The expectations of metastatic cancer patients regarding palliative chemotherapy: A Brazilian-German qualitative study.

OBJECTIVE: To explore the expectations of Brazilian and German patients regarding metastatic cancer and palliative chemotherapy. METHODS: Interviews with 48 metastatic cancer patients from Brazil and Germany were conducted. The interviews were transcribed and analyzed using the thematic analysis approach to identify common themes. The sociodemographic data were collected using an instrument developed by the authors. RESULTS: A total of 48 patients participated in the study (58% were Brazilian and 42% were German). Of all participants, 35% were men and 65% were women. The participants' mean age was 41 years. The general idea captured from the interviewees' speech was that their diseases were curable or "while there is chemotherapy, there is life"; thus, the data analysis enabled the elaboration of the central theme, entitled "Mistaken expectations of metastatic cancer patients regarding palliative chemotherapy: While there is chemotherapy, there is life," with 5 subthemes, namely: (1) communication and expectations; (2) normal life; (3) the person behind the disease; (4) religiosity and spirituality; and (5) the fortitude to choose between continuing or discontinuing treatment. SIGNIFICANCE OF RESULTS: Regardless of cultural aspects, patients with metastatic cancer on palliative chemotherapy tend to believe in the healing potential of treatments. Dividing expectations only into curable or incurable is insufficient, as even patients who have acknowledged the incurability of their disease expect to live, as long as they remain under treatment as if the disease did not exist.

Assessment of the Sun Nuclear ArcCHECK to detect errors in 6MV FFF VMAT delivery of brain SABR using ROC analysis.

Institutions use a range of different detector systems for patient-specific quality assurance (QA) measurements conducted to assure that the dose delivered by a patient's radiotherapy treatment plan matches the calculated dose distribution. However, the ability of different detectors to detect errors from different sources is often unreported. This study contains a systematic evaluation of Sun Nuclear's ArcCHECK in terms of the detectability of potential machine-related treatment errors. The five investigated sources of error were multileaf collimator (MLC) leaf positions, gantry angle, collimator angle, jaw positions, and dose output. The study encompassed the clinical treatment plans of 29 brain cancer patients who received stereotactic ablative radiotherapy (SABR). Six error magnitudes were investigated per source of error. In addition, the Eclipse AAA beam model dosimetric leaf gap (DLG) parameter was varied with four error magnitudes. Error detectability was determined based on the area under the receiver operating characteristic (ROC) curve (AUC). Detectability of DLG errors was good or excellent (AUC >0.8) at an error magnitude of at least ±0.4 mm, while MLC leaf position and gantry angle errors reached good or excellent detectability at error magnitudes of at least 1.0 mm and 0.6°, respectively. Ideal thresholds, that is, gamma passing rates, to maximize sensitivity and specificity ranged from 79.1% to 98.7%. The detectability of collimator angle, jaw position, and dose output errors was poor for all investigated error magnitudes, with an AUC between 0.5 and 0.6. The ArcCHECK device's ability to detect errors from treatment machine-related sources was evaluated, and ideal gamma passing rate thresholds were determined for each source of error. The ArcCHECK was able to detect errors in DLG value, MLC leaf positions, and gantry angle. The ArcCHECK was unable to detect the studied errors in collimator angle, jaw positions, and dose output.

Effects of Volume Training on Strength and Endurance of Back Muscles: A Randomized Controlled Trial.

CONTEXT: Strength/resistance training volume has historically been supported in the American College of Sports Medicine recommendations. However, for the back muscles, exercise prescription related to the number of sets, such as single versus multiple, is not well established in the literature. OBJECTIVE: The purpose of this study was to compare the effects of 2 training volumes on strength and endurance of back-extensor muscles in untrained young participants with regard to a repeated-measures design. DESIGN: Randomized controlled trial. SETTING: Laboratory of functional evaluation and human motor performance. PARTICIPANTS: Forty-four untrained young participants (mean age = 21 y) were randomized into single-set (n = 14), multiple-set (MSG, n = 15), and untrained control (n = 15) groups. INTERVENTION: The single-set group and MSG underwent a 10-week progressive resistance training program (2 d/wk) using a 45° Roman chair. MAIN OUTCOME MEASURES: Back maximal strength (dynamometer) and isometric and dynamic endurance (time limit, trunk extension-flexion cycles, and electromyography muscle fatigue estimates). RESULTS: The results showed differences between the MSG and control group for isometric endurance time (mean = 19.8 s; 95% confidence interval, -44.1 to 4.8), but without time intervention significance. Significant improvement after training (P < .05) was found predominantly during dynamic endurance (number of repetitions) for both the MSG (+61%) and single-set group (+26%) compared with preintervention, whereas the control group reported no benefit. There was no significant (P > .05) difference in either strength or electromyography estimates after training. CONCLUSIONS: Both multiple and single volume training were efficient in promoting better back endurance during dynamic performance based on mechanical variables (time and number of repetitions).

