Coping trajectories of intensive care nurses as second victims: A grounded theory.

A qualitative study that provides evidence of the institutional support required by intensive care unit (ICU) nurses as second victims of adverse events (AEs). BACKGROUND: The phenomenon of second victims of AE in healthcare professionals can seriously impact professional confidence and contribute to the ongoing occurrence of AEs in hospitals. OBJECTIVES: The objective of this study was to describe the coping trajectories of second victims among nurses working in ICUs in public hospitals in Chile. METHODS: Conducting qualitative research through the grounded theory method, this study focused on high-complexity hospitals in Chile, using theoretical sampling. The participants consisted of 11 nurses working in ICUs. Techniques used included in-depth interviews conducted between March and May 2023, as well as a focus group interview. Analysis, following the grounded theory approach proposed by Strauss and Corbin, involved constant comparison of data. Open, axial, and selective coding were applied until theoretical data saturation was achieved. The study adhered to reliability and authenticity criteria, incorporating a reflexive process throughout the research. Ethical approval was obtained from the ethics committee, and the study adhered to the consolidated criteria for reporting qualitative research. RESULTS: From the interviews, 29 codes were identified, forming six categories: perception of support when facing an AE, perception of helplessness when facing an AE, initiators of AE, responses when facing an AE, professional responsibility, and perception of AE. The perception of support when facing an AE emerged as the main category, determining whether the outcome was stagnation or overcoming of the phenomenon after the AE. CONCLUSIONS: For the coping process of ICU nurses following an AE, the most crucial factor is the support from colleagues and supervisors.

Overview of nursing ethics teaching in Brazilian public higher education institutions.

OBJECTIVES: to outline the teaching of ethics in undergraduate Nursing programs in Brazilian public higher education institutions. METHODS: descriptive and exploratory study, carried out through the documentary analysis of pedagogical projects of undergraduate Nursing programs in Brazil. RESULTS: 153 active undergraduate Nursing programs were found, of which 106 provide the pedagogical project. In addition to deontological teaching, the teaching of ethics was identified in a transversal way associated with themes such as Social Context, Hospital and Community Care, Pharmacology, Systematization of Nursing Care, Surgical Nursing, Epidemiology, Palliative Care, Management in Nursing, Diversity, Women's, Children's, Adolescent's, Adult's and Older People's Health, and Mental Health. FINAL CONSIDERATIONS: the challenge in teaching nursing ethics is its integration with each action of caring, teaching and managing.

Prevalence of the second victim phenomenon among intensive care unit nurses and the support provided by their organizations.

BACKGROUND: Health professionals can be 'second victims' of adverse patient events. Second victimhood involves a series of physical and psychological signs and symptoms of varying severity and is most prevalent among nurses and women and in intensive care units (ICUs). Previous research has described personal and organizational coping strategies. AIM: The objective of this research is to determine the prevalence of second victimhood, focusing on psychological distress, among Chilean adult intensive care nurses and its relationship with the support provided by their organizations. STUDY DESIGN: A descriptive, correlational and cross-sectional study was conducted in seven intensive care units of Chilean hospitals. RESULTS: Of a sample of 326 nurses, 90.18% reported having been involved in an adverse event and 67% reported psychological distress resulting from the adverse event. Embarrassment was the most prevalent psychological symptom (69%). Only 2.8% reported that their organization had an action plan for professionals in the event of a serious adverse event. Participants who had spent longer working in an ICU reported more support from their organization around adverse events. CONCLUSION: Two-thirds of Chilean adult intensive care unit nurses report psychological stress following an adverse event. These results should be assessed internationally because second victims have major implications for the well-being of health professionals and, therefore, for retention and the quality of care. RELEVANCE TO CLINICAL PRACTICE: Critical care leaders must actively promote a safe environment for learning from adverse events, and hospitals must establish a culture of quality that includes support programmes for second victims.

Prevalence and gender disparities of type 2 diabetes mellitus and obesity in Esmeraldas, Ecuador: a population-based survey in a hard-to-reach setting.

