Abstract Sisal (Agave sisalana) is a plant exploited in semi-arid regions of Brazil for fiber production, but the floral scape of sisal (peduncle) is collected and often burned, causing environmental problems, even through irregular disposal. To circumvent this scenario, the objective of this work was to produce reconstituted panels using the sisal arrow and castor-based polyurethane resin. The panels were obtained using 175 g of crushed sisal arrow core with dimensions smaller than 2 mm and adopting 10% castor-based polyurethane resin and The samples were pressed under tension of 2 MPa. The properties of reconstituted panel were evaluated through NBR 14810-1 (ABNT, 2013) and NBR 14810-2 (ABNT, 2018), the physical properties were investigated: moisture, density, thickness swelling and absorption; as well as mechanical properties: MOR, MOE, internal bond and parallel compression. The found results show that the panel is classified as low density (419.8 kg/m³), and with physical and mechanical properties similars to other panels of the same classification in the literature. For average values of MOR and MOE it was found 5.24 MPa and 147.49 MPa, respectively. For internal bonding it was found 0.14 MPa and for parallel compression properties it was found 1.14 MPa.

Resumo O sisal (Agave sisalana) é uma planta explorada nas regiões semiáridas do Brasil para produção de fibras, mas o escapo floral do sisal (flecha) é coletado e frequentemente queimado causando problemas ambientais, até mesmo pelo descarte irregular. Para contornar este cenário, o objetivo deste trabalho foi produzir painéis reconstituídos usando a flecha do sisal e resina poliuretana à base de mamona. Os painéis foram obtidos empregando 175 g do miolo da flecha de sisal triturada com dimensões inferiores a 2 mm e adotando 10% de resina poliuretana à base de mamona e as amostras foram prensadas com tensão de 2 MPa. Avaliou-se no painel reconstituído, através da NBR 14810-1 (ABNT, 2013) e NBR 14810-2 (ABNT, 2018) as propriedades físicas: umidade, densidade, inchamento e absorção; bem como as propriedades mecânicas: MOR, MOE, força de ligação e compressão paralela. Os resultados encontrados mostram que o painel é classificado como de baixa densidade (419,8 kg/m³), e de propriedades físicas e mecânicas semelhantes a outros painéis de mesma classificação da literatura. Para MOR e MOE foram encontrados 5,24 MPa e 147,49 MPa de média, respectivamente. Já os ensaios de tração perpendicular e compressão paralela obtiveram resultados de 0,14 MPa e 1,14 MPa, respectivamente.

ABSTRACT The symbiosis of common beans with nitrogen-fixing bacteria provides an efficient approach to sustainable and economical food production. Therefore, this study aimed to evaluate the application of cost-effective nitrogen management strategies in organic common bean cultivation, including the application of poultry manure and organic liquid fertilizer, seed and co-inoculation with diazotrophic bacteria (Azospirillum brasilense and/or Rhizobium tropici), and supplementary Rhizobium tropici inoculation. The study spanned three years in a well-established organic cultivation field (2018) and an initial organic cultivation area (2019 and 2020) in Brazil. It was arranged in a randomized blocks design in a 2 × 5 (2018) and 2 × 6 (2019 and 2020) factorial scheme, with four replicates. The most profitable strategy involves seed inoculation with Azospirillum brasilense and additional inoculation with Rhizobium tropici at stage V4-5 (fifth trifoliate leaf fully expanded), while the most costly strategy was the application of poultry manure at the V3 stage (first trifoliate leaf fully expanded). Thus, the use of diazotrophic bacteria for seed inoculation and co-inoculation (Azospirillum brasilense and/or Rhizobium tropici) ensured financial returns and system profitability in common bean cultivation.

