Resumen Marco contextual: La hospitalización y la intervención quirúrgica son percibidas por el niño como acontecimientos amenazantes que repercuten en su comportamiento, concretamente en la ansiedad y el miedo. Objetivo: Evaluar la eficacia de una película preparatoria para los procedimientos que deben realizarse antes de la cirugía ambulatoria con el fin de reducir la ansiedad y el miedo. Metodología: Estudio aleatorizado y controlado en el que participaron 60 niños (de 6 a 14 años) sometidos a cirugía ambulatoria. El grupo de intervención vio una película en el periodo preoperatorio y el grupo de control recibió los cuidados habituales. La eficacia de la película se midió con la escala Children’s Anxiety Meter-State y el miedo con la Children’s Fear Scale. Resultados: No hubo diferencias significativas (p > 0,05) entre el grupo de intervención que vio la película y el grupo de control que siguió los cuidados preoperatorios habituales. Conclusión: Es importante evaluar con precisión si los costes de esta intervención compensan los beneficios. Se sugiere seguir investigando en este ámbito, ajustando otros programas que resulten más eficaces en este contexto.

Abstract Background: Children often perceive hospitalization and surgery as threatening events that can lead to feelings of anxiety and fear. These feelings may affect their behaviors. Objective: To evaluate the effectiveness of an educational video in reducing anxiety and fear before outpatient surgery. Methodology: A randomized controlled study was conducted with 60 children (6 - 14 years old) undergoing outpatient surgery. The intervention group watched an educational video during the preoperative period, while the control group received standard preoperative care. The effectiveness of the video was measured using the Children’s Anxiety Meter-State scale, and fear was measured using the Children’s Fear Scale. Results: No significant differences (p > 0.05) were found between the intervention group that watched the video and the control group that received standard preoperative care. Conclusion: An accurate assessment of whether the costs of this intervention outweigh the benefits is essential. Further research is recommended, particularly in adapting other programs that have proven more effective in this context.

Resumo Enquadramento: A hospitalização e a cirurgia são consideradas pela criança como eventos ameaçadores e com repercussões no seu comportamento, nomeadamente ansiedade e medo. Objetivo: Avaliar a efetividade de um filme preparatório para procedimentos a realizar antes de uma cirurgia de ambulatório visando a redução da ansiedade e medo. Metodologia: Estudo randomizado, controlado, envolvendo 60 crianças (6-14 anos), submetidas a cirurgia de ambulatório. O grupo de intervenção visualizou um filme no período pré-operatório e o grupo de controlo recebeu os cuidados habituais. A efetividade do filme foi medida através da escala de ansiedade Children’s Anxiety Meter-State e o medo pela escala Children’s Fear Scale. Resultados: Não se observaram diferenças significativas (p > 0,05) entre o grupo de intervenção que visualizou o filme e o grupo de controlo que seguiu os cuidados pré-operatórios habituais. Conclusão: Importa avaliar de forma precisa se os custos envolvidos nesta intervenção compensam os benefícios. Sugere-se mais investigação nesta área, ajustando outros programas que se revelem mais efetivos neste contexto.

Abstract The IMF´s practices affect the lives of millions of persons all around the world. Recently, institutional actors of the United Nations have defined the rules that it should follow to promote the respect and effectiveness of Human Rights. However, the Fund acts as if such rules do not in fact exist. The article aims to analyze the juridical nexus that ties the IMF to Human Rights, problematizing the «argumentative strategies» through which it legitimizes its position on the field. This way of approaching to the debate allows the paper to: 1) prove the IMF's juridical link to these Rights and, at the same time, show the benefits and limits of the critics that are directed to said link; 2) introduce in a single coherent narrative the developments on this subject that the specialized literature exhibits in a fragmented manner; 3) show how the newest trends that inform the doctrine of Human Rights are translated into official juridical documents. It is argued that the Fund has the international obligation of respecting and enforcing Human Rights from its own mandate and considering the rules of institutional actors on this regard, under penalty of incurring in responsibility for their violation. IMFs s world Recently However exist argumentative strategies field 1 time 2 manner 3 documents regard violation