Effects of Holding an External Load on the Standing Balance of Older and Younger Adults With and Without Chronic Low Back Pain.

OBJECTIVE: The purpose of this study was to assess the effect of holding an external load on the standing balance of younger and older adults with and without chronic low back pain (CLBP). METHODS: Twenty participants with and 20 without CLBP participated in the study. Each group contained 10 younger (50% men) and 10 older adults (50% men). Participants were instructed to look straight ahead while standing on a force platform during two 120-second trials with and without holding an external load (10% of body mass). The center of pressure area, mean velocity, and mean frequency in the anteroposterior and mediolateral directions were measured. RESULTS: Older adults had worse standing balance than younger adults did (P < .001, d = 0.20). There were no significant balance differences between participants with and without CLBP within age groups during standing balance condition. However, holding the external load significantly increased postural instability for both age groups and CLBP status, with mean effect size across center of pressure variables of d = 0.82 for older participants without CLBP and d = 2.65 for younger participants without CLBP. These effects for people with CLBP were d = 1.65 for subgroup of older and d = 1.60 for subgroup of younger participants. CONCLUSION: Holding an external load of 10% of body mass increased postural instability of both younger and older adults with and without CLBP.

A Randomized Trial Comparing Quality of Life After Low-Dose Rate or High-Dose Rate Prostate Brachytherapy Boost With Pelvic External Beam Radiation Therapy.

PURPOSE: To compare health-related quality of life (QoL) in urinary, bowel, and sexual domains after combined external beam radiation therapy (EBRT) and either low-dose rate (LDR) or high-dose rate (HDR) prostate brachytherapy (BT). METHODS AND MATERIALS: Eligible men with intermediate or high-risk prostate cancer treated with combined pelvic EBRT and BT were randomly assigned to either HDR (15 Gy) or LDR (110 Gy) boost. International Prostate Symptom Score, Index of Erectile Function, and Expanded Prostate Cancer Composite were collected at baseline, 1, 3, 6, and 12 months, every 6 months to 3 years and then annually along with prostate-specific antigen/testosterone. Fisher's exact test compared categorical variables and the Mann-Whitney U test Expanded Prostate Cancer Index Composite (EPIC) domain scores. RESULTS: From January 2014 to December 2019, a random number generator assigned 195 men: 108 to HDR and 87 to LDR. Median age was 71 years. Risk group was high in 57% and unfavorable intermediate in 43%. Androgen deprivation (used in 74%) began with 3 months neoadjuvant and continued for median 12 months. Baseline EPIC scores were similar for the LDR/HDR cohorts: 89 and 88 respectively for Genito-urinary; 92 and 93 for Gastro-intestinal. EPIC urinary scores decreased at 1 month for HDR but recovered promptly to a steady state by 6 months. LDR scores reached a nadir at 3 months with slow recovery to 18 months, after which urinary QoL was similar for HDR and LDR. Bowel QOL scores fell in both cohorts reaching respective nadirs at 12 months. HDR patients recovered close to baseline and maintained higher scores than LDR patients to 5 years. The decline for LDR patients remained more than the minimum clinically important difference out to 5 years. CONCLUSIONS: The patient experience for combined EBRT and prostate BT is improved with HDR BT. Urinary QoL improves over time to be equivalent between the 2 modalities after 18 months, but LDR patients report lasting bowel symptoms.

Impact of a large-scale telemedicine network on emergency visits and hospital admissions during the coronavirus disease 2019 pandemic in Brazil: Data from the UNIMED-BH system.

