Effectiveness of video-assisted debriefing versus oral debriefing in simulation-based interdisciplinary health professions education: A randomized trial.

AIM: We aimed to compare the debriefing experience, simulation assessment, reflection, anxiety and simulation satisfaction of using oral debriefing versus video-assisted debriefing after a simulated clinical session in an interdisciplinary cohort of health sciences students. BACKGROUND: Debriefing is a reflective process that takes place after a clinical simulation and that can be performed either in a traditional way (oral) or using video-assisted debriefing. DESIGN: A randomized controlled trial was conducted in 143 health sciences students (35.7% male, 61.5% female). METHODS: The simulation scenario was designed to evaluate the procedure for donning and doffing personal protective equipment. Differences in debriefing experience, simulation assessment, reflection, anxiety and satisfaction were assessed. RESULTS: Regarding debriefing experience, significant differences were observed for the category "learning" (34.9 (6.13) vs. 36.7 (3.89); p = 0.039). For simulation assessment, significantly higher scores for all categories were identified in video-assisted debriefing compared with oral debriefing (p<0.001). There were also significant differences between the oral debriefing versus video-assisted debriefing for the overall score of reflection ability (86.97 (10.55) vs. 90.74 (9.67); p=0.028) as well as for the category "reflective communication" (24.72 (3.77) vs 26.04 (4.07); p=0.047). Perceived satisfaction was significantly higher in the video-assisted debriefing group compared with oral debriefing group (p <0.001). For anxiety, no significant differences were observed between debriefing groups. CONCLUSION: Video-assisted debriefing after a simulated clinical session improves debriefing experience, simulation assessment, reflection and simulation satisfaction, but does not increase anxiety compared with oral debriefing among health sciences students.

Tracking of structural defects induced by Eu-doping in ß-Ag2MoO4: their influences on electrical properties.

In this study, several methods were employed to investigate the electrical characteristics of ß-Ag2MoO4 systems, both Eu-doped and undoped, synthesized using the microwave-assisted hydrothermal method. The focus extended to understanding how synthesis time influences material defects, with doping fixed at 1%. A systematic shift in the silver vacancy (VAg) concentration was observed within the doped ß-Ag2MoO4 system. Specifically, this study demonstrated that the incorporation of Eu3+ into polycrystalline ß-Ag2MoO4 initially increases the VAg concentration. However, as the synthesis time progresses, the VAg concentration decreases, resulting in alterations in the resulting electrical properties, arising from the intricate interplay between the number of grain boundaries and carrier density. By combining information obtained from photoluminescence, positron annihilation lifetime spectroscopy, and impedance spectroscopy, a comprehensive conduction mechanism was formulated, shedding light on both doped and undoped ß-Ag2MoO4 systems.

Impacto de la maestría en la formación investigativa de sus egresados a través de sus publicaciones / The Master's Degree in Research Training's Impact on its Graduates, Analyzed through their Publications

Introducción: La Maestría en Investigación en Aterosclerosis constituye una propuesta académica para elevar la calidad de la formación en salud sobre la base de métodos de investigación y aterosclerosis. Evaluar el impacto de su formación científica, evidenciará la relación causa-efecto entre la acción de superación y el comportamiento en el desempeño. Existen criterios de medida que sirven para hacerlo. Este trabajo empleó la publicación de artículos científicos. Objetivo: Evaluar el impacto de la maestría mediante el efecto producido sobre el desempeño investigativo de los graduados, a través de sus publicaciones en revistas científicas. Métodos: Estudio bibliométrico, descriptivo y retrospectivo. Se buscaron publicaciones de alumnos de tres ediciones en Google Académico. El criterio de desempeño investigativo evaluado fue el de artículos publicados. Se midieron las publicaciones de artículos científicos en cuanto a cantidad, calidad y extensión, en dos etapas; se compararon para medir impacto. Resultados: Se incrementaron significativamente los artículos originales y las revisiones bibliográficas en la segunda etapa. Se identificaron graduados más productivos, más citados, líderes; se publicó más en revistas grupo I. Las palabras clave estaban relacionadas con la aterosclerosis; se hallaron diferentes tipos de colaboración. Conclusiones: El incremento de publicaciones, especialmente artículos científicos con mayor liderazgo y colaboración en los últimos años, de citas y predominio en bases de datos internacionales, fueron muestra de productividad, visibilidad e impacto de la actividad científica(AU)