BACKGROUND: Type 2 Diabetes (T2DM) prevalence is increasing in low- and middle-income countries along with high levels of obesity which vary according to socioeconomic and contextual characteristics. We aim to estimate the prevalence of T2DM and obesity in men and women in a hard-to-reach rural area in northern Ecuador considering socio-demographic characteristics. METHODS: Cross-sectional descriptive study based on a population-based survey in the Eloy Alfaro health district of Esmeraldas between October 2020 and January 2022. We collected sociodemographic information and risk factors for non-communicable diseases with an adapted version of the STEPS survey, performed oral glucose tolerance tests, biochemistry and took physical measurements. We estimated the prevalence of T2DM, obesity, and calculated Odds Ratios (OR) with confidence intervals by logistic regression in Stata v.15. RESULTS: The overall prevalence of T2DM was 6.8% (CI95%: 4.9-8.7), markedly higher among women compared to men (10.4%, CI95% 7.3-13.4%, compared 2.0%, CI95% 0.4-3.7% respectively). The risk of having T2DM in women was 5 times higher than in men adjusting for age, ethnicity, employment, household earnings and obesity (OR: 5.03; 95%CI: 1.68-15.01). Regarding age, the risk of T2DM increased by 6% per year (adjusted OR: 1.06; 95%CI: 1.03-1.08). Obesity prevalence was 30.8% (CI95%: 27.3-34.3), in women was nearly three times higher than in men (43.2% CI95%: 38.2-48.2, compared to 14.7% prevalence, CI95%: 10.6-18.8). Indigenous women had a lower prevalence of obesity compared with the Afro-Ecuadorian women (OR: 0.05; 95%CI: 0.02-0.18) after adjusting for age, employment status, household earnings and setting. CONCLUSION: We found alarming differences between the prevalence of T2DM and obesity in women and men that may be explained by gender roles, exacerbated in the rural context. Health promotion measures with a gender perspective should be adapted according to the characteristics of isolated rural contexts.

Access to health services for chronic disease care during the COVID-19 pandemic in Ecuador: A qualitative analysis using a Social Determinants of Health approach.

This qualitative study aims to explore how the COVID-19 pandemic impacted healthcare access for patients with chronic conditions in Ecuador from the patient's perspective. We interviewed 19 patients diagnosed with arterial hypertension or type 2 diabetes in rural and urban areas of Ecuador during August and September 2020. We used the Framework Method to analyse the interview transcripts with ATLAS.Ti 8.4 and organised the ideas discussed using categories from the World Health Organization Commission on the Social Determinants of Health conceptual framework. Reorganization of health services during the pandemic meant that patients with arterial hypertension or diabetes could no longer attend face-to-face appointments for disease follow-up. System failures related to medication supply led to increased out-of-pocket payments, which, together with reduced or absent earnings, and in a context with limited social protection policies, meant that patients frequently went for prolonged periods without medication. Rural health initiatives, support from family and use of traditional medicine were reported as ways to manage their chronic condition during this time. Barriers to disease management disproportionately affected individuals with low socioeconomic positions. Stock shortages, lack of protective labour policies and limited reach of anticipatory policies for health emergencies likely worsened pre-existing health inequities in Ecuador.

Transcriptome Profiling of the Liver in Nellore Cattle Phenotypically Divergent for RFI in Two Genetic Groups.

The identification and selection of genetically superior animals for residual feed intake (RFI) could enhance productivity and minimize environmental impacts. The aim of this study was to use RNA-seq data to identify the differentially expressed genes (DEGs), known non-coding RNAs (ncRNAs), specific biomarkers and enriched biological processes associated with RFI of the liver in Nellore cattle in two genetic groups. In genetic group 1 (G1), 24 extreme RFI animals (12 low RFI (LRFI) versus 12 high RFI (HRFI)) were selected from a population of 60 Nellore bulls. The RNA-seq of the samples from their liver tissues was performed using an Illumina HiSeq 2000. In genetic group 2 (G2), 20 samples of liver tissue of Nellore bulls divergent for RFI (LRFI, n = 10 versus HRFI, n = 10) were selected from 83 animals. The raw data of the G2 were chosen from the ENA repository. A total of 1811 DEGs were found for the G1 and 2054 for the G2 (p-value ≤ 0.05). We detected 88 common genes in both genetic groups, of which 33 were involved in the immune response and in blocking oxidative stress. In addition, seven (B2M, ADSS, SNX2, TUBA4A, ARHGAP18, MECR, and ABCF3) possible gene biomarkers were identified through a receiver operating characteristic analysis (ROC) considering an AUC > 0.70. The B2M gene was overexpressed in the LRFI group. This gene regulates the lipid metabolism protein turnover and inhibits cell death. We also found non-coding RNAs in both groups. MIR25 was up-regulated and SNORD16 was down-regulated in the LRFI for G1. For G2, up-regulated RNase_MRP and SCARNA10 were found. We highlight MIR25 as being able to act by blocking cytotoxicity and oxidative stress and RMRP as a blocker of mitochondrial damage. The biological pathways associated with RFI of the liver in Nellore cattle in the two genetic groups were for energy metabolism, protein turnover, redox homeostasis and the immune response. The common transcripts, biomarkers and metabolic pathways found in the two genetic groups make this unprecedented work even more relevant, since the results are valid for different herds raised in different ways. The results reinforce the biological importance of these known processes but also reveal new insights into the complexity of the liver tissue transcriptome of Nellore cattle.

