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The aim was to analyze changes in drug safety practices in Brazil from 2016 to 2023. A retrospective documental study was conducted based on reports from the Brazilian National Assessment of Patient Safety Practices. Data were collected from national Pareto graphs and analyzed in light of Pareto Theory, which states the most vital elements are responsible for 80% of problems. A total of 68% of Brazilian hospitals with ICU beds adhered to the evaluation of patient safety practices by 2023. Among 21 indicators, an average of 12 vital practices were identified as sources of noncompliance. The degree of compliance was greater in the structure domain compared to the process domain. Drug safety was among the most critical sources of noncompliance. A progressive improvement occurred between 2016 and 2019, with a reduction in noncompliance from 9% to 5.82%. Beginning in 2020, however, a tendency toward stagnation was found, with the percentage of noncompliance maintained at around 6% until 2023. The interruption in progress may be attributed to the COVID-19 pandemic, during which efforts and resources were diverted to help deal with the health crisis. The results enable an empirical understanding of advances and limitations with regards to adherence to drug safety practices at Brazilian hospitals, which contributes to strengthening knowledge on the current maturity of the safety culture in Brazil and the development of effective management strategies for the Brazilian Unified National Health System and drug safety. Este trabalho analisou a evolução das práticas de segurança medicamentosa no Brasil, no período de 2016 a 2023. Estudo retrospectivo documental, a partir dos relatórios da Avaliação Nacional das Práticas de Segurança do Paciente. Os dados foram coletados a partir dos gráficos de Pareto nacionais e analisados à luz da Teoria de Pareto, a qual evidencia os elementos mais vitais, responsáveis por 80% dos problemas. Constatou-se que 68% dos hospitais brasileiros com leitos de UTI aderiram à avaliação das práticas de segurança do paciente até 2023. Entre 21 indicadores, em média, 12 práticas vitais foram identificadas como fontes de não conformidades. O grau de conformidade foi maior no domínio estrutura em comparação a processo. A segurança medicamentosa esteve entre as fontes mais críticas de não conformidades. Entre 2016 e 2019, obteve melhora progressiva com redução de não conformidades de 9% para 5,82%. Contudo, a partir de 2020, tendeu à estagnação, com percentual de não conformidades mantido em cerca de 6% até 2023. A interrupção do progresso pode ser atribuída à pandemia de COVID-19, que desviou esforços e recursos para o enfrentamento da crise sanitária. Os resultados permitem compreender, com base empírica, avanços e limitações na adesão às práticas de segurança medicamentosa nos hospitais brasileiros, o que contribui para fortalecer o conhecimento sobre a maturidade atual da cultura de segurança no Brasil e subsidia a elaboração de estratégias de gestão eficazes para o SUS e para a segurança medicamentosa. El objetivo del estudio fue analizar la evolución de las prácticas de seguridad de los medicamentos en Brasil, en el período comprendido entre 2016 y 2023. Se trata de un estudio retrospectivo documental, basado en los informes de le Evaluación Nacional de las Prácticas de Seguridad del Paciente. Los datos se recopilaron a partir de los gráficos de Pareto nacionales y se analizaron a la luz de la Teoría de Pareto, que pone de relieve los elementos más importantes, responsables del 80% de los problemas. Se constató que el 68% de los hospitales brasileños con camas de UCI se adhirieron a la evaluación de las prácticas de seguridad del paciente hasta 2023. Entre 21 indicadores, se identificaron, en promedio, 12 prácticas vitales como fuentes de incumplimientos. El grado de conformidad fue mayor en el ámbito estructural en comparación con el procesal. La seguridad de los medicamentos se encontraba entre las fuentes más críticas de incumplimientos. Entre 2016 y 2019, se observó una mejora progresiva, con una reducción de los incumplimientos del 9% al 5,82%. Sin embargo, a partir de 2020, hubo una tendencia al estancamiento, con un porcentaje de incumplimientos que se mantuvo en torno al 6% hasta 2023. La interrupción del progreso puede atribuirse a la pandemia de COVID-19, que desvió esfuerzos y recursos para hacer frente a la crisis sanitaria. Los resultados permiten comprender, con base empírica, los avances y las limitaciones en la adhesión a las prácticas de seguridad de los medicamentos en los hospitales brasileños, lo que contribuye a fortalecer el conocimiento sobre la madurez actual de la cultura de seguridad en Brasil y subsidia la elaboración de estrategias de gestión eficaces para el Sistema Único de Salud y para la seguridad de los medicamentos.