Resumen Con sus prácticas, el FMI afecta la vida de millones de personas alrededor del mundo. Recientemente, la ONU ha definido las pautas que los agentes del campo financiero deben seguir para promover el respeto y la efectividad de los Derechos Humanos (DDHH). Sin embargo, el Fondo actúa como si de hecho tales pautas no existiesen. Este trabajo procura analizar el nexo jurídico que ata al FMI a los DDHH, problematizando las «estrategias argumentativas» a través de las cuales él legitima su posición al respecto. Esta manera de ingresar al debate permite: 1) sustentar jurídicamente la ligazón del Fondo a estos derechos y, al mismo tiempo, mostrar las bondades y límites de las críticas que se le endilgan a dicha ligazón; 2) presentar en un único relato coherente los desarrollos sobre esta temática que la literatura especializada exhibe de manera fragmentada; 3) dar cuenta de cómo las últimas tendencias que informan la doctrina de los DDHH se traducen en documentos jurídicos oficiales. Se argumenta que el FMI tiene la obligación internacional de respetar y efectivizar los DDHH desde su propio mandato y considerando las pautas de los actores institucionales al respecto, so pena de incurrir en responsabilidad por su violación. prácticas mundo Recientemente DDHH. . (DDHH) embargo existiesen estrategias argumentativas respecto permite 1 tiempo 2 fragmentada 3 oficiales violación (DDHH

INTRODUCTION: South Africa has a high unemployment rate and few post-school employment opportunities for learners with disabilities. School-to-work transition programmes in special educational needs schools prepare learners with disabilities for work in the open labour market, optimizing post-school employment opportunities. Occupational therapists are the main key role players in facilitating school-to-work transition programme in many contexts of education. AIM: This study explores the perceptions of occupational therapists of a school-to-work transition programme at the school for learners with special needs. METHODS: This study was a descriptive qualitative study. The researchers conducted semi-structured interviews with six occupational therapists involved in delivering the programme at the school. To ensure ethical compliance, we obtained clearance from the UP-Research Ethics Committee. The collected data underwent reflective thematic analysis for interpretation. FINDINGS: Three prominent themes emerged from the data analysis: (1) The Significance of the Programme: Participants highlighted the importance and benefits of the program. (2) Facilitators affecting school-to-work transition programme: Various factors that positively influenced the smooth transition from school to the workforce were identified and discussed. (3) Barriers to school-to-work transition programme: Participants also pointed out obstacles and challenges that hindered the successful transition from school to the workforce. CONCLUSION: The school-to-work transition programme was influenced by personal, environmental, and occupational barriers and facilitators. The findings highlighted that the benefits of the programme should be viewed in a broader context, as learners mature and develop self-confidence. The value of the programme thus extends beyond employment opportunities. IMPLICATIONS FOR PRACTICE The research findings inform barriers that need to be focused on in order to have a successful and effective school-to-work transition programme. There are facilitators that show the perceived effectiveness of the school-to-work transition programme that could assist in motivating for more assistance from stakeholders of the school.

Abstract Introduction. Canavalia ensiformis, widely used as green manure, has proven benefits from mycorrhizal inoculation. The effectiveness of the arbuscular mycorrhizal inoculants used in Cuba depend on the edaphic condition in which the crop develops, however there are no experimental results on eutric chromic cambisol soils from Jibacoa. Objective. Evaluate in this soil the response of canavalia to the application of 3 mycorrhizal inoculants. Materials and methods. The research was carried out at the Jibacoa Agro-Forestry Experimental Station, Villa Clara province, Cuba. In a completely randomized design, 3 inoculants formulated with the strains INCAM-2/Funneliformis mosseae, INCAM-4/Glomus cubense and INCAM-11/Rizhophagus irregularis and a control without inoculation were studied. At the time that the canavalia flowered, the following were evaluated: the number of effective nodules; the height; the dry mass of the root, stem, leaves, total and the efficiency index was determined. Results. Canavalia presented a positive and differentiated response to mycorrhizal inoculation. The inoculation with INCAM-2 significantly increased the number of effective nodules (21.9%) with values higher than the control treatment and the inoculation with INCAM-4, it also caused the greatest height with increases of 66.1%, higher (p<0.05) to those found with the other inoculants. INCAM-2 always caused higher values of dry mass (p<0.01) in any of the organs and total in relation to the control treatment, however, they did not differ (p<0.01) from those obtained with the other inoculants, which did not always differ from the control treatment. The response based on total dry mass was ordered as follows: INCAM-2 with 71.90% > INCAM-11 with 50.17% > INCAM-4 with 38.29%. Conclusions. Canavalia presented a positive response to mycorrhizal inoculation in the eutric chromic cambisol soil with increases in its nodulation, growth and dry mass production. The INCAM-2 inoculant was always the most effective.

