O MANEJO DA DOR EM INDIVÍDUOS QUE POSSUEM FIBROMIALGIA: UMA REVISÃO INTEGRATIVA DE LITERATURA.

A Fibromialgia(FM) é uma patologia crônica, multifatorial e não progressiva diretamente relacionada à percepção da dor descrita pelo paciente ao longo do atendimento clínico, já que a realização e análise de exames físicos, laboratoriais e de imagem, na maioria das vezes, não apresentam alterações ou indicativos de patologias, como inflamações e lesões ou degenerações teciduais, dificultando a conclusão e compreensão do seu diagnóstico. O termo fibromialgia foi cunhado pela primeira vez por uma revisão de Hench em 1976, mas seu reconhecimento como síndrome ocorreu após publicação do trabalho de Yunus et al. em 1981. (HENCH, 1976; YUNUS et al., 1981).  O Colégio Americano de Reumatologia (ACR), no ano de 1990, elaborou critérios de classificação e justificativas para o manejo da FM que foram aceitos pelo meio científico. Tal fato contribuiu muito para a um padronização do diagnóstico fibromiálgico e impulsionou de forma imensamente engajadora os estudos sobre essa doença. (WOLFE et al., 1990) A caracterização da FM é descrita normalmente por dores exacerbadas e difusas em variadas regiões do corpo, ou seja, uma hipersensibilidade dolorosa, até mesmo ao leve toque, classificada, também, como queixas álgicas, que se manifestam em momentos após traumas ou estresses, como brigas familiares, práticas de atitudes não desejadas pelo paciente, sensações e emoções consideradas prejudiciais à saúde mental e ao bem-estar deste, sendo, muitas vezes, sua expressividade emocional relacionada à recaptação dos neurotransmissores serotonina e a noradrenalina pelo sistema nervoso. (RIBEIRO E PATO, 2004) Nesse contexto, também observa-se que existe correlação entre outros sinais e sintomas que interferem intensificando o quadro das dores transmitidas pelos neurotransmissores no paciente, como a depressão, a ansiedade, cefaleia, náuseas, distúrbios intestinais, fadigas musculares, insônia e as manias. (HOEFLER E DIAS, 2010) Um fator bastante relevante para atuar de forma eficiente com a demanda de tratamento para essa síndrome de hipersensibilidade é a empatia e escuta ativa do paciente, já que a ausência de provas para a sua comprovação, é o principal fator que, na maioria das vezes, gera descaso e desvalorização do quadro do paciente, o fazendo retornar em inúmeros momentos a consultas médicas para a busca do diagnóstico e da compreensão do que este realmente sofre. No contexto atual, existem exames que possibilitam a análise do cérebro em tempo real, observando as interações e o comportamento desse sistema, diante de possíveis fatores de influência, tais medidas, que ainda são inovadoras no âmbito da medicina, e estão corroborando para o auxílio de pacientes com Fibromialgia, ratificando e investigando os sinais neurais que geram a dor relatada pelos pacientes.  Tal dor, em consenso científico, já tem a sua existência associada a situações e emoções que provocam piora das dores da FM e está pode desencadear entraves além dos sintomatológicos, como afastamento social, alteração do sono, cansaço, distúrbios emocionais e instabilidades urinárias e intestinais. &nbsp