The aim of this study was to investigate the relationship between sexual behavior, condom use, and socioeconomic, demographic, and health characteristics in elderly Brazilians. This is a cross-sectional study, utilizing data from the National Health Survey (2019). The outcome of interest was unprotected sexual intercourse. The associations were analyzed using Poisson regression. The prevalence of unprotected sexual intercourse was 88%. The prevalence of unprotected sexual intercourse was higher among elderly individuals aged 70-79 and those with a negative perception of their own health. In contrast, an inverse association was observed between marital status and the reported outcome. Individuals who were divorced, single, or widowed exhibited a lower prevalence of unprotected sexual intercourse. These findings were also observed among those with a higher income. The relationship between sexuality and affectivity and quality of life is such that it is essential to expand care for the elderly to include disease prevention and health promotion practices related to sexual habits. Objetivou-se investigar o comportamento sexual e o uso de preservativos e sua associação com as características socioeconômicas, demográficas e de saúde em idosos brasileiros. Trata-se de um estudo transversal, com dados provenientes da Pesquisa Nacional Saúde, 2019. O desfecho considerado foi a prática de relação sexual desprotegida. As associações foram analisadas por meio de regressão de Poisson. A prevalência de relações sexuais desprotegidas foi de 88%. Idosos de 70-79 anos e com percepção negativa de sua própria saúde apresentaram maiores prevalências de prática de relação sexual desprotegida. Em contraste, houve uma associação inversa entre estado civil e o desfecho referido: idosos divorciados/solteiros e viúvos apresentaram menores prevalências de relações sexuais desprotegidas, assim como aqueles com maior renda. A sexualidade e afetividade estão intimamente relacionadas à qualidade de vida, o que torna essencial expandir o cuidado com o idoso para incluir também práticas de prevenção de doenças e promoção da saúde relacionadas a hábitos sexuais. Este estudio tuvo como objetivo investigar el comportamiento sexual y el uso del condón, así como su asociación con características socioeconómicas, demográficas y de salud en adultos mayores brasileños. Se trata de un estudio transversal con datos de la Encuesta Nacional de Salud de 2019. El resultado considerado fue la práctica de relaciones sexuales sin protección. Las asociaciones se analizaron mediante regresión de Poisson. La prevalencia de relaciones sexuales sin protección fue del 88 %. Los adultos mayores de 70 a 79 años y aquellos con una percepción negativa de su propia salud presentaron mayores prevalencias de relaciones sexuales sin protección. En contraste, se observó una asociación inversa entre el estado civil y el resultado mencionado: las personas mayores divorciadas/solteras y viudas presentaron menor prevalencia de relaciones sexuales sin protección, al igual que aquellas con mayores ingresos. La sexualidad y la afectividad están íntimamente relacionadas con la calidad de vida, lo que hace esencial ampliar la atención a las personas mayores para incluir también prácticas de prevención de enfermedades y promoción de la salud relacionadas con los hábitos sexuales.
The aim of the present study was to analyze the presence of pesticide residues in foods of the Brazilian "staple food basket". Samples of refined sugar, type 1 fine long polished rice, traditional powdered coffee, type 1 white wheat flour, type 1 common black beans, and refined soybean oil were collected from supermarkets in the states of Mato Grosso, Paraná, Rio Grande do Sul, and Santa Catarina. These states are part of Region 3 of the Inter-Union Department of Statistics and Socioeconomic Studies on the national staple food basket. The active ingredients analyzed were the ten with the highest volume sold for each crop from 2019 to 2023, as reported by the departments of agriculture of the four states. Descriptive statistics (frequencies) were used for characterization of the variables of interest. Residues of imazapyr (Mato Grosso and Paraná) and tricyclazole (Mato Grosso, Rio Grande do Sul, and Santa Catarina) were detected in rice samples. Glyphosate was detected in coffee (Paraná and Mato Grosso) and flour (Paraná). Glufosinate was detected in flour in the state of Santa Catarina. Glufosinate was detected in beans in all states, in addition to glyphosate (Rio Grande do Sul) and carbendazim (Mato Grosso). Although pesticide residues remained within legal limits, it should be noted that these limits do not ensure the absence of risk. Chronic exposure, especially in vulnerable populations, and the sum of diverse food sources can increase the potential for negative health effects. Exposure reduction strategies, such as opting for low-risk or organic products and applying complementary mitigation techniques, continue to be important. Objetivou-se analisar a presença de resíduos de agrotóxicos em alimentos da Cesta Básica dos brasileiros. Amostras de açúcar refinado, arroz polido longo fino tipo 1, café em pó tradicional, farinha de trigo branca tipo 1, feijão preto comum tipo 1 e óleo de soja refinado foram coletadas em supermercados no Mato Grosso, Paraná, Rio Grande do Sul e Santa Catarina. Os estados fazem parte da Região 3 de estratificação do Departamento Intersindical de Estatística e Estudos Socioeconômicos da Cesta Básica nacional. Os ingredientes ativos analisados foram os dez de maior volume comercializados para cada cultura, de 2019 a 2023, informados pelos departamentos de agricultura dos estados. Foram utilizadas estatísticas descritivas de frequência para caracterizar o estudo. Em amostras de arroz foram detectados resíduos de imazapir (Mato Grosso e Paraná) e triciclazol (Mato Grosso, Rio Grande do Sul e Santa Catarina). No café, o glifosato foi detectado no Paraná e em Mato Grosso e na farinha do Paraná, enquanto o glufosinato foi detectado na farinha de Santa Catarina. Em relação ao feijão, o glufosinato foi detectado em todos os estados, além do glifosato (Rio Grande do Sul) e carbendazim em Mato Grosso. Embora os resíduos de agrotóxicos tenham permanecido dentro dos limites legais, é preciso destacar que esses limites não garantem a ausência de risco. Exposições crônicas, especialmente em populações vulneráveis, e a soma de fontes alimentares diversas podem aumentar o potencial de efeitos negativos à saúde. Estratégias de redução da exposição, como optar por produtos de baixo risco ou orgânicos e aplicar técnicas complementares de mitigação, continuam sendo importantes. El objetivo del estudio fue analizar la presencia de residuos de plaguicidas en los alimentos básicos de la canasta básica de alimentos de los brasileños. Se recogieron muestras de azúcar refinado, arroz pulido largo fino tipo 1, café molido tradicional, harina de trigo blanca tipo 1, frijol negro común tipo 1 y aceite de soja refinado en supermercados de Mato Grosso, Paraná, Rio Grande do Sul y Santa Catarina. Los estados forman parte de la Región 3 de estratificación del Departamento Intersindical de Estadística y Estudios Socioeconómicos de la canasta básica brasileña. Los ingredientes activos analizados fueron los diez de mayor volumen comercializados para cada cultivo, de 2019 a 2023, según la información facilitada por los departamentos de agricultura de los estados. Se utilizaron estadísticas descriptivas de frecuencia para caracterizar el estudio. En muestras de arroz se detectaron residuos de imazapir (Mato Grosso y Paraná) y triciclazol (Mato Grosso, Rio Grande do Sul y Santa Catarina). En el café, se detectó glifosato en Paraná y Mato Grosso y en la harina de Paraná, mientras que se detectó glufosinato en la harina de Santa Catarina. En cuanto a los frijoles, se detectó glufosinato en todos los estados, además de glifosato (Rio Grande do Sul) y carbendazim en Mato Grosso. Aunque los residuos de plaguicidas se mantuvieron dentro de los límites legales, cabe destacar que estos límites no garantizan la ausencia de riesgo. La exposición crónica, especialmente en poblaciones vulnerables, y la suma de diversas fuentes alimentarias pueden aumentar el potencial de efectos negativos para la salud. Las estrategias de reducción de la exposición, como optar por productos de bajo riesgo u orgánicos y aplicar técnicas complementarias de mitigación, siguen siendo importantes.