INTRODUCTION: Triage by on-demand telemedicine is a strategy for healthcare surge control in the COVID-19 pandemic. We aimed to assess the impact of a large-scale COVID-19 telemedicine system on emergency department (ED) visits and all-cause and cardiovascular hospital admissions in Brazil. METHODS: From March 18, 2020-May 18, 2020 we evaluated the database of a cooperative private health insurance, with 1.28 million clients. The COVID-19 telemedicine system consisted of: a) mobile app, which redirects to teleconsultations if indicated; b) telemonitoring system, with regular phone calls to suspected/confirmed COVID-19 cases to monitor progression; c) emergency ambulance system (EAS), with internet phone triage and counselling. ED visits and hospital admissions were recorded, with diagnoses assessed by the Diagnosis Related Groups method. COVID-19 diagnosis and deaths were identified from the patients' registries, and outcomes assessed until June 1st. RESULTS: In 60 days, 24,354 patients accessed one of the telemedicine systems. The most frequently utilized was telemonitoring (16,717, 69%), followed by teleconsultation (13,357, 55%) and EAS (687, 3%). The rates of ED and hospital admissions were: telemonitoring 19.7% (3,296) and 4.7% (782); teleconsultation 17.3% (2,313) and 2.4% (318) and EAS: 55.9% (384) and 56.5% (388) patients. At total 4.1% (1,010) had hospital admissions, 36% (363) with respiratory diseases (44 requiring mechanical ventilation) and 4.4% (44) with cardiovascular diagnoses. Overall, 277 (1.1%) patients had confirmed COVID-19 diagnosis, and 160 (0.7%) died, 9 with COVID-19. CONCLUSION: Telemedicine resulted in low rates of ED visits and hospital admissions, suggesting positive impacts on healthcare utilization. Cardiovascular admissions were remarkably rare.

MRI-defined treatment margins, urinary toxicity, and PSA response in LDR prostate brachytherapy.

PURPOSE: Implant quality metrics as measured by D90 and V100 do not address the adequacy of periprostatic margins. Relative margin deficiencies may relate to efficacy and margin excesses to post-implant toxicity. Our purpose is to determine MRI-defined treatment margins on prostate achieved with LDR brachytherapy. METHODS AND MATERIALS: Post implant CT and MR images from 487 consecutive patients who received LDR brachytherapy from 2010 to 14 were co-registered. Four prostate quadrants were defined; anterior-superior (AS), posterior-superior (PS), anterior-inferior (AI), posterior-inferior (PI). Dosimetric variables were measured for prostate, and for each quadrant with a 0-, 2-, 3-, and 5-mm margin, as well as for the membranous urethra defined on MRI. RESULTS: Prostate D90 (no margin) was associated with D90 to the volume enclosed by 2 mm, 3 mm and 5 mm margins (R2 = 0.9 - 1.0) with an average 7.1% decrease in dose per mm of margin. Mean D90 for PS, AI and PI quadrants were > 110% of prescription dose for margins of 2-, 3-, and 5-mm. AS quadrant mean D90s were generally lower (83.2% for 2 mm, 76.4% for 3 mm and 62.2% for 5 mm). Urethral strictures (n = 9) were associated with higher doses in the AI quadrant, and higher membranous urethral V125 (51 vs. 32%, p 0.013) and V150 (34.5 vs. 17.6%, p 0.01). CONCLUSIONS: Using MR-CT post implant dosimetry, margin coverage up to 5 mm was excellent with less margin coverage in the AS quadrant. Late ≥ grade 2 toxicity and urinary strictures are more likely to occur with relative margin excess in the anterior-inferior quadrant and higher doses caudal to the prostate apex. Within this analysis, there was no relationship between treatment margins, and PSA outcome.

Comparison between postoperative TRUS-CT fusion with MRI-CT fusion for postimplant quality assurance in prostate LDR permanent seed brachytherapy.

PURPOSE/OBJECTIVE Permanent seed Low-Dose-Rate brachytherapy is planned and delivered using transrectal ultrasound (TRUS). Post-implant evaluation for quality assurance is usually performed using Computed Tomography (CT). Registration of the CT images with MRI reduces subjectivity in contouring by improving prostate edge detection. We hypothesized that a set of TRUS images post procedure may provide the same benefit. MATERIAL/METHODS Consecutive patients undergoing Low-Dose-Rate prostate brachytherapy were recruited. TRUS images were recorded under anesthesia at completion of their implant. In addition, all patients underwent standard post-implant quality assurance including prostate CT and MRI at day 30. These were co-registered, contoured and seeds were identified. Three independent observers contoured and registered the post implant TRUS images to the Day 30 CT using seed matching. Prostate volumes and dosimetric parameters were compared through Intraclass Correlation Coefficient (ICC) to evaluate the concordance between MRI and ultrasound (US). RESULTS 26 patients were recruited from 10/17 to 01/18. Mean prostate volume was 34.5 (SD 10.8) cm3 at baseline on planning TRUS images, 37.4 (SD 11.3) cm3 on Day 0 post implant TRUS and 36.7 (SD 11.7) cm3 on Day 30 MRI. D90 was 112.6% (SD 9.3) on CT-MRI and 112.9% (SD 11.1) on CT-US. V100 was 94.6% (SD 3.8) for CT-MRI, 95.1% (SD 4.3) for CT-US. Student t-tests were used to compare groups. No significant differences were noted. CONCLUSION Post implant TRUS may be useful for quality assurance for post-implant dosimetry particularly if access to an MRI is limited.