Construção e validação de Quiz para avaliação de conhecimento cognitivo sobre febre maculosa / Creation and validation of a quiz to assess cognitive knowledge about spotted fever / Construcción y validación de un cuestionario para evaluar los conocimientos cognitivos sobre la fiebre maculosa

Objetivo: construir e validar um Quiz de avaliação cognitiva sobre Febre Maculosa, voltado para avaliar o conhecimento de estudantes que moram e/ou frequentam cidades de risco para a doença. Métodos: estudo metodológico desenvolvido em três etapas: construção do Quiz; validação de aparência e conteúdo com nove juízes, com análise realizada através do cálculo de Índice de Validade de Conteúdo, com valor de corte 0,80; e validação semântica, seguindo a metodologia DISABKIDS® com 12 alunos de cursos técnicos profissionalizantes, com avaliação dos dados realizada por estatística descritiva, tendo sido utilizado o programa Statistical Package for the Social Sciences. Resultados: o processo de validação foi subdividido em duas etapas: validação de aparência e conteúdo por profissionais das áreas de biologia e educação e validação semântica por alunos de cursos profissionalizantes. O Quiz foi elaborado e aplicado e os resultados mostraram um índice de validade de conteúdo superior a 0,80 para todas as variáveis analisadas. Na validação semântica, o Quiz foi considerado como de fácil compreensão e não houve dificuldade para o preenchimento. Conclusão: o Quiz construído foi validado quanto à aparência, ao conteúdo e à semântica, tendo alcançado concordância satisfatória, o que garante ser um instrumento adequado para o processo de avaliação sobre a temática investigada. Com isso, espera-se contribuir para a difusão de conhecimento acerca da identificação dos fatores de risco e da prevenção da saúde relacionados à Febre Maculosa.(AU)

Objective: to create and validate a cognitive assessment Quiz about Spotted Fever, targeted at evaluating what students living in and/or traveling to risk cities know about the disease. Methods: a methodological study developed in three stages: creation of the Quiz; face and content validation with nine judges, with analysis performed by calculating the Content Validity Index, with a cutoff value of 0.80; and semantic validation, following the DISABKIDS®methodology with 12 students from professional technical courses, with data evaluation performed by means of descriptive statistics, using the Statistical Package for the Social Sciences program. Results: the validation process was subdivided into two stages: face and content validation by professionals in the Biology and Education areas, and semantic validation by students attending professional courses. The Quiz was prepared and applied and the results showed a Content Validity Index above 0.80 for all the variables analyzed. In the semantic validation, the Quiz was considered as easy to understand and there were no difficulties filling it in. Conclusion: the Quiz created was validated in terms of face, content and semantics, having achieved satisfactory agreement, which guarantees that it is an adequate instrument for the evaluation process on the theme investigated. With this, the expectation is to contribute to disseminating knowledge about the identification of risk and health prevention factors related to Spotted fever.(AU)

Objetivo: construir y validar un Cuestionario de evaluación cognitiva sobre la Fiebre Maculo-sa, destinado a evaluar los conocimientos de los estudiantes que viven y/o asisten a ciudades con riesgo para la enfermedad. Métodos: estudio metodológico desarrollado en tres etapas: construcción del Cuestionario; validación de apariencia y contenido con nueve jueces con aná-lisis realizado mediante el cálculo del Índice de Validez de Contenido, con un valor de corte de 0.80 y validación semántica, siguiendo la metodología DISABKIDS® con 12 estudiantes de carreras técnicas profesionales, con evaluación de datos realizada mediante estadística des-criptiva, donde se utilizó el programa Statistical Package for the Social Sciences. Resultados: el proceso de validación se subdividió en dos etapas: validación de apariencia y contenido por profesionales de las áreas de biología y educación, y validación semántica por estudiantes de carreras profesionales. El Cuestionario fue diseñado y aplicado. Los resultados mostraron un índice de validez de contenido superior a 0,8 para todas las variables analizadas...(AU)

Overview of nursing ethics teaching in Brazilian public higher education institutions / Panorama de la enseñanza de ética en enfermería en las instituciones públicas de enseñanza superior de Brasil / Panorama do ensino de ética em enfermagem nas instituições públicas de ensino superior do Brasil

ABSTRACT Objectives: to outline the teaching of ethics in undergraduate Nursing programs in Brazilian public higher education institutions. Methods: descriptive and exploratory study, carried out through the documentary analysis of pedagogical projects of undergraduate Nursing programs in Brazil. Results: 153 active undergraduate Nursing programs were found, of which 106 provide the pedagogical project. In addition to deontological teaching, the teaching of ethics was identified in a transversal way associated with themes such as Social Context, Hospital and Community Care, Pharmacology, Systematization of Nursing Care, Surgical Nursing, Epidemiology, Palliative Care, Management in Nursing, Diversity, Women's, Children's, Adolescent's, Adult's and Older People's Health, and Mental Health. Final Considerations: the challenge in teaching nursing ethics is its integration with each action of caring, teaching and managing.

