O (des)cuidado em saúde às pessoas LGBTQIAP+ dispensado por profissionais em unidades básicas de saúde / The (lack of)health care provided to LGBTQIAP+ people by professionals in primary care centers / El (des)cuidado en salud a las personas LGBTQIAP+ dispensado por profesionales en unidades básicas de salud

Objetivo: compreender o cuidado em saúde dispensado às pessoas LGBTQIAP+ por profissionais em Unidades Básicas de Saúde, a partir do referencial teórico da Política Nacional de Saúde LGBT (PNSILGBT) estabelecida pelo Sistema Único de Saúde (SUS). Método: estudo descritivo, com abordagem qualitativa, que entrevistou 12 profissionais de saúde da Atenção Básica. Os dados coletados passaram pela Análise Lexical utilizando-se do software IRAMUTEQ. Resultados: emergiram três categorias temáticas que possibilitaram compreender que os profissionais reconhecem as violências praticadas na assistência a essa população, as barreiras no acesso e as dificuldades enfrentadas por pessoas LGBTQIAP+. Considerações finais: o desconhecimento das políticas e a não percepção das consequências dessas ações para a saúde dessa população remete muito mais ao (des)cuidado do que efetivamente ao cuidado condizente as suas reais necessidades em saúde.

Objective: to understand the health care provided to LGBTQIAP+ people by professionals in Primary Care Centers, based on the theoretical framework of the National LGBT Health Policy (PNSILGBT) established by the Unified Health System (SUS). Method: a descriptive study with a qualitative approach, which interviewed 12 primary care health professionals. The data collected was subjected to Lexical Analysis using the IRAMUTEQ software. Results: Three thematic categories emerged which made it possible to understand that professionals recognize the violence practiced in assisting this population, the barriers to access and the difficulties faced by LGBTQIAP+ people. Final considerations: the lack of knowledge of the policies and the lack of perception of the consequences of these actions for the health of this population leads much more to (lack of)care than to care in line with their real health needs.

Objetivo: comprender el cuidado en salud brindado a las personas LGBTQIAP+ por profesionales en Unidades Básicas de Salud, partiendo del marco teórico de la Política Nacional de Salud LGBT (PNSILGBT) establecida por el Sistema Único de Salud (SUS). Método: estudio descriptivo, con enfoque cualitativo, que entrevistó a 12 profesionales de salud de la Atención Básica. Los datos recogidos fueron analizados mediante Análisis Léxico utilizando el software IRAMUTEQ. Resultados: surgieron tres categorías temáticas que permitieron comprender que los profesionales reconocen las violencias ejercidas en la asistencia a esta población, las barreras en el acceso y las dificultades enfrentadas por personas LGBTQIAP+. Consideraciones finales: el desconocimiento de las políticas y la no percepción de las consecuencias de estas acciones para la salud de esta población reflejan mucho más el (des)cuido que efectivamente el cuidado acorde a sus reales necesidades en salud.

A prospective observational study to compare and evaluate delta down, aortic velocity time integral variability, and superior vena cava collapsibility index as predictors of fluid responsiveness in patients with supratentorial brain tumors undergoing elective neurosurgery.

Background: Patients undergoing surgical resection of brain tumors frequently exhibit a spectrum of hemodynamic fluctuations necessitating careful fluid management. This study aimed to evaluate the feasibility of dynamic predictors of fluid responsiveness, such as delta down (DD), aortic velocity time integral variability (VTIAoV), and superior vena cava collapsibility index (SVCCI), in patients undergoing neurosurgery for brain tumors. Methods: In this prospective study, 30 patients scheduled to undergo elective neurosurgery for brain tumor resection were enrolled. Baseline measurements of vitals, anesthetic parameters, and study variables were recorded post-induction. Subsequently, patients received a fluid bolus of 10 mL/kg of colloid over 20 min, and measurements were repeated post-loading. Data were presented as mean ± standard deviation. The normally distributed continuous variables were compared using Student's t-test, with P < 0.05 considered statistically significant. The predictive capability of variables for fluid responsiveness was assessed using Pearson's coefficient analysis (r). Results: Of the 30 patients, 22 were identified as volume responders (R), while eight were non-responders (NR). DD >5 mmHg effectively distinguished between R and NR (P < 0.001), with a good predictive ability (r = 0.759). SVCCI >38% differentiated R from NR (P < 0.001), with excellent predictability (r = 0.994). Similarly, VTIAoV >20% was also a good predictor (P < 0.05; r = 0.746). Conclusion: Our study revealed that most patients undergoing surgical resection of brain tumors exhibited fluid responsiveness. Among the variables assessed, SVCCI >38% emerged as an excellent predictor, followed by VTIAoV >20% and DD >5 mm Hg, for evaluating fluid status in this population.