RESUMO A simbiose do feijão comum com bactérias fixadoras de nitrogênio proporciona uma abordagem eficiente para a produção de alimentos sustentável e econômica. Portanto, este estudo teve como objetivo avaliar a aplicação de estratégias custo-efetivas de manejo de nitrogênio no cultivo orgânico do feijão comum, incluindo a aplicação de esterco de aves e fertilizante orgânico líquido, inoculação de sementes e coinoculação com bactérias diazotróficas (Azospirillum brasilense e/ou Rhizobium tropici), e inoculação suplementar com Rhizobium tropici. O estudo durou três anos em um campo de cultivo orgânico bem estabelecido (2018) e uma área inicial de cultivo orgânico (2019 e 2020) no Brasil. O delineamento foi em blocos casualizados em esquema fatorial 2 × 5 (2018) e 2 × 6 (2019 e 2020), com quatro repetições. A estratégia mais lucrativa envolve a inoculação de sementes com Azospirillum brasilense e inoculação adicional com Rhizobium tropici no estádio V4-5 (quinta folha trifoliada totalmente expandida), enquanto a estratégia mais cara foi a aplicação de esterco de aves no estádio V3 (primeira folha trifoliada totalmente expandida). Assim, o uso de bactérias diazotróficas para inoculação e coinoculação de sementes (Azospirillum brasilense e/ou Rhizobium tropici) garantiu retorno financeiro e rentabilidade do sistema no cultivo do feijão comum.

Abstract Paper aims Due to the scarcity of research that approaches the Lean Office in conjunction with Industry 4.0 Technologies, this article aims to discuss, understand and analyze the associations between these two concepts, as well as identify gaps to be explored. Originality This research contributes with guidelines for applying Industry 4.0 Technologies in administrative areas and possibilities of an association with the Lean for the development of the Smart Office. Research method Based on a systematic review of the literature, with a basic purpose, a descriptive objective, and qualitative data, a framework for developing the Smart Office is presented. Main findings An association model between Lean Office tools and Industry 4.0 Technologies is provided. It even classifies and addresses the impact and trends in administrative environments so that managers can develop the Smart Office. Implications for theory and practice Industry 4.0 technologies have been widely discussed in companies that seek to improve processes, mainly industries; however, there are still few applications in administrative environments. The applicability and association of new technologies for Smart Office can explore future studies and contribute to the growth of these areas in addition to the creation of new articles relating to technologies in this environments.

ABSTRACT BACKGROUND: Dynapenia is a risk factor of mortality. Therefore, the development of low-cost and easy-to-apply tools is essential to optimize the health surveillance actions of older people. OBJECTIVES: To compare the time spent on habitual physical activity (HPA) and sedentary behavior (SB) among dynapenic and non-dynapenic older adults and ascertain the predictive ability of these behaviors on outcome. DESIGN AND SETTING: A cross-sectional population epidemiological survey was conducted involving 208 older adults. METHODS: HPA and SB were quantified using the International Physical Activity Questionnaire, and dynapenia was identified by handgrip strength (women: 18.37 kgf; men: 26.75 kgf). RESULTS: The prevalence was 24.50%. In both sexes, dynapenic individuals reported a HPA median time of 70.00 minutes/week (min/wk), while non-dynapenic women and men reported HPA median times of 240.00 and 280.00 min/wk, respectively (P < 0.05). For SB among dynapenic individuals, a median of 388.75 min/day was observed in women and 428.57 min/d in men. In contrast, non-dynapenic women and men had 291.42 and 274.28 min/day in SB (P < 0.05), respectively. The best cutoff HPA to discriminate the outcome was 150.00 min/wk in women (sensitivity: 73.30%; specificity: 60.67%) and 140.00 min/wk in men (sensitivity, 71.43%; specificity, 61.54%). The best cutoff SB was 381.43 min/day in women (sensitivity, 53.30%; specificity, 84.80%) and 351.43 min/day in men (sensitivity, 71.43%; specificity, 73.85%). CONCLUSION: Older individuals with dynapenia spent less time on HPA and more time in SB. Furthermore, HPA was found to be a better discriminator of dynapenic individuals, and SB better discriminated non-dynapenic individuals.