RESUMEN Objetivos: trazar el panorama de la enseñanza de la ética en los cursos de graduación en Enfermería en las instituciones públicas de enseñanza superior brasileñas. Métodos: estudio descriptivo y exploratorio, realizado por medio del análisis documental de proyectos pedagógicos de cursos de graduación en Enfermería en Brasil. Resultados: han sido encontrados 153 cursos activos de graduación en Enfermería, de los cuales 106 tienen disponible el proyecto pedagógico. Además de la enseñanza deóntica, fue identificado la enseñanza de ética de forma transversal relacionada a temas como Contexto Social, Atención Hospitalaria y Comunitaria, Farmacología, Sistematización de la Asistencia en Enfermería, Enfermería Quirúrgica, Epidemiología, Cuidados Paliativos, Gestión en Enfermería, Diversidad, Salud de la Mujer, Niño, Adolescente, Adulto y Anciano y Salud Mental. Consideraciones Finales: el desafío en la enseñanza de la ética en enfermería y su integración con cada acción de cuidar, enseñar y administrar.

RESUMO Objetivos: traçar o panorama do ensino da ética nos cursos de graduação em Enfermagem nas instituições públicas de ensino superior brasileiras. Métodos: estudo descritivo e exploratório, realizado por meio da análise documental de projetos pedagógicos de cursos de graduação em Enfermagem no Brasil. Resultados: foram encontrados 153 cursos ativos de graduação em Enfermagem, dos quais 106 disponibilizam o projeto pedagógico. Além do ensino deontológico, foi identificado o ensino de ética de forma transversal associada a temas como Contexto Social, Atenção Hospitalar e Comunitária, Farmacologia, Sistematização da Assistência em Enfermagem, Enfermagem Cirúrgica, Epidemiologia, Cuidados Paliativos, Gestão em Enfermagem, Diversidade, Saúde da Mulher, Criança, Adolescente, Adulto e Idoso e Saúde Mental. Considerações Finais: o desafio no ensino da ética em enfermagem é sua integração com cada ação de cuidar, ensinar e gerenciar.

Comparison between epidural technique and mid-axillary ultrasound-guided TAP block for postoperative analgesia of laparoscopic radical prostatectomy: a quasi-randomized clinical trial.

BACKGROUND: Our goal was to evaluate whether TAP block offers the same analgesic pain control compared to epidural technique in laparoscopic radical prostatectomy surgery through the morphine consumption in the first 48 hours. METHODS: In this study, 45 patients were recruited and assigned to either TAP or epidural. The main study outcome was morphine consumption during the first 48 hours after surgery. Other data recorded were pain at rest and upon movement, technique-related complications and adverse effects, surgical and postoperative complications, length of surgery, need for rescue analgesia, postoperative nausea and vomiting, start of intake, sitting and perambulation, first flatus, and length of in-hospital stay. RESULTS: From a total of 45 patients, two were excluded due to reconversion to open surgery (TAP group = 20; epidural group = 23). There were no differences in morphine consumption (0.96 vs. 0.8 mg; p = 0.78); mean postoperative VAS pain scores at rest (0.7 vs. 0.5; p = 0.72); or upon movement (1.6 vs. 1.6; p = 0.32); in the TAP vs. epidural group, respectively. Sitting and perambulation began sooner in TAP group (19 vs. 22 hours, p = 0.03; 23 vs. 32 hours, p = 0.01; respectively). The epidural group had more technique-related adverse effects. CONCLUSION: TAP blocks provide the same analgesic quality with optimal pain control than epidural technique, with less adverse effects.

Multi-Year Mass-Trapping With Autocidal Gravid Ovitraps has Limited Influence on Insecticide Susceptibility in Aedes aegypti (Diptera: Culicidae) From Puerto Rico.

