Construction and Validation of Simulated scenario for the development of Nursing Students Diagnostic Reasoning

Objective: to describe the process of construction and validation of a clinical simulation scenario whose objective of the scenario was the development of diagnostic reasoning skills in nursing students. Method: this is a descriptive study of the process of construction and content validation of a clinical simulation scenario for the development of diagnostic reasoning skills in students of the fourth semester of the Undergraduate Nursing course. Results: The scenario was validated by eight experts in the area covered by the study. The level of agreement between the judges above 90% was considered. Conclusion: In order for clinical simulation to be effective, it is necessary to have prior planning and clear objectives. Following a practical theoretical-script facilitates the development of the scenario, favoring the student's learning process.

Analysis of immunization time, amplitude, and adverse events of seven different vaccines against SARS-CoV-2 across four different countries

BackgroundScarce information exists in relation to the comparison of seroconversion and adverse events following immunization (AEFI) with different SARS-CoV-2 vaccines. Our aim was to correlate the magnitude of the antibody response to vaccination with previous clinical conditions and AEFI.MethodsA multicentric comparative study where SARS-CoV-2 spike 1-2 IgG antibodies IgG titers were measured at baseline, 21-28 days after the first and second dose (when applicable) of the following vaccines: BNT162b2 mRNA, mRNA-1273, Gam-COVID-Vac, Coronavac, ChAdOx1-S, Ad5-nCoV and Ad26.COV2. Mixed model and Poisson generalized linear models were performed.ResultsWe recruited 1867 individuals [52 (SD 16.8) years old, 52% men]. All vaccines enhanced anti-S1 and anti-S2 IgG antibodies over time (p<0.01). The highest increase after the first and second dose was observed in mRNA-1273 (p<0.001). There was an effect of previous SARS-CoV-2 infection; and an interaction of age with previous SARS-CoV-2 infection, Gam-COVID-Vac and ChAdOx1-S (p<0.01). There was a negative correlation of Severe or Systemic AEFI (AEs) of naïve SARS-CoV-2 subjects with age and sex (p<0.001); a positive interaction between the delta of antibodies with Gam-COVID-Vac (p=0.002). Coronavac, Gam-COVID-Vac and ChAdOx1-S had less AEs compared to BNT162b (p<0.01). mRNA-1273 had the highest number of AEFIs. The delta of the antibodies showed an association with AEFIs in previously infected individuals (p<0.001).ConclusionsThe magnitude of seroconversion is predicted by age, vaccine type and SARS-CoV-2 exposure. AEs are correlated with age, sex, and vaccine type. The delta of the antibody response only correlates with AEs in patients previously exposed to SARS-CoV-2.Registration numberClinicalTrials.gov, identifier NCT05228912

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Relatório de estágio em farmácia comunitária

Relatório de estágio realizado no âmbito do Mestrado Integrado em Ciências Farmacêuticas, apresentado à Faculdade de Farmácia da Universidade de Coimbr

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Effect of different models of conducting debriefing on levels of satisfaction and self-confidence in learning in nursing students: a randomized controlled clinical trial

