ones in the field of paleo and astrobiology. As one goes deeper in time, the traces of life become feeble and ambiguous, blending with the surrounding geology. Well-preserved metasedimentary rocks from the Archaean are relatively rare, and in very few cases contain structures resembling biological traces or fossils. These putative biosignatures have been studied for decades and many biogenicity criteria have been developed, but there is still no consensus for many of the proposed structures. Synchrotron-based techniques, especially on new generation sources, have the potential for contributing to this field of research, providing high sensitivity and resolution that can be advantageous for different scientific problems. Exploring the X-ray and matter interactions on a range of geological materials can provide insights on morphology, elemental composition, oxidation states, crystalline structure, magnetic properties, and others, which can measurably contribute to the investigation of biogenicity of putative biosignatures. Here, we provide an overview of selected synchrotron-based techniques that have the potential to be applied in different types of questions on the study of biosignatures preserved in the geological record. The development of 3rd and recently 4th generation synchrotron sources will favor a deeper understanding of the earliest records of life on Earth and also bring up potential analytical approaches to be applied for the search of biosignatures in meteorites and samples returned from Mars in the near future.

Contributions and challenges of hospital nursing management: scientific evidence. / Contribuições e desafios do gerenciamento de enfermagem hospitalar: evidências científicas.

AIM: Analyze the scientific evidence, national and international, about contributions and challenges of nursing management in hospital care. METHOD: Integrative literature review, with guiding question: What are the scientific evidence about nursing management in hospital care? Data was collected in LILACS, PubMed, Scopus, CINAHL and EMBASE databases. The final sample of 14 articles resulted in two categories: "Contributions" and "Challenges." RESULTS: Contributions refer to aspects that facilitate the development and organization of work from a technical-political perspective, by qualifying the productive processes. The challenges were related to professional development, work satisfaction, overload, quality of service, conflict resolution and teamwork. CONCLUSION: Management and care processes are inseparable, requires adequate and up-to-date knowledge to provide a better care experience for the health services user and coordinate team actions.

Corrigendum: Evaluating Biogenicity on the Geological Record With Synchrotron-Based Techniques.

[This corrects the article DOI: 10.3389/fmicb.2019.02358.].

Contribuições e desafios do gerenciamento de enfermagem hospitalar: evidências científicas / Contribuciones y desafíos de la gestión de enfermería hospitalaria: evidencias científicas / Contributions and challenges of hospital nursing management: scientific evidence

Resumo OBJETIVO Analisar as evidências científicas, nacionais e internacionais, sobre contribuições e desafios do gerenciamento de enfermagem na atenção hospitalar. MÉTODO Revisão integrativa da literatura, com questão norteadora: Quais evidências científicas sobre o gerenciamento de enfermagem na atenção hospitalar? Dados coletados nas bases de dados LILACS, PubMed, Scopus, CINAHL e EMBASE. A amostra final de 14 artigos resultou em duas categorias: "Contribuições" e "Desafios". RESULTADOS As contribuições referem-se a aspectos que facilitam o desenvolvimento e organização do trabalho na perspectiva técnico-política, ao qualificar os processos produtivos. Os desafios estão atrelados à formação profissional, à satisfação com o trabalho, à sobrecarga, à manutenção da qualidade dos serviços, resolução de conflitos e trabalho em equipe. CONCLUSÃO Processos gerenciais e assistenciais são indissociáveis, requerem conhecimento adequado e atualizado para oferecer melhor experiência de cuidado ao usuário e coordenar ações da equipe.

Resumen OBJETIVO Analizar las evidencias científicas, nacionales e internacionales, sobre contribuciones y desafíos del manejo de enfermería en la atención hospitalaria. MÉTODO Revisión integrativa, con cuestión-guia: ¿Cuáles son las evidencias científicas sobre gestión de enfermería en la atención hospitalaria? Datos recogidos en las bases de datos LILACS, PubMed, Scopus, CINAHL y EMBASE. La muestra final de 14 artículos resultó en dos categorías: "Contribuciones" y "Desafíos". RESULTADOS Las contribuciones se refieren a aspectos que facilitan el desarrollo y organización del trabajo desde la perspectiva técnico-política, al calificar los procesos productivos. Los desafíos están vinculados a la formación profesional, satisfacción con el trabajo, sobrecarga, mantenimiento de calidad, resolución de conflictos y trabajo en equipo. CONCLUSIÓN Procesos gerenciales y asistenciales son indisociables, requieren conocimiento adecuado y actualizado para ofrecer la mejor experiencia de cuidado y coordinar acciones del equipo.