ABSTRACT Objective: The aim of this study was to analyze the temporal trends in vaccination coverage (VC) during the first year of life of children in Brazil. Methods: Data on VC for the first year of life from 2011 to 2020 for Bacille Calmette-Guerin (BCG), hepatitis B, polio, pentavalent, and triple viral vaccines at the national, regional, and state levels were obtained from the Information System of the National Immunization Program. Trends were analyzed using Prais-Winsten generalized linear regression models and average annual percent change (APC) estimates. Results: Decreasing trends were observed for the BCG (APC −3.58%; p<0.05), pentavalent (APC −4.10%; p<0.05), polio (APC −2.76%; p<0.05), and triple viral (APC −2.56%; p<0.05) vaccines in the country. Hepatitis B vaccine was the only vaccine that displayed stationary behavior (APC −4.22%; p>0.05). During the study period, no increasing trends were observed in any territory or vaccine. Conclusions: This study shows a recent significant reduction and decreasing trends in VC during the first year of life of children in Brazil, indicating the need for interventions to curb this ongoing phenomenon and to recover acceptable VC rates in the country.

RESUMO Objetivo: Analisar a tendência temporal da cobertura vacinal (CV) em crianças com idade menor ou igual a um ano no Brasil. Métodos: Foram empregados dados da CV no primeiro ano de vida de 2011 a 2020 referentes às vacinas BCG, hepatite B, poliomielite, pentavalente e tríplice viral, obtidos do Sistema de Informação do Programa Nacional de Imunizações (SI-PNI). Os dados estão agregados em nível nacional, regional e estadual. Para a análise de tendência foi utilizado o modelo de regressão linear generalizado de Prais-Winsten e foi calculada a variação percentual média anual (APC). Resultados: As tendências de CV para as vacinas BCG (APC −3,58%; p<0,05), pentavalente (APC −4,10%; p<0,05), poliomielite (APC −2,76%; p<0,05) e tríplice viral (APC −2,56%; p<0,05) foram decrescentes no país. Apenas para a CV da vacina contra hepatite B foi identificado comportamento estacionário (APC −4,22%; p>0,05). Nenhum território ou vacina apresentou tendência crescente para cobertura vacinal no período estudado no Brasil. Conclusões: Este estudo alerta sobre a redução expressiva das CV no primeiro ano de vida nos últimos anos no Brasil e sua tendência decrescente, sendo imperativa a adoção de intervenções com o fim de frear o fenômeno em curso e de resgatar níveis aceitáveis de CV no país.

Resumo Neste trabalho foi realizado um estudo sobre o comportamento à falha do aço dos conectores de cisalhamento fabricados com recortes regulares retangulares. A equação para a capacidade resistente relacionada à falha do aço da conexão é normalmente tratada na literatura em função da espessura, da resistência ao escoamento da chapa do conector, da repetição geométrica e do fator de forma. O estudo do conector com recorte regular retangular compreendeu a dedução da equação para a falha do aço segundo o critério de von Mises e a comparação dos resultados obtidos com resultados numéricos produzidos para esse trabalho e experimentais provenientes de outros trabalhos. É apresentado o fator de forma encontrado em cada fase do estudo. Além disso, a partir dos resultados numéricos foi possível avaliar a distribuição de tensões sobre o pino de aço do conector e verificar a coerência do modelo mecânico que considera uma seção crítica retilínea e um carregamento uniformemente distribuído devido à pressão do concreto sobre o pino de aço. retangulares espessura trabalhos disso

Abstract In this work, a study was carried out on the steel failure behavior of composite dowel shear connectors with regular rectangular cutoff. The bearing capacity equation related to the steel failure is normally treated in the literature as a function of the thickness, yield strength, geometric repetition and shape coefficient. The connector with regular rectangular cutoff study comprised the deduction of the steel failure equation according to von Mises criterion and the comparison of the results obtained from numerical analysis produced for this work and experimental results from literature. The shape coefficient found in each phase of the study is presented. Furthermore, from the numerical results it was possible to evaluate the stress distribution on the steel dowel and verify the coherence of the mechanical model that considers a straight critical section and a uniformly distributed load due to the concrete pressure on the steel dowel. thickness strength presented Furthermore

