One-year follow-up of children hospitalized with COVID-19: a prospective cohort study.

OBJECTIVE: Currently, little is known about the long-term outcomes of COVID-19 in the pediatric population. The aim of this study was to investigate the long-term clinical outcomes of pediatric patients hospitalized with COVID-19. METHODS: This was a prospective cohort study involving unvaccinated children and adolescents admitted to a tertiary hospital in southern Brazil with a COVID-19 diagnosis. Data were collected from electronic medical records for one year after the diagnosis. RESULTS: A total of 66 children were included: the median age was 2.9 years; 63.6% were male; and 48.5% were under 2 years of age. Over 70% had at least one comorbidity prior to the COVID-19 diagnosis. During the one-year follow-up period, 59.1% of the children revisited the emergency department, 50% required readmission, and 15.2% died. Younger children with longer hospital stays were found to be at greater risk of readmission. Having cancer and impaired functionality were found to increase the risk of death within one year. CONCLUSIONS: Our findings indicate that most children hospitalized with COVID-19 have comorbidities. Younger age at admission and a longer hospital stay seem to be risk factors for readmission. In addition, the presence of cancer and impaired functionality are apparently associated with the poor outcome of death within the first year after the diagnosis of COVID-19.

Functional status of hospitalized pediatric patients with COVID-19 in southern Brazil: a prospective cohort study.

OBJECTIVE: The present study aimed to assess the functional status of children diagnosed with COVID-19 at the time of hospitalization and the associations with clinical features. METHODS: This prospective cohort study was carried out with children diagnosed with COVID-19 admitted to a tertiary hospital. The patients' functioning was assessed using the pediatric Functional Status Scale (FSS). RESULTS: A total of 62 children with a median age of 3 years old were included in the study, and 70% had some comorbidity prior to the diagnosis of COVID-19. The median length of stay was nine days, during which period five patients died. The FSS assessment of the sample showed that approximately 55% had some functional alteration. The group of patients with the highest FSS scores presented a lengthier hospital stay (p = 0.016), required more oxygen therapy (p < 0.001), mechanical ventilation (p = 0.001), and intensive care unit admissions (p = 0.019), and had more cardiac (p = 0.007), neurological (p = 0.003), and respiratory (p = 0.013) comorbidities. In the multivariate analysis, there was an association between the dependent variable length of stay and the total FSS score (b = 0.349, p = 0.004) and the presence of comorbidities (b = 0.357, p = 0.004). CONCLUSIONS: We observed that more than half of the children hospitalized due to COVID-19 had some level of functional change. Greater alterations in functional status were associated with the presence of previous comorbidities, a greater need for ventilatory support, and longer hospital stays.

One-year follow-up of children hospitalized with COVID-19: a prospective cohort study / Acompanhamento de um ano de crianças hospitalizadas com COVID-19: estudo prospectivo de coorte

ABSTRACT Objective: Currently, little is known about the long-term outcomes of COVID-19 in the pediatric population. The aim of this study was to investigate the long-term clinical outcomes of pediatric patients hospitalized with COVID-19. Methods: This was a prospective cohort study involving unvaccinated children and adolescents admitted to a tertiary hospital in southern Brazil with a COVID-19 diagnosis. Data were collected from electronic medical records for one year after the diagnosis. Results: A total of 66 children were included: the median age was 2.9 years; 63.6% were male; and 48.5% were under 2 years of age. Over 70% had at least one comorbidity prior to the COVID-19 diagnosis. During the one-year follow-up period, 59.1% of the children revisited the emergency department, 50% required readmission, and 15.2% died. Younger children with longer hospital stays were found to be at greater risk of readmission. Having cancer and impaired functionality were found to increase the risk of death within one year. Conclusions: Our findings indicate that most children hospitalized with COVID-19 have comorbidities. Younger age at admission and a longer hospital stay seem to be risk factors for readmission. In addition, the presence of cancer and impaired functionality are apparently associated with the poor outcome of death within the first year after the diagnosis of COVID-19.