Chloroplastic ascorbate modifies plant metabolism and may act as a metabolite signal regardless of oxidative stress.

Ascorbate is a major plant metabolite that plays crucial roles in various processes, from reactive oxygen scavenging to epigenetic regulation. However, to what extent and how ascorbate modulates metabolism is largely unknown. We investigated the consequences of chloroplastic and total cellular ascorbate-deficiencies by studying chloroplastic ascorbate-transporter mutant lines lacking PHOSPHATE TRANSPORTER 4; 4 (PHT4; 4) , and the ascorbate-deficient vtc2-4 mutant of Arabidopsis (Arabidopsis thaliana). Under regular growth conditions, both ascorbate deficiencies caused minor alterations in photosynthesis, with no apparent signs of oxidative damage. In contrast, metabolomics analysis revealed global and largely overlapping alterations in the metabolome profiles of both ascorbate-deficiency mutants, suggesting that chloroplastic ascorbate modulates plant metabolism. We observed significant alterations in amino acid metabolism, particularly in arginine metabolism, activation of nucleotide salvage pathways, and changes in secondary metabolism. In addition, proteome-wide analysis of thermostability revealed that ascorbate may interact with enzymes involved in arginine metabolism, the Calvin-Benson cycle, and several photosynthetic electron transport components. Overall, our results suggest that, independently of oxidative stress, chloroplastic ascorbate modulates the activity of diverse metabolic pathways in vascular plants and may act as an internal metabolic signal.

Biological invasions and epidemics with nonlocal diffusion along a line.

The goal of this work is to understand and quantify how a line with nonlocal diffusion given by an integral enhances a reaction-diffusion process occurring in the surrounding plane. This is part of a long term programme where we aim at modelling, in a mathematically rigorous way, the effect of transportation networks on the speed of biological invasions or propagation of epidemics. We prove the existence of a global propagation speed and characterise in terms of the parameters of the system the situations where such a speed is boosted by the presence of the line. In the course of the study we also uncover unexpected regularity properties of the model. On the quantitative side, the two main parameters are the intensity of the diffusion kernel and the characteristic size of its support. One outcome of this work is that the propagation speed will significantly be enhanced even if only one of the two is large, thus broadening the picture that we have already drawn in our previous works on the subject, with local diffusion modelled by a standard Laplacian. We further investigate the role of the other parameters, enlightening some subtle effects due to the interplay between the diffusion in the half plane and that on the line. Lastly, in the context of propagation of epidemics, we also discuss the model where, instead of a diffusion, displacement on the line comes from a pure transport term.

Multivalued nonlinear dominated mappings on a closed ball and associated numerical illustrations with applications to nonlinear integral and fractional operators.

In the context of complete strong b -metric-like spaces, we prove new multi-fixed point solutions for the pair of multivalued, dominated operators that fulfill the generalized nonlinear contractions on a closed ball. We employ a mix of two different types of mappings in our approach: one is a class of multi-dominated mappings, while the other is a weaker class of strictly increasing mappings. Additionally, some new fixed-point results concerning the multi-graph-dominated structure in graph contraction are presented. To validate the hypothesis of acquired results, a few sample cases are presented. A numerical experiment has been carried out to approximate the fixed point. In addition, to demonstrate the originality of our findings, we proposed simple and efficient solutions to the system of fractional differential equations and nonlinear Volterra-type integral equations.

Long-term myocardial performance of the systemic right ventricle during exercise in patients with transposition of the great arteries and atrial switch operation.

