Framework based on complex networks to model and mine patient pathways

The automatic discovery of a model to represent the history of encounters of a group of patients with the healthcare system -- the so-called ``pathway of patients'' -- is a new field of research that supports clinical and organisational decisions to improve the quality and efficiency of the treatment provided. The pathways of patients with chronic conditions tend to vary significantly from one person to another, have repetitive tasks, and demand the analysis of multiple perspectives (interventions, diagnoses, medical specialities, among others) influencing the results. Therefore, modelling and mining those pathways is still a challenging task. In this work, we propose a framework comprising: (i) a pathway model based on a multi-aspect graph, (ii) a novel dissimilarity measurement to compare pathways taking the elapsed time into account, and (iii) a mining method based on traditional centrality measures to discover the most relevant steps of the pathways. We evaluated the framework using the study cases of pregnancy and diabetes, which revealed its usefulness in finding clusters of similar pathways, representing them in an easy-to-interpret way, and highlighting the most significant patterns according to multiple perspectives.Comment: 35 pages, 11 figures, 2 appendice

Evidence That the Periaqueductal Gray Matter Mediates the Facilitation of Panic-Like Reactions in Neonatally-Isolated Adult Rats

Plenty of evidence suggests that childhood separation anxiety (CSA) predisposes the subject to adult-onset panic disorder (PD). As well, panic is frequently comorbid with both anxiety and depression. the brain mechanisms whereby CSA predisposes to PD are but completely unknown in spite of the increasing evidence that panic attacks are mediated at midbrain's dorsal periaqueductal gray matter (DPAG). Accordingly, here we examined whether the neonatal social isolation (NSI), a model of CSA, facilitates panic-like behaviors produced by electrical stimulations of DPAG of rats as adults. Eventual changes in anxiety and depression were also assessed in the elevated plus-maze (EPM) and forced-swimming test (FST) respectively. Male pups were subjected to 3-h daily isolations from post-natal day 2 (PN2) until weaning (PN21) allotting half of litters in individual boxes inside a sound-attenuated chamber (NSI, n = 26) whilst siblings (sham-isolated rats, SHAM, n = 27) and dam were moved to another box in a separate room. Non-handled controls (CTRL, n = 18) remained undisturbed with dams until weaning. As adults, rats were implanted with electrodes into the DPAG (PN60) and subjected to sessions of intracranial stimulation (PN65), EPM (PN66) and FST (PN67-PN68). Groups were compared by Fisher's exact test (stimulation sites), likelihood ratio chi-square tests (stimulus-response threshold curves) and Bonferroni's post hoc t-tests (EPM and FST), for P<0.05. Notably, DPAG-evoked panic-like responses of immobility, exophthalmus, trotting, galloping and jumping were markedly facilitated in NSI rats relative to both SHAM and CTRL groups. Conversely, anxiety and depression scores either did not change or were even reduced in neonatally-handled groups relative to CTRL, respectively. Data are the first behavioral evidence in animals that early-life separation stress produces the selective facilitation of panic-like behaviors in adulthood. Most importantly, results implicate the DPAG not only in panic attacks but also in separation-anxious children's predispositions to the late development of PD.Fundacao de Amparo a Pesquisa do Espirito Santo (FAPES)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Associacao Fundo de Incentivo a Pesquisa (AFIP)Universidade Federal do Espirito Santo (UFES)FAPESUFES/AFIPUniv Fed Espirito Santo, Dept Physiol Sci, Vitoria, ES, BrazilUniv Fed Espirito Santo, Dept Sports, Vitoria, ES, BrazilUniversidade Federal de São Paulo, Dept Psychobiol, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Psychobiol, São Paulo, BrazilFAPES: 38.413.280/2007CNPq: 55203345/11UFES/AFIP: 23068020409/2010-43Web of Scienc

The effects of a high-protein diet and resistance training on organ mass and metabolic profile in rats: Os efeitos de uma dieta rica em proteínas e treinamento de resistência sobre a massa dos órgãos e o perfil metabólico em ratos