Abstract The study and understanding of the concepts related to critical state soil mechanics is relatively recent in Brazil, especially among practicing geotechnical engineers in the mining industry, where simpler solutions were traditionally adopted. This raises the necessity to develop studies capable of promoting discussions about the benefits of the approaches from the critical state theory. In this context, this research aims to evaluate the behavior of an iron ore tailings from the Quadrilátero Ferrífero through critical state computational models, considering the Modified Cam-Clay and NorSand model. The numerical results from the use of the models simulated the ductile/brittle behavior of the material in drained shear and it was observed that for loose samples both models produced similar results. The simulations in undrained shear, on the other hand, highlighted the differences between the models, with the NorSand showing a strength loss in undrained shear (strain-softening) whereas the Modified Cam-Clay Model exhibited a ductile behavior. In general, the NorSand model was the one that presented the best numerical response in relation to the experimental behavior, which may be linked to the use of the largest number of parameters, to the concept that particulate materials exist in a set of states and the silty characteristic of the material. Additionally, it was observed the difficulty to simulate the dense behavior of materials with the model, which may be associated with the formation of ‘shear bands’ during the experimental test and the complexity of modeling the occurrence of this phenomenon in virtual tests using the NorSand model. Brazil industry adopted theory context CamClay Cam Clay ductilebrittle brittle hand strainsoftening strain softening (strain-softening general parameters Additionally bands

Abstract Air temperature is a climatic factor that affects the incidence of dengue, with effects varying according to time and space. We investigated the relationship between minimum air temperature and dengue incidence in Minas Gerais, Brazil, and evaluated the influence of socioeconomic and geographic variables on this relationship. This is a time series study with analysis conducted in three distinct stages: modeling using a distributed lag non-linear model, meta-analysis of models obtained, and meta-regression with geographic and socioeconomic data. Minimum temperature was a protective factor at extreme cold temperatures (RR = 0.65; 95%CI: 0.56-0.76) and moderate cold temperatures (RR = 0.71; 95%CI: 0.64-0.79), and a risk factor at moderate hot temperatures (RR = 1.15; 95%CI: 1.07-1.24), but not at extreme hot temperatures (RR = 1.1; 95%CI: 0.99-1.22). Heterogeneity of the models was high (I2 = 60%), which was also observed in meta-regression. Moderate and extreme cold temperatures have a protective effect, while moderate hot temperatures increase the risk. However, minimum air temperature does not explain the variability in the region, not even with the other variables in meta-regression.

Resumen La temperatura del aire es un factor climático que afecta la incidencia del dengue, con efectos que varían según el tiempo y el territorio. Investigamos la relación entre la temperatura mínima del aire y la incidencia de la enfermedad en Minas Gerais, Brasil, y evaluamos la influencia de variables socioeconómicas y geográficas en esta relación. Se trata de un estudio de serie temporal cuyo análisis se realiza en tres etapas distintas: modelación mediante el uso de distributed lag non-linear model (modelos distributivos no lineales con retraso), metaanálisis de los modelos obtenidos y metarregresión con datos geográficos y socioeconómicos. La temperatura mínima fue un factor de protección ante temperaturas extremadamente frías (RR = 0,65; IC95%: 0,56-0,76) y moderadas (RR = 0,71; IC95%: 0,64-0,79) y factor de riesgo en temperaturas de calor moderado (RR = 1,15; IC95%: 1,07-1,24), pero no en extremo (RR = 1,1; IC95%: 0,99-1,22). La heterogeneidad de los modelos fue alta (I2 = 60%), y esta medida no se modificó en la metarregresión. Las temperaturas frías moderadas y extremas tienen un efecto protector, mientras que las temperaturas moderadamente altas aumentan el riesgo. Sin embargo, la temperatura mínima del aire no explica la variabilidad de la región, ni siquiera con las demás variables en metarregresión.