Resumen Introducción. Canavalia ensiformis ampliamente utilizada como abono verde, presenta beneficios comprobados por la inoculación micorrízica. La efectividad de los inoculantes micorrízicos arbusculares utilizados en Cuba dependen de la condición edáfica en que se desarrolla el cultivo; sin embargo, hay pocos resultados experimentales en suelos Cambisol éutrico crómico de Jibacoa. Objetivo. Evaluar en este suelo la respuesta de la canavalia a la aplicación de 3 inoculantes micorrizicos. Materiales y métodos. La investigación se realizó en la Estación Experimental Agro-Forestal de Jibacoa, provincia Villa Clara, Cuba. En un diseño completamente aleatorizado se estudiaron 3 inoculantes formulados con las cepas INCAM-2/Funneliformis mosseae, INCAM-4/Glomus cubense e INCAM-11/Rizhophagus irregularis y un control sin inocular. En el momento que floreció la canavalia se evaluó: la cantidad de nódulos efectivos; la altura; la masa seca de la raíz, del tallo, de las hojas, la total y se determinó el índice de eficiencia. Resultados. La canavalia presentó una respuesta positiva y diferenciada a la inoculación micorrízica. La inoculación con INCAM-2 incrementó significativamente la cantidad de nódulos efectivos (21,9%) con valores superiores al tratamiento control y a la inoculación con INCAM-4, además originó la mayor altura con aumentos del 66,1%, superiores (p<0,05) a las encontradas con los otros inoculantes. INCAM-2 siempre provocó valores superiores de masa seca (p<0,01) en cualquiera de los órganos y la total en relación con el tratamiento control, no obstante, no se diferenciaron (p<0,01) a los obtenidos con los otros inoculantes, los cuales no siempre se diferenciaron del tratamiento control. La respuesta se ordenó de acuerdo con la masa seca total como sigue: INCAM-2 con 71,90% > INCAM-11 con 50,17% > INCAM-4 con 38,29%. Conclusiones. La canavalia presentó una respuesta positiva a la inoculación micorrízica en el suelo Cambisol éutrico crómico con incrementos en su nodulación, crecimiento y producción de masa seca. El inoculante INCAM-2 siempre resultó el más efectivo.

Abstract Sodium-glucose cotransporter 2 inhibitors (SGLT2i), originally developed as innovative antihyperglycemic agents, have demonstrated significant benefits in improving metabolic markers and protecting the kidneys and heart in patients with or without type 2 diabetes mellitus. The mechanisms behind these unexpected cardiorenal benefits cannot be attributed solely to improved glycemic control. Recent data suggest that metabolic reprogramming plays a role in the development of cardiorenal metabolic disease. Despite the effectiveness of SGLT2i in the management of chronic kidney disease (CKD)-related comorbidities in adults, their use in the pediatric population remains to be validated. The challenge in pediatric CKD lies in the imbalance between the metabolic needs of a growing child and the declining functional capacity of a failing kidney. Developing strategies to address modifiable factors in the progression of kidney disease is critical given the extended lifespan of the pediatric population. SGLT2i have emerged as innovative candidates for the treatment of CKD in children. By improving renal hemodynamic adaptation and mitigating overall CKD complications, these agents have the potential to be a novel therapeutic option for pediatric patients. This review will focus on the current understanding of how SGLT2i may provide cardiorenal protection.

Resumo Os inibidores do cotransportador 2 de sódio e glicose (SGLT2), inicialmente considerados medicamentos antihiperglicémicos inovadores, demonstraram benefícios significativos na melhoria dos marcadores metabólicos e na proteção renal e cardíaca em doentes com ou sem diabetes mellitus tipo 2. Estas vantagens cardiorenais inesperadas não podem ser atribuídas exclusivamente ao controle glicémico melhorado. Dados recentes sugerem que a reprogramação metabólica desempenha um papel no desenvolvimento de doenças metabólicas cardiorenais. Apesar da eficácia dos inibidores do SGLT2 no tratamento de comorbilidades associadas à doença renal crónica (DRC) em adultos, o seu uso na população pediátrica aguarda validação. O desafio na DRC pediátrica reside no desequilíbrio entre as necessidades metabólicas da criança em crescimento e a capacidade funcional diminuída do rim em falência. Face à expectativa de vida prolongada da população pediátrica, é fundamental o desenvolvimento de estratégias dirigidas a fatores modificáveis na progressão da DRC. Os inibidores do SGLT2 surgem como candidatos inovadores para o tratamento da DRC em crianças. Ao melhorar a adaptação hemodinâmica renal e mitigar as complicações gerais da DRC, estes agentes afiguram-se como uma potencial nova abordagem terapêutica para doentes pediátricos. Esta revisão incidirá no entendimento atual de como os inibidores do SGLT2 podem conferir proteção cardiorrenal.