A high-protein diet associated or not with strength exercise impacts satiety, fat accumulation, mass gain, changes biochemical and morphological. The study evaluated the association between adipose tissue mass and organs, in addition to the blood biochemical profile of rats fed a high-protein diet (HD) submitted to strength training (RT). Adult male Wistar rats were divided into groups (n=7/each): sedentary-normoprotein (SN-14%), sedentary-hyperprotein (SH-35%), trained-normoprotein (TN-14%), and trained-hyperprotein (TH-35%). RT consisted of 4 sets of 10 water jumps/8 weeks. HD and RT reduced the adiposity index (p&lt;0.001). Regardless of HD, RT increased the mass of the gastrocnemius (p&lt;0.001) and soleus (p=0.01). Heart mass was inversely correlated (p&lt;0.01) with retroperitoneal fat. There was an inverse dependence between the mass of the gastrocnemius and retroperitoneal (p&lt;0.01), omental (p&lt;0.05), subcutaneous inguinal (p&lt;0.01), and visceral adiposity (p&lt;0.05). There was a positive dependence between kidney mass and serum creatinine levels (p&lt;0.001). Liver mass showed a positive dependence (p&lt;0.01) on total cholesterol, HDL-c (p&lt;0.01), and triglycerides (p&lt;0.05). The results showed that isolated HD and associated with RT reduced the visceral adiposity, but did not increase the gastrocnemius and soleus mass. The participation of DH and TR stands out as measures of behavior tendency among the studied variables

A VALORIZAÇÃO DOS SABERES DOCENTES NA CONSTRUÇÃO DO ALMANAQUE DE ESPAÇOS NÃO FORMAIS DE ENSINO DA REGIÃO METROPOLITANA DE RIBEIRÃO PRETO

Cientes de que os professores, a partir de suas próprias práticas, estruturam, ressignificam e orientam seus trabalhos, o GRUPO de estudos da localidade – ELO do Laboratório interdisciplinar de formação de educadores – LAIFE da USP campus Ribeirão Preto - SP, em parceria com professores e alunos de diversos segmentos do ensino, construiu o Almanaque de espaços não formais de ensino da região metropolitana de Ribeirão Preto - SP. O objetivo de referida iniciativa, foi reunir práticas e experiências dos docentes e alunos envolvidos para a proposição de atividades norteadoras que possibilitam um olhar analítico dos espaços geográficos dos municípios da região metropolitana de Ribeirão Preto - SP. O processo de elaboração do almanaque foi organizado em etapas que envolveram reuniões de planejamento e pesquisa sobre possíveis espaços não formais de ensino, visitas aos espaços não formais de ensino, avaliação dos espaços visitados para composição do almanaque, reuniões para elaboração das propostas de atividades, descrição dos espaços e das atividades em grupos de professores e posterior reunião para revisão e validação dos materiais elaborados. Ao longo desse processo, pudemos perceber que em diversos momentos. A mobilização dos saberes docentes oriundos da formação profissional, da experiência, e dos conhecimentos disciplinares, construídos ao longo exercício da docência dos educadores envolvidos aflorou por meio de debates. Tais saberes se revelaram, também, na elaboração das atividades ou relatos de práticas já realizadas nos espaços não formais de ensino ou locais análogos aos mesmos. Como produto final, obtivemos um compilado que reúne espaços não formais de ensino com sugestões de atividades, descrições, contatos, iconografia e referências bibliográficas para aprofundamento histórico e geográfico de cada espaço. As atividades descritas no almanaque se configuram como uma reunião de diferentes saberes desenvolvidos por meio da prática de um coletivo de docentes da mais variada atuação e por isso, reflete a riqueza que professores podem nos ofertar ao compartilhar os relatos de suas jornadas nos processos de ensino e aprendizagem, quer seja nas salas de aula ou fora dos muros da escola.&nbsp

Roux-en-y gastric bypass improves in short term the clinical-anthropometric parameters and reduces risk for obesity-related cardiometabolic diseases / Bypass gástrico roux-en-y melhora a curto prazo os parâmetros clínico-antropométricos e reduz o risco de doenças cardiometabólicas relacionadas à obesidade