Resumo A temperatura do ar é um fator climático que afeta a incidência da dengue, com efeitos variando conforme o tempo e o espaço. Investigamos a relação entre a temperatura mínima do ar e a incidência da doença em Minas Gerais, Brasil, e avaliamos a influência de variáveis socioeconômicas e geográficas nessa relação, calculando-se o risco relativo (RR). Este é um estudo de série temporal com análise conduzida em três etapas distintas: modelagem por uso de distributed lag non-linear model (modelos não-lineares distributivos com defasagem), metanálise dos modelos obtidos e metarregressão com dados geográficos e socioeconômicos. A temperatura mínima foi um fator de proteção quando em temperaturas frias extremas (RR = 0,65; IC95%: 0,56-0,76) e moderadas (RR = 0,71; IC95%: 0,64-0,79) e fator de risco em temperaturas de calor moderado (RR = 1,15; IC95%: 1,07-1,24), mas não em extremo (RR = 1,1; IC95%: 0,99-1,22). A heterogeneidade dos modelos foi elevada (I2 = 60%) e essa medida não foi alterada em metarregressão. Temperaturas frias moderadas e extremas causam efeito protetivo, enquanto moderadas quentes aumentam o risco. No entanto, a temperatura mínima do ar não explica nem a variabilidade da região, nem mesmo com as outras variáveis em metarregressão.

Resumo Avaliou-se a puericultura na ESF em município-sede de macrorregião de saúde do Nordeste brasileiro. Realizou-se estudo avaliativo com dois níveis de análise: a gestão municipal e local. Aprofundou-se a avaliação local em quatro EqSF mediante entrevistas com gestores, profissionais e puérperas, análise documental e observação não-participante. As fontes de dados foram trianguladas e processadas no software Nvivo, e o material empírico cotejado com uma situação-objetivo segundo os níveis de análise da pesquisa e elaborada pelos pesquisadores. No nível municipal, a definição clara de atribuições para os pontos de atenção em puericultura e fluxos assistenciais foi um dos critérios mais críticos e, no âmbito local, a integração de ações com outros serviços primários, a contrarreferência e ações educativas coletivas no território. A implementação das práticas de puericultura nas EqSF é fortemente dependente dos determinantes político-organizacionais entre o âmbito municipal e local, e os resultados aqui evidenciados podem se aplicar a outros sistemas municipais de saúde com configurações semelhantes. Este estudo contribuiu para a avaliação da puericultura sustentada na proposição de critérios que consideraram a interdependência municipal e local na organização das ações de avaliação do crescimento e desenvolvimento infantil.

Abstract Childcare was evaluated in the ESF in a municipality that is the headquarters of a health macro-region in the Brazilian Northeast. An evaluative study was carried out with two levels of analysis: municipal and local management. The local assessment was deepened in four EqSF through interviews with managers, professionals and postpartum women, document analysis and non-participant observation. The data sources were triangulated and processed in the Nvivo software, and the empirical material was compared with an objective situation according to the research analysis levels and prepared by the researchers. At the municipal level, the clear definition of assignments for childcare care points and assistance flows was one of the most critical criteria and, at the local level, the integration of actions with other primary services, counter-referral and collective educational actions in the territory. The implementation of childcare practices in EqSF is strongly dependent on political-organizational determinants between the municipal and local levels, and the results shown here may apply to other municipal health systems with similar configurations. This study contributed to the evaluation of childcare based on the proposition of criteria that considered municipal and local interdependence in the organization of actions to evaluate child growth and development.

Abstract Background: Ultra-low-dose Spinal Anesthesia (SA) is the practice of employing minimal doses of intrathecal agents so that only the roots that supply a specific area are anesthetized. The aim of this study was to compare the effectiveness and safety of ultra-low-dose spinal anesthesia with that of Perineal Blocks (PB). Methods: A two-arm, parallel, double-blind randomized controlled trial comparing two anesthetic techniques (SA and PB) for hemorrhoidectomy and anal fistula surgery was performed. The primary outcomes were postoperative pain, complementation and/or conversion of anesthesia, and hemodynamic changes. Results: Fifty-nine patients were included in the final analysis. The mean pain values were similar in the first 48 h in both groups (p > 0.05). The individuals allocated to the SA group did not need anesthetic complementation; however, those in the PB group required it considerably (SA group, 0% vs. PB group, 25%; p = 0.005). Hemodynamic changes were more pronounced after PB: during all surgical times, the PB group showed lower MAP values and higher HR values (p < 0.05). Postoperative urinary retention rates were similar between both groups (SA group 0% vs. PB group 3.1%, p = 0.354). Conclusion: SA and PB are similarly effective in pain control during the first 48 h after hemorrhoidec-tomy and anal fistula surgery. Although surgical time was shorter among patients in the PB group, the SA technique may be preferable as it avoids the need for additional anesthesia. Furthermore, the group that received perineal blocks was under sedation with a considerable dose of propofol.