Implementation of Single-Fraction Lung Stereotactic Ablative Radiotherapy in a Multicenter Provincial Cancer Program During the COVID-19 Pandemic.

Background During the novel coronavirus disease 2019 (COVID-19) pandemic, cancer centers considered shortened courses of radiotherapy to minimize the risk of infectious exposure of patients and staff members. Amidst a pandemic, the process of implementing new treatment approaches can be particularly challenging in larger institutions with multiple treatment centers. We describe the implementation of single-fraction (SF) lung stereotactic ablative radiotherapy (SABR) in a multicenter provincial cancer program. Materials and Methods British Columbia, Canada has a provincial cancer program with six geographically distributed radiotherapy centers serving a population of 5.1 million, over 944,735 square kilometers. In March 2020, provincial mitigation strategies were developed in case of reduced access to radiotherapy due to the COVID-19 pandemic. SF lung SABR was identified by the provincial lung radiation oncology group as a mitigation measure supported by high-quality randomized evidence that could provide comparable outcomes and toxicity to existing fractionated SABR protocols. A working group consisting of radiation oncologists and medical physicists reviewed the medical literature and drafted consensus guidelines that were reviewed by a group of center representatives as a component of provincial lung radiotherapy mitigation strategic planning. Individual centers were encouraged to implement SF lung SABR as their resources and staffing would allow. Centers were then surveyed about barriers to implementation. Results On March 24, 2020, a working group was created and consensus guidelines for SF lung SABR were drafted. The final version was approved and distributed by the working group on March 26, 2020. The provincial lung radiotherapy mitigation strategy group adopted the guidelines for implementation on April 1, 2020. Implementation was completed at the first center on April 27, 2020. Barriers to implementation were identified at five of six centers. Two centers in regions with disproportionately high COVID-19 cases described inadequate staffing as a barrier to implementation. One center encountered delays due to pre-scheduled commissioning of new treatment techniques. Three centers cited competing priorities as reasons for delay. As of May 2021, two centers had active SF lung SABR programs in place, three centers were in the process of implementation, and one center had no immediate plans for implementation due to ongoing resource issues. Conclusion SF lung SABR was adopted by a provincial cancer program within weeks of conception through rapid communication during the development of COVID-19 pandemic mitigation strategies for radiotherapy. Although consensus guidelines were written and approved in an expedited timeframe, the completion of implementation by individual centers was variable due to differences in resource allocation and staffing among the centers. Strong organizational structures and early identification of potential barriers may improve the efficiency of implementing new treatment initiatives in large multicenter radiotherapy programs.

Reduction in Hospital Admissions Associated with Coronary Events during the COVID-19 Pandemic in the Brazilian Private Health System: Data from the UNIMED-BH System.

INTRODUCTION: We aimed to evaluate the impact of the new coronavirus disease 2019 on coronary hospitalizations in the Brazilian private health system. METHODS: Data on coronary admissions in 2020 and a 2-year historical series were collected from the UNIMED-BH insurance system. RESULTS: Admission rates in 2020 reduced by 26% (95%CI, 22-30) in comparison with 2018/2019, markedly from March to May (37%) compared to the peak of the pandemic (June-September, 19%). Mortality was higher in 2020 (5.4%, 95%CI 4.5-6.4) than in 2018/2019 (3.6%, 95%CI 3.2-4.1). CONCLUSIONS: There was a significant decrease in coronary admissions, with higher mortality during the COVID-19 pandemic.

Prediction of Carcass Traits of Santa Inês Lambs Finished in Tropical Pastures through Biometric Measurements.

The aim of this study was to predict carcass traits of Santa Inês lambs finished in tropical pastures by using biometric measurements. Data originated from two experiments involving 56 lambs (32 in experiment I and 24 in experiment II). In both experiments, the sheep were finished in that were finished in pastures of Panicum maximum and Brachiaria brizantha, experiment I being conducted in the rainy season and experiment II in the dry season. The following biometric measurements were recorded before slaughter: body length (BL), withers height (WH), rump height (RH), thorax width (TW), rump width (RW), chest width (CW), heart girth (HG), thigh circumference (TC), rump circumference (RC) and leg length (LL), in addition to live weight at slaughter (SW). After slaughter, hot carcass weight (HCW), cold carcass weight (CCW) and the weights of primal cuts (shoulder, neck, loin, leg and rib) were recorded. In the equations generated to predict SW, HCW and CCW, R2 ranged from 0.58 to 0.91 and the measurements of WH, TC, CW, HG and RW were the most relevant. In the equations developed to predict the weight of primal cuts, in turn, R2 ranged from 0.26 to 0.99. In these models, SW, BL, CW, TC, LL and HG explained most of the variation in the weight of primal cuts. Biometric measurements can be used to accurately and precisely predict HCW, CCW and the weight of primal cuts from the carcass of Santa Inês sheep finished in tropical pastures, since the equations presented R2 and correlation coefficient and agreement above 0.8.