RESUMO Objetivo: Atualmente, pouco se sabe sobre os desfechos em longo prazo da COVID-19 na população pediátrica. O objetivo deste estudo foi investigar os desfechos clínicos em longo prazo de pacientes pediátricos hospitalizados com COVID-19. Métodos: Trata-se de um estudo prospectivo de coorte com crianças e adolescentes não vacinados internados em um hospital terciário do Sul do Brasil com diagnóstico de COVID-19. Os dados referentes ao período de um ano após o diagnóstico foram extraídos dos prontuários médicos eletrônicos. Resultados: Foram incluídas 66 crianças: a mediana da idade foi de 2,9 anos; 63,6% eram do sexo masculino; 48,5% tinham menos de 2 anos de idade. Mais de 70% tinham pelo menos uma comorbidade antes do diagnóstico de COVID-19. Durante o período de um ano de acompanhamento, 59,1% das crianças retornaram ao pronto-socorro, 50% necessitaram de readmissão e 15,2% morreram. O risco de readmissão foi maior em crianças mais novas que permaneceram internadas durante mais tempo. Câncer e funcionalidade prejudicada aumentaram o risco de morte até um ano depois. Conclusões: Nossos achados indicam que a maioria das crianças hospitalizadas com COVID-19 apresenta comorbidades. Ser mais jovem no momento da internação hospitalar e permanecer internado durante mais tempo parecem ser fatores de risco de readmissão. Além disso, câncer e funcionalidade prejudicada são fatores aparentemente relacionados com o mau desfecho de óbito no primeiro ano após o diagnóstico de COVID-19.

Functional status of hospitalized pediatric patients with COVID-19 in southern Brazil: a prospective cohort study / Estado funcional de pacientes pediátricos hospitalizados com COVID-19 no sul do Brasil: um estudo de coorte prospectivo

ABSTRACT Objective: The present study aimed to assess the functional status of children diagnosed with COVID-19 at the time of hospitalization and the associations with clinical features. Methods: This prospective cohort study was carried out with children diagnosed with COVID-19 admitted to a tertiary hospital. The patients' functioning was assessed using the pediatric Functional Status Scale (FSS). Results: A total of 62 children with a median age of 3 years old were included in the study, and 70% had some comorbidity prior to the diagnosis of COVID-19. The median length of stay was nine days, during which period five patients died. The FSS assessment of the sample showed that approximately 55% had some functional alteration. The group of patients with the highest FSS scores presented a lengthier hospital stay (p = 0.016), required more oxygen therapy (p < 0.001), mechanical ventilation (p = 0.001), and intensive care unit admissions (p = 0.019), and had more cardiac (p = 0.007), neurological (p = 0.003), and respiratory (p = 0.013) comorbidities. In the multivariate analysis, there was an association between the dependent variable length of stay and the total FSS score (b = 0.349, p = 0.004) and the presence of comorbidities (b = 0.357, p = 0.004). Conclusions: We observed that more than half of the children hospitalized due to COVID-19 had some level of functional change. Greater alterations in functional status were associated with the presence of previous comorbidities, a greater need for ventilatory support, and longer hospital stays.

RESUMO Objetivo: O objetivo do presente estudo foi de avaliar o estado funcional de crianças diagnosticadas com COVID-19 no momento da internação e as associações com suas características clínicas. Métodos: Este estudo de coorte prospectivo foi realizado com crianças diagnosticadas com COVID-19 internadas em um hospital terciário. A funcionalidade dos pacientes foi avaliada por meio da Escala de Estado Funcional (FSS) pediátrica. Resultados: Foram incluídas no estudo 62 crianças com idade mediana de 3 anos, das quais 70% apresentavam alguma comorbidade antes do diagnóstico de COVID-19. O tempo mediano de internação foi de nove dias, período no qual cinco pacientes vieram a óbito. A avaliação da FSS da amostra mostrou que aproximadamente 55% apresentavam alguma alteração funcional. O grupo de pacientes com os maiores escores na FSS teve um maior tempo de internação (p = 0,016), necessitou de mais oxigenoterapia (p < 0,001), ventilação mecânica (p = 0,001) e internações em unidade de terapia intensiva (p = 0,019) e tinha mais comorbidades cardíacas (p = 0,007), neurológicas (p = 0,003) e respiratórias (p = 0,013). Na análise multivariada, observou-se uma associação entre a variável dependente tempo de internação e o escore total da FSS (b = 0,349, p = 0,004) e a presença de comorbidades (b = 0,357, p = 0,004). Conclusões: Verificou-se que mais da metade das crianças internadas devido à COVID-19 apresentaram algum nível de alteração funcional. Maiores alterações no estado funcional foram associadas à presença de comorbidades prévias, maior necessidade de suporte ventilatório e maior tempo de internação.