OBJECTIVE: The echocardiographic assessment of the systemic right ventricle (sRV) performance during stress testing is limited and evaluation is not routinely performed. The aim of the study is to investigate sRV myocardial performance at rest and with exercise in patients with complete transposition of the great arteries (dTGA) who have undergone atrial switch operation. METHODS: In a single-center cross-sectional study, 41 patients with dTGA following the atrial switch operation and gender-matched 20 healthy volunteers underwent exercise echocardiography on a bicycle ergometer in the semi-supine position to assess sRV systolic function indices: tricuspid annular plane systolic excursion (TAPSE), right ventricular area change (FAC), global longitudinal strain (GLS) and systemic velocity time integral (VTI). RESULTS: Patients with sRV were characterized by lower systolic function assessed by TAPSE, s', FAC, GLS both at baseline and at peak exercise, compared with the control group. sRV GLS decreased during exercise in patients with sRV (-6 + 2.84) compared to increased in patients with systemic left ventricle (0.47 + 2.74), p < 0.001. There was no increase in VTI during exercise in patients with sRV, compared to controls (Δ VTI -0.01 ± 2.96 cm vs. Δ VTI 4.50 ± 3.13 cm, p < 0.001). There was a trend towards higher chronotropic incompetence in patients with sRV vs. control (61% vs. 45%, p = 0.28). CONCLUSION: Our results confirmed that patients with dTGA have reduced ability to increase myocardial contractility and stroke volume during exercise. Chronotropic incompetence was prevalent in dTGA patients.

Implementation of Rapid Nucleic Acid Amplification Based on the Super Large Thermoelectric Cooler Rapid Temperature Rise and Fall Heating Module.

In the rapid development of molecular biology, nucleic acid amplification detection technology has received more and more attention. The traditional polymerase chain reaction (PCR) instrument has poor refrigeration performance during its transition from a high temperature to a low temperature in the temperature cycle, resulting in a longer PCR amplification cycle. Peltier element equipped with both heating and cooling functions was used, while the robust adaptive fuzzy proportional integral derivative (PID) algorithm was also utilized as the fundamental temperature control mechanism. The heating and cooling functions were switched through the state machine mode, and the PCR temperature control module was designed to achieve rapid temperature change. Cycle temperature test results showed that the fuzzy PID control algorithm was used to accurately control the temperature and achieve rapid temperature rise and fall (average rising speed = 11 °C/s, average falling speed = 8 °C/s) while preventing temperature overcharging, maintaining temperature stability, and achieving ultra-fast PCR amplification processes (45 temperature cycle time < 19 min). The quantitative results show that different amounts of fluorescence signals can be observed according to the different concentrations of added viral particles, and an analytical detection limit (LoD) as low as 10 copies per µL can be achieved with no false positive in the negative control. The results show that the TEC amplification of nucleic acid has a high detection rate, sensitivity, and stability. This study intended to solve the problem where the existing thermal cycle temperature control technology finds it difficult to meet various new development requirements, such as the rapid, efficient, and miniaturization of PCR.

Refinements of Pólya-SzegO and Chebyshev type inequalities via different fractional integral operators.

Various differential and integral operators have been introduced and applied for the generalization of several integral inequalities. The purpose of this article is to create a more generalized fractional integral operator of Saigo type. This operator will be used alongwith the existing Saigo type and Q-Saigo type fractional integral operators to establish extended and generalized versions of several inequalities, including Pólya-Szego and Chebyshev type inequalities.

Robust control of a wind energy conversion system: FPGA real-time implementation.

This study employs an FPGA board to implement a robust control technique for wind energy conversion systems (WECS). This approach facilitates extensive testing and validation of the control system across diverse wind conditions, utilizing the FPGA's parallel processing capabilities and advanced control algorithms. This method ensures robustness against nonlinearities and system uncertainties. FPGA-in-the-loop (FIL) testing provides precise and effective simulation results, enabling rapid prototyping and iterative modifications of control algorithms. The effectiveness of the robust control strategy is confirmed by FIL findings, demonstrating significant improvements in WECS stability and efficiency. Furthermore, the study highlights the strategy's potential to enhance WECS reliability and efficiency in real-world applications.

When artistic is altruistic: the power of beauty from P. A. Sorokin's sociology to Building Beauty social project.