Mass-trapping has been used to control outbreaks of Aedes aegypti (Linnaeus) (Diptera: Culicidae) in Puerto Rico since 2011. We investigated the effect of multi-year, insecticide-free mass trapping had on the insecticide susceptibility profile of Ae. aegypti. Eggs collected in southern Puerto Rico were used to generate F1 populations that were tested for susceptibility to permethrin, sumethrin, bifenthrin, deltamethrin, and malathion according to CDC bottle bioassays protocols. All populations of Ae. aegypti were resistant to the synthetic pyrethroids and mosquitoes from two locations were partially resistant to malathion. Population genetic analysis, using a double digest restriction sites associated DNA sequencing (ddRADseq) approach, indicated a large amount of migration between study sites effectively homogenizing the mosquito populations. Mass-trapping using noninsecticidal autocidal gravid ovitraps did not restore susceptibility to five active ingredients that are found in commercial insecticides. Migration between communities was high and would have brought outside alleles, including resistant alleles to the treatment communities. Further investigation suggests that household use of commercially available insecticide products may continue to select for resistance in absence of public health space spraying of insecticides.

Coping strategies in health care providers as second victims: A systematic review.

AIM: To analyze personal and organizational strategies described in the literature for dealing with the second victim phenomenon among healthcare providers. BACKGROUND: The second victim phenomenon involves many associated signs and symptoms, which can be physical, psychological, emotional, or behavioral. Personal and organizational strategies have been developed to deal with this phenomenon. MATERIALS AND METHODS: A systematic review was carried out in PubMed, Cochrane Library, Web of Science, Scopus, PsycINFO, Science Direct, and Cumulative Index to Nursing and Allied Health Literature databases, searching for evidence published between 2010 and 2019 in Spanish, English, German, and Portuguese. RESULTS: Seven hundred and eighty-three articles were identified. After eliminating duplicates, applying inclusion and exclusion criteria and critical analysis tools of the Joanna Briggs Institute, 16 research articles were included: 10 quantitative studies (design: descriptive, correlational, systematic, or integrative review) and six qualitative studies (descriptive, systematic review). There are several different personal and organizational strategies for dealing with the second victim phenomenon. Among these, peer support and learning from adverse events are highly valued. In personal strategies stands out the internal analysis of the adverse event that the professional performs to deal with the generated negative feelings. In organizational strategies, the most valued are second victim support programs with rapid response teams and made up of peers. CONCLUSIONS: The main organizational coping strategies for tackling this phenomenon are online programs in countries such as the United States, Spain, and other European countries. Formal evaluation of these programs and research is required in Latin America. IMPLICATIONS FOR NURSING AND HEALTH POLICIES: Adequately coping with the second victim phenomenon allows health professionals and organizations to learn from adverse events. Furthermore, by supporting health professionals who suffer from the second victim phenomenon, the organization takes care of its most valuable resource, its human capital. This contributes toward building a culture of healthcare quality in organizations, which will reduce adverse events in the future.

Contextualizing Evidence for Action on Diabetes in Low-Resource Settings-Project CEAD Part-II, Strengthening the Health System: A Mixed-Methods Study Protocol.

Diabetes is a major public health problem, increasingly affecting low- and middle-income countries. The project CEAD (Contextualizing Evidence for Action in Diabetes in low-resource settings) aims to evaluate the implementation of comprehensive diabetes care in two low-resource settings in Ecuador and to stimulate context-led health systems innovations to improve diabetes care and reduce inequity. The mixed-methods approach includes a 24-month retrospective study to assess the current level of implementation of comprehensive diabetes care and participants will be followed up prospectively for two years to assess changes in healthcare and clinical outcomes from the outset of the research. We will include individuals diagnosed with type-2 diabetes aged over 18 years, who are accessing diabetes care in health facilities in the study districts. Varied stakeholders (patients and family members, community members, healthcare workers and decision-makers) will interpret the underlying causes of the observed weaknesses and propose solutions to strengthen diabetes-related healthcare in focus group discussions (FG). A second set of FG will analyze perceived improvements in healthcare based on prospective cohort findings and consider the success/failure of any context-led innovations occurring throughout the research. Our study will demonstrate how evidence can be contextualized to stimulate local innovations and overcome weaknesses of diabetes-related healthcare in low resource settings.

Incorporation of Poly(Itaconic Acid) with Quaternized Thiazole Groups on Gelatin-Based Films for Antimicrobial-Active Food Packaging.

Poly(itaconic acid) (PIA) was synthesized via conventional radical polymerization. Then, functionalization of PIA was carried out by an esterification reaction with the heterocyclic groups of 1,3-thiazole and posterior quaternization by N-alkylation reaction with iodomethane. The modifications were confirmed by Fourier transform infrared (FTIR) and proton nuclear magnetic resonance (1H-NMR), as well as ζ-potential measurements. Their antimicrobial activity was tested against different Gram-negative and Gram-positive bacteria. After characterization, the resulting polymers were incorporated into gelatin with oxidized starch and glycerol as film adjuvants, and dopamine as crosslinking agent, to develop antimicrobial-active films. The addition of quaternized polymers not only improved the mechanical properties of gelatin formulations, but also decreased the solution absorption capacity during the swelling process. However, the incorporation of synthesized polymers increased the deformation at break values and the water vapor permeability of films. The antioxidant capacity of films was confirmed by radical scavenging ability and, additionally, those films exhibited antimicrobial activity. Therefore, these films can be considered as good candidates for active packaging, ensuring a constant concentration of the active compound on the surface of the food, increasing products' shelf-life and reducing the environmental impact generated by plastics of petrochemical origin.