Resumen Antecedentes: El aumento de casos de cáncer y los costosos tratamientos incrementan los gastos sanitarios. Se desperdician medicamentos equivalentes al 5% del gasto anual. Es importante implementar estrategias de contención de costos. Objetivo: Implementar y evaluar una estrategia de reducción de costos en medicamentos oncológicos. Métodos: Se analizaron dosis y cantidades de medicamentos oncológicos de enero a junio de 2022, calculando el uso total y costos comparando con un sistema descentralizado para estimar el impacto económico. Resultados: Compartir viales logró un ahorro de $9,000,705.64MNX. La preparación centralizada totalizó $52,775,243.24MNX, con una reducción del 14% en gastos. Discusión: Este estudio pionero en México coincide con reducciones similares en otros países, resaltando la importancia de aplicar estrategias de contención de costos en países en desarrollo. Conclusión: La implementación de una unidad de preparación centralizada y la compartición de viales ofrecen beneficios económicos. Se requiere investigación adicional para optimizar su eficacia.

Abstract Background: Rising cancer rates and expensive drugs have inflated treatment costs. Medication wastage constitutes 5% of drug expenditure. Effective cost containment strategies are essential. Objective: To implement and assess a cost-cutting strategy for oncology drugs. Methods: Doses and quantities of oncology drugs were analyzed from January to June of 2022, calculating the total usage and costs by comparing with a decentralized system to estimate the economic impact. Results: Sharing vials achieved a savings of $9,000,705.64MNX. Centralized preparation totaled $52,775,243.24MNX, with a 14% reduction in expenses. Discussion: This pioneering study in Mexico aligns with similar reductions in other countries, underscoring the importance of applying cost containment strategies in developing nations. Conclusion: Implementing a centralized preparation unit and vial sharing offer economic benefits, with further research needed to optimize their effectiveness.

Ecological infrastructure (natural ecosystems that provide important services and save on built infrastructure costs) can have an important role in securing water supply, particularly in water-scarce areas, but this importance is not reflected in investment decisions, partly due to a lack of evidence. In South Africa, one of the main threats to water supply is the proliferation of woody invasive alien plants which significantly reduce stream flow and water yields. We used existing spatial data and estimates of the impact of woody invasive plants on flows and water yields and on restoration costs to analyse the viability of investing in ecological infrastructure at the scale of major water supply areas. The analysis involved comparison of the costs and effects on water yields of catchment restoration with those of planned built infrastructure interventions designed to meet increasing water demands in the medium to long term. The cost-effectiveness analysis used the unit reference value as a measure of comparison, which is based on the discounted flows of costs and water supplied over a defined time. Restoration could supply 24% of the combined yield of planned built infrastructure interventions by 2050, and is not only cost-effective but has the added advantage of a range of co-benefits delivered by improving ecosystem health. This finding suggests that investing in ecological infrastructure should be considered ahead of new built-infrastructure projects. SIGNIFICANCE: • Clearing invasive alien plants from South Africa's main water catchment areas could increase water yields by 997 million m³ by 2050 relative to a business-as-usual approach, equivalent to a quarter of the yield gains through implementation of built infrastructure interventions planned over the same period. • Invasive alien plant clearing would be more cost-effective than built infrastructure interventions in all water supply systems, except one, the Orange River System. • These findings add to the growing body of literature that advocates for ecological infrastructure investments to secure hydrological ecosystem services.