CARDIOPATIA FETAL: AS MALFORMAÇÕES CARDÍACAS UMA REVISÃO DE LITERATURA

Fetal heart disease, a condition that affects the cardiovascular development of the fetus, can result in significant intrauterine functional impairment. The complexity of these conditions can affect not only the cardiovascular system, but also influence fetal growth and the function of other organs. Therefore, the importance of continuous monitoring during pregnancy aims to early detect possible changes in blood flow and oxygenation in the fetus. Furthermore, it highlights the need for a multidisciplinary approach, involving pediatric cardiologists, obstetricians, and neonatologists, to optimize neonatal management and outcomes. Objectives: Analyze the types of heart disease and their implications for the cardiovascular system, highlighting the different types of congenital malformations in the cardiovascular system. Methodology: This is descriptive research of the narrative literature review type, which sought to highlight the types of heart diseases and their congenital malformations in the intrauterine fetus and presenting the fetal diagnosis through fetal echocardiography. The research was carried out through online access to the National Library of Medicine (PubMed MEDLINE), Scientific Electronic Library Online (Scielo), Latin American and Caribbean Literature in Health Sciences (LILACS) databases in December 2023. Results and Discussions: Congenital heart disease affects around 40% of fetuses, being one of the most common malformations and considered to have the highest mortality rate. For the diagnosis used for this pathology, fetal echocardiography plays a fundamental role in the early detection of these malformations, allowing a detailed evaluation of the cardiac anatomy. Among the frequent heart diseases identified are intraventricular communication, atrioventricular septal defect, interatrial communication and patent ductus arteriosus. Each of these conditions has distinct characteristics, from the different affected regions to abnormalities in the valve structures. Conclusion:  Understanding fetal heart disease and its impact on intrauterine functional impairment is a field in constant evolution. Collaboration between researchers and health professionals is essential for improving therapeutic measures and surgical interventions carried out when necessary, improving results for both the fetus and the mother, thus reducing the risk of fetal deathA cardiopatia fetal, uma condição que afeta o desenvolvimento cardiovascular do feto, pode resultar em um significativo comprometimento funcional intrauterino. A complexidade dessas condições pode afetar não apenas o sistema cardiovascular, mas também influenciar o crescimento fetal e a função de outros órgãos. Dessa forma, a importância do monitoramento contínuo durante a gestação, visa detectar precocemente possíveis alterações no fluxo sanguíneo e na oxigenação no feto. Além disso, ressalta a necessidade de uma abordagem multidisciplinar, envolvendo cardiologistas pediátricos, obstetras, e neonatologistas, para otimizar o manejo e os resultados neonatais. Objetivos: Analisar os tipos de cardiopatias e suas implicações no sistema cardiovascular, ressaltando os diferentes tipos das malformações congênitas no sistema cardiovascular. Metodologia: Trata-se de uma pesquisa descritiva do tipo revisão narrativa da literatura, que buscou evidenciar os tipos de cardiopatias e suas malformações congênitas no feto intraútero e apresentando o diagnóstico fetal por meio do ecocardiograma fetal.  A pesquisa foi realizada através do acesso online nas bases de dados National Library of Medicine (PubMed MEDLINE), Scientific Electronic Library Online (Scielo), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) no mês de dezembro de 2023.  Resultados e Discussões: A cardiopatia congênita atinge cerca de 40% dos fetos, sendo uma das malformações de mais frequentes e considerada de maior mortalidade. Para o diagnóstico utilizado para essa patologia, a ecocardiografia fetal desempenha um papel fundamental na detecção precoce dessas malformações, permitido uma avaliação detalhada da anatomia cardíaca. Entre as cardiopatias frequentes identificadas estão a comunicação intraventricular, o defeito do septo atrioventricular, a comunicação interatrial e a persistência do canal arterial.  Cada uma dessas condições apresenta características distintas, desde as diferentes regiões acometidas até as anormalidades nas estruturas das válvulas. Conclusão: A compreensão da cardiopatia fetal e seu impacto do comprometimento funcional intrauterino é um campo em contante evolução. A colaboração entre pesquisadores e profissionais da saúde é essencial para o aprimoramento das medidas terapêuticas e intervenções cirúrgicas realizadas quando necessário, melhorando os resultados tanto para o feto quanto para a mãe, dessa forma diminuindo o risco de morte fetal

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

Optimasi Portofolio Resiko Menggunakan Model Markowitz MVO Dikaitkan dengan Keterbatasan Manusia dalam Memprediksi Masa Depan dalam Perspektif Al-Qur`an

Risk portfolio on modern finance has become increasingly technical, requiring the use of sophisticated mathematical tools in both research and practice. Since companies cannot insure themselves completely against risk, as human incompetence in predicting the future precisely that written in Al-Quran surah Luqman verse 34, they have to manage it to yield an optimal portfolio. The objective here is to minimize the variance among all portfolios, or alternatively, to maximize expected return among all portfolios that has at least a certain expected return. Furthermore, this study focuses on optimizing risk portfolio so called Markowitz MVO (Mean-Variance Optimization). Some theoretical frameworks for analysis are arithmetic mean, geometric mean, variance, covariance, linear programming, and quadratic programming. Moreover, finding a minimum variance portfolio produces a convex quadratic programming, that is minimizing the objective function ðð¥with constraintsð ð 𥠥 ðandð´ð¥ = ð. The outcome of this research is the solution of optimal risk portofolio in some investments that could be finished smoothly using MATLAB R2007b software together with its graphic analysis

Differential cross section measurements for the production of a W boson in association with jets in proton–proton collisions at √s = 7 TeV

Measurements are reported of differential cross sections for the production of a W boson, which decays into a muon and a neutrino, in association with jets, as a function of several variables, including the transverse momenta (pT) and pseudorapidities of the four leading jets, the scalar sum of jet transverse momenta (HT), and the difference in azimuthal angle between the directions of each jet and the muon. The data sample of pp collisions at a centre-of-mass energy of 7 TeV was collected with the CMS detector at the LHC and corresponds to an integrated luminosity of 5.0 fb[superscript −1]. The measured cross sections are compared to predictions from Monte Carlo generators, MadGraph + pythia and sherpa, and to next-to-leading-order calculations from BlackHat + sherpa. The differential cross sections are found to be in agreement with the predictions, apart from the pT distributions of the leading jets at high pT values, the distributions of the HT at high-HT and low jet multiplicity, and the distribution of the difference in azimuthal angle between the leading jet and the muon at low values.United States. Dept. of EnergyNational Science Foundation (U.S.)Alfred P. Sloan Foundatio