Avaliação ludoterápica centrada na criança surda / Psychological evaluation centered on the deaf children

O presente artigo enquadra-se como um relato de experiência, onde descreve os desafios e as dificuldades enfrentadas no trabalho de avaliação psicológica realizado com crianças surdas dentro do contexto educacional, referente ao período de 2010-2012. Apresenta também as bases utilizadas para a sua concretização, tendo estas se dado a partir dos pressupostos rogerianos. Do ponto de vista metodológico, classifica-se como exploratório e qualitativo, pois de acordo com Gil (1991) e Minayo e Minayo (2001), visa uma maior familiaridade com o problema, na medida em que busca a compreensão do significado das relações que se estabelecem. Espera-se que este relato de experiência possa auxiliar a todos os profissionais envolvidos com a criança surda a olharem para a particularidade da existência e da experiência desta criança, valorizando assim, a capacidade que todo organismo vivo tem de tender a sua atualização (Rogers, 1997).(AU)

The following article fits as an account of experience, where describes the challenges and difficulties faced in the work of the psychological evaluation conducted inside the educational context with deaf children in the period 2010-2012. Also present the bases used for its implementation from the assumptions rogerian. From the methodological point of view, classifies as exploratory and qualitative, because, according to Gil (1991) and Minayo and Minayo (2001), seeks a greater familiarity with the problem, as it seeks to understand the meaning the relationships that are established. It is hoped that this experience report could help all professionals involved with the deaf child to look to the particularity of existence and experience of this child, thus valuing the capacity that every living organism has of tend to its actualization (Rogers, 1997).(AU)

En este artículo se clasifica a sí mismo como un relato de experiencia, que describe los retos y las dificultades que enfrentan en el trabajo de evaluación psicológica llevada a cabo con los niños sordos en el contexto educativo, para el período 2010-2012. También se presentan las bases utilizadas para su realización, y éstos se dan a partir de los supuestos rogerianos. Desde el punto de vista metodológico, se clasifica como exploratorio y cualitativo, ya que según Gil (1991) y Minayo y MINAYO (2001), busca una mayor familiaridad con el problema, ya que trata de comprender la importancia de las relaciones se establecen. Se espera que este informe experiencia puede ayudar a todos los profesionales que intervienen en el niño sordo a mirar la particularidad de la existencia y la experiencia de este niño, aumentando así la posibilidad de que cada organismo vivo tiene que atender a su actualización (Rogers, 1997).(AU)

How to predict the timing of eruption of mandibular second premolars.

OBJECTIVE: To evaluate the relationship between the stages of dental formation and the timing of eruption of mandibular second premolars. MATERIALS AND METHODS: The sample comprised panoramic radiographs of 25 children, 7 to 12 years old, observed by space supervision during development of dentition. The initial radiograph (T1) was taken in the mixed dentition period and the progress radiograph (T2) close to the eruption of mandibular second premolars. The stages of dental formation were determined by the proportion between crown length and total length (CL/TL) as well by the Simpson and Kunos index. Average values between right and left sides (35, 45) were correlated to the time elapsed until dental eruption (T2-T1). Statistical analysis was performed by Pearson correlation analysis. RESULTS: The proportion CL/TL presented higher correlation index with time to eruption than the Simpson and Kunos index. The linear regression equation for prediction of timing of eruption showed high coefficient of determination, low deviation, and good accuracy. According to survival analysis, mean deviation at 95% confidence level was between 3.6 and 6.4 months. There was no difference in contralateral measurements, with high intraclass correlation coefficient for both CL/TL proportion and Simpson and Kunos index. CONCLUSIONS: More advanced stages of dental formation indicate less time until dental eruption. The strong correlation with crown length/total length proportion (CL/TL) provides a linear regression equation for prediction of the timing of eruption of mandibular second premolars.