RESUMO Introdução: As crianças constituem um grupo populacional vulnerável a queimaduras. A utilização do esporte como alternativa terapêutica aumenta os indicadores fisiológicos e a eficácia dos tratamentos reabilitativos. Objetivo: Determinar o efeito das ações motoras do tênis de campo como alternativa terapêutica na recuperação da funcionalidade motora de membros superiores em crianças queimadas. Materiais e métodos: Foi realizado um estudo de desenho pré-experimental de controle mínimo, com duração de doze semanas entre o mês de janeiro a abril de 2023. A amostra selecionada foi realizada a partir de uma amostragem intencional estratificada não probabilística, cinco crianças com queimaduras de uma amostra de 8 pacientes, que atenderam aos critérios de inclusão e realizaram ações motoras adaptadas realizadas no tênis de campo. Os dados obtidos foram processados com o software estatístico SPSS 28. Resultados: Os resultados obtidos demonstraram alterações estatisticamente significativas na amostra analisada em relação à funcionalidade motora dos membros superiores, dores ao movimentar-se, problemas de força muscular e limitações na amplitude de movimento. 100 % obtiveram pontuações mais elevadas nos elementos em avaliação. Conclusões: As ações motoras do tênis de campo como alternativa terapêutica foram eficazes na recuperação da funcionalidade motora de membros superiores em crianças queimadas.

RESUMEN Introducción: Los niños constituyen un grupo de población vulnerable a la producción de quemaduras. El uso de deportes como alternativa terapéutica incrementa indicadores fisiológicos y la efectividad de los tratamientos rehabilitadores. Objetivo: examinar el efecto de acciones motrices del tenis de campo como alternativa terapéutica en la recuperación de la funcionabilidad motriz de miembros superiores en niños quemados. Materiales y métodos: Se realizó un estudio de diseño pre experimental de control mínimo, con doce semanas de duración entre el mes de enero a abril de 2023. La muestra seleccionada se realizó a partir de un muestreo intencional estratificado no probabilístico, se seleccionaron cinco niños con quemaduras de una muestra de ocho pacientes, los cuales cumplieron con los criterios de inclusión y realizaron acciones motrices adaptadas que realiza el tenis de campo. Los datos obtenidos fueron procesados con el software estadístico SPSS 28. Resultados: Los resultados obtenidos mostraron cambios estadísticamente significativos en la muestra analizada en relación con la funcionabilidad motriz de los miembros superiores, dolor al movimiento, problemas de fuerza muscular y limitaciones en los rangos de movimiento. El 100 % logró registros superiores en los elementos sometidos a evaluación. Conclusiones: Las acciones motrices del tenis de campo como alternativa terapéutica fueron efectivas en la recuperación de la funcionabilidad motriz de miembros superiores en niños quemados.

ABSTRACT Introduction: Children are vulnerable to burns. The utilization of sports as therapy increases the physiological indicators and rehabilitation effectiveness. Aim: To examine the effect of motor actions in field tennis as a therapeutic alternative for the recovery of motor functions in burned children's upper limbs. Materials and methods: A pre-experimental design study with minimum control was done for twelve weeks between January and April 2023. The sample was selected according to a non-probabilistic stratified intentional sampling. From a total population of 8 children with burns, 5 met the inclusion criteria and performed adapted motor ctions used in field tennis. The data were processed through SPSS 28. Results: The results showed statistically significant changes in the sample about the motor functionality of the upper limbs, pain when moving, muscle strength issues, and movement limitations. All the subjects achieved higher indicator values. Conclusions: The motor actions in field tennis can be used effectively for therapy in the recovery of motor functionality of the upper limbs of burned children.

Abstract Radiotherapy (RT) is a key component of managing head and neck cancer patients. However, despite the emergence and improvement of new RT techniques, late complications may occur, such as osteoradionecrosis of the mandible (ORNM). The diagnosis is based on clinical/radiological criteria. In the established ORNM, the chronic process does not solve spontaneously, and optimal management still needs to be established. Over the last decades, a broad therapeutic spectrum has been considered, including hyperbaric oxygen therapy (HBOT). Although, the clinical impact of HBOT varies according to the literature, which is why there is a current controversy regarding its benefits. Further prospective and randomised studies are needed to validate its effectiveness in the 'real-world' clinical practice. This article aims to synthesise the existing data, analyse previous studies´ results, identify gaps in knowledge, and discuss ORNM’ management, including a proposal for an algorithm, with a particular focus on HBOT.