Abstract AIM Analyze the scientific evidence, national and international, about contributions and challenges of nursing management in hospital care. METHOD Integrative literature review, with guiding question: What are the scientific evidence about nursing management in hospital care? Data was collected in LILACS, PubMed, Scopus, CINAHL and EMBASE databases. The final sample of 14 articles resulted in two categories: "Contributions" and "Challenges." RESULTS Contributions refer to aspects that facilitate the development and organization of work from a technical-political perspective, by qualifying the productive processes. The challenges were related to professional development, work satisfaction, overload, quality of service, conflict resolution and teamwork. CONCLUSION Management and care processes are inseparable, requires adequate and up-to-date knowledge to provide a better care experience for the health services user and coordinate team actions.

Avaliação em saúde para a gestão do Sistema Único de Saúde: uma revisão integrativa / Health assessment for the management of the Unified Health System: an integrative review

A avaliação em saúde é um tema em pauta, que é estudado e discutido mundialmente, tendo como prioridade a visibilidade na gestão de recursos públicos e a implicação dos resultados na melhoria do desempenho do sistema de saúde. Este estudo tem como objetivo: analisar a produção científica, nacional e internacional, acerca das evidências da avaliação em saúde para a gestão do Sistema Único de Saúde, no período de 1988 a 2017. Revisão integrativa (RI) percorreu cinco etapas para sua elaboração, os estudos primários foram selecionados nas bases de dados LILACS, MEDLINE via PUBMED, SCOPUS, EMBASE e CINAHL. A amostra da revisão integrativa foi composta por 26 estudos, que foram inseridos e armazenados no software EndNote Basic, e para sistematizar os artigos selecionados optou-se pelo uso do software Rayyan. A seleção dos artigos foi realizada em dupla conferência por dois pesquisadores, de modo independente. Após a síntese dos estudos primários selecionados, foram agrupados em categorias para favorecer a análise e as comparações. Os estudos primários foram agrupados em duas categorias: A categoria "Avaliação de Serviços, Programas e Ações de Saúde" agrupa dezenove artigos que trazem aspectos de avaliação de utilização, implantação e/ou objetivos de avaliações referentes aos serviços, programas ou intervenções de ações. Destaca-se que, dentre os artigos, sete referem-se aos aspectos relativos à Atenção Hospitalar e doze estudos dizem respeito à Atenção Básica. A categoria "Enfoque Metodológico da Avaliação em Saúde" agrupa sete artigos que trazem propostas e métodos de avaliação que implicam na gestão dos serviços ofertados pelo Sistema Único de Saúde. O conhecimento e os resultados produzidos acerca da avaliação de serviços de saúde trazem contribuições para a gestão em saúde, à medida que os resultados evidenciam aspectos relevantes, tais como; a potencialidade para monitorizar, planejar, fornecer subsídios para reorientar mudanças dentro dos serviços, racionalizar o cuidar; avaliar o grau de implementação, de resultados obtidos, de políticas ou programas; direcionar ações, identificar necessidades e, principalmente, tomar decisões

Health assessment is a topic that is studied and discussed worldwide, with priority being given to visibility in the management of public resources and the implication of the results in improving the performance of the health system. This study aims to analyze the national and international scientific production on the evidence of health assessment for the management of the Unified Health System, from 1988 to 2017. Integrative review (IR) covered five stages for its elaboration, the primary studies were selected from the LILACS, PubMed, SCOPUS, Embase and CINAHL databases. The sample of the integrative review was composed by 26 studies, which were inserted and stored in the EndNote Basic software, and to systematize the selected articles the use of Rayyan software was chosen. The selection of articles was done in a double conference by two researchers, independently. After synthesis of the selected primary studies, they were grouped into categories to favor the analysis and comparisons. Primary studies were grouped into two categories: The "Evaluation of Health Services, Programs and Actions" category comprises nineteen articles that provide evaluation aspects of the use, implementation and/or evaluation objectives related to services, programs or actions interventions. It should be noted that, among the articles, seven refer to aspects related to hospital care and twelve studies concern primary care. The category "Methodological Approach to Health Assessment" includes seven articles that bring proposals and evaluation methods that imply the management of the services offered by the Unified Health System. Knowledge and results produced about the evaluation of health services bring contributions to the health management, as results show relevant aspects such as the potential to monitor, plan, provide subsidies to reorient change within services, rationalize care; evaluate the degree of implementation and results obtained from policies or programs; target actions, identify need and especially make decisions

Potencial de ação duplo e alterações ecográficas do nervo mediano em doentes com síndrome do túnel cárpico / Double peak action potential and ultrasonography nerve evaluation in patients with carpal tunnel syndrome