Patient safety is a strategic challenge for the Brazilian Unified National Health System (SUS) and a priority for hospital quality. This study describes the variation in safety culture among Brazilian hospitals and analyzes whether structural and organizational factors may explain part of these differences. A cross-sectional study was conducted with data collected in 2021 from 42,038 healthcare providers working at 304 public and private hospitals distributed throughout all regions of the country. Safety culture was measured based on the proportion of positive answers to 42 statements of the Hospital Survey on Patient Safety Culture, which is an international questionnaire developed by the U.S. Agency for Health Research and Quality and adapted to the Brazilian context. The variables of interest were geographic location, type of management, and hospital size, which were analyzed using multivariate linear regression with resampling (bootstrap). Considerable variation was found among hospitals for the 12 dimensions of safety culture analyzed. Two dimensions were considered strengths (average of more than 75% positive responses), while one was identified as a weakness (average of less than 50%). The statistical model explained 37% of the variation. The main associated factors were location in the Northeast region, indirect public management, small institutional size, and teaching-hospital status. In conclusion, patient safety culture varies significantly among hospitals in the country and is related to structural characteristics that could be the target of public policies and management strategies. The present findings strengthen initiatives such as the Brazilian National Patient Safety Program and offer practical support for decision-making within the SUS. A segurança do paciente é um desafio estratégico para o Sistema Único de Saúde (SUS) e uma prioridade para a qualidade hospitalar no Brasil. Este estudo descreve a variação da cultura de segurança entre hospitais brasileiros e analisa se fatores estruturais e organizacionais podem explicar parte dessas diferenças. Foi realizado um estudo transversal com dados coletados em 2021 de 42.038 profissionais de saúde que atuam em 304 hospitais públicos e privados, distribuídos por todas as regiões do país. A cultura de segurança foi mensurada a partir da proporção de respostas positivas a 42 afirmações do Hospital Survey on Patient Safety Culture, um questionário internacional desenvolvido pela Agência para Pesquisa e Qualidade em Saúde dos Estados Unidos (AHRQ) e adaptado para o contexto brasileiro. As variáveis analisadas incluíram localização geográfica, tipo de gestão e porte hospitalar, por meio de regressão linear multivariada com reamostragem (bootstrap). Observou-se ampla variação entre os hospitais nas 12 dimensões avaliadas da cultura de segurança. Duas dimensões foram consideradas como pontos fortes (com médias superiores a 75% de respostas positivas), enquanto uma foi identificada como fragilidade (com média inferior a 50%). O modelo estatístico explicou 37% da variação e apontou como principais fatores associados a localização na Região Nordeste, a gerência pública indireta, o pequeno porte institucional e o status de hospital de ensino. Conclui-se que a cultura de segurança do paciente varia significativamente entre hospitais do país e está relacionada a características estruturais que podem ser alvo de políticas públicas e estratégias de gestão. Os achados fortalecem iniciativas como o Programa Nacional de Segurança do Paciente e oferecem subsídios práticos para a tomada de decisão no âmbito do SUS. La seguridad del paciente es un reto estratégico para el Sistema Único de Salud (SUS) y una prioridad para la calidad hospitalaria en Brasil. Este estudio describe la variación de la cultura de seguridad entre los hospitales brasileños y analiza si los factores estructurales y organizativos pueden explicar parte de estas diferencias. Se realizó un estudio transversal con datos recopilados en 2021 de 42.038 profesionales sanitarios que trabajan en 304 hospitales públicos y privados, distribuidos por todas las regiones del país. La cultura de la seguridad se midió a partir de la proporción de respuestas positivas a 42 afirmaciones de la Hospital Survey on Patient Safety Culture, un cuestionario internacional desarrollado por la Agencia para la Investigación y la Calidad en la Salud de los Estados Unidos (AHRQ) y adaptado al contexto brasileño. Las variables analizadas incluyeron la ubicación geográfica, el tipo de gestión y el tamaño del hospital, mediante regresión lineal multivariante con remuestreo (bootstrap). Se observó una amplia variación entre los hospitales en las 12 dimensiones evaluadas de la cultura de seguridad. Dos dimensiones se consideraron puntos fuertes (con una media superior al 75% de respuestas positivas), mientras que una se identificó como punto débil (con una media inferior al 50%). El modelo estadístico explicó el 37% de la variación y señaló como principales factores asociados la ubicación en la región Nordeste, la gestión pública indirecta, el pequeño tamaño institucional y la categoría de hospital escuela. Se concluye que la cultura de seguridad del paciente varía significativamente entre los hospitales del país y está relacionada con características estructurales que pueden ser objeto de políticas públicas y estrategias de gestión. Los hallazgos refuerzan iniciativas como el Programa Nacional de Seguridad del Paciente y ofrecen subsidios prácticos para la toma de decisiones en el ámbito del SUS.