Resumo A radioterapia (RT) é uma componente fundamental do tratamento multimodal dos doentes com cancro da cabeça e pescoço. Contudo, apesar do surgimento e aperfeiçoamento das técnicas de RT, podem ocorrer complicações tardias, como a osteorradionecrose da mandíbula (ORNM). O seu diagnóstico é baseado em critérios clínicos/radiológicos. Na ORNM estabelecida, o processo crónico não resolve espontaneamente e, até à data, não foi estabelecida uma abordagem terapêutica ótima. Nas últimas décadas foram considerados diversos tipos de tratamento, incluído a oxigenoterapia hiperbárica (HBOT). Contudo, o impacto clínico da HBOT varia de acordo com a literatura, o que gera controvérsia em relação aos seus benefícios. Estudos prospetivos e aleatorizados adicionais são essenciais para validar a eficácia deste tratamento na prática clínica. O objetivo deste artigo é sintetizar os dados existentes, analisar os resultados de estudos prévios, identificar lacunas no conhecimento e discutir a abordagem da ORNM, incluindo uma proposta de algoritmo terapêutico com especial enfoque na HBOT.

This article deals with the nature of social cost-benefit analysis (SCBA) and economic impact analysis (ECIA) of road projects and describes the coherence of and distinctions between the two types of analysis. In the final part of the article, the reasons are given for not including in an SCBA the economic impacts of a road as determined through an ECIA, regardless of how positive they may be. The SCBA of a road project is a systematic procedure to determine the economic viability of the road project by considering the costs and benefits that accrue when the road is constructed and during the service period of the project. The cost component in the SCBA of a road project is the once-off investment or capital cost of taking the road into service or improving it. The benefit component in the SCBA of a road is the difference between recurring costs associated with an improved road and without the road improvement. Recurring costs of a road include (a) road user costs, (b) external costs arising from road use and (c) maintenance costs to protect and preserve the usefulness of the road. The beneficiaries in an SCBA are the road users. The following road user groups can be distinguished: (i) Normal traffic (consisting of existing, normal-growth and non-induced development traffic; (ii) diverted traffic; and (iii) induced traffic (consisting of generated, induced development, and transferred traffic.) To assess the efficiency of resource allocation, an SCBA is based on the consideration of social cost. From the perspective of allocative efficiency, as determined by an SCBA, a road project is regarded as economically viable when the current value of the reduction in recurring costs associated with the road during its service life exceeds the current value of the once-off investment cost of taking the road into service. Road provision and use have economic impacts. Unlike an SCBA, which focuses on the efficiency with which a road project increases accessibility for and the mobility of road users, a regional economic impact analysis (ECIA) focuses on the effectiveness of a project to affect the performance of the economy of a region by enhancing time and place utilities creation by non-road-users. Consequently, an analysis of the effect construction, operation and use of a road will have on regional economic performance should focus on their expected income multiplier and accelerator effects on the number and size of activities in the economy of a region. The following non-road-user groups can be distinguished: (a) The public, (b) landowners, occupants and land users, (c) roadside enterprises, (d) utility enterprises and (e) goods consignors and consignees (in their capacity as non-road-users). An ECIA is based on a consideration of market prices. In an ECIA the following objectives serve as criteria for judging the impact of a road project on the performance of the economy: • Economic growth (including economic development) • Full employment • Price stability • Balance of payments stability • Equitable distribution of income These impacts, regardless of how positive they may be, are not included in an SCBA for the following reasons: • A comprehensive economic assessment consists of two components that are performed in tandem, namely an SCBA and an ECIA. An SCBA relies on allocative efficiency as assessment criterion, while an ECIA relies on output effectiveness as assessment criterion. The inclusion of effectiveness criteria among efficiency criteria in an SCBA will result in a misrepresentation of project viability. • Double counting of benefits will occur when road user cost savings and economic impacts are combined. • Not all the economic benefits obtained through coordinated investment in various sectors, one of which may be a road, can be ascribed to the investment in the road alone. The reason for conducting an ECIA of a road project is to determine to what measure the analysed road is expected to affect the performance of the economy of the region concerned. Although the results of an ECIA do not form part of the outcome of an SCBA, an ECIA can be used as an instrument in the pursuit of the economic policy objectives of a government.