Modified Starch as a Filter Controller in Water-Based Drilling Fluids.

Herein, the effectiveness of an itaconic acid (IA) graft copolymer on native corn starch (NCS) as a filter control agent in fresh water-based drilling fluids (WBDFs) was evaluated. The copolymer (S-g-IA_APS) was synthesized by conventional radical dispersion polymerization using the redox initiation system (NH4)2S2O8/NaHSO3. The modification of the starches was verified by volumetry, Fourier transform infrared spectroscopy (FTIR), thermogravimetric analysis (TGA), and scanning electron microscopy (SEM). Then, three WBDFs were formulated in which only the added polymer (NCS, S-g-IA_APS, and a commercial starch (CPS)) was varied to control the fluid losses. The physico-chemical, rheological, and filtering properties of the formulated systems were evaluated in terms of density (ρ), pH, plastic viscosity (µp), apparent viscosity (µa), yield point (Yp), gel strength (Rg), and filtrated volume (VAPI). In order to evaluate the resistance to temperature and contaminants of the WBDFs, they were subjected to high pressure and high temperature filtering (VHPHT). The filter control agents were also subjected to aging and contamination with cement and salt. The S-g-IA_APS addition improved the filtering behavior at a high pressure and temperature by 38%.

Analysis of the evolution of competences in the clinical practice of the nursing degree.

OBJECTIVE: to analyze the student's progression in the acquisition of specific and transversal competences in relation to the competence dimensions.Method: the cross-sectional descriptive study was carried out in the clinical practice subjects included in the Nursing Degree. We included 323 students and we contemplated the development of competences through an ad-hoc questionnaire with 4 dimensions: delivery and care management, therapeutic communication, professional development and care management. RESULTS: the academic results between the practice of the second and third year showed an improvement in care provision and therapeutic communication skills (Clinical Placements I: 12%-29%; Clinical Placements II: 32%-47%) and worsened in professional development and care management (Clinical Placements I: 44%-38%; Clinical Placements II: 44%-26%). CONCLUSION: the correlations between these two years were high in all the dimensions analyzed. The evaluation of competence progression in the context of clinical practice in nursing university studies allows us to optimize these practices to the maximum and establish professional profiles with a greater degree of adaptation to the professional future.

Os elementos de um sistema educacional inclusivo visto da perspectiva dos professores / Los elementos de un sistema educacional inclusivo desde la perspectiva de los profesores / The elements of an inclusive educational system as seen from the perspective of teachers

La educación inclusiva es el derecho que garante la participación de todos los alumnos, así como su participación y también la posibilidad de progresar dentro del sistema educacional. A lo largo del estudio, daremos una breve mirada en ese proceso, que sigue en marcha, abordando los aspectos más relevantes en relación a la legislación y literatura referente a este tema. El objetivo principal es proponer una escala de medida del nivel de inclusión y conocer cuáles son los aspectos fundamentales para realizar una inclusión verdadera. El aspecto más nuevo incluido en este estudio está relacionado a los resultados de la investigación empírica, que empresta una estructura científica para ese proceso. Proponemos una escala de mensuración para la educación inclusiva (CSEI) que - llevando en consideración la opinión de 133 profesores - incluye 10 factores considerados esenciales para llegarse a una conclusión confiable. Además de eso, usando modelos de regresión causal y linear, podemos ilustrar el hecho de que el conocimiento relativo a la inclusión es más importante que el conocimiento relativo a la deficiencia. Además de eso, la mejora en las medidas de integra, así como la corrección de deficiencias en la enseñanza, son aspectos fundamentales a ser considerados para cumplirse la educación inclusiva.

A educação inclusiva é o direito que garante a participação de todos os alunos, assim como a sua participação e também a possibilidade de progredirem dentro do sistema educacional. Ao longo do estudo a seguir, daremos uma breve olhada nesse processo, ainda em andamento, abordando os aspectos mais relevantes em relação à legislação e literatura referente a este assunto. O objetivo principal é propor uma escala de medida do nível de inclusão e conhecer quais são os aspectos fundamentais para realizar uma inclusão verdadeira. O aspecto mais novo incluído neste estudo está relacionado aos resultados da pesquisa empírica, que empresta uma estrutura científica para esse processo. Propomos uma escala de mensuração para a educação inclusiva (CSEI) que - levando em consideração a opinião de 133 professores - inclui 10 fatores considerados essenciais para se chegar a uma conclusão confiável. Além disso, usando modelos de regressão causal e linear, podemos ilustrar o fato de que o conhecimento relativo à inclusão é mais importante do que o conhecimento relativo à deficiência. Além disso, a melhoria nas medidas de integração, bem como a correção de deficiências no ensino, são aspectos fundamentais a serem considerados para se atingir a educação inclusiva.