Roux-en-Y gastric bypass surgery (RYGB) is the most applied technique in the treatment of severe obesity worldwide. However, its impact on anthropometric parameters and the risk for cardiometabolic diseases in obese patients is uncertain. To evaluate anthropometric clinical parameters and the evolution of risk factors for obesity-related diseases in individuals of both sexes undergoing RYGB. Sixty-nine adults subjects from both sexes submitted to RYGB surgery treatment were divided into 3 groups: G1(&lt;13 months, n=24); G2 (&gt;13 and &lt;25 months, n=21), and G3 (&gt;25 and &lt;37 months, n=24). Sociodemographic and anthropometric information before and after surgery were collected. The abdominal perimeter was used in the classification of cardiometabolic risk and the BMI was used for the risk of obesity-related diseases. Hypotheses were tested by Student's t-test and ANOVA, and the significance level adopted was 5%. The average age was 36.0±10.0 years, with 69.6% being male and 30.4% female. Anthropometric parameters (weight, BMI, and abdominal circumference) were higher among women, except for weight loss and percentage of weight loss. There was a difference in weight loss between the sexes in the moments before and after RYGB. There was a decrease in the risk of disease due to obesity and cardiovascular diseases after RYGB. Weight loss and %WL were greater years by year in the short term of 3 years after surgery. RYGB proved to be an effective strategy for both sexes in combating obesity, providing in the short term a significant improvement in clinical-anthropometric parameters and reduction of risk factors for obesity-related cardiometabolic diseases

High-Protein bar Supplemented with Chia Seed Improves Lipidemic Parameters in Wistar Rats

Chia (Salvia hispanical.) seeds are known to have high content of polyunsaturated fatty acids (PUFA) and fiber. This study aimed to evaluate the effect of a High-Protein Bar (PB) supplemented with chia seed added to the feed on the organs, tissues, and biochemical parameters of male Wistar adult rats (n=32) divided into four groups (n=8), namely group I (ration + 20% chia seeds); group II (ration + PB without chia seeds); group III (ration + 20% PB containing 15% chia seed); group IV (ration + 20% PB containing 20% chia seeds). The shelf-life of PBs was assessed during 45 days in terms of texture, color, and antioxidant activity using the \u3b2-carotene/linoleic acid assay. The centesimal composition of the formulations showed a significantly higher value of fiber offered to group I. Animals of groups III and IV showed a lower consumption of the ration (p&lt;0.05), while those of group I lower weight of the heart as well as of retroperitoneal, epididymal and perirenal tissues (p&lt;0.05). The biochemical parameters showed a significant improvement (p&lt;0.05) in testosterone levels in groups that received the rations partially replaced by chia seed-containing PB. In addition, group II, which received the ration enriched with PB without chia seed, showed the highest serum triacylglycerol value, highlighting the important role of chia seeds on lipidemic parameters. It is worth mentioning that more in-depth studies must be carried out to validate the results obtained in the current study

Mapeamento do descarte irregular do caroço do açaí no bairro do Jurunas no município de Belém/PA / Mapping the irregular disposal of the açaí seeds in the Jurunas neighborhood in the municipality of Belém/PA

O consumo diário do açaí faz parte da rotina da alimentação do paraense. A partir desse cenário, é possível identificar a existência de batedores do fruto em diversos pontos no município de Belém. Entretanto, esse hábito cultural regional desencadeia impactos no meio ambiente e na saúde público, a através das disposições irregular de caroço do açaí (pós beneficiamento da polpa) em lugares públicos contribui para um cenário problemático na cidade. A partir disso, a Política Nacional de Resíduos Sólidos (Lei nº 12.305/10) institui que devem ser desenvolvidos sistemas de gestão ambiental e empresarial voltados para a melhoria dos processos produtivos e do reaproveitamento dos resíduos sólidos. Dessa forma, o trabalho teve como objetivo mapear os descartes inadequados do resíduo do caroço do açaí no bairro do Jurunas em Belém-PA. Através de pesquisas bibliográficas de artigos acadêmicos e visitas in loco nas áreas de despejo e elaboração de um questionário preestabelecido para os gerentes dos estabelecimentos, verificando a quantidade produzida, a destinação e uma visualização dos impactos oriundos do beneficiamento do açaí dos empreendimentos. Esses estabelecimentos apresentaram média de 9,1 horas por dia de funcionamento produzindo uma média diária de 130 kg de caroço de açaí. Entre os dez comércios analisados, cinco foram verificados em desacordo com a Lei nº 12.305/10. Foi observado que o bairro do Jurunas não possui um projeto específico que trabalhe a coleta, transporte e destinação final elaborado pela prefeitura e deparamos também com a falta de responsabilidade dos estabelecimentos, que de forma arcaica, fazem o beneficiamento do fruto sem a responsabilidade social e ambiental.