Introduction: The master's degree in Atherosclerosis Research is an academic proposal to raise the quality of health training based on research methods and atherosclerosis. To assess the impact of scientific training will show the cause-effect relationship between improvement action and performance behavior. There are measurement criteria that serve to this purpose. This work used the publication of scientific articles. Objective: To assess the impact of the master's degree through the effect produced on the research performance of graduates, through their publications in scientific journals. Methods: A descriptive and retrospective bibliometric study was carried out, searching, in Google Scholar, for publications by students from three editions. The assessed research performance criterion was the number of published articles. Publications of scientific articles were measured in terms of quantity, quality and length, in two stages; they were compared to measure impact. Results: Original articles and bibliographic reviews increased significantly in the second stage. More productive and more cited leading graduates were identified; more articles were published in group I journals. The keywords were related to atherosclerosis; different types of collaboration were found. Conclusions: The increase in publications, especially scientific articles with higher leadership and collaboration in recent years, as well as in citations and the predominance of representativeness in international databases, evidenced productivity, visibility and impact of the scientific activity(AU)

Relationship between the Synthesis Method and the Magnetoelectric Properties of Bismuth Sodium-Potassium Titanate/Nickel Cobalt Ferrite Lead-Free Composites.

In this work, the influence of the synthesis methods of piezoelectric and magnetostrictive phases on the final properties of the Bi0.5(Na0.8K0.2)0.5TiO3-Ni0.5Co0.5Fe2O4 composites was studied. Different routes were used to individually synthesize each phase, and the composites were prepared using different fractions for each phase. Composites were sintered, and the structural, microstructural, dielectric, and magnetoelectric properties were evaluated. According to the selected synthesis method employed for each phase, different particle sizes and reactivities of the individual phases were obtained. These differences determined the suitable sintering temperature for each set of composites and were responsible for the final properties. In fact, magnetoelectric properties were modulated by the combination of composition and synthesis routes.

Sourdough Biotechnology Applied to Gluten-Free Baked Goods: Rescuing the Tradition.

Recent studies suggest that the beneficial properties provided by sourdough fermentation may be translated to the development of new GF products that could improve their technological and nutritional properties. The main objective of this manuscript is to review the current evidence regarding the elaboration of GF baked goods, and to present the latest knowledge about the so-called sourdough biotechnology. A bibliographic search of articles published in the last 12 years has been carried out. It is common to use additives, such as hydrocolloids, proteins, enzymes, and emulsifiers, to technologically improve GF products. Sourdough is a mixture of flour and water fermented by an ecosystem of lactic acid bacteria (LAB) and yeasts that provide technological and nutritional improvements to the bakery products. LAB-synthesized biopolymers can mimic gluten molecules. Sourdough biotechnology is an ecological and cost-effective technology with great potential in the field of GF products. Further research is necessary to optimize the process and select species of microorganisms robust enough to be competitive in any circumstance.

"Be Careful What You Swallow": A Case Series of Swallow Syncope.

Swallow (deglutition) syncope is a rare form of neurally mediated cardioinhibitory reflex syncope occurring during swallowing. Patients may present to clinicians across multiple disciplines, so high awareness and careful evaluation are essential. We report 3 such individuals, describing our strategies in diagnosis, investigation and treatment, particularly focusing on conservative management. (Level of Difficulty: Intermediate.).

Low dietary inclusion of nutraceuticals from microalgae improves feed efficiency and modifies intermediary metabolisms in gilthead sea bream (Sparus aurata).