The article contributes to the ongoing debates on the social value and sociological relevance of the arts by examining the intuitions of the Russian-American sociologist P. A. Sorokin (1889-1968) on the concept of "beauty" as a force akin to what he calls "Altruistic Creative Love", both potentially catalysing a process of "fraternisation of humanity". Starting from the author's sociological reflections on the relationship between "Altruistic Love" and "beauty" and an analytical model of "altruistic artistic social action," the article proposes the analysis of a specific social project named Building Beauty, promoted in Turin (Italy) by universities, public bodies and the third sector, which aims to foster the social inclusion of homeless people through participatory processes, discovering expressions of beauty with aesthetic and sociological relevance simultaneously, able to move social transformations.

Simulation of anaerobic biodegradation process in a tubular bioreactor with a biofilm layer: Steady-state and unsteady-state conditions.

In this paper, anaerobic biodegradation process in a tubular bioreactor with an inner biofilm layer for steady-state and unsteady-state conditions are simulated. The effects of various parameters including bioreactor diameter, fraction of active biomass transferred to liquid phase, and residence time of the liquid on bioreactor performance are examined. Simulations indicate that decreasing diameter of bioreactor leads to increasing degree of conversion of the substrate in liquid phase and decreasing dimensionless concentration of the substrate in biofilm. With an increase in the fraction of active biomass transferred to liquid, substrate concentrations in liquid and biofilm slightly vary. Increased residence time of the liquid phase results in the degree of conversion of substrate goes up, but substrate concentration in biofilm lowers a little. In addition, it is found that biomass concentration of liquid phase is boosted with decreased bioreactor diameter and increased residence time of liquid. A proportional-integral controller is designed and the tuned parameters of K P = - 0.131 and K I = 0.02 are obtained using genetic algorithm. It is observed that controller regulate well the degree of conversion of the substrate within 120 s for both servo and regulatory modes.

Assessment of the correlation between Doppler derived dP/dt and aortic velocity-time integral during cardiac resynchronization therapy optimization.

PURPOSE: Suboptimal response to cardiac resynchronization therapy (CRT) may be improved by optimization of device parameters using echocardiography. For this purpose, the aortic velocity-time integral (aVTI) has been used as a target metric to define optimal velocity timings for each ventricle. dP/dt is a parameter used for the assessment of myocardial contractility. In this study, we aimed to evaluate the effectiveness of Doppler-derived dP/dt in optimization by assessing the possible correlation between aVTI and dP/dt. METHODS: Patients with CRT admitted for routine follow-up were included in the study. Aortic VTI and dP/dt measurements were recorded in four different standard pacing configurations during reprogramming. RESULTS: A total of 45 patients were included in the final analysis. No correlation was found between the aVTI and the delta dP/dt value in the two configurations where the change in dP/dt was maximum (p = 0.894). In the two configurations where the change in aVTI was maximum, there was also no correlation between the delta dP/dt and the delta aVTI (p = 0.715). When patients were dichotomized according to the median value of dP/dt, there were no differences in aVTI, NYHA classes, LVEF, and mitral regurgitation (MR) severity (p = 0.4; p = 0.5; p = 0.7; p = 0.3; respectively). The change in both dP/dt and aVTI was statistically significant when switching from RV-only to QRS width-targeted configuration (p = 0.001; p = 0.041; respectively). CONCLUSION: In conclusion, aVTI recorded at different pacing configurations did not correlate with dP/dt during interventricular optimization. However, both parameters consistently showed a positive effect of biventricular pacing on contractile synchronization and stroke volume.

An enhanced proportional resonance controller design for the PMSM based electric vehicle drive system.

Permanent magnet synchronous machine (PMSM) has proven to be a more economical traction drive system for electric vehicle (EV) applications owing to increased efficiency and high-power density. However, the drive system requires more efficient control schemes to deliver better dynamic performance irrespective of dynamic changes in the motor speed, machine parameters and disturbances. Hence, to tackle the dynamic changes, to enhance the wider operating speed, to achieve precise speed tracking capability, and improved efficiency, a novel control algorithm for the PMSM based EV is proposed in this paper. The control algorithm is implemented by adopting the merits of conventional proportional resonance (PR) and proportional integral (PI) controller. The proposed control strategy is designed with an outer PI speed regulator and the inner enhanced PR (EPR) current regulator. The uniqueness of the proposed EPR controller is that the controller is designed to damp the torsional mode oscillation owing to dynamic changes such as speed and torque regulation evading the additional control loop. The effectiveness of the control scheme is tested in MATLAB Simulink and hardware-in-loop (HIL) real time simulator RT5700. To validate the effectiveness of the proposed control scheme the results are compared with the conventional control schemes. The results presented show that the proposed control technique successfully enhances the static and dynamic performance, and resilience of the EV system. Also, the proposed scheme significantly reduces the flux ripples, torque ripples, current jitter, peak overshoot, undershoot compared to the conventional current controllers.