Sports and Functional Training Improve a Subset of Obesity-Related Health Parameters in Adolescents: A Randomized Controlled Trial.

To investigate the effects of two different modes of physical activity on body composition, physical fitness, cardiometabolic risk, and psychological responses in female adolescents participating in a multi-disciplinary program. The 12-week randomized intervention included 25-adolescents with overweight divided into two groups: sports practice-SPG and functional training-FTG. The SPG intervention was divided into three sports: basketball, handball, and futsal. SPG participants performed one sport 3-times/week, over the course of 1 month. The FTG performed concurrent exercises 3-times/week. This study was registered in Clinical Trials Registry Platform under number: RBR-45ywtg and registered in Local Ethics Committee number: 2,505.200/2018. The intensity of physical exercises-PE was matched between groups by the rating of perceived exertion. The primary outcome was body composition, and secondary outcomes were physical fitness, cardiometabolic risk, and psychological responses. There was a significant time-effect for body mass, body mass index, and low-density lipoprotein (LDL-c), all being reduced. There were increases over time for musculoskeletal mass, aerobic fitness, and high-density lipoprotein (HDL-c) (p < 0.05). There was a group time interaction with body fat percentage being lower post-intervention in the SPG (p < 0.05). No significant differences were observed for the other variables. Both physical activity models were effective in improving a subset of obesity-related health parameters. The findings should be extended by further investigation using more sophisticated measures of energy expenditure. Clinical Trial Registration: https://ensaiosclinicos.gov.br/, identifier: RBR-45ywtg.

Dose to the dominant intraprostatic lesion using HDR vs. LDR monotherapy: A Phase II randomized trial.

PURPOSE: To present the dosimetric results of a Phase II randomized trial comparing dose escalation to the MRI-defined dominant intraprostatic lesion (DIL) using either low-dose-rate (LDR) or high-dose-rate (HDR) prostate brachytherapy. MATERIAL AND METHODS: Patients receiving prostate brachytherapy as monotherapy were randomized to LDR or HDR brachytherapy. Prostate and DILs were contoured on preoperative multiparametric MRI. These images were registered with transrectal ultrasound for treatment planning. LDR brachytherapy was preplanned using I-125 seeds. HDR brachytherapy used intraoperative transrectal ultrasound-based planning to deliver 27 Gy/2 fractions in separate implants. DIL location was classified as peripheral, central, or anterior. A student t-test compared DIL D90 between modalities and DIL locations. RESULTS: Of 60 patients, 31 underwent LDR and 29 HDR brachytherapy. Up to three DILs were identified per patient (100 total) with 74 peripheral, six central, and 20 anterior DILs. Mean DIL volume was 1.9 cc (SD: 1.7 cc) for LDR and 1.6 cc (SD 1.3 cc) for HDR (p = 0.279). Mean DIL D90 was 151% (SD 30%) for LDR and 132% (SD 13%) for HDR. For LDR, mean peripheral DIL D90 was 159% (SD 27%) and central or anterior 127% (SD 13%). HDR peripheral DILs received 137% (SD 12%) and central or anterior 119% (SD 7%). DIL D90 for peripheral lesions was higher than anterior and central (p < 0.001). CONCLUSIONS: DIL location affects dose escalation, particularly because of urethral proximity, such as for anterior and central DILs. HDR brachytherapy may dose escalate better when target DIL is close to critical organs.

Occupational stress among emergency and urgent care nurses at a public hospital in Teresina, Piaui, Brazil.