A dupla face da diversidade: o preconceito e a necessidade de igualdade / The double face of diversity: the preconception and the need for equality

Apresenta-se aqui parte de uma pesquisa realizada entre 2007-2008 que buscou compreender as concepções de mediadores familiares a respeito da união homoafetiva. Trabalhando interdisciplinarmente, buscou-se identificar e comparar as representações sociais sobre a homossexualidade de seis mediadores familiares, sendo três deles formados em Psicologia e outros três em Direito. Desta forma, apresenta-se como um estudo de campo que utilizou, como técnica de coleta de dados, entrevistas semi-estruturadas. Serão apresentadas aqui questões relativas às crenças dos mediadores frente à homossexualidade, relacionando-as sempre ao estudo das representações sociais. A pesquisa encontrou como resultado representações sociais da homossexualidade atreladas a valores positivos, mas sempre restritos à identificação dos direitos igualitários e da necessidade de respeito para com a pessoa homossexual. Assim, apesar de as concepções serem positivas, os valores apresentados ainda remetem às concepções de família tradicional heterossexual que, por sua vez, não contemplam relações entre pessoas do mesmo sexo(AU)

Is presented here part of a research carried trought beetwen 2007-2008, that tries to understand the familiar mediators conceptions about the homoaffectivity union. Working iri an interdisciplinary way,it attempted to identify and compare the social representation about the homosexuality of six familiar mediators, being three of them graduate in Psicology and another three in Law. In this way, the work presents itself like a field study, that uses as technique of data collecting half-structuralized interviews. It will show here questions related to the mediators beliefs about homosexuality, always Inaking a relation with the social representations study. The research found as a result Social representations of homosexuality linked to positive values, but always restricted to an identification with the equal rights and the respect need for the homosexual person. In this way, despite the positive conceptions, the values presented still refer to heterosexual traditional family, that, in it's turn, doesn't contemplate relationship between the same gender person(AU)

Cumulative effect of disinfection procedures on microhardness and tridimensional stability of a poly(methyl methacrylate) denture base resin.

Microwave irradiation has been used for disinfection of dentures instead of chemical solutions; yet, its effect on resin properties after repeated procedures still is unclear. This study evaluated the cumulative effect of two disinfection methods on Knoop microhardness and tridimensional stability of a poly(methyl methacrylate) denture base resin. For the microhardness measurement, 24-resin discs received mechanical polishing and were submitted to the following treatments: (1) control (no disinfection), (2) chemical disinfection (immersion in 100ppm chloride solution for 24h), or (3) microwave disinfection (irradiation at 690 W for 6 min). Disinfection procedures were performed twice (T1, T2) with a 7-day interval. Knoop microhardness was recorded after polishing (T0) and after T1 and T2. For the dimensional stability test (measured by the adaptation of the denture bases), 36-maxillary denture bases were obtained from type III dental stone casts duplicated from a metallic master model and submitted to the disinfection treatment. Adaptation of denture bases was measured at baseline (T0) and after T1 and T2 by weighing a vinyl polysiloxane film reproducing the gap between resin base and master model. Data were analyzed by ANOVA GLM for repeated measures and Bonferroni's test, alpha = 0.05. Knoop microhardness was not modified by any disinfection procedure but decreased over time. Denture resin bases submitted to microwave disinfection had gradual increase of distortion over time, while bases immersed in chloride solution did not differ from the control group and remained dimensionally stable from T1 to T2.

Exposure to the oral side effects of medication in a community-based sample.

This descriptive study assessed the self-reported medications taken by 1,163 European-American and Mexican-American community-dwelling adults (age range 32 to 81 years of age) from the Oral Health: San Antonio Longitudinal Study of Aging (OH:SALSA) sample and reports on the potential oral side effects (OSE) of their medications. Data collection included sociodemographic characteristics, number of prescription and non-prescription drugs, and frequency of potential OSE. Medications were checked in three drug references, and all potential OSE were classified into 16 major categories. The mean number of medications taken per subject was 2.7. Persons 65 years or older, females, European Americans, and suburban residents reported taking more drugs than their counterparts. There was no difference in the number of drugs taken due to income or education (p>0.05). The Spearman rank order correlation between age and number of medications was 0.30 (p<0.001). The most frequent potential OSE was dry mouth in 664 subjects (57%), followed by bleeding in 456 (39%), alteration in taste of 389 (33%), and stomatitis in 331 (28%). The distribution of subjects with respect to number of potential OSE was: none, 20%; 1 to 2, 24%; 3 to 4, 26%; 5 to 6, 14%; and 7 or more, 16%. Many older community-dwelling persons may be at risk for multiple oral complications due to medications they are taking.