Computation of differential and integral operators using M -polynomials of gold crystal.

Gold is generally considered a noble metal since it is inherently inert in its bulk state. However, gold demonstrates reactivity when it is in its ionic state. The inherent inertness of bulk gold has resulted in its widespread recognition as a vital raw material in various biomedical processes. The applications of these technologies include drug delivery microchips, dental prostheses, reconstructive surgery, culinary additives, and cardiovascular stents. Gold can also exist in molecules or ions, particularly gold ions, which facilitates the production of gold nanomaterials. In this paper, we have computed differential and integral operators by using the M -Polynomial of gold crystals and by utilizing this polynomial, we have also computed eleven topological indices like 1 s t Zagreb, 2 n d Zagreb, Hyper, Sigma, Second Modified, General Randic, General Reciprocal Randic, 3 r d Redefined Zagreb, Symmetric Division Degree, Harmonic, Inverse Sum indices for the structure of Gold crystal.

Effect of different inner pressures of air insoles and walking durations on plantar pressure time integral.

Air insoles have provided insights for reducing the risk of diabetic foot ulcers (DFU). The pressure time integral (PTI) is an effective assessment that considers the time effect in various physical activities. We investigated the interactions between three different insole inner pressures (80, 160, and 240 mmHg) and two walking durations (10 and 20 min). The big toe (T1), first metatarsal head (M1), and second metatarsal head (M2) were investigated in 13 healthy participants. One-way analysis of variance (ANOVA) showed that the effects of each insole inner pressure significantly differed (P < 0.05) with a 10 min walking duration. The PTI values resulting from 80 mmHg in M2 (38.4 ± 3.8, P = 0.002) and 160 mmHg in M1 (44.3 ± 4.3, P = 0.027) were lower than those from 240 mmHg. Additionally, the paired t test showed that the effects of each walking duration were also considerably different at 160 mmHg. The PTI at 10 min was lower than that at 20 min in M1 (44.31 ± 4.31, P = 0.015) and M2 (47.14 ± 5.27, P = 0.047). Thus, we suggest that walking with a pressure of 160 mmHg for 10 min has a lower risk of DFU.

Assessment of neural function recovery in premature infants at high risk of brain injury using amplitude integrated electroencephalography and GMs scales.

Preterm infants are a high-risk group for brain injury, and it is important to evaluate the neurological recovery of preterm infants. Therefore, this paper evaluates the neurological recovery in preterm infants at high risk of brain injury by amplitude-integrated EEG and GMs scale. The study collected basic information on preterm infants and performed amplitude integrated EEG examination and GMs scale evaluation. Amplitude integrated EEG examination attaches electrodes using multielectrode arrays onto specific areas of the premature head to record brain wave activity to monitor electrical activity in the preterm brain in real time and amplify and process through the signals received by the electrodes to obtain more detailed EEG data. The GMs scale evaluates the developmental and functional status of the child and allows an objective assessment of the development and recovery of neurological function by observing their performance in motor, language, cognition, and social interaction. Analysis of the data by statistical processing. The results showed that early brain injury was evident in high-risk infants. Amplitude integrated EEG parameters can have some predictive value for brain injury. There were also differences in GMs scale assessment between brain injury and non-brain injury. Amplitude integrated EEG combined with GMs scale has certain value in predicting brain injury and can provide an important basis for early intervention in children with preterm brain injury and help to improve their neurodevelopmental outcome.

Peltier-based temperature regulation: A method for performance optimization in solid-state lasers.