ABSTRACT Introduction: In Brazil, the blood donor screening for hepatitis B virus (HBV) includes laboratory testing for serological (HBsAg and Anti-HBc) and molecular (HBV DNA) markers. This study aims to correlate serology reactive results with HBV DNA detection among blood donors with at least one HBV infection marker detected in a blood bank in northern Brazil. Method: A retrospective search for HBV reactive blood donor data from January 2017 to December 2019 was performed. Serological screening was performed by chemiluminescent microparticle immunoassays Architect HBsAg and Architect Anti-HBc, whereas molecular screening was performed by the HBV nucleic acid test (HBV NAT). Main results: A total of 556 HBsAg reactive results were detected, between positive (47.66%) and inconclusive (52.34%). A total of 3,658 Anti-HBc reactive results were detected, between positive (83.71%) and inconclusive (16.29%). None of the inconclusive results were associated with HBV DNA detection. The HBV DNA detection rates were 47.55% among HBsAg positive samples and 4.08% among Anti-HBc positive samples. The signal-to-cutoff (S/CO) ratio median of HBV NAT positive samples was superior in comparison to HBV NAT negative samples (p < 0.0001). The thresholds found to optimize sensitivity and specificity were 404.15 for Architect HBsAg and 7.77 for Architect Anti-HBc. Three blood donors were in the window period and 1 occult HBV infection case was detected. Conclusion: High S/CO ratios were more predictive of HBV DNA detection. However, a number of HBV NAT positive samples gave low values, while some HBV NAT negative samples showed high values, reaffirming the significance of molecular testing to enhance transfusion safety.

Abstract Introduction: Chronic kidney disease (CKD) is defined as a progressive decline of kidney functions. In childhood, the main triggering factors are congenital anomalies of the kidneys and urinary tract (CAKUT) and glomerulopathies. Inflammatory responses present challenges for diagnosis and staging, which justifies studies on biomarkers/indexes. Aim: To define blood cell count indexes and verify their association with pediatric CKD etiology and staging. The included indexes were: Neutrophil-Lymphocyte Ratio (NLR), Derived Neutrophil-Lymphocyte Ratio (dNLR), Lymphocyte-Monocyte Ratio (LMR), Systemic Inflammation Response Index (SIRI), Aggregate Index of Systemic Inflammation (AISI), and Systemic Immune-Inflammation Index (SII). Methods: We determined the indexes in 52 pediatric CKD patients and 33 healthy controls by mathematical calculation. CKD patients were separated in five groups based on the etiology and staging: Group IA: glomerulopathies at stage 1 or 2; IB: glomerulopathies at stage 3 or 4; IIA: CAKUT at stage 1 or 2; IIB: CAKUT at stage 3 or 4; and III: stages 3 or 4 of other etiologies. In addition, we combined all patients with CKD in one group (IV). Group V was a healthy control group. Results: Lower values of LMR were observed for groups IB and IIB compared to group V (p = 0.047, p = 0.031, respectively). Increased values of SIRI were found for group III versus group V (p = 0.030). There was no difference for other indexes when the groups were compared two by two. Conclusion: The LMR and SIRI indexes showed promising results in the evaluation of inflammation, as they correlated with CKD etiologies and specially staging in these patients.