Effect of microwave disinfection on denture base adaptation and resin surface roughness.

This study evaluated the effect of disinfection methods [chemical disinfection (immersion in 100 ppm chloride solution) or microwave disinfection (690 W for 6 min)] on the internal adaptation of denture bases and resin surface roughness. For the adaptation test, 18 maxillary denture bases were obtained from stone casts duplicated from a metallic master model and submitted to the following treatments: 1) control (no disinfection), 2) chemical disinfection or 3) microwave disinfection. Disinfection procedures were performed twice (T1, T2) with a 7-day interval between them. Internal adaptation was measured at baseline (T0) and after T1 and T2 by weighing a vinyl polysiloxane film reproducing the gap between the resin base and the master model. For surface roughness measurement, 60 rectangular (5x10x40 mm) resin specimens were either mechanically or chemically polished and then submitted to the disinfection treatments. Surface roughness (Ra) was recorded after polishing (T0) and after T1 and T2. Data were analyzed by ANOVA GLM for repeated measures and Bonferroni correction at 5% significance level. Bases submitted to microwave disinfection had gradual increase of misfit, while bases immersed in chloride solution did not differ from the control group. Surface roughness increased in the mechanical polishing groups with microwave disinfection and decreased in the chemical polishing groups.

Effect of microwave disinfection on denture base adaptation and resin surface roughness

This study evaluated the effect of disinfection methods [chemical disinfection (immersion in 100 ppm chloride solution) or microwave disinfection (690 W for 6 min)] on the internal adaptation of denture bases and resin surface roughness. For the adaptation test, 18 maxillary denture bases were obtained from stone casts duplicated from a metallic master model and submitted to the following treatments: 1) control (no disinfection), 2) chemical disinfection or 3) microwave disinfection. Disinfection procedures were performed twice (T1, T2) with a 7-day interval between them. Internal adaptation was measured at baseline (T0) and after T1 and T2 by weighing a vinyl polysiloxane film reproducing the gap between the resin base and the master model. For surface roughness measurement, 60 rectangular (5x10x40 mm) resin specimens were either mechanically or chemically polished and then submitted to the disinfection treatments. Surface roughness (Ra) was recorded after polishing (T0) and after T1 and T2. Data were analyzed by ANOVA GLM for repeated measures and Bonferroni correction at 5 percent significance level. Bases submitted to microwave disinfection had gradual increase of misfit, while bases immersed in chloride solution did not differ from the control group. Surface roughness increased in the mechanical polishing groups with microwave disinfection and decreased in the chemical polishing groups.

Este estudo avaliou o efeito de métodos de desinfecção [desinfecção química (imersão em solução clorada 100 ppm) ou desinfecção por microondas (690 W por 6 min)] na adaptação interna de bases de próteses totais e na rugosidade superficial da resina. Para o teste de adaptação, 18 bases superiores foram duplicadas a partir de um modelo-mestre metálico e submetidas aos seguintes tratamentos: 1) controle (sem desinfecção), 2) desinfecção química ou 3) desinfecção por microondas. Os procedimentos de desinfecção foram realizados duas vezes (T1, T2) com intervalo de 7 dias. A adaptação interna foi medida no baseline (T0), após T1 e T2 por pesagem de um filme de silicona de adição que reproduzia o espaço entre base de resina e modelo-mestre. Para a rugosidade superficial, 60 espécimes retangulares (5x10x40 mm) receberam polimento mecânico ou químico e foram submetidos aos tratamentos de desinfecção. A rugosidade superficial (Ra) foi registrada após o polimento (T0) e após T1 e T2. Os dados foram analisados por ANOVA GLM para medições repetidas e teste de Bonferroni com nível de significância de 5 por cento. As bases submetidas à desinfecção por microondas tiveram aumento gradual de desadaptação, enquanto que as bases imersas em solução clorada não diferiram do grupo controle. A rugosidade superficial aumentou nos grupos de polimento mecânico e desinfecção por microondas e diminuiu nos grupos de polimento químico.