Introdução: A síndrome do túnel cárpico (STC) é sustentada pela presença de lentificação do potencial de ação do nervo mediano no estudo ortodrómico de condução nervosa sensitiva em comparação com o nervo radial (EC-MR). Uma técnica modificada de registo simultâneo de ambos os nervos (EC-MRsimul) pode ser utilizada, detetando a lentificação do nervo mediano através da presença de potencial de ação sensitivo duplo (PAS-D). O objetivo deste estudo é correlacionar o PAS-D com os achados de EC-MR e com o edema perineural em doentes com diagnóstico de STC. Métodos: Indivíduos saudáveis e doentes com STC há menos de 12 meses foram submetidos a avaliação eletrofisiológica, incluindo o EC-MR e o EC-MRsimul. Foi também realizada ultrassonografia para registo da área seccional do nervo mediano (AS-NM) no punho e antebraço e, respetivo índice punho-antebraço (I-PA). Resultados: Foram recrutados 38 doentes com idade média de 54,8 ± 15,3 anos com STC e 18 indivíduos saudáveis. A diferença de latência distal entre o nervo mediano e radial foi superior nos doentes (0,80 ± 0,30ms vs. 0,15 ± 0,20ms; p=0,015). O EC­MRsimul demonstrou a presença de PAS-D nos indivíduos sintomáticos. A AS­NM no punho foi também superior nos doentes (8,9 ± 0,9mm2 vs. 6,6 ± 0,7mm2; p<0.003), tendo sido identificado um quisto sinovial e um neurinoma. O edema perineural traduzido pela AS-SM correlacionou-se positivamente com a diferença de latência interpico no EC-MR e com a presença de PAS-D. Conclusão: O PAS-D está associado à presença de lentificação da condução e ao edema perineural do nervo mediano no contexto de STC ou devido a lesões ocupantes de espaço. (AU)

Introduction: Carpal tunnel syndrome (CTS) is characterized by median nerve action potential slowing, which can be shown in comparative orthodromic sensory nerve conduction studies between median and radial nerve (NCS-MR). A modified technique with simultaneous recording of both nerves (NCS-MRsimul) can also be used to detect median nerve slowing through the presence of double peak action potential (DPp). The study aims to correlate the presence of DPp with NCS-MR findings and with perineural edema in patients diagnosed with STC. Methods: Healthy individuals and patients with CTS for less than 12 months underwent NCS-MR and MRsimul. An ultrasonography evaluation was also performed to record the medial nerve sectional area (SA-MN) on the wrist and forearm, and the wrist-to-forearm ratio (WFR) was calculated. Results: We recruited 38 patients with CTS whose mean age was 54.8 ± 15.3 years and 18 healthy individuals. Distal latency difference between the median and radial nerves was higher in patients with CTS (0.80 ± 0.30 ms vs. 0.15 ± 0.20 ms, p = 0.015). NCS-MRsimul showed DPp in symptomatic individuals. SA-MN in the wrist was also higher in patients with CTS (8.9 ± 0.9 mm2 vs. 6.6 ± 0.7 mm2 , p <0.003). Ultrasonography evaluation identified a synovial cyst and a neurinoma. Perineural edema traduced by higher SA-MN and WFR correlated positively with interpeak latency difference in NCS-MR and with the presence of DPp. Conclusions: DPp was associated with median nerve sensory action potential slowing and with perineural edema due to either CTS or to space-occupying lesions. (AU)

Reflections on graduate professor training / Reflexiones sobre la formación docente en el postgrado / Reflexões sobre a formação docente na pós-graduação

Abstract Objective: To reflect on activities aimed at the development of graduation students, in a teaching internship program, in the perspective of master's degree and doctoral graduate education and training. Method: It is a reflexive study, based on the discursive formulation about required competencies and guidelines proposed by the National Graduation Plan (named PNPG, Plano Nacional de Pós-Graduação) for professor training articulated to the graduate. Results: The teaching internship program is a way for the formation of university professors, through the preparation of the graduate student. In addition, it shows the relevance of the professor supervisor role in the construction of the learning of these individuals. Conclusion and implications for practice: The first contact with teaching practice, through the teaching internship program, is relevant for constructing a critical look at the teaching-learning process. In this type of Program, it is possible to learn to be and make teaching in a participatory manner, to value interactive relations, to boost autonomy, to stimulate self-evaluation and self-reflection of the graduate student, allowing them to participate actively in the learning process.