The aim of this work was to evaluate two functional feeds for the gilthead seabream, Sparus aurata, containing low inclusion of two microalgae-based products (LB-GREENboost, LBGb; and LB-GUThealth, LBGh). Fish (12-13 g) were fed for 13 weeks a control diet or one of the four diets supplemented with both products at 0.5% or 1%. LBGb and LBGh did not affect specific growth rate or survival, but increased feed efficiency by decreasing feed intake and enlarging the intestines. LBGb increased hepatosomatic index and reduced cortisol levels in plasma, while both products lowered plasma lactate. Extensive metabolite and metabolic enzyme profiling revealed that microalgae supplementations, especially 1% LBGh: (i) decrease plasma lactate and increase hepatic glycogen, (ii) reduce hepatic gluconeogenesis, (iii) enhance hepatic lipogenic activity and lipid secretion, (iv) led fish to double triglyceride content in muscle and to stimulate its lipid oxidative capacity, and (v) increase the content of monounsaturated fatty acids and the omega-3 alpha-linolenic acid in muscle. This study demonstrates that both microalgae-based products are suited to improve feed efficiency and orchestrate significant changes in the intermediary metabolism in gilthead seabream juveniles.

A retrospective cohort study to assess PET-CT findings and clinical outcomes in Takayasu arteritis: does 18F-fluorodeoxyglucose uptake in arteries predict relapses?

The objective of this study is to investigate the use of PET-CT scan with 18F-fluorodeoxyglucose (18F-FDG) as a method to predict outcomes in patients with Takayasu arteritis (TAK), as well as to analyze associations between 18F-FDG PET-CT findings with disease relapses, sustained remission, new angiographic lesions, ischemic events, and changes in therapy for TAK. At baseline assessment, 36 TAK patients underwent 18F-FDG PET-CT scan and maximal standardized uptake value (SUVmax) in arteries ≥ 1.3 was predictive for clinical disease activity. Thirty-two TAK patients were then followed-up for a median 83.5 months. Twenty-three (71.9%) patients developed clinical relapses and new arterial lesions were observed in 14 (43.8%) cases. Disease relapses [85.0% vs. 50.0%, p = 0.049; odds ratio (OR): 5.667; 95% confidence interval (95 CI): 1.067-30.085] and the need for changing immunosuppressive therapy (85.0% vs. 41.7%, p = 0.018; OR: 7.933; 95CI: 1.478-42.581) were more frequently found in patients with SUVmax ≥ 1.3 at baseline compared with those presenting SUVmax < 1.3. No associations were found between SUVmax ≥ or < 1.3 in large arteries at baseline and the development of ischemic events, sustained remission or new angiographic lesions. In multivariate analysis, associations between baseline SUVmax ≥ 1.3 and disease relapses were not independent (hazard ratio: 1.07; 95 CI 0.39-2.92; p = 0.892). In conclusion, arterial SUVmax is marginally associated with disease relapses and with the need to change therapy in TAK. 18F-FDG uptake in large arteries is not associated with the development of new arterial lesions in TAK.

Plasma 1α-Hydroxycorticosterone as Biomarker for Acute Stress in Catsharks (Scyliorhinus canicula).

Glucocorticoids are pleiotropic steroid hormones mediating redistribution of energy. They induce breakdown of glycogen stores and consequent plasma hyperglycaemia after stressful situations. Glucocorticoid actions in most vertebrate species are exerted by cortisol and corticosterone. However, 1α-hydroxycorticosterone is the dominant corticosteroid hormone in elasmobranchs, though its effects as a glucocorticoid are unknown. Here we demonstrate, by using ultra-performance liquid chromatography coupled to tandem mass spectrometry for the quantification of 1α-hydroxycorticosterone in plasma of the elasmobranch Scyliorhinus canicula, the response of this hormone to an acute-stress situation and for the first time its glucocorticoid action in elasmobranchs. After an acute air-exposure challenge, S. canicula increased plasma levels of 1α-hydroxycorticosterone altogether with enhanced glycolysis and gluconeogenesis pathways to fuel energy demanding tissues, such as white muscle, during the first hours after the stress situation. We foresee our study as a starting point to evaluate stress responses in elasmobranchs, as well as for future applications in the management of these key ecosystem species.

Transport and Recovery of Gilthead Seabream (Sparus aurata L.) Sedated With Clove Oil and MS-222: Effects on Stress Axis Regulation and Intermediary Metabolism.