Resumo Introdução: Doença renal crônica (DRC) é definida como um declínio progressivo das funções renais. Na infância, os principais fatores desencadeantes são anomalias congênitas dos rins e trato urinário (CAKUT) e glomerulopatias. Respostas inflamatórias apresentam desafios para diagnóstico e estadiamento, o que justifica estudos sobre biomarcadores/índices. Objetivo: Definir índices de contagem de células sanguíneas e verificar sua associação com etiologia e estadiamento da DRC pediátrica. Os índices incluídos foram: Razão Neutrófilo-Linfócito (NLR), Razão Neutrófilo-Linfócito Derivada (dNLR), Razão Linfócito-Monócito (LMR), Índice de Resposta à Inflamação Sistêmica (SIRI), Índice Agregado de Inflamação Sistêmica (AISI) e Índice de Inflamação Imune Sistêmica (SII). Métodos: Determinamos índices em 52 pacientes pediátricos com DRC e 33 controles saudáveis por cálculo matemático. Pacientes com DRC foram separados em cinco grupos conforme etiologia e estadiamento: Grupo IA: glomerulopatias em estágio 1 ou 2; IB: glomerulopatias em estágio 3 ou 4; IIA: CAKUT em estágio 1 ou 2; IIB: CAKUT em estágio 3 ou 4; e III: estágios 3 ou 4 de outras etiologias. Além disso, combinamos todos os pacientes com DRC em um grupo (IV). Grupo V foi um grupo controle saudável. Resultados: Observamos valores menores de LMR nos grupos IB e IIB comparados ao grupo V (p=0,047; p=0,031, respectivamente). Encontramos valores maiores de SIRI para o grupo III versus grupo V (p=0,030). Não houve diferença para outros índices quando os grupos foram comparados dois a dois. Conclusão: Os índices LMR e SIRI apresentaram resultados promissores na avaliação da inflamação, pois correlacionaram-se com as etiologias da DRC e, principalmente, com o estadiamento desses pacientes.

Abstract Access to medical care is essential to achieve quality primary health care (PHC). In Brazil, access difficulties still persist. The Doctors for Brazil Program (PMpB in Portuguese) aims to expand the offer of medical services in places of difficult provision or high vulnerability. It innovates insofar as it prioritizes smaller and rather isolated cities, by selecting professionals through an isonomic process, offering them training in Family and Community Medicine and a chance to build their first federal medical career in PHC. The program offers competitive salaries, progression and financial incentives that value long-term commitment and performance. The PMpB is rolled out by the Agency for the Development of Primary Health Care (Adaps), which allows better management of public policies. The first nine months of the program showed promising results, as approximately 23,000 candidates seeking to join the program through its selection process, i.e., 97.1% vacancies were filled and retention rate after admittance was 95.4%. These results show to what extent PMpB has improved in quality compared to previous policies, as well as how essential it is to keep implementing the program so that it may reach its full PHC coverage potential within the Brazilian public health system.

Resumo O acesso ao cuidado médico é essencial para o alcance da atenção primária à saúde (APS) de qualidade. No Brasil, ainda persistem dificuldades de acesso. O Programa Médicos pelo Brasil (PMpB) pretende ampliar a oferta de serviços médicos em locais de difícil provimento ou alta vulnerabilidade. Traz como inovações a priorização das menores e mais isoladas cidades; a seleção de profissionais por processo isonômico; a formação em medicina de família e comunidade; e o fato de ser a primeira carreira médica federal na APS, com salários competitivos, progressão e incentivos financeiros que valorizam a longitudinalidade e o desempenho. O PMpB é executado pela Agência para o Desenvolvimento da Atenção Primária à Saúde (Adaps), o que permite mais eficiência na gestão da política pública. Os primeiros nove meses do programa mostram resultados promissores, com aproximadamente 23 mil médicos interessados em ingressar no programa por meio de seu processo seletivo, 97,1% de ocupação das vagas e 95,4% de permanência após o ingresso. Tais resultados sinalizam o avanço de qualidade do PMpB em relação às políticas anteriores, bem como a necessidade de continuar com sua implementação, a fim de que ela atinja todo o seu potencial de cobertura na APS do SUS.

Abstract The present research aimed to analyze the contributions of Duolingo and IMVU to the ludopedagogical practices in the teaching and learning of Spanish Language through the reports of students and a teacher from the first year of high school in a private institution. Twelve students and one Spanish language teacher participated in the research. For data collection, we used a sociodemographic questionnaire with five questions and a structured questionnaire with nine questions. The analyses were performed according to the proposed objective based on the reports of the students and the teacher. The results show that the students report that the use of Duolingo and IMVU contributes to the strengthening of the learning processes of writing and speaking in Spanish language classes. Therefore, the use of games and digital applications is considered an important tool for teaching Spanish language in high school.