BACKGROUND: The number of emergency and urgent care providers with occupational stress is quite large and is a source of concern for hospital managers. Nurses are the professional category most affected among workers exposed to occupational stress. OBJECTIVE: To investigate the level of occupational stress among emergency and urgent care nurses at a public hospital in Teresina, Piaui, Brazil, by means of the Bianchi Stress Questionnaire. METHODS: Cross-sectional descriptive study conducted from November 2016 through January 2017 at a public emergency and urgency care hospital in Teresina. The sample comprised 20 nurses allocated to the department red, yellow, green and stabilization zones. Data were collected by means of the Bianchi Stress Questionnaire (BSQ), fed to a database and processed using software Statistical Package for the Social Sciences version 23.0. Analysis consisted of descriptive statics. RESULTS: Participants were predominantly female (75%) within age range 31 to 40 years old (65%); most had graduated 6 to 10 years earlier (60%), 90% had attended graduate education and 70% had worked at the department for more than 6 years. The global stress score ranged from 2.4 to 5.25, mean 3.46; the highest stress level corresponded to BSQ domain A. Conclusion: Interpersonal relationships in emergency and urgent care departments might be a cause of occupational stress among workers.

INTRODUÇÃO: Nos serviços de urgência e emergência, o número de profissionais acometidos pelo estresse ocupacional é bastante elevado e tem gerado grande preocupação para a gestão hospitalar. Entre os profissionais de saúde com maior exposição ao estresse ocupacional, os enfermeiros encontram-se como os mais afetados. OBJETIVO: Verificar o nível de estresse ocupacional dos enfermeiros pela Escala Bianchi na unidade de urgência e emergência de um hospital público de Teresina, Piauí. MÉTODOS: Estudo transversal descritivo realizado nos meses de novembro de 2016 a janeiro de 2017 em um hospital público de urgências e emergência de Teresina, Piauí. A amostra foi composta de 20 enfermeiros que exercem suas funções nas salas vermelha, amarela, verde e estabilização. Os dados foram coletados utilizando a Escala Bianchi de Stress. Os dados foram inseridos em bancos de dados e processados no software Statistical Package for the Social Sciences, versão 23.0, e foram calculadas estatísticas descritivas. RESULTADOS: A amostra foi eminentemente feminina (75%), com faixa etária entre 31 e 40 anos (65%), sendo que a maioria apresentava entre 6 e 10 anos (60%) de graduado em enfermagem, 90% com pós-graduação e 70% desenvolvem as atividades na unidade de emergência há mais de 6 anos. Os enfermeiros obtiveram escore individual de estresse entre 2,4 e 5,25. O nível médio de estresse com escore global foi 3,46 com destaque ao domínio A. CONCLUSÃO: Foi possível constatar que as relações interpessoais nos serviços de urgência e emergência podem ser uma das causas do estresse ocupacional entre os profissionais.

Enhancing enzymatic hydrolysis of coconut husk through Pseudomonas aeruginosa AP 029/GLVIIA rhamnolipid preparation.

This work investigated the influence of chemical (Triton X-100) and biological surfactant preparation (rhamnolipids) in coconut husk hydrolysis that was subjected to pretreatment with acid-alkali or alkaline hydrogen peroxide. The natural and pretreated biomass was characterized using the National Renewable Energy Laboratory protocol analysis as well as X-ray diffraction and scanning electron microscopy. The results demonstrated that in terms of the total reducing sugars, there was no significant difference between the hydrolysis using Triton X-100 and rhamnolipids, regardless of the pretreatment. A cellulosic conversion value as high as 33.0% was obtained in experiments with rhamnolipids. The coconut husk was observed to be a potential biomass that could produce second generation ethanol, and the rhamnolipid preparation can be used to support for the enzymatic hydrolysis, enhancing the advantage of cellulose conversion into glucose over chemical surfactants because it is an environmentally friendly approach.

Mcconnell's patellar taping does not alter knee and hip muscle activation differences during proprioceptive exercises: A randomized placebo-controlled trial in women with patellofemoral pain syndrome.

The purpose of this study was to assess the effect of patellar taping on muscle activation of the knee and hip muscles in women with Patellofemoral Pain Syndrome during five proprioceptive exercises. Forty sedentary women with syndrome were randomly allocated in two groups: Patellar Taping (based in McConnell) and Placebo (vertical taping on patella without any stretching of lateral structures of the knee). Volunteers performed five proprioceptive exercises randomly: Swing apparatus, Mini-trampoline, Bosu balance ball, Anteroposterior sway on a rectangular board and Mediolateral sway on a rectangular board. All exercises were performed in one-leg stance position with injured knee at flexion of 30° during 15s. Muscle activation was measured by surface electromyography across Vastus Medialis, Vastus Lateralis and Gluteus medius muscles. Maximal voluntary contraction was performed for both hip and knee muscles in order to normalize electromyography signal relative to maximum effort during the exercises. ANOVA results reported no significant interaction (P>0.05) and no significant differences (P>0.05) between groups and intervention effects in all exercise conditions. Significant differences (P<0.01) were only reported between muscles, where hip presented higher activity than knee muscles. Patellar taping is not better than placebo for changes in the muscular activity of both hip and knee muscles during proprioceptive exercises. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov NCT02322515.