Inclusive education is the right which guarantees the attendance of all students, as well as their participation and also the possibility for them to progress, within the educational system. Throughout the following study we will take a brief look at this process, still in progress, dealing with the most relevant aspects with regards to legislation and literature relative to this subject. The main objective is to propose a scale of measurement of the level of inclusion and to know what are the fundamental aspects to carry out a true inclusion. The most novel aspect included in this study is related to the results of empirical research, which lends a scientific framework for this process. We propose a measurement scale for inclusive education (CSEI) which - taking into consideration the opinion of 133 teachers - includes 10 factors deemed to be essential in order to reach a reliable conclusion. Furthermore, using causal and linear regression models, we can illustrate the fact that knowledge relative to inclusion is more important than that knowledge relative to disability. Also, the improvement in measures for integration, as well as the correction of deficiencies in teaching, are fundamental aspects to consider in order to achieve inclusive education.

Analysis of the evolution of competences in the clinical practice of the nursing degree / Análise da evolução de competências da prática clínica no curso de enfermagem / Análisis de la evolución de las competencias en la práctica clínica del grado en enfermeira

Objective: to analyze the student's progression in the acquisition of specific and transversal competences in relation to the competence dimensions. Method: the cross-sectional descriptive study was carried out in the clinical practice subjects included in the Nursing Degree. We included 323 students and we contemplated the development of competences through an ad-hoc questionnaire with 4 dimensions: delivery and care management, therapeutic communication, professional development and care management. Results: the academic results between the practice of the second and third year showed an improvement in care provision and therapeutic communication skills (Clinical Placements I: 12%-29%; Clinical Placements II: 32%-47%) and worsened in professional development and care management (Clinical Placements I: 44%-38%; Clinical Placements II: 44%-26%). Conclusion: the correlations between these two years were high in all the dimensions analyzed. The evaluation of competence progression in the context of clinical practice in nursing university studies allows us to optimize these practices to the maximum and establish professional profiles with a greater degree of adaptation to the professional future.

Objetivo: analisar a progressão de estudantes na aquisição de competências específicas e transversais em relação às dimensões de competência. Método: este estudo transversal descritivo foi realizado no contexto das disciplinas de prática clínica do curso de enfermagem. O desenvolvimento de competências de 323 alunos foi analisado usando um questionário ad-hoc com quatro dimensões: provisão e gerenciamento do cuidado; comunicação terapêutica; desenvolvimento profissional; e gerenciamento do cuidado. Resultados: os resultados acadêmicos obtidos no segundo e terceiro anos apresentaram melhora nas habilidades referentes à provisão do cuidado e comunicação terapêutica (Práticas Clínicas I: 12%-29%; Práticas Clínicas II: 32%-47%) e uma piora no desenvolvimento profissional e gerenciamento do cuidado (Práticas Clínicas I: 44%-38%; Práticas Clínicas II: 44%-26%). Conclusão: as correlações entre estes dois anos foram altas em todas as dimensões analisadas. A avaliação da progressão de competências no contexto da prática clínica do curso de enfermagem nos permite otimizar estas práticas ao máximo e estabelecer perfis profissionais com maior grau de adaptação para o futuro profissional.

Objetivo: analizar la progresión del alumno en la adquisición de competencias específicas y transversales en relación con las dimensiones de competencia. Método: el estudio descriptivo transversal se realizó en los sujetos de práctica clínica incluidos en la licenciatura de Enfermería. Incluimos 323 estudiantes y contemplamos el desarrollo de competencias a través de un cuestionario ad hoc con 4 dimensiones: suministro y gestión del cuidado; comunicación terapéutica; desarrollo profesional; y, gestión del cuidado. Resultados: los resultados académicos entre la práctica del segundo y tercer año mostraron una mejora en la provisión del cuidado y en las habilidades de comunicación terapéutica: (Colocaciones clínicas I: 12% -29%; Colocaciones clínicas II: 32% -47%) y empeoraron en el desarrollo profesional y en la gestión del cuidado (Colocaciones clínicas I: 44%-38%; Colocaciones clínicas II: 44%-26%). Conclusión: las correlaciones entre estos dos años fueron altas en todas las dimensiones analizadas. La evaluación de la progresión de competencias, en el contexto de la práctica clínica, en los estudios universitarios de enfermería, nos permite optimizar estas prácticas al máximo y establecer perfiles profesionales con un mayor grado de adaptación al futuro profesional.