Transport processes between aquaculture facilities activate the stress response in fish. To deal with these situations, the hypothalamic-pituitary-interrenal (HPI) axis releases cortisol, leading to an increase in circulating energy resources to restore homeostasis. However, if the allostatic load generated exceeds fish tolerance limits, stress-related responses will compromise health and welfare of the animals. In this context, anesthetics have arisen as potential agents aiming to reduce negative effects of stress response. Here we assessed the effects of a sedative dose of clove oil (CO) and MS-222 on hallmarks involved in HPI axis regulation and energy management after simulated transport, and further recovery, in gilthead seabream (Sparus aurata L.) juveniles. Fish were placed in a mobile setup of water tanks where transport conditions were simulated for 6 h. Sedation doses of either CO (2.5 mg L-1) or MS-222 (5 mg L-1) were added in the water tanks. A control group without anesthetics was also included in the setup. Half of the animals (n = 12 per group) were sampled immediately after transport, while remaining animals were allowed to recover for 18 h in clean water tanks and then sampled. Our results showed that the HPI axis response was modified at peripheral level, with differences depending on the anesthetic employed. Head kidney gene-expressions related to cortisol production (star and cyp11b1) matched concomitantly with increased plasma cortisol levels immediately after transport in CO-sedated fish, but these levels remained constant in MS-222-sedated fish. Differential changes in the energy management of carbohydrates, lipids and amino acids, depending on the anesthetic employed, were also observed. The use of CO stimulated amino acids catabolism, while MS-222-sedated fish tended to consume liver glycogen and mobilize triglycerides. Further studies, including alternative doses of both anestethics, as well as the assessment of time-course HPI activation and longer recovery periods, are necessary to better understand if the use of clove oil and MS-222 is beneficial for S. aurata under these circumstances.

Effects of Albumin Treatment on Systemic and Portal Hemodynamics and Systemic Inflammation in Patients With Decompensated Cirrhosis.

BACKGROUND & AIMS: We investigated the effect of albumin treatment (20% solution) on hypoalbuminemia, cardiocirculatory dysfunction, portal hypertension, and systemic inflammation in patients with decompensated cirrhosis with and without bacterial infections. METHODS: We performed a prospective study to assess the effects of long-term (12 weeks) treatment with low doses (1 g/kg body weight every 2 weeks) and high doses (1.5 g/kg every week) of albumin on serum albumin, plasma renin, cardiocirculatory function, portal pressure, and plasma levels of cytokines, collecting data from 18 patients without bacterial infections (the Pilot-PRECIOSA study). We also assessed the effect of short-term (1 week) treatment with antibiotics alone vs the combination of albumin plus antibiotics (1.5 g/kg on day 1 and 1 g/kg on day 3) on plasma levels of cytokines in biobanked samples from 78 patients with bacterial infections included in a randomized controlled trial (INFECIR-2 study). RESULTS: Circulatory dysfunction and systemic inflammation were extremely unstable in many patients included in the Pilot-PRECIOSA study; these patients had intense and reversible peaks in plasma levels of renin and interleukin 6. Long-term high-dose albumin, but not low-dose albumin, was associated with normalization of serum level of albumin, improved stability of the circulation and left ventricular function, and reduced plasma levels of cytokines (interleukin 6, granulocyte colony-stimulating factor, interleukin 1 receptor antagonist, and vascular endothelial growth factor) without significant changes in portal pressure. The immune-modulatory effects of albumin observed in the Pilot-PRECIOSA study were confirmed in the INFECIR-2 study. In this study, patients given albumin had significant reductions in plasma levels of cytokines. CONCLUSIONS: In an analysis of data from 2 trials (Pilot-PRECIOSA study and INFECIR-2 study), we found that albumin treatment reduced systemic inflammation and cardiocirculatory dysfunction in patients with decompensated cirrhosis. These effects might be responsible for the beneficial effects of albumin therapy on outcomes of patients with decompensated cirrhosis. ClinicalTrials.gov, Numbers: NCT00968695 and NCT03451292.

Regulation of the phosphate metabolism in Streptomyces genus: impact on the secondary metabolites.