Multimode squeezed light is a key resource for high-dimensional quantum technologies, enhancing metrological sensitivity, boosting communication security, and enabling parallel processing in computation. Its practical potential, however, remains constrained by the inherent single-mode operation of homodyne detection, necessitating post-processing for multimode characterization. Here, we overcome this long-standing challenge by employing multimode optical parametric amplification, enabling loss-tolerant direct detection of squeezing in each mode, which in turn permits mode sorting after amplification. As a result, we demonstrate, for the first time to the best of our knowledge, the real-time monitoring of multimode squeezing. With a spatial light modulator sorting the modes, we simultaneously measure squeezing in nine spatial modes co-propagating within one beam. Although mode sorting and filtering reduce the detection efficiency to less than 0.3%, we observe high-purity squeezing of up to  - 7.9 ± 0.6 dB - to the best of our knowledge, the highest squeezing recorded for pulsed light. Furthermore, we demonstrate real-time, loss-tolerant characterization of continuous-variable entanglement and extend it to the detection of cluster states. Similar methods can be applied in the frequency domain, facilitating a crucial capability for scalable quantum technologies.
Endophytic fungi from Deschampsia antarctica, the southernmost flowering plant, provide insights into the cold adaptation mechanisms of plant-associated fungi in extreme environments. This study presents the genome sequences and comparative analysis of eight fungal isolates from D. antarctica leaves. These Antarctic fungal isolates were analyzed alongside 121 plant-associated fungal genomes to uncover signatures of adaptation and endophytic specialization. Antarctic endophytes show striking patterns, including reduced genome size (∼26.3 Mb on average), streamlined gene content (∼8844 genes), and notably small secretomes (∼288 proteins). Despite this reduced gene repertoire, they maintain a robust set of genes encoding carbohydrate-active enzymes (CAZymes) but lack those for lignin and bacterial cell wall degradation, indicating a symbiotic lifestyle that avoids host damage and predation. One isolate, Alternaria sp. UNIPAMPA017 stood out, with 26% of its genome occupied by transposable elements. Lifestyle, rather than phylogeny, was the main driver of CAZyme and secretome profiles, underscoring ecological convergence. Compared to endophytes from Arabidopsis and Populus, D. antarctica endophytes harbor fewer pectin-degrading enzymes, reflecting their adaptation to the cell wall structure of their monocot host. Together, these fungi reveal a pattern of genomic reduction and functional fine-tuning, hallmarks of life adapted to persist in cold, nutrient-scarce niches.
The first observation of the decay B^{+}→pΛ[over ¯] is presented using proton-proton collision data collected by the LHCb experiment between 2016 and 2018 at a center-of-mass energy of 13 TeV, corresponding to an integrated luminosity of 5.4  fb^{-1}. The signal significance exceeds seven standard deviations. Using the B^{+}→K_{S}^{0}π^{+} decay as a normalization channel, the branching fraction is measured and combined with previous LHCb results based on data collected at 7 and 8 TeV in 2011 and 2012, yielding B(B^{+}→pΛ[over ¯])=(1.24±0.17±0.05±0.03)×10^{-7}, where the first uncertainty is statistical, the second is systematic, and the third comes from the uncertainty on the branching fraction of the normalization channel. The B^{+}→pΛ[over ¯] weak decay parameter is measured to be α_{B}=0.87_{-0.29}^{+0.26}±0.09, indicating the presence of comparable S-wave and P-wave decay amplitudes.