High-Protein Diet Associated with Resistance Training Improves Performance and Decreases Adipose Index in Rats

International Journal of Exercise Science 13(2): 1366-1381, 2020. The study tested the hypothesis that a high protein diet based on isolated whey protein (IWP) associated with strength training improves performance and reduces body fat without promoting health damage. Male Wistar rats, 45 days old, were divided into four groups (n = 8 / group): normoprotein sedentary (IWP 14%; NS); hyperprotein sedentary (IWP 35%; HS); normoprotein trained (IWP 14%; NT) and hyperprotein trained (IWP 35%; HT). All groups performed the maximum load test at the beginning and after the vertical ladder training protocol for 6 weeks (3x/week). The performance improved in HT when compared to other groups. There was no difference in the plasma levels of testosterone, IGF-1 and the hematological parameters remained normal. The relative weights of the kidneys were higher in the groups fed with high protein; the liver was higher in HT compared to NS and NT, and the heart was higher in HS compared to NS and NT. Concerning relative muscle weight, quadriceps, and gastrocnemius, HT showed higher value compared to NT. Diet containing 35% isolate whey protein associated with resistance training improved performance as well as increased muscles and organs weight of the animals, without damaging the tissues related to protein metabolism (confirmed by unchanged hematological parameters), which may minimize the risk of developing cardiometabolic disorders

Programa Médicos pelo Brasil: primeiros resultados

Access to medical care is essential for achieving quality Primary Health Care (PHC). In Brazil, access difficulties persist. The Doctors for Brazil Program (PMpB in Portuguese) intends to expand the offer of medical services in places of difficult provision or high vulnerability. It brings as innovations the prioritization of smaller and more isolated cities; the selection of professionals through an isonomic process; training in Family Practice and; the first federal medical career in the PHC, with competitive salaries, progression and financial incentives that value longitudinality and performance. The PMpB is executed by the Agency for the Development of Primary Health Care (Adaps), which allows for more efficient management. The first nine months of the program show promising results, with approximately 23,000 physicians interested in joining the program through its selection process, 97,1% of occupying vacancies and 95,4% of retention. Such results indicate an improvement in the quality of the PMpB in relation to previous policies, as well as the need to continue with its implementation, so that it reaches its full potential of coverage in the PHC of the public health system.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. Ele 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; 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 através 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

Latin American registry of renal involvement in COVID-19 disease. The relevance of assessing proteinuria throughout the clinical course

The Latin American Society of Nephrology and Hypertension conducted a prospective cohort, multinational registry of Latin American patients with kidney impairment associated to COVID-19 infection with the objective to describe the characteristics of acute kidney disease under these circumstances. The study was carried out through open invitation in order to describe the characteristics of the disease in the region. Eight-hundred and seventy patients from 12 countries were included. Median age was 63 years (54–74), most of patients were male (68.4%) and with diverse comorbidities (87.2%). Acute kidney injury (AKI) was hospital-acquired in 64.7% and non-oliguric in 59.9%. Multiorgan dysfunction syndrome (MODS) due to COVID-19 and volume depletion were the main factors contributing to AKI (59.2% and 35.7% respectively). Kidney replacement therapy was started in 46.2%. Non-recovery of renal function was observed in 65.3%. 71.5% of patients were admitted to ICU and 72.2% underwent mechanical ventilation. Proteinuria at admission was present in 62.4% of patients and proteinuria during hospital-stay occurred in 37.5%. Those patients with proteinuria at admission had higher burden of comorbidities, higher baseline sCr, and MODS was severe. On the other hand, patients with de novo proteinuria had lower incidence of comorbidities and near normal sCr at admission, but showed adverse course of disease. COVID-19 MODS was the main cause of AKI in both groups. All-cause mortality of the general population was 57.4%, and it was associated to age, sepsis as cause of AKI, severity of condition at admission, oliguria, mechanical ventilation, non-recovery of renal function, in-hospital complications and hospital stay. In conclusion, our study contributes to a better knowledge of this condition and highlights the relevance of the detection of proteinuria throughout the clinical course