The analysis of the inorganic phosphate effect over the antibiotics production is a long-distance history in the Streptomyces genus, which began almost at the same time that Michael Ende published his book entitled The Neverending Story. In some way, the unveiling of the pho regulon and its influence over the secondary metabolites production is an unfinished story, which keeps this subject as a trending topic, nowadays. Up to date, different studies have been releasing knowledge about particular areas of the pho regulon of different Streptomyces species. Nevertheless, for the first time, these knowledge drops are grouped in a review presenting a broad overview of the phosphate regulation and its impact over the secondary metabolites production in industrially relevant species. Even though the genetic response against phosphate scarcity is similar, as a whole, in different Streptomyces species, the fine-tuning is species-specific. Thus, the response regulator PhoP directly controls the secondary metabolites production in some species, whereas it regulates them in an indirect manner in other species. This information, unraveled in this review, is the result of the intensive analysis along last decade in several species of the genus that is allowing to distinguish how the phosphate response is unleashed in Streptomyces coelicolor, Streptomyces lividans, Streptomyces natalensis, Streptomyces lydicus, Streptomyces avermitilis, and Streptomyces tsukubaensis.

3,4-Dihydroisocoumarins, Interesting Natural Products: Isolation, Organic Syntheses and Biological Activities.

BACKGROUND: 3,4-dihydroisocoumarins are an important small group belonging to the class of naturally occurring lactones isolated from different bacterial strains, molds, lichens, and plants. The structures of these natural compounds show various types of substitution in their basic skeleton and this variability influences deeply their biological activities. These lactones are structural subunits of several natural products and serve as useful intermediates in the synthesis of different heterocyclic molecules, which exhibit a wide range of biological activities, such as anti-inflammatory, antiplasmodial, antifungal, antimicrobial, antiangiogenic and antitumoral activities, among others. Their syntheses have attracted attention of many researchers reporting many synthetic strategies to achieve 3,4-dihydroisocoumarins and other related structures. OBJECTIVE: In this context, the isolation of these natural compounds from different sources, their syntheses and biological activities are reviewed, adding the most recent advances and related developments. CONCLUSION: This review aims to encourage further work on the isolation and synthesis of this class of natural products. It would be beneficial for synthetic as well as the medicinal chemists to design selective, optimized dihydroisocoumarin derivatives as potential drug candidates, since dihydroisocoumarin scaffolds have significant utility in the development of therapeutically relevant and biologically active compounds.

A multiple hypothesis approach to explain species richness patterns in neotropical stream-dweller fish communities.

Several hypotheses are used to explain species richness patterns. Some of them (e.g. species-area, species-energy, environment-energy, water-energy, terrestrial primary productivity, environmental spatial heterogeneity, and climatic heterogeneity) are known to explain species richness patterns of terrestrial organisms, especially when they are combined. For aquatic organisms, however, it is unclear if these hypotheses can be useful to explain for these purposes. Therefore, we used a selection model approach to assess the predictive capacity of such hypotheses, and to determine which of them (combined or not) would be the most appropriate to explain the fish species distribution in small Brazilian streams. We perform the Akaike's information criteria for models selections and the eigenvector analysis to control the special autocorrelation. The spatial structure was equal to 0.453, Moran's I, and require 11 spatial filters. All models were significant and had adjustments ranging from 0.370 to 0.416 with strong spatial component (ranging from 0.226 to 0.369) and low adjustments for environmental data (ranging from 0.001 to 0.119) We obtained two groups of hypothesis are able to explain the richness pattern (1) water-energy, temporal productivity-heterogeneity (AIC = 4498.800) and (2) water-energy, temporal productivity-heterogeneity and area (AIC = 4500.400). We conclude that the fish richness patterns in small Brazilian streams are better explained by a combination of Water-Energy + Productivity + Temporal Heterogeneity hypotheses and not by just one.

Analysis and validation of the pho regulon in the tacrolimus-producer strain Streptomyces tsukubaensis: differences with the model organism Streptomyces coelicolor.