To investigate the capacity of the Auditory Processing Domains Questionnaire (APDQ), in its Brazilian Portuguese version, to differentiate children and adolescents with diverse neurodevelopmental conditions based on their caregivers' responses. This was an analytical, multicenter study. Consisted of guardians of individuals aged between seven and 17 years old, divided into three groups according to neurodevelopmental condition: Control Group (CG); Human Communication Disorders Group (HCDG); and Attention Deficit Hyperactivity Disorder Group (ADHDG). All caregivers completed the APDQ, a scale consisting of 50 questions divided into three domains. The questionnaire generates a percentage score for each domain, a total score, and an indication of risk for developmental impairment, referred to as the outcome. The data was analyzed descriptively and analytically, considering a significance level of 5% (p<0.05). There was a significant difference between the groups in the total score and in the APDQ domains, indicating that the instrument can differentiate between children with and without neurodevelopmental disorders. In the attention domain, there was a significant difference between ADHDG and HCDG, distinguishing the performance between these groups. In terms of outcomes, the APDQ was able to differentiate between the groups, classifying the majority of CG individuals as "normal listening", and those from HCDG and ADHDG as being at risk of "language, learning and listening difficulties". The use of the APDQ was effective in distinguishing the different neurodevelopmental conditions. The attention domain stood out, which enabled to differentiate between HCDG and ADHDG. Investigar a capacidade do “Auditory processing domains questionnaire (APDQ)”, em sua versão português brasileiro, de diferenciar crianças e adolescentes com diferentes condições de neurodesenvolvimento com base nas respostas de seus responsáveis. Estudo do tipo analítico e multicêntrico. Constituído por responsáveis de indivíduos entre sete e 17 anos de idade, distribuídos em três grupos em função da condição do neurodesenvolvimento, a saber: Grupo Controle (GC); Grupo Distúrbios da Comunicação Humana (GDCH) e Grupo Transtorno do Déficit de Atenção e Hiperatividade (GTDAH). Todos os responsáveis responderam o APDQ, que é uma escala composta por 50 questões reunidas em três domínios. O questionário gera um escore percentual para cada domínio, um total e a possibilidade de risco para alteração no desenvolvimento denominada como desfecho. Os dados foram analisados de forma descritiva e analítica, considerando um nível de significância de 5% (p<0,05). Houve diferença significativa entre os grupos na pontuação total e nos domínios do APDQ, indicando que o instrumento consegue diferenciar crianças com e sem alterações do neurodesenvolvimento. No domínio de atenção, verificou-se diferença significativa entre GTDAH e GDCH, permitindo distinguir o desempenho desses grupos. Em relação aos desfechos, o APDQ conseguiu diferenciar os grupos entre si, classificando a maioria dos indivíduos do GC como “escuta normal” e os do GDCH e GTDAH como de risco para “dificuldade na linguagem, aprendizagem e escuta”. O uso do APDQ foi eficaz para distinguir as diferentes condições de neurodesenvolvimento. Destacou-se o domínio da atenção que permitiu diferenciar o GDCH e o GTDAH. Investigar a capacidade do “Auditory processing domains questionnaire (APDQ)”, em sua versão português brasileiro, de diferenciar crianças e adolescentes com diferentes condições de neurodesenvolvimento com base nas respostas de seus responsáveis. Estudo do tipo analítico e multicêntrico. Constituído por responsáveis de indivíduos entre sete e 17 anos de idade, distribuídos em três grupos em função da condição do neurodesenvolvimento, a saber: Grupo Controle (GC); Grupo Distúrbios da Comunicação Humana (GDCH) e Grupo Transtorno do Déficit de Atenção e Hiperatividade (GTDAH). Todos os responsáveis responderam o APDQ, que é uma escala composta por 50 questões reunidas em três domínios. O questionário gera um escore percentual para cada domínio, um total e a possibilidade de risco para alteração no desenvolvimento denominada como desfecho. Os dados foram analisados de forma descritiva e analítica, considerando um nível de significância de 5% (p<0,05). Houve diferença significativa entre os grupos na pontuação total e nos domínios do APDQ, indicando que o instrumento consegue diferenciar crianças com e sem alterações do neurodesenvolvimento. No domínio de atenção, verificou-se diferença significativa entre GTDAH e GDCH, permitindo distinguir o desempenho desses grupos. Em relação aos desfechos, o APDQ conseguiu diferenciar os grupos entre si, classificando a maioria dos indivíduos do GC como “escuta normal” e os do GDCH e GTDAH como de risco para “dificuldade na linguagem, aprendizagem e escuta”. O uso do APDQ foi eficaz para distinguir as diferentes condições de neurodesenvolvimento. Destacou-se o domínio da atenção que permitiu diferenciar o GDCH e o GTDAH.
Adaptation plays a critical role in implementation science (IS) by optimizing the fit of evidence-based interventions (EBIs) to local contexts and populations. Adaptation is especially relevant in digital health, where technologies, user preferences, and needs evolve rapidly. Yet, methodological approaches to guide and document adaptation processes are seldom included. Grounded in an IS framework, we describe a multi-phase process and results for the adaptation of a digital health intervention (DHI) for HIV prevention and treatment for sexual and gender minority (SGM) youth in Malawi, Kenya, Nigeria, and Zambia. Guided by the Assessment, Decision, Administration, Production, Topical Experts, Integration, Training, and Testing (ADAPT-ITT) model, we adapted the EBI HealthMpowerment (HMP) DHI for SGM youth. We conducted eight focus group discussions with SGM youth (N = 80) living with or at risk for HIV and four with other key experts (N = 29) to inform app adaptations. Rapid qualitative analyses were conducted, and the findings were summarized using the Mobile App Rating Scale. Subsequently, we conducted beta testing with 40 SGM youth to assess the app's usability with the validated System Usability Scale. The data were collected from June 2024 to April 2025. Most HMP adaptations were within two domains of the Mobile App Rating Scale: Engagement and Information Quality. Engagement adaptations focused on increasing support and reducing provider response times through the app, along with added gamification. Information Quality adaptations focused on expanding resources (e.g., mental health, economic strengthening) and ensuring that healthcare referrals made via the app were to SGM-competent providers. Functionality enhancements included adding content in local languages and integrating WhatsApp. Data safety was prioritized and addressed by creating an emergency lockout code. For Subjective Quality, participants perceived the app favorably for its support for medication adherence. Results from the beta testing indicated a score of 70.0, indicating above-average usability. Modifications were made to the ADAPT-ITT model to embed consultations with key experts throughout the different phases. The HMP app was collaboratively and iteratively adapted with SGM youth and key partners. This methodological approach enhances HMP's functionality, quality, and safety, increasing the likelihood of success in future trials and scale-up. NCT06350682. Registered on February 20, 2024. https://reporter.nih.gov/project-details/11373152.