This article presents a direct method for temperature control in solid-state lasers, where temperature stability is crucial for optimizing the performance and reliability of such lasers. The proposed method utilizes Peltier chips for both cooling and heating the laser crystal to achieve precise temperature regulation. The system design is based on the step response of the open-loop thermal system and employs a proportional-integral (PI) controller for closed-loop temperature control. Comprehensive testing on a femtosecond Titanium-Sapphire Laser (Ti:Sapphire laser) demonstrated that the system is capable of maintaining the desired operating temperature with remarkable stability and efficiency, highlighting its practicality for real-world applications. Method Outline:•Utilization of Peltier chips for precise temperature control.•Estimation of first-order transfer function based on step response.•Implementation of a proportional-integral (PI) controller for closed-loop temperature regulation.

Estimation of time-varying kernel densities and chronology of the impact of COVID-19 on financial markets.

The time-varying kernel density estimation relies on two free parameters: the bandwidth and the discount factor. We propose to select these parameters so as to minimize a criterion consistent with the traditional requirements of the validation of a probability density forecast. These requirements are both the uniformity and the independence of the so-called probability integral transforms, which are the forecast time-varying cumulated distributions applied to the observations. We thus build a new numerical criterion incorporating both the uniformity and independence properties by the mean of an adapted Kolmogorov-Smirnov statistic. We apply this method to financial markets during the onset of the COVID-19 crisis. We determine the time-varying density of daily price returns of several stock indices and, using various divergence statistics, we are able to describe the chronology of the crisis as well as regional disparities. For instance, we observe a more limited impact of COVID-19 on financial markets in China, a strong impact in the US, and a slow recovery in Europe.

Incorporating body mass index into esophageal manometry metrics and mean nocturnal baseline impedance for the evaluation of gastro-esophageal reflux disease.

This study aims to enhance the effectiveness of high resolution manometry (HRM) and pH-impedance monitoring metrics in distinguishing between gastro-esophageal reflux disease (GERD) and non-GERD. A retrospective propensity score matching (PSM) study was conducted on 643 patients with GERD symptoms. PSM matched 134 GERD patients with 134 non-GERD controls. Body mass index (BMI), intra-esophageal pressure (IEP) and intra-gastric pressure (IGP) were significantly higher in the GERD group compared to the non-GERD group. BMI was correlated with IEP and IGP positively. IGP was positively correlated with esophagogastric (EGJ) pressure (EGJ-P) in participants with EGJ type 1 and 2, but not in participants with EGJ type 3. BMI was correlated with distal MNBI negatively. Logistic regression showed BMI as an independent risk factor for GERD. Receiver operating characteristic curve (ROC) and decision curve analysis (DCA) showed that BMI adjusted EGJ contractile integral (EGJ-CI) and BMI adjusted MNBI were superior to the corresponding original ones in predicting GERD susceptibility. According to the findings, BMI and IGP are the main factors contributing to the development of GERD. BMI affects IEP through the adaptive response of EGJ-P to IGP. Incorporating BMI into the calculations of EGJ-CI and MNBI can improve their ability in predicting GERD susceptibility.

Motion/force coordinated trajectory tracking control of nonholonomic wheeled mobile robot via LMPC-AISMC strategy.

Nonholonomic constrained wheeled mobile robot (WMR) trajectory tracking requires the enhancement of the ground adaptation capability of the WMR while ensuring its attitude tracking accuracy, a novel dual closed-loop control structure is developed to implement this motion/force coordinated control objective in this paper. Firstly, the outer-loop motion controller is presented using Laguerre functions modified model predictive control (LMPC). Optimised solution condition is introduced to reduce the number of LMPC solutions. Secondly, an inner-loop force controller based on adaptive integral sliding mode control (AISMC) is constructed to ensure the desired velocity tracking and output driving torques by combining second-order nonlinear extended state observer (ESO) with the estimation of dynamic uncertainties and external disturbances during WMR travelling process. Then, Lyapunov stability theory is utilised to guarantee the consistent final boundedness of the designed controller. Finally, the system is numerically simulated and practically verified. The results show that the double-closed-loop control strategy devised in this paper has better control performance in terms of complex trajectory tracking accuracy, system resistance to strong interference and computational timeliness, and is able to realise effective coordinated control of WMR motion/force.