Reliability of a digital image method for measuring medial mandibular flexure in dentate subjects

A deflexão mandibular medial (MMF) é uma deformação funcional que ocorre com a aproximação das hemi-mandíbulas em abertura e protrusão, podendo afetar próteses convencionais e implanto-suportadas em arco. OBJETIVOS: Este trabalho avaliou a confiabilidade intra- e inter-examinador de um método de imagem digital para aferição linear da MMF. MATERIAL E MÉTODOS: Foram selecionados sete voluntários adultos dentados, obtendo-se registros oclusais inferiores de silicona de adição em repouso, abertura e protrusão máximas. Os registros foram escaneados juntamente com um paquímetro Mitutoyo com abertura de 10mm num aumento de 200%. A imagem foi processada no programa Adobe Photoshop obtendo-se pontos de referência intermolares, e as medições lineares foram feitas no programa ImageTool (UTHSCSA) calibrado com a medida padrão do paquímetro. Foram feitas medições em triplicata da medida da distância intermolar para cada imagem. A MMF foi calculada subtraindo-se a distância intermolar em abertura da distância em repouso/ protrusão. Os dados foram analisados por coeficientes de correlação intraclasse (ICC) para estimar a confiabilidade intra- e inter-examinadores. RESULTADOS: Os valores de MMF variaram de -0,21 a 0,44mm. Os ICCs intra-examinador foram 0,982 e 0,993, e o ICC inter-examinador foi 0,696. CONCLUSAO: Os resultados demonstram excelente confiabilidade intra-examinador e boa confiabilidade inter-examinador deste método de imagem digital para aferição de MMF em adultos dentados.

Rugosidade superficial de resina acrílica submetida a diferentes métodos de polimento / Superface roughness of acrylic submitted polishing methods

Este trabalho avaliou a rugosidade superficial de uma resina acrílica ativada termicamente polimerizada por técnica convencional e por microondas, submetida a polimento mecânico ou polimento químico. Amostras de resina acrílica (Veracril) foram confeccionadas (5x10x40 mm) e divididas em seis grupos (n=10/grupo): Polimerização convencional sem polimento (CS); Polimerização convencional, polimento mecânico (CM); Polimerização convencional, polimento químico (CQ); Polimerização por microondas, sem polimento (MS); Polimerização por microondas, polimento mecânico (MM); e Polimerização por microondas, polimento químico (MQ). A rugosidade superficial média Ra foi avaliada com rugosímetro Mitutoyo SJ-201. As médias (DP) de Ra (ìM) obtidos foram: CS = 0,24 (0,02) B; CM = 0,15(0,07) a; CQ = 0,25 (0,05) b; MS = 0,23 (0,02) b; MM = 0,14 (0,01) a; MQ = 0,28 (0,03) b. Médias seguidas por letras distintas foram estatisticamente diferentes entre si (ANOVA e Teste de Tukey, alfa=0,05). Não houve influência do tipo de polimerização na rugosidade superficial. Os grupos com polimento mecânico apresentaram os menores valores de rugosidade em comparação com outros grupos do polimento químico e sem polimento. O polimento químico não foi eficaz em proporcionar uma superfície mais lisa

Reliability of a digital image method for measuring medial mandibular flexure in dentate subjects.

UNLABELLED: Medial mandibular flexure (MMF) is the functional approximation of hemi-mandibles in jaw opening and protrusion, which may affect conventional or implant-supported arch prostheses. OBJECTIVE: This study evaluated the intra- and inter-rater reliability of a digital image method for linear measurement of MMF in dentate subjects. MATERIAL AND METHODS: Mandibular occlusal impressions in vinyl polysiloxane during rest and maximum opening were obtained from seven adult volunteers. Each impression and the Mitutoyo digital calipers with a 10mm opening were scanned at a 200% magnification. The images were processed using Adobe Photoshop software to get reference points on contralateral first molars. Linear intermolar measurements were taken using the Image Tool software (UTHSCSA), which was calibrated with the standard opening of the digital calipers. Intermolar distance was measured in triplicate for each image by two independent examiners. MMF was calculated by subtracting the intermolar distance in maximum opening (or protrusion) from the distance in rest position. Data were analyzed by intraclass correlation (ICC) tests for estimating intra- and inter-rater reliability. RESULTS: MMF values ranged from -0.21 to 0.44mm. Intra-rater ICCs were 0.982 and 0.993, and inter-rater ICC was 0.696. CONCLUSION: The present results show excellent intra-rater and good inter-rater reliability of this digital image method for measuring MMF in dentate subjects.