Inorganic and organic phosphate controls both primary and secondary metabolism in Streptomyces genus. Metabolism regulation by phosphate in Streptomyces species is mediated by the PhoR-PhoP two-component system. Response regulator PhoP binds to conserved sequences of 11 nucleotides called direct repeat units (DRus), whose organization and conservation determine the binding of PhoP to distinct promoters. Streptomyces tsukubaensis is the industrial producer of the clinical immunosuppressant tacrolimus (FK506). A bioinformatic genome analysis detected several genes with conserved PHO boxes involved in phosphate scavenging and transport, nitrogen regulation, and secondary metabolite production. In this article, the PhoP regulation has been confirmed by electrophoretic mobility shift assays (EMSA) of the most relevant members of the traditional pho regulon such as the two-component system PhoR-P or genes involved in high-affinity phosphate transport (pstSCAB) and low-affinity phosphate transport (pit). However, the PhoP control over phosphatase genes in S. tsukubaensis is significantly different from the pattern reported in the model bacteria Streptomyces coelicolor. Thus, neither the alkaline phosphatase PhoA nor PhoD is regulated by PhoP. On the contrary, the binding of PhoP to the promoter of a novel putative phosphatase PhoX was confirmed. A crosstalk of the PhoP and GlnR regulators, which balances phosphate and nitrogen utilization, also occurs in S. tsukubaensis but slightly modified. Finally, PhoP regulates genes, like afsS, that link phosphate control and secondary metabolite production in S. tsukubaensis. In summary, there are notable differences between the regulation of specific genes of the pho regulon in S. tsukubaensis and the model organism S. coelicolor.

Clinical course and short-term mortality of cirrhotic patients with infections other than spontaneous bacterial peritonitis.

BACKGROUND & AIMS: Clinical course and risk factors of death in non-spontaneous bacterial peritonitis (SBP) infections are poorly known. We assessed the prevalence of acute kidney injury (AKI) and type-1 hepatorenal syndrome (HRS), hospital, 30-day and 90-day mortality and risk factors of death in 441 decompensated patients. METHODS: Analysis of 615 non-SBP infections (161 urinary infections (UTI), 95 cellulitis, 92 suspected infections, 92 bacteraemias, 84 pneumonias, 21 bronchitis, 18 cholangitis, 15 spontaneous empyema, 13 secondary peritonitis, 24 other). RESULTS: Ninety-six percent of infections solved. AKI and type-1 HRS were developed in 37% and 9% of infections respectively. Overall hospital, 30-day and 90-day mortality rates were 11%, 12% and 18% respectively. Clinical course and mortality differed markedly across infections. Endocarditis, osteoarticular infections, pneumonia, spontaneous bacteraemia, cholangitis, secondary peritonitis and UTI showed higher rates of AKI. Prevalence of type-1 HRS was not significantly different among infections. Endocarditis, secondary peritonitis, pneumonia and bacteraemia showed lower rates of renal impairment resolution and higher hospital mortality associated with AKI (42% vs 12%, P<.0001) or type-1 HRS (71% vs 27%, P=.003) than the rest of infections. Age (HR: 1.04), serum sodium (HR: 0.91), serum bilirubin (HR: 1.06), INR (HR: 1.91), hepatic encephalopathy (HR: 2.44), ascites (HR: 3.06) and multidrug-resistant isolation (HR: 2.27) at infection diagnosis were independent predictors of death during hospitalization. CONCLUSIONS: Non-SBP infections constitute a heterogeneous group regarding clinical course and prognosis. Endocarditis, secondary peritonitis, pneumonia and bacteraemia show worse prognosis. The combination of data of liver and renal dysfunction and of the type of infection allows the identification of patients with poor prognosis.

Angiotensin II and ischemic preconditioning synergize to improve mitochondrial function while showing additive effects on ventricular postischemic recovery.

Recent studies indicate that the cardioprotective effects of ischemic preconditioning (IPC) against sustained ischemia/reperfusion can be replicated by angiotensin II (Ang II). However, it is not clear whether IPC and Ang II-induced preconditioning (APC) act through similar mechanisms or synergize to enhance cardioprotection. In this study, Langendorff-perfused rat hearts were subjected to IPC, APC, or their combination (IPC/APC) followed by ischemia/reperfusion. IPC, and less potently APC, significantly increased the percent recoveries of the left ventricular developed pressure, the first derivative of developed pressure, and the rate pressure product compared with control. Furthermore, the postischemic recovery of the heart was significantly higher for IPC/APC compared with IPC or APC. The improvements in cardiac function by IPC, APC, and IPC/APC were associated with similar reductions in lactate dehydrogenase release and infarct size. However, a significant improvement in mitochondrial respiration was observed with IPC/APC. The postischemic recovery observed with APC and IPC/APC was inhibited by treatment with losartan, an Ang II type-1 receptor blocker, during the preconditioning phase but not by chelerythrine, a pan-PKC inhibitor. Both drugs, however, abolished the enhanced mitochondrial respiration by IPC/APC. Altogether, these results indicate that APC and IPC interact through mechanisms that enhance cardioprotection by affecting cardiac function and mitochondrial respiration.