Layered materials offer a singular, versatile platform for the development of quantum communication and sensing applications based on optically addressable spins. Insulating and semiconducting layered materials host optically addressable spins that can be created via top-down and bottom-up approaches, and recent advances with photonic and electronic devices can achieve in situ manipulation of their optical and spin transitions. Combined with the large variety of naturally occurring and artificially synthesized layered materials, van der Waals (vdW) materials provide extensive opportunities, from novel defect engineering to scalable device engineering. However, challenges include identification of the microscopic configuration of the atomic and electronic structures that give rise to optically addressable spins in these materials, as well as achieving the desired level of reproducibility at defect, material, and device levels simultaneously. Here, we present an overview of the recent advances in these areas, including a discussion of the microscopic origin of some of the quantum emitters in vdW materials, as well as strategies toward developing functional devices based on these systems.
To develop and validate the Voice Bank for Various Emotions for Brazilian Portuguese (EMOVOX-BR). Observational and cross-sectional study. The corpus of this study consisted of 1,638 sound signals, in different speech tasks, produced by professional actors and actors in training, native speakers of Brazilian Portuguese (PT-BR). From these audios, those containing the phrase in PT-BR "look at the blue plane" in the variation of the six basic emotions plus neutral emission were selected. In the validation stage, the sample was composed of Brazilian speech-language pathologist judges, with experience in the area of voice, to perform the auditory-perceptual judgment of the voices to select the sound signals to compose and validate the EMOVOX-BR. They judged the identification and valence of the emotion, and which vocal parameters were most decisive in the recognition of emotions. Tests were used to verify intra- and inter-judge agreement and reliability. EMOVOX-BR was made up of 39 audios, 24 male and 15 female voices. In the validation phase, all audios obtained a high accuracy rate in recognizing emotions from voice. The emotions anger, disgust and neutral were the most easily identified, with rates above 70%. The pitch and loudness parameters were the most relevant for recognizing emotions. EMOVOX-BR is a pioneering voice bank in PT-BR, made up of 39 audios from native speakers, with variations in the six basic emotions and neutral emission. Elaborar e validar o Banco de Vozes nas Variadas Emoções para o português brasileiro (EMOVOX-BR). Estudo observacional e transversal. O corpus deste estudo foi constituído por 1.638 sinais sonoros, em diferentes tarefas de fala, produzidos por atores profissionais e em formação, nativos e falantes do português brasileiro (PT-BR). Desses áudios, selecionou-se os que continham a frase em PT-BR “olha lá o avião azul” na variação das seis emoções básicas mais emissão neutra. Na etapa de validação, a amostra foi composta por juízas fonoaudiólogas brasileiras, com experiência na área de voz, para realizar o julgamento perceptivo-auditivo das vozes para selecionar os sinais sonoros para compor e validar o EMOVOX-BR. Julgaram a identificação e valência da emoção, e quais parâmetros vocais foram mais decisivos no reconhecimento das emoções. Utilizou-se testes para verificar a concordância e confiabilidade intra e interjuizas. O EMOVOX-BR foi formado por 39 áudios, 24 vozes masculinas e 15 femininas. Na fase de validação, todos os áudios obtiveram uma alta taxa de acerto no reconhecimento das emoções a partir da voz. As emoções, raiva, nojo e neutra foram as mais facilmente identificadas, com taxas superiores a 70%. Os parâmetros pitch e loudness foram os mais relevantes para o reconhecimento das emoções. O EMOVOX-BR é um banco de vozes pioneiro no PT-BR, composto por 39 áudios de falantes nativos, com variação nas seis emoções básicas e emissão neutra.
Gold nanoparticles (AuNPs) were synthesized via two complementary routes, an inorganic surfactant-mediated method and a plant-extract-assisted biosynthesis, to elucidate how synthesis pathways influence nanoparticle physicochemical properties. In the inorganic route, hexadecyltrimethylammonium bromide (CTAB)-stabilized AuNPs were prepared using CTAB dissolution temperatures of 70-90 °C. UV-Vis spectroscopy showed localized surface plasmon resonance (LSPR) bands at 554-556 nm, while dynamic light scattering (DLS) indicated a decrease in hydrodynamic diameter from 110 to 97 nm with increasing dissolution temperature. Zeta potentials above +40 mV indicated strong electrostatic stabilization, and transmission electron microscopy (TEM) revealed ultrasmall Au cores with a narrow size distribution (2.4-3.0 nm) and a face-centered cubic crystal structure. In the biosynthetic route, AuNPs were obtained using aqueous Erythroxylum coca leaf extracts (1-4% w/v). The extracts exhibited a concentration-dependent red shift (~380 to ~420 nm), and biosynthesized AuNPs displayed LSPR bands in the 550-580 nm range. DLS yielded hydrodynamic diameters of 270-390 nm, with pronounced aggregation (3341 nm) at the lowest extract concentration. Under optimized conditions (HC5, n = 5), reproducible plasmonic and colloidal properties were obtained (maximum absorbance, localized surface plasmon resonance wavelength (λmax) = 569.6 ± 1.7 nm; hydrodynamic diameter (DH) = 237.6 ± 24.3 nm; absolute zeta potential (|ζ|)= 32.2 ± 2.6 mV). TEM analysis indicated predominantly quasi-spherical particles with a broader, log-normal size distribution, consistent with extract-mediated growth under heterogeneous organic capping environments.