Resumo A presente pesquisa teve como objetivo analisar as contribuições do Duolingo e do IMVU para as práticas ludopedagógicas no ensino e aprendizagem de Língua Espanhola por meio dos relatos de estudantes e um professor do primeiro ano do Ensino Médio de uma instituição privada. Participaram da pesquisa doze alunos e um professor de língua espanhola. Como instrumento de coleta de dados foi utilizado um questionário sociodemográfico com cinco questões e um questionário estruturado com nove questões. As análises foram realizadas de acordo com o objetivo proposto com base nos relatos dos alunos e do professor. Os resultados demonstram que os alunos relatam que o uso do Duolingo e do IMVU corroboram para a potencialização dos processos de aprendizagem da escrita e da fala nas aulas de língua espanhola. Considera-se, portanto, o uso de jogos e aplicativos digitais como uma importante ferramenta para o ensino de língua espanhola no Ensino Médio.

Resumen Esta investigación tuvo como objetivo analizar los aportes de Duolingo e IMVU a las prácticas ludopedagógicas en la enseñanza y el aprendizaje de la Lengua Española a través de los relatos de estudiantes y de un profesor del primer año de Enseñanza Media en una institución educativa privada. Doce estudiantes y un profesor de lengua española participaron en la investigación. Como instrumento de recolección de datos se utilizó un cuestionario sociodemográfico con cinco preguntas y un cuestionario estructurado con nueve preguntas. Los análisis se realizaron según el objetivo propuesto a partir de los informes de los alumnos y el profesor. Los resultados demuestran que los estudiantes manifiestan que el uso de Duolingo y el IMVU corrobora la potencialización de los procesos de aprendizaje de la escritura y la expresión oral en las clases de lengua español. Por lo tanto, el uso de juegos y aplicaciones digitales se considera una herramienta importante para la enseñanza de la lengua española en la Enseñanza Media.

Abstract: The concept of dignified death or a good death has been widespread among health professionals, who routinely deal with it and experience the ethical dilemma about what should really be done in the face of a terminally ill patient. Given this, the present study aims to show the concepts and how cases of terminally ill patients have been conducted within the Intensive Care Units (ICU). To argue about the application and functionality of euthanasia, orthothanasia and dysthanasia in ICUs, a literature review of 14 articles was carried out. It was concluded that the knowledge that the professional has in relation to these themes needs to be taken into account and to distinguish the specific theme that is addressed, not forgetting to emphasize the rights provided for in the constitution and the well-being of the paciente and his family.

Resumen: El concepto de “muerte digna” o “buena muerte” ha sido muy difundido entre los profesionales de la salud, que lo manejan de manera rutinaria y experimentan el dilema ético sobre lo que realmente se debe hacer ante un enfermo terminal. Ante esto, el presente estudio tiene como objetivo mostrar los conceptos y cómo los casos de pacientes terminales han sido tratados dentro de las Unidad de Cuidados Intensivos (UCI). Para argumentar respecto de la aplicación y funcionalidad de la eutanasia, la ortotanasia y la distanasia en las UCI, se realizó una revisión bibliográfica de 14 artículos. Se concluyó que se debe considerar el conocimiento del profesional con relación a estos temas y distinguir el tema específico que se aborda, sin olvidar enfatizar los derechos previstos en la Constitución y el bienestar del paciente y su familia.

Resumo: O conceito de morte digna ou boa morte tem sido difundido entre os profissionais de saúde, os quais lidam com isso rotineiramente e vivem o dilema ético sobre o que realmente deve ser feito diante de um paciente terminal. Visto isso, o presente estudo visa mostrar os conceito e como tem sido conduzido os casos de pacientes em fase terminal dentro das Unidades de Terapia Intensiva (UTI). Para argumentar sobre a aplicação e a funcionalidade da eutanasia, ortotanásia e distanásia nas UTIs foi realizada uma revisão bibliográfica de 14 artigos. Concluiu-se que precisa ser levado em consideração o conhecimento que o profissional tem em relação a esses temas e distinguir a temática específica que é tratado, não esquecendo de salientar os direitos previstos na constituição e o bem-estar do paciente e de sua família.