Effects of a multi-professional approach on anthropometric variables and food profile of overweight or obese adolescents / Efeitos de uma abordagem multi-profissional sobre variáveis antropométricas e de perfil alimentar de adolescentes com sobrepeso ou obesidade

INTRODUCTION: Investigating the of overweight or obese adolescents' nutritional quality is substantial to guide healthy eating strategiesOBJECTIVE: To assess the effects of a multi-professional approach on anthropometric parameters, body composition, and the level of food processing in adolescentsMETHODS: Twelve overweight/obese male adolescents between 13-17 years old participated in a series of 12-week multi-professional interventions led by physical education, nutrition, and psychology professionals. The participants were assessed before the intervention as well as at 6 and 12 weeks. Anthropometric assessments were performed, including body weight, stature, and body mass index; body composition, with fat mass (FM), body fat (%BF), skeletal muscle mass, and resting metabolic rate (RMR), and by filling in a three-day food record, to assess the ingested foods by its level of processing: fresh, minimally processed, processed, and ultra-processedRESULTS: No differences were observed in anthropometric parameters performed at different stages (p>0.05). Reductions in FM and %BF and increases in SMM and RMR (p<0.05) were identified after, the 12-week intervention. There was an increase in the consumption of natural foods/g and increased the caloric consumption of processed foods/kcal after 12-week of intervention (p<0.05CONCLUSION: The model resulted in a decrease in fat mass and body fat percentage, an in skeletal muscle mass, resting metabolic rate, natural foods/g, and processed foods/kcal

INTRODUÇÃO: Investigar a qualidade nutricional de adolescentes com sobrepeso ou obesidade é substancial para orientar estratégias de alimentação saudávelOBJETIVO: Avaliar os efeitos de uma abordagem multiprofissional sobre os parâmetros antropométricos, de composição corporal e o nível de processamento de alimentos em adolescentesMÉTODO: Doze adolescentes do sexo masculino com sobrepeso/obesidade, entre 13-17 anos participaram de uma série de intervenções multiprofissionais ao longo de 12 semanas, que foram conduzidas por profissionais de educação física, nutricionistas e psicólogos. Os participantes foram avaliados antes da intervenção, após 6 e após 12 semanas. As avaliações antropométricas foram realizadas, incluindo o peso corporal, a estatura e o índice de massa corporal; para a composição corporal foram incluídas: a massa gorda (MG), percentual de gordura corporal (%G), massa muscular esquelética (MME) e taxa metabólica basal (TMB), bem como o preenchimento do registro alimentar de três dias, para avaliar os alimentos ingeridos, via nível de processamento: in natura, minimamente processado, processado e ultraprocessadoRESULTADOS: Não foram observadas diferenças significativas nos parâmetros antropométricos realizados nas diferentes etapas (p>0,05). Reduções na MG e %G e aumentos na MME e TMB (p<0,05) foram identificados após 12 semanas de intervenção. Houve um aumento do consumo de alimentos in natura/g e aumento do consumo calórico de alimentos industrializados/kcal, após 12 semanas de intervenção (p<0,05CONCLUSÃO: O modelo proposto resultou em uma diminuição da massa gorda e percentual de gordura corporal, aumento da massa muscular esquelética, taxa metabólica basal, consumo de alimentos naturais/g e alimentos processados/kcal

Five-week sensory motor training program improves functional performance and postural control in young male soccer players - A blind randomized clinical trial.

Sensory motor training programs are used in the rehabilitation and prevention of injuries among soccer players. Inconsistencies are found in the literature regarding the duration of the protocols and the exercises and equipment used. OBJECTIVE: To evaluate the benefits of a five-week sensory motor training program on the functional performance and postural control of young soccer players. METHODS: The study sample comprised 22 young male soccer players who were evaluated using: the Figure-of-Eight Test (F8), Side Hop Test (SHT), Star Excursion Balance Test (SEBT), and a force platform. The players were randomly divided into a control group (N = 10), who continued their soccer practice sessions and an intervention group (N = 12), who continued their soccer practice sessions and were also enrolled in a supervised five-week sensory motor training program. RESULTS: After the five-week training program, the intervention group obtained significant results in the F8, SHT and SEBT, as well as in the following parameters: area of pressure of sway center (COP), mean velocity and mean frequency of COP. CONCLUSION: The five-week sensory motor training program, carried out with easily available and low cost equipment, was effective at improving functional performance and postural control in young soccer players.