Trends in the biosynthesis and production of the immunosuppressant tacrolimus (FK506).

The current off-patent state of tacrolimus (FK506) has opened the hunting season for new generic pharmaceutical formulations of this immunosuppressant. This fact has boosted the scientific and industrial research on tacrolimus for the last 5 years in order to improve its production. The fast discovery of tacrolimus producer strains has generated a huge number of producers, which presents the biosynthetic cluster of FK506 as a high promiscuous genetic region. For the first time, the current state-of-the-art on the tacrolimus biosynthesis, production improvements and drug purification is reviewed. On one hand, all the genes involved in the tacrolimus biosynthesis, in addition to the traditional PKS/NRPS, as well as their regulation are analysed. On the other hand, tacrolimus direct and indirect precursors are reviewed as a straight manner to improve the final yield, which is a current trend in the field. Twenty years of industrial and scientific improvements on tacrolimus production are summarised, whereas future trends are also drafted.

Ressignificando-se como mulher na experiência do parto: experiência de participantes de movimentos sociais pela humanização do parto / Reframing herself as a woman in childbirth experience: experience of participants in social movements for the humanization of birth

Introdução: A medicalização do parto é uma transformação cultural que influenciou a capacidade de enfrentamento autônomo da experiência de parir. As redes e movimentos sociais pela humanização do parto são apontados como promotores da autonomia no exercício do direito à saúde, na medida em que possibilitam apoio mútuo, compartilhamento de experiências e mobilização coletiva das mulheres para reivindicarem seus direitos no parto. Objetivos: 1) Compreender o significado para a mulher de sua participação nos movimentos sociais pela humanização do parto, a trajetória de gestação e parto dessa mulher e como essa participação influencia sua experiência de gestação e parto; 2) Elaborar um modelo teórico explicativo da experiência de gestação e parto da mulher que participa de movimentos sociais pela humanização do parto. Método: Pesquisa qualitativa, conduzida pelo referencial teórico do Interacionismo Simbólico e referencial metodológico da Teoria Fundamentada nos Dados. O cenário do estudo foi constituído por grupos de usuárias do movimento pela humanização do parto, em Belo Horizonte (MG). Os sujeitos foram 15 mulheres e os dados foram obtidos por meio de observação participante, entrevistas intensivas e análise textual de relatos de parto. Resultados: Foram construídas as categorias Rompendo barreiras em busca de uma experiência de parto normal, Conquistando o protagonismo no processo do parto e Ressignificando a experiência vivida, que permitiram compreender a trajetória de gestação e parto da mulher que integra os movimentos sociais pela humanização do parto.A análise e o modo como estas categorias interagem possibilitaram identificar a categoria central Ressignificando-se como mulher na experiência do parto. O modelo teórico explicita o movimento da mulher de ressignificar-se na experiência do parto, participando de uma engrenagem capaz de ressignificar culturalmente o parto, na medida em que cada mulher compartilha sua experiência e convida outras mulheres para participarem dos movimentos sociais pela humanização do parto. Deste modo, contribui para uma ressignificação cultural do parto como experiência fortalecedora para a mulher e com significado de superação e prazer. Ao ressignificar-se como mulher, ela se considera uma pessoa mais forte, capaz de cuidar de si e dos filhos, capaz de tudo o que desejar e transformada por sua experiência de parto. Mesmo quando não consegue parir, considera que a mulher tem direito de viver o parto como um evento que fortalece sua feminilidade e deseja lutar por esse direito, para que outras mulheres se superem e experimentem o prazer de parir. Conclusão: De modo consensual, as mulheres que participam de movimentos sociais pela humanização do parto compartilham entre si o significado do parto como experiência de superação e prazer. Esse processo contínuo, ao longo do tempo, é capaz de modificar a estrutura social que sustenta o significado do parto como sofrimento e risco e de ressignificar culturalmente o parto, sendo de grande relevância para países como o Brasil, com elevadas taxas de intervenções no parto, em especial, de cesarianas desnecessárias e indesejadas.