Resumen Objetivo: Reflexionar sobre las actividades dirigidas al desarrollo de estudiantes de post-graduación en un programa de prácticas de enseñanza, en la perspectiva de stricto sensu graduado de educación y formación. Método: Se trata de un estudio reflexivo, fundamentado en la formulación discursiva acerca de competencias requeridas y directrices propuestas por el Plan Nacional de Postgrado para capacitación docente articulada al posgrado. Resultados: El programa de práctica docente es una vía para la formación de profesores universitarios, a través de la preparación del estudiante de postgrado. Además, muestra la relevancia del papel docente supervisor en la construcción del aprendizaje de estos individuos. Conclusión e Implicaciones para la práctica: El primer contacto con la práctica de la docencia, a través del programa de práctica docente, se muestra relevante para la construcción de una mirada con criticidad del proceso enseñanza-aprendizaje. En este tipo de programa es posible aprender a ser y hacer la docencia de forma coparticipativa, valorar relaciones interactivas, impulsar la autonomía, estimular la autoevaluación y autorreflexión del postgrado permitiendo que participen activamente en el proceso de aprendizaje.

Resumo Objetivo: Refletir acerca de atividades voltadas para o desenvolvimento de pós-graduandos, em programa de estágio docente, na perspectiva de ensino e formação na pós-graduação Stricto sensu. Método: Trata-se de estudo reflexivo, fundamentado na formulação discursiva acerca de competências requeridas e diretrizes propostas pelo Plano Nacional de Pós-Graduação para a capacitação docente articulada à pós-graduação. Resultados: O programa de estágio docente é uma via para a formação de professores universitários por meio do preparo do pós-graduando. Além disso, mostra a relevância do papel docente supervisor na construção da aprendizagem desses indivíduos. Conclusão e implicações para a prática: O primeiro contato com a prática da docência, por meio do programa de estágio docente, mostra-se relevante para a construção do olhar com criticidade do processo de ensino-aprendizagem. Nesse tipo de programa, é possível aprender a ser e a fazer a docência de forma coparticipativa, valorizar as relações interativas, impulsionar a autonomia, estimular a autoavaliação e autorreflexão do pós-graduando, permitindo que participe, ativamente, do processo de aprendizagem.

Processo de trabalho: percepção da equipe de saúde da família / Work process: perception of the family health team

Objetivo: descrever a percepção de uma equipe multiprofissional da Estratégia Saúde da Família sobre a organização do processo de trabalho na sua unidade. Método: trata-se de estudo qualitativo, descritivo, desenvolvido numa unidade de saúde com 11 profissionais, utilizando a técnica de grupo focal, norteada pela Autoavaliação para Melhoria do Acesso e da Qualidade da Atenção Básica na dimensão de organização do processo de trabalho. Submeteu-se os dados à técnica de Análise de Conteúdo. Resultados: aponta-se que, na organização dos dados, emergiram duas categorias: Aspectos organizacionais e Aspectos relacionais. Enfatizam-se a importância do enfermeiro para a coordenação das ações e a necessidade de se fomentar o trabalho colaborativo para a integralidade das ações. Conclusão: constata-se a necessidade de se instituir, no âmbito da equipe de saúde, a reflexão rotineira sobre a organização dos processos de trabalho pautada nos atributos da atenção primária à saúde, além da prática de avaliação como ferramenta para melhorar a qualidade da atenção.(AU)

Objective: to describe the perception of a multiprofessional Family Health Strategy team about the organization of the work process in their unit. Method: this is a qualitative, descriptive study, developed in a health unit with 11 professionals, using the focus group technique, guided by the Self-Assessment for Improving Access and Quality of Primary Care in the dimension of work process organization. The data was submitted to the technique of Content Analysis. Results: it is pointed out that, in the data organization, two categories emerged: Organizational Aspects and Relational Aspects. Emphasize the importance of nurses for the coordination of actions and the need to encourage collaborative work for the integrality of actions. Conclusion: there is a need to establish, within the health team, routine reflection on the organization of work processes based on the attributes of primary health care, in addition to the practice of evaluation as a tool to improve the quality of care.(AU)

Objetivo: describir la percepción de un equipo multiprofesional de Estrategia de Salud Familiar sobre la organización del proceso de trabajo en su unidad. Método: este es un estudio cualitativo, descriptivo, desarrollado en una unidad de salud con 11 profesionales, utilizando la técnica de grupo de enfoque, guiado por la Autoevaluación para mejorar el acceso y la calidad de la atención primaria en la dimensión de la organización del proceso de trabajo. Los datos fueron sometidos a la técnica de Análisis de Contenido. Resultados: se señala que, en la organización de datos, surgieron dos categorías: Aspectos organizacionales y Aspectos relacionales. Se enfatiza la importancia de las enfermeras para la coordinación de las acciones y la necesidad de fomentar el trabajo colaborativo para la integralidad de las acciones. Conclusión: es necesario establecer, dentro del equipo de salud, una reflexión rutinaria sobre la organización de los procesos de trabajo basados en los atributos de la atención primaria de salud, además de la práctica de la evaluación como una herramienta para mejorar la calidad de la atención.(AU)