Efectos de dos programas de ejercicios resistidos en la aptitud física relacionada con la salud de mujeres obesas con síntomas de algia en las rodillas / Effects of two resistance exercise programs on the health-related fitness of obese women with pain symptoms in the knees

Introducción: El sobrepeso afecta negativamente al sistema cardiovascular y al osteomioarticular, favoreciendo el dolor en las articulaciones de las extremidades inferiores. Por lo tanto, se han aplicado estrategias para reducir el sobrepeso a través de cambios en el estilo de vida. Objetivo: investigar los efectos de dos programas de intervención multidisciplinares sobre la aptitud física relacionada con la salud de mujeres obesas con síntomas de dolor en las rodillas. Métodos: Se evaluó a mujeres entre 40 y 59 años con obesidad (n=59) en el tiempo pre y post intervención en antropometría, composición corporal, aptitud física, nivel de discapacidad en rodilla y cadera y calidad de vida relacionada con la salud. Se realizó un ensayo clínico aleatorizado de grupos paralelos, utilizando dos programas de ejercicio de resistencia y reeducación alimentaria, durante ocho semanas. Todos los participantes recibieron el mismo contenido de intervención nutricional y para ejercicios físicos se aleatorizaron en dos grupos, G1 siendo el "grupo de fuerza" utilizando máquinas (n=30), y G2 siendo el grupo de "entrenamiento funcional" (n=29). Veintiocho mujeres (G1=18 + G2=10) fueron incluidas en los análisis finales. Los grupos y el tiempo se evaluaron mediante análisis bidireccional de la varianza, con medidas repetidas. Se asumió una p < 0,05 para todos los análisis. Resultados: se identificó un efecto de tiempo, con valores más altos para la fuerza máxima de tracción lumbar isométrica (MILTS), luego del período de intervención en ambos grupos (p < 0.05). Sin embargo, para las otras variables investigadas, no se identificaron diferencias significativas (p > 0.05). Conclusión: La ausencia de resultados significativos para todas las variables, excepto FIMTL, puede estar justificada por la adherencia moderada de los participantes a las intervenciones (~ 59% a 66%) ya que el estudio se realizó durante el período de aislamiento social (COVID-19). Sin embargo, se cree que los modelos de intervención fueron positivos en el mantenimiento de las variables estudiadas.

Introduction: Overweight negatively impacts the cardiovascular system and osteomyoarticular, promoting pain in the joints of the lower limbs. Therefore, strategies have been applied to reduce overweight through lifestyle changes. Objective: to investigate the effects of two multidisciplinary intervention programs on the health-related physical fitness of obese women with pain symptoms in the knees. Methods: Women between 40 and 59 years of age with obesity (n=59) were evaluated in the pre- and post-intervention time regarding anthropometry, body composition, physical fitness, level of disability in the knee and hip, and health-related quality of life. A randomized clinical trial of parallel groups was conducted, using two resistance exercise programs and food re-education, for eight weeks. All participants received the same nutritional intervention content and for physical exercises were randomized into two groups, G1 being the "strength group" using machines (n=30), and G2 being the "functional training" group (n=29). Twenty-eight women (G1=18 + G2=10) were included in the final analyses. The groups and time were evaluated by two-way analysis of variance, with repeated measures. A p < 0.05 was assumed for all analyses. Results: a time effect was identified, with higher values for maximum isometric lumbar-traction strength (MILTS), after the intervention period in both groups (p < 0.05). However, for the other variables investigated, no significant differences were identified (p > 0.05). Conclusion: The absence of significant results for all variables, except FIMTL, may be justified by the moderate adherence of the participants to interventions (~59% to 66%) since the study was conducted during the period of social isolation (COVID-19). However, it is believed that the intervention models were positive in maintaining the variables studied.

Reduction in Hospital Admissions Associated with Coronary Events during the COVID-19 Pandemic in the Brazilian Private Health System: Data from the UNIMED-BH System

Abstract INTRODUCTION: We aimed to evaluate the impact of the new coronavirus disease 2019 on coronary hospitalizations in the Brazilian private health system. METHODS: Data on coronary admissions in 2020 and a 2-year historical series were collected from the UNIMED-BH insurance system. RESULTS: Admission rates in 2020 reduced by 26% (95%CI, 22-30) in comparison with 2018/2019, markedly from March to May (37%) compared to the peak of the pandemic (June-September, 19%). Mortality was higher in 2020 (5.4%, 95%CI 4.5-6.4) than in 2018/2019 (3.6%, 95%CI 3.2-4.1). CONCLUSIONS: There was a significant decrease in coronary admissions, with higher mortality during the COVID-19 pandemic.