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Acid stimulation of carbonate rocks aims to create channels within the rock, known as wormholes, to restore or enhance permeability, increasing production. Among the acids used in this type of treatment, 15 wt % hydrochloric acid (HCl) stands out due to its high reactivity, formation of soluble reaction products in aqueous media, and cost-effectiveness. To minimize corrosion of metallic structures and avoid emulsion formation after contact with formation oil, acid solutions are commonly prepared with additives such as corrosion inhibitors and emulsion preventers. To evaluate the influence of these additives on wormhole formation, this study performed core flooding experiments at different injection rates to construct pore volume to breakthrough (PVbt) curves, both in the presence and absence of these additives. The tests employed 15 wt % HCl solutions, with and without additives, using Indiana Limestone rocks containing 98.57% calcite. The experiments were conducted in a core flooding system under an injection rate range of 0.25-16 mL/min, at 25 °C, with a confining pressure of 2000 psi and back pressure of 1200 psi. After the tests, the cores were analyzed by X-ray microcomputed tomography to evaluate wormhole formation. The results indicated that additives reduced PVbt values at low flow rates, suggesting slower reaction kinetics and higher wormhole formation efficiency. The presence of additives decreased the optimal interstitial velocity by approximately 77% (from 0.91 to 0.21 cm/min), indicating that they provide better reaction control and enhance treatment efficiency. Moreover, micro-CT images confirmed the formation of dominant wormholes at almost all flow rates in the presence of additives, whereas in their absence (e.g., at 0.5 mL/min), the sample collapsed before breakthrough. The Buijse-Glasbergen model provided a good fit to the experimental data (R 2 = 0.99) for the additive-free curve. For the additive-containing system, however, an empirical adjustment of the model exponent was required to improve the correlation (from R 2 = 0.85 to R 2 = 0.93). The results demonstrate that these additives not only inhibit corrosion and prevent emulsions but also controlled the reactivity effect. This behavior significantly broadens the scope of their application, reinforcing their strategic importance in carbonate reservoir treatments.
To improve physical health screening and assessment practices for individuals with severe and persistent mental disorders treated at a Psychosocial Care Center in Brazil. A best practice implementation project following the JBI Evidence Implementation Framework conducted in the municipality of Itatiba in the state of São Paulo, with users of the Psychosocial Care Center II. The baseline audit (n = 278) and follow-up audit (n = 134) assessed compliance with seven evidence-based criteria. The data collection process occurred in different phases, which included identifying the area of practice to be changed, engaging change agents, assessing the context and readiness for change, auditing current service practices, implementing practice changes, evaluating the implemented strategies, and monitoring changes in practice. Baseline compliance was low, with several indicators below 10%. After implementing standardized documentation tools, integrating nursing assessments at intake, and planning inter-service coordination, key improvements were observed. Documentation of physical examination increased from 9.0% to 47.1% (+38.1 pp), Body Mass Index recording from 0% to 22.4% (+22.4 pp), and scheduling of follow-up appointments from 1.1% to 21.6% (+20.5 pp). However, minimal or no progress occurred in laboratory testing, electrocardiogram requests, and monitoring of antipsychotic side effects. The project strengthened internal routines and demonstrated the feasibility of implementing evidence-based practices. Nevertheless, limited progress in criteria dependent on external factors and the need for stronger professional integration highlight the importance of greater investment to address persistent care gaps. Melhorar as práticas de triagem e avaliação da saúde física de indivíduos com transtornos mentais graves e persistentes tratados em um Centro de Atendimento Psicossocial no Brasil. Projeto de implementação de melhores práticas seguindo a Estrutura de Implementação de Evidências da JBI realizado no município de Itatiba, no estado de São Paulo, com usuários do Centro de Atendimento Psicossocial II. A auditoria inicial (n = 278) e a auditoria de acompanhamento (n = 134) avaliaram a conformidade com sete critérios baseados em evidências. O processo de coleta de dados ocorreu em diferentes fases, que incluíram a identificação da área de prática a ser alterada, o envolvimento de agentes de mudança, a avaliação do contexto e da prontidão para a mudança, a auditoria das práticas atuais de serviço, a implementação de mudanças na prática, a avaliação das estratégias implementadas e o monitoramento das mudanças na prática. A conformidade inicial foi baixa, com vários indicadores abaixo de 10%. Após a implementação de ferramentas de documentação padronizadas, a integração das avaliações de enfermagem na admissão e o planejamento da coordenação entre serviços, foram observadas melhorias significativas. A documentação do exame físico aumentou de 9,0% para 47,1% (+38,1 pp), o registo do Índice de Massa Corporal de 0% para 22,4% (+22,4 pp) e o agendamento de consultas de acompanhamento de 1,1% para 21,6% (+20,5 pp). No entanto, houve um progresso mínimo ou nenhum progresso nos exames laboratoriais, nos pedidos de eletrocardiogramas e na monitorização dos efeitos secundários dos antipsicóticos. O projeto fortaleceu as rotinas internas e demonstrou a viabilidade da implementação de práticas baseadas em evidências. No entanto, o progresso limitado em critérios dependentes de fatores externos e a necessidade de uma integração profissional mais forte destacam a importância de um maior investimento para lidar com as lacunas persistentes nos cuidados de saúde.