Penilaian Kinerja Keuangan Koperasi di Kabupaten Pelalawan

This paper describe development and financial performance of cooperative in District Pelalawan among 2007 - 2008. Studies on primary and secondary cooperative in 12 sub-districts. Method in this stady use performance measuring of productivity, efficiency, growth, liquidity, and solvability of cooperative. Productivity of cooperative in Pelalawan was highly but efficiency still low. Profit and income were highly, even liquidity of cooperative very high, and solvability was good

Juxtaposing BTE and ATE – on the role of the European insurance industry in funding civil litigation

One of the ways in which legal services are financed, and indeed shaped, is through private insurance arrangement. Two contrasting types of legal expenses insurance contracts (LEI) seem to dominate in Europe: before the event (BTE) and after the event (ATE) legal expenses insurance. Notwithstanding institutional differences between different legal systems, BTE and ATE insurance arrangements may be instrumental if government policy is geared towards strengthening a market-oriented system of financing access to justice for individuals and business. At the same time, emphasizing the role of a private industry as a keeper of the gates to justice raises issues of accountability and transparency, not readily reconcilable with demands of competition. Moreover, multiple actors (clients, lawyers, courts, insurers) are involved, causing behavioural dynamics which are not easily predicted or influenced. Against this background, this paper looks into BTE and ATE arrangements by analysing the particularities of BTE and ATE arrangements currently available in some European jurisdictions and by painting a picture of their respective markets and legal contexts. This allows for some reflection on the performance of BTE and ATE providers as both financiers and keepers. Two issues emerge from the analysis that are worthy of some further reflection. Firstly, there is the problematic long-term sustainability of some ATE products. Secondly, the challenges faced by policymakers that would like to nudge consumers into voluntarily taking out BTE LEI

Search for stop and higgsino production using diphoton Higgs boson decays

Results are presented of a search for a "natural" supersymmetry scenario with gauge mediated symmetry breaking. It is assumed that only the supersymmetric partners of the top-quark (stop) and the Higgs boson (higgsino) are accessible. Events are examined in which there are two photons forming a Higgs boson candidate, and at least two b-quark jets. In 19.7 inverse femtobarns of proton-proton collision data at sqrt(s) = 8 TeV, recorded in the CMS experiment, no evidence of a signal is found and lower limits at the 95% confidence level are set, excluding the stop mass below 360 to 410 GeV, depending on the higgsino mass

Severe early onset preeclampsia: short and long term clinical, psychosocial and biochemical aspects

Preeclampsia is a pregnancy specific disorder commonly defined as de novo hypertension and proteinuria after 20 weeks gestational age. It occurs in approximately 3-5% of pregnancies and it is still a major cause of both foetal and maternal morbidity and mortality worldwide1. As extensive research has not yet elucidated the aetiology of preeclampsia, there are no rational preventive or therapeutic interventions available. The only rational treatment is delivery, which benefits the mother but is not in the interest of the foetus, if remote from term. Early onset preeclampsia (<32 weeks’ gestational age) occurs in less than 1% of pregnancies. It is, however often associated with maternal morbidity as the risk of progression to severe maternal disease is inversely related with gestational age at onset2. Resulting prematurity is therefore the main cause of neonatal mortality and morbidity in patients with severe preeclampsia3. Although the discussion is ongoing, perinatal survival is suggested to be increased in patients with preterm preeclampsia by expectant, non-interventional management. This temporising treatment option to lengthen pregnancy includes the use of antihypertensive medication to control hypertension, magnesium sulphate to prevent eclampsia and corticosteroids to enhance foetal lung maturity4. With optimal maternal haemodynamic status and reassuring foetal condition this results on average in an extension of 2 weeks. Prolongation of these pregnancies is a great challenge for clinicians to balance between potential maternal risks on one the eve hand and possible foetal benefits on the other. Clinical controversies regarding prolongation of preterm preeclamptic pregnancies still exist – also taking into account that preeclampsia is the leading cause of maternal mortality in the Netherlands5 - a debate which is even more pronounced in very preterm pregnancies with questionable foetal viability6-9. Do maternal risks of prolongation of these very early pregnancies outweigh the chances of neonatal survival? Counselling of women with very early onset preeclampsia not only comprises of knowledge of the outcome of those particular pregnancies, but also knowledge of outcomes of future pregnancies of these women is of major clinical importance. This thesis opens with a review of the literature on identifiable risk factors of preeclampsia