Environmentally Friendly Fertilizers Based on Starch Superabsorbents.

Superabsorbents starches (SASs) were synthesized and characterized starting from native corn starch, bitter cassava and sweet cassava by graft copolymerization with itaconic acid. Additionally, their swelling behavior was studied both in water and in buffer solutions with different pHs and saline solutions. Their applicability was tested as environmentally friendly fertilizers in the absorption and release of urea, potassium nitrate and ammonium nitrate at different concentrations of fertilizers. The values of swelling at the equilibrium (H∞) in water and different media of the graft copolymers demonstrated their superabsorbent capacity, polyelectrolyte behavior, and smart response to environmental stimuli. The percentage of fertilizer absorbed and released from the SASs was a function of the initial concentration of the fertilizer in the medium. The loading and release of SASs were depended on the initial concentration of the fertilizer in the medium as well as the nature, structure, and morphology of the starch used.

Sexual Dimorphism of Brown Adipose Tissue Function.

OBJECTIVE: To determine whether brown adipose tissue (BAT) activity in school-age children differs between the sexes and to explore the impact of dietary intake, sedentary behavior, and picky/fussy eating. STUDY DESIGN: Children aged 8.5-11.8 years of age (n = 36) underwent infrared thermography to determine the temperature of the skin overlying the main superficial BAT depot in the supraclavicular region before and after 5 minutes of mild cold exposure (single-hand immersion in cool tap water at about 20°C). The relationships between the supraclavicular region temperature and parental reports of food consumption, eating behavior, and inactivity were explored. RESULTS: The supraclavicular region temperature was higher in boys (n = 16) at baseline, and after cold exposure. Boys displayed a greater thermogenic response to cold. Strong negative correlations were observed between the supraclavicular region temperature and body mass index percentile, and differences in supraclavicular region temperature between girls and boys persisted after adjustment for body mass index percentile. A negative linear relationship was observed between protein and vegetable intake and supraclavicular region temperature in girls only, but did not persist after adjustment for multiple comparisons. There was no difference in the adjusted supraclavicular region temperature between active or inactive children, or picky and nonpicky eaters. CONCLUSIONS: These findings indicate sexual dimorphism in BAT thermogenic activity and a sex-specific impact of diet. Future studies should aim to quantify the contribution of BAT to childhood energy expenditure, energy imbalance, and any role in the origins of childhood obesity.

Síndrome celulitis-adenitis, una forma infrecuente de presentación de la sepsis neonatal tardía: A propósito de dos casos / Adenitis-cellulitis syndrome, an infrequent form of presentation of the late-onset neonatal septicemia: Report of two cases

La sepsis es la principal causa de mortalidad neonatal. La forma precoz, habitualmente, está relacionada con la colonización recto-vaginal u otros factores de riesgo materno. En la forma tardía, es difícil establecer su origen; por lo general, es nosocomial o de la comunidad. El Streptococcus agalactiae (Streptococcus beta-hemolítico del grupo B) es el germen implicado con más frecuencia en la sepsis neonatal en países desarrollados. La forma tardía, generalmente, se presenta con septicemia y meningitis, y, en ocasiones, pueden detectarse infecciones osteoarticulares o de piel y tejidos blandos. El síndrome celulitis-adenitis en la región cervical, forma poco frecuente de presentación, es causado por Staphylococcus aureus y, ocasionalmente, por Streptococcus agalactiae. Se reportan 2 casos de sepsis neonatal tardía con clínica de celulitis-adenitis cervical causados por Streptococcus beta-hemolítico del grupo B, con una evolución satisfactoria con terapia antibiótica de amplio espectro.

Septicemia is the main cause of neonatal mortality. The early-onset neonatal sepsis is usually related to maternal factor risks including recto-vaginal colonization. In the late-onset neonatal septicemia it is more difficult to establish the etiology because the majority of the cases are nosocomial or community related. The Streptococcus agalactiae (beta-hemolytic Streptococcus) is the most frequent germ associated with neonatal sepsis in developed countries. The late-onset form usually occurs with septic symptoms and meningitis and, in a few cases, with osteoarticular, skin and soft tissue infection. Adenitis-cellulitis syndrome is rarely seen, and its main cause is Staphylococcus aureus, followed by Streptococcus agalactiae. We report two cases of group B Streptococcus late-onset neonatal septicemia, both of them with adenitis-cellulitis syndrome. Patients recovered uneventfully after an adequate antibiotic therapy.