A stability-indicating HPLC-UV method enabling the simultaneous separation and monitoring of perampanel (PER) and all degradation products was developed and applied, providing adequate resolution and peak purity. Forced degradation studies were conducted to define the degradation profile of PER under acidic, alkaline, oxidative, photolytic, and metal-ion stress conditions. Five degradation products (DP-1 to DP-5) were identified by HPLC-UV and structurally characterized by HRMS/MS, and 1D/2D NMR spectroscopy (1H, 13C, COSY, and HSQC). Acidic hydrolysis produced a benzamide derivative (DP-1) and a benzoic acid derivative (DP-2), oxidative stress generated a pyridine N-oxide derivative (DP-3), and alkaline conditions yielded two previously unreported products, a ring-cleavage derivative of perampanel (DP-4) and a hydroxylated pyridone derivative of perampanel (DP-5). DP-1 was also detected during accelerated stability studies of PER tablets formulated with acidic excipients, demonstrating excipient-drug incompatibility under stressed storage conditions (40 °C/75% RH). The toxicity risk of the five degradation products was assessed using complementary in silico approaches (statistical and expert-rule methods) in accordance with ICH M7 guidance. None of the degradation products showed mutagenic concern and were therefore classified as ICH M7 Class 4 or Class 5 impurities. These results expand the structural knowledge of PER degradation products, clarify its main degradation pathways, and provide experimental and toxicological support for formulation development and impurity control.
A search is presented for the two-body charmed baryonic decays, B[over ¯]_{(s)}^{0}→Λ_{c}^{+}Λ[over ¯]_{c}^{-}, using a data sample collected by the LHCb experiment during 2011-2012 and 2015-2018, corresponding to an integrated luminosity of 9  fb^{-1}. The first observation of the B[over ¯]_{s}^{0}→Λ_{c}^{+}Λ[over ¯]_{c}^{-} decay is reported with 6.2σ significance along with 4.3σ evidence for the B[over ¯]^{0}→Λ_{c}^{+}Λ[over ¯]_{c}^{-} decay. The branching fractions are measured to be B(B[over ¯]^{0}→Λ_{c}^{+}Λ[over ¯]_{c}^{-})=(1.01_{-0.28}^{+0.27}±0.08±0.15)×10^{-5} and B(B[over ¯]_{s}^{0}→Λ_{c}^{+}Λ[over ¯]_{c}^{-})=(5.0±1.3±0.5±0.8)×10^{-5}, where the first uncertainty is statistical, the second systematic, and the third due to external inputs. These results provide novel experimental inputs for the theoretical framework describing two-body baryonic decays of B mesons via W-emission and W-exchange mechanisms.
For early-stage triple-negative breast cancer (TNBC), the KEYNOTE-522 trial established neoadjuvant pembrolizumab plus chemotherapy (CT), followed by adjuvant pembrolizumab, as the standard of care. Nevertheless, uncertainties remain on how to integrate this regimen with other adjuvant therapies such as capecitabine or olaparib. This study evaluated real-world treatment patterns and safety of adjuvant therapies following neoadjuvant chemoimmunotherapy. The Neo-Real study includes patients with TNBC treated with neoadjuvant pembrolizumab plus CT in Brazil and Argentina. This study describes real-world adjuvant treatment patterns and safety; survival outcomes are not reported in this analysis. Among 726 patients included, 692 underwent surgery, and 62.9% achieved pathologic complete response (pCR). Of those with pCR, 84.8% received adjuvant pembrolizumab alone, while 14.3% received no adjuvant therapy. Among patients with residual disease and no germline BRCA1/2 mutations (n = 207), 57.5% received pembrolizumab plus capecitabine, 26.1% pembrolizumab alone, and 12.6% capecitabine alone. In BRCA1/2-mutated patients (n = 26), 57.7% received pembrolizumab plus olaparib, 19.2% pembrolizumab alone, and 11.5% olaparib alone. Safety data were available for 359 patients. Adjuvant pembrolizumab alone caused a lower incidence of grade ≥ 3 AEs (6.7%) compared with combination regimens (P = 0.002). Drug discontinuation due to toxicity occurred in 5.7%, 11.2%, and 7.7% of patients receiving pembrolizumab, pembrolizumab + capecitabine, and pembrolizumab + olaparib, respectively (P = 0.126). Most patients with pCR continued adjuvant pembrolizumab, while combination strategies predominated among those with residual disease and were associated with higher rates of grade ≥ 3 AEs. The efficacy of these combined regimens remains to be determined.
Given the high disparities present in cancer care worldwide and even more challenging infrastructure and access for low- and middle-income countries, adhering precisely to international guidelines has become a challenging and complex task. Recommendations from an independent multidisciplinary panel of experts from 13 countries, including medical oncologists, pathologists, surgeons, and radiation oncologists, who met during IGCS to address some of these challenges. The panel met in New York City in September of 2022 during the International Gynecological Cancer Society Congress and was composed of specialists from developing countries in Africa, Asia, Eastern Europe, Latin America, and the Middle East. The panel addressed 103 questions and provided recommendations for the management of early, locally advanced, recurrent, and/or metastatic endometrial cancer. The questions were carefully developed by the group and specifically directed to, and answered by, specialists according to their respective areas of expertise. Consensus was defined as at least 75% of the voting members selecting a particular recommendation, whereas a majority vote was considered when one option garnered between 50.0% and 74.9% of votes. Resource limitation was defined as any issues limiting access to qualified surgeons, contemporary imaging or radiation-oncology techniques, antineoplastic drugs, or funding for providing modern medical care. Eighteen of the 109 (16.5%) questions presented to the panel reached consensus, whereas a majority vote was reached for 43 (39.4%) additional questions. The recommendations for the remaining questions were considerably heterogeneous and were considered experts opinion only. Establishing guidelines with recommendations in areas with resource limitations may help healthcare providers and improve patient care around the world.