Introdução: A avaliação da satisfação e autoconfiança de alunos na participação de uma atividade simulada pode ser considerada indicador de qualidade dentro das instituições, principalmente por apontar a eficácia das estratégias de ensino utilizadas. Na simulação clínica, o debriefing é considerada a etapa mais importante, uma vez que facilita a discussão e a autorreflexão do aluno participante da cena. Nesta etapa o facilitador espera que o estudante identifique problemas, ofereça voluntariamente suas perspectivas e consiga absorver ações para usar em sua prática. Portanto, é importante avaliar a satisfação e autoconfiança de alunos quanto ao uso de diferentes modelos de debriefing. Objetivo: Avaliar o efeito de dois diferentes modelos de debriefing nos níveis de satisfação e autoconfiança na aprendizagem em estudantes de enfermagem. Método: Trata-se de um ensaio clínico controlado randomizado e um plano de ação para capacitação sobre o uso da simulação clínica como estratégia de ensino aprendizagem. O ensaio clínico foi realizado com 20 estudantes do curso de graduação em Enfermagem de uma universidade pública da zona da Mata Mineira. Os alunos foram divididos aleatoriamente em grupo controle (debriefing segundo o modelo do Ciclo de Gibbs – tipo usualmente utilizado no curso de graduação em Enfermagem da instituição de estudo) e grupo experimental (debriefing segundo Modelo 3D). Para a coleta de dados as seguintes etapas foram seguidas de acordo com o grupo em que os alunos foram alocados: execução do cenário simulado; participação do debriefing; avaliação da satisfação e autoconfiança na aprendizagem dos alunos. Realizou-se estatística descritiva e inferencial a partir do T de Student para amostras independentes. Resultados: Não houve significância estatística na subescala de satisfação na aprendizagem (p valor ≥ 0,05) e a autoconfiança na aprendizagem (p valor ≥ 0,05). Verificou-se que a atividade simulada aumentou o nível de satisfação e autoconfiança na aprendizagem para ambos os grupos, porém, não houve diferença estatisticamente significante para as médias das subescalas e global O desenvolvimento implementação do desta produto técnico metodologia “capacitação” instigou nos treinamentos para e inspirou profissionais a da enfermagem recém-admitidos e para aprimoramento das técnicas para os que já apresentam experiência na assistência. Conclusão: Percebeu-se que não houve diferença entre os níveis de satisfação e autoconfiança entre os grupos, apontando assim que os dois modelos do debriefing avaliados neste estudo não interferiram no desenvolvimento destes constructos. Em relação à capacitação realizada, verificou- se que a simulação clínica é uma estratégia que deve ser utilizada na instituição onde o produto técnico foi desenvolvido. Palavras-chave: Aprendizagem. Enfermagem. Ensino em Enfermagem. Satisfação pessoal. Simulação.Introduction: The assessment of student satisfaction and self-confidence in participating in a simulated activity can be considered an indicator of quality within institutions, mainly because it indicates the effectiveness of the teaching strategies used. In clinical simulation, debriefing is considered the most important step, as it facilitates the discussion and self-reflection of the student participating in the scene. In this step, the facilitator expects the student to identify problems, voluntarily offer their perspectives and be able to absorb actions to use in their practice. Therefore, it is important to assess student satisfaction and self-confidence regarding the use of different debriefing models. Objective: To evaluate the effect of two different debriefing models on the levels of satisfaction and self-confidence in learning in nursing students. Method: This is a randomized controlled clinical trial and an action plan for training on the use of clinical simulation as a teaching-learning strategy. The clinical trial was carried out with 20 undergraduate nursing students at a public university in the Mata Mineira zone. Students were randomly divided into a control group (debriefing according to the Gibbs Cycle model – the type usually used in the undergraduate Nursing course at the study institution) and an experimental group (debriefing according to the 3D Model). For data collection, the following steps were followed according to the group in which the students were allocated: execution of the simulated scenario; debriefing participation; evaluation of satisfaction and self- confidence in student learning. Descriptive and inferential statistics were performed using Student's T for independent samples. Results: There was no statistical significance in the learning satisfaction subscale (p value ≥ 0.05) and self-confidence in learning (p value ≥ 0.05). It was found that the simulated activity increased the level of satisfaction and self-confidence in learning for both groups, however, there was no statistically significant difference for the averages of the subscales and global. training for newly admitted nursing professionals and for improving techniques for those who already have experience in care. Conclusion: It was noticed that there was no difference between the levels of satisfaction and self-confidence between the groups, thus indicating that the two debriefing models evaluated in this study did not interfere in the development of these constructs. Regarding the training carried out, it was found that clinical simulation is a strategy that should be used in the institution where the technical product was developed. Keywords: Learning. Nursing. Teaching in Nursing. Personal satisfaction. Simulation

Film-Forming Polymers for Tooth Erosion Prevention

Different agents have been proposed to prevent the progression of acid induced dental substance losses, which are called erosive tooth wear (ETW), such as fluorides, calcium, and phosphate-based products; however, there is a need for a further increase in efficacy. Recently, the ability of polymers to interact with the tooth surface, forming acid resistant films, has come into the focus of research; nevertheless, there is still the need for a better understanding of their mode of action. Thus, this article provides an overview of the chemical structure of polymers, their mode of action, as well as the effect of their incorporation into oral care products, acid beverages, and antacid formulations, targeting the prevention of ETW. Recent evidence indicates that this may be a promising approach, however, additional studies are needed to confirm their efficacy under more relevant clinical conditions that consider salivary parameters such as flow rate, composition, and clearance. The standardization of methodological procedures such as acid challenge, treatment duration, and combination with fluorides is necessary to allow further comparisons between studies. In conclusion, film-forming polymers may be a promising cost-effective approach to prevent and control erosive demineralization of the dental hard tissue