Introduction: The medicalization of childbirth is a cultural change that has affected womens empowerment to face their childbirth experience. Social networks and consumer movements for childbirth humanization are seen as promoters of womens autonomy on health right performance as they provide mutual support, the sharing of experiences and social mobilization of women to claim their rights in childbirth. Aims: 1) To understand the meaning according to womans perspectives on her involvement in social movements for the humanization of childbirth, her pathway during pregnancy and childbirth and how her own participation in the social movement have influenced pregnancy and birth experiences; 2) To develop a theoretical model in order to explain the experience of pregnancy and childbirth of woman participating in social movements for the humanization of childbirth. Method: Qualitative research carried out using the theoretical framework of Symbolic Interactionism and the methodological framework of Grounded Theory. The study setting consisted of consumer health groups connected to the childbirth humanization movement in Belo Horizonte (MG), Brazil. Data were collected through participant observation of the social movements groups as well as intensive face to face interviews and textual birth reports with fifteen women. Results: Analysis of the data elicited a number of themes. These included "Breaking barriers searching for an experience of normal childbirth", "Conquering to place herself at the centre of her process of childbirth" and "Reframing the experience" which allowed us to understand the pregnancy and childbirth stories of the woman who engaged in the movement for the humanization of childbirth. Further analysis of the interaction of these categories identified a core category: "Reframing herself as a woman in the experience of childbirth".The theoretical model explains how woman reframed herself in the experience of childbirth as each woman shares her experience and invites other women to join the movement to humanize childbirth. The movement therefore contributed to a cultural redefinition of childbirth as an empowering experience for woman and a source of resilience and pleasure. By reframing herself as a woman she considered herself a stronger person, able to care for herself and her children, able to make whatever she wants, and transformed by her experience of childbirth. Even when she can't give birth, believes that women have a right to live childbirth as an event that strengthens their femininity and want to fight for this right, in order that other women might also experience the pleasure of giving birth. Conclusion: Women who participate in social movements for the humanization of childbirth share among themselves the meaning of the childbirth as an experience of overcoming and pleasure. Over time, this process is able to change the dominant notion of childbirth as suffering and risky and to culturally reframe childbirth. This process is of great relevance in countries like Brazil, with high rates of intervention in childbirth, specially, unnecessary and unwanted caesarean section.

Gestantes que participam da organização não governamental bem nascer: estudo descritivo / Mujeres embarazadas que participan de la organización no gubernamental bem nacer: estudio descriptivo / Pregnant women who participate of the non-government organization bem nascer: a descriptive study

Conhecer o perfil sócio-demográfico, a história obstétrica e a participação de gestantes nas atividades da Organização NãoGovernamental (ONG) Bem Nascer. Estudo descritivo com mulheres que participaram das atividades de janeiro a maio de2011. Dados coletados por meio de questionário aplicado nas rodas de conversa ou por e-mail. O perfilpredominante foi:média de idade de 32 anos; união estável ou casada;parda; ensino superior; renda familiar igual ou superior a quatrosalários mínimos; trabalho fora de casa; nulíparas;acesso ao setor suplementar de saúde; desejo de ter parto vaginal como mínimo de intervenções. A maioria conheceu a ONGatravés de amigos e da Internet. As razões para participar foram abusca de informações sobre parto normal e a troca de experiências. Este estudo corrobora achados de pesquisa quetambém estudou mulheres que procuram experiência departo natural, sem intervenção, fora do hospital.Apesar deretratar a realidade de um número pequeno de gestantes, sabe-se que o movimento social pelo parto humanizado vemcrescendo no país. Isto aponta para a possibilidadede mais mulheres procurarem seus direitos, a fim de viverem umaexperiência de parto normal com assistência humanizada.