Die hoofdoel van die sosialekoste-voordeel-ontleding (SKVO) van 'n pad is om die inligting oor die koste en voordele te verskaf wat nodig is om die lewensvatbaarheid, al dan nie, van die voorsiening en gebruik van die pad te beraam. Die kostekomponent in die SKVO is die eenmalige investeringskoste om die pad tot stand te bring, en die voordeelkomponent is die daling van die herhalende koste wat uit die gebruik en instandhouding van die pad sal spruit. Die hoofdoel van die ekonomiese-impakontleding (EKIO) van 'n pad behels dat die verwagte gevolge van die voorsiening en gebruik van die pad op die ekonomiese vertoning van 'n bepaalde streek geïdentifiseer en bereken word. Dié ontleding berus hoofsaaklik op die volgende: (a) die beraming van die verwagte eenmalige streeksinkome-vermenigvuldigereffek wat uit die investeringsbesteding aan die pad sal spruit, en (b) die beraming van die herhalende streeksinkome-versnellereffek wat uit die gebruik en instandhouding van die pad sal spruit. Die ekonomiese uitwerking van 'n padprojek word nie by 'n SKVO ingereken nie. Die rede hiervoor is drievoudig: Eerstens berus 'n SKVO op toewysingsdoelmatigheid as beoordelingsnorm, en 'n EKIO op doeltreffendheid as beoordelingsnorm. Die kombinering van doeltreffendheidsnorme en doelmatigheidsnorme sal tot 'n wanvertolking van 'n projek se ekonomiese lewensvatbaarheid lei. Tweedens sal voordele dubbeld getel word indien padgebruikerskostebesparings en ekonomiese impakte saamgevoeg word. Derdens kan ekonomiese voordele wat verkry word deur gekoördineerde investering in verskeie sektore, waarvan een 'n pad is, nie alles aan investering in die pad toegeskryf word nie.

ABSTRACT Bisphosphonates (BPs) are medications widely used in clinical practice to treat osteoporosis and reduce fragility fractures. Its beneficial effects on bone tissue have been consolidated in the literature for the last decades. They have a high affinity for bone hydroxyapatite crystals, and most bisphosphonates remain on the bone surface for a long period of time. Benefits of long-term use of BPs: Large and important trials (Fracture Intervention Trial Long-term Extension and Health Outcomes and Reduced Incidence with Zoledronic acid Once Yearly-Pivotal Fracture Trial) with extended use of alendronate (up to 10 years) and zoledronate (up to 6 years) evidenced significant gain of bone mineral density (BMD) and vertebral fracture risk reduction. Risks of long-term use of BPs: The extended use of antiresorptive therapy has drawn attention to two extremely rare, although severe, adverse events. That is, atypical femoral fracture and medication-related osteonecrosis of the jaw are more common in patients with high cumulative doses and longer duration of therapy. BPs have demonstrated safety and effectiveness throughout the years and evidenced increased BMD and reduced fracture risks, resulting in reduced morbimortality, and improved quality of life. These benefits overweight the risks of rare adverse events. (BPs fractures decades crystals time longterm term Longterm Long YearlyPivotal Yearly Pivotal up 1 (BMD reduction severe events is medicationrelated medication related morbimortality life

RESUMEN Objetivo: Reflexionar sobre los aportes de representar los elementos de la práctica de enfermería en la norma ISO 18.104:2023. Método: Estudio teórico con análisis de la norma. Se describieron estructuras categóricas para representar la práctica de enfermería en sistemas terminológicos y se analizaron las contribuciones identificadas en las partes de la versión. Resultados: Hay innovación en la inclusión del resultado sensible a la acción del enfermero, explicación del diagnóstico de enfermería como indicador de demanda de servicios y complejidad del cuidado, representación de conceptos a través de mapas mentales y sugerencia del uso de modelos de restricción para las acciones de enfermería. Describe que el Proceso de Enfermería está constituido por el diagnóstico, la acción y el resultado sensible a la acción del enfermero. Consideraciones finales: La indicación del diagnóstico de enfermería como indicador traerá beneficios para la producción de conocimiento y la toma de decisiones. Aunque los resultados del cuidado no son respuestas exclusivas a la acción del enfermero, los atributos modificables de un diagnóstico de enfermería generan conocimiento sobre la práctica clínica, la efectividad de las acciones de enfermería y el estado de salud de los sujetos del cuidado. Hay coherencia en la comprensión de la evolución del concepto de Proceso de Enfermería. Objetivo 18.1042023. 181042023 18.104 2023. 18 104 2023 18.104:2023 Método versión Resultados enfermero finales decisiones clínica 1042023 18.1042023 18104202 18104 18.10 1 10 202 18.104:202 104202 18.104202 1810420 1810 18.1 20 18.104:20 10420 18.10420 181042 181 18. 2 18.104:2 1042 18.1042 18.104:

ABSTRACT Objective: To reflect on the contributions of representing nursing practice elements in the ISO 18.104:2023 standard. Method: This is a theoretical study with standard analysis. Categorical structures were described to represent nursing practice in terminological systems and contributions identified in the parts of the version were analyzed. Results: There is innovation in the inclusion of nurse sensitive outcomes, nursing action, nursing diagnosis explanation as an indicator of nursing service demand and complexity of care, representation of concepts through mental maps and suggestion of use of restriction models for nursing actions. It describes that the Nursing Process is constituted by nursing diagnosis, nursing action and nurse sensitive outcomes. Final considerations: Indicating a nursing diagnosis as an indicator will bring benefits for knowledge production and decision-making. Although care outcomes are not exclusive responses to nursing action, the modifiable attributes of a nursing diagnosis generate knowledge about clinical practice, nursing action effectiveness and subjects of care’ health state. There is coherence in understanding the Nursing Process concept evolution. Objective 18.1042023 181042023 18.104 2023 18 104 18.104:202 Method analysis analyzed Results actions considerations decisionmaking. decisionmaking decision making. making decision-making state evolution 1042023 18.104202 18104202 18104 18.10 202 1 10 18.104:20 104202 18.10420 1810420 1810 18.1 20 18.104:2 10420 18.1042 181042 181 18. 2 18.104: 1042

RESUMO Objetivo: Refletir sobre as contribuições da representação dos elementos da prática de enfermagem na norma ISO 18.104:2023. Método: Estudo teórico com análise da norma. Foram descritas estruturas categoriais para representação da prática da enfermagem nos sistemas terminológicos e analisadas as contribuições identificadas nas partes da versão. Resultados: Há inovação na inclusão do resultado sensível à ação da enfermeira, explicitação do diagnóstico de enfermagem como indicador da demanda de serviços e complexidade de assistência, representação dos conceitos por mapas mentais e sugestão do uso de modelos de restrição para ações de enfermagem. Descreve que o Processo de Enfermagem é constituído pelo diagnóstico, ação e resultado sensível à ação da enfermeira. Considerações finais: A indicação do diagnóstico de enfermagem como um indicador trará benefícios para produção de conhecimento e tomada de decisão. Embora os resultados do cuidado não sejam respostas exclusivas a uma ação da enfermeira, os atributos modificáveis de um diagnóstico de enfermagem geram conhecimentos sobre a prática clínica, a eficácia das ações de enfermagem e o estado de saúde dos sujeitos de cuidado. Há coerência na compreensão da evolução do conceito de Processo de Enfermagem. Objetivo 18.1042023. 181042023 18.104 2023. 18 104 2023 18.104:2023 Método versão Resultados enfermeira assistência finais decisão clínica 1042023 18.1042023 18104202 18104 18.10 1 10 202 18.104:202 104202 18.104202 1810420 1810 18.1 20 18.104:20 10420 18.10420 181042 181 18. 2 18.104:2 1042 18.1042 18.104:

Abstract Background: Clinical trials showed the safety of Edoxaban, a non-vitamin K-dependent oral anticoagulant (NOAC), and its efficacy to prevent stroke and systemic embolism in non-valvular atrial fibrillation (NVAF) patients and also to prevent and treat venous thromboembolism. However, additional research is needed to evaluate the safety and effectiveness of Edoxaban in a real-world scenario in the Brazilian population. Objective: In order to understand the risks and benefits of Edoxaban use in routine clinical settings, the EdoBRA study is being conducted to gain insight into the safety and effectiveness of Edoxaban use in non-preselected patients with NVAF in Brazil. Methods: The EdoBRA study is a multicenter, prospective, observational study conducted in 36 sites in Brazil. NVAF patients ≥ 18 years treated with commercially available Edoxaban who initiated treatment for at least 14 days and no longer than 90 days prior to enrollment, and who are not simultaneously participating in any interventional study are eligible for this study. Seven hundred patients are planned to be enrolled and one-year of follow up, with data collections expected at baseline and 3, 6, and 12 months after the study enrollment. The primary safety objective is ISTH Clinically Relevant Bleeding, and the secondary effectiveness objective focuses on relevant cardiovascular outcomes related to NVAF. Conclusion: EdoBRA observational study will generate relevant additional information about NOAC Edoxaban on various aspects of patient management in routine care, such as its safety and effectiveness profile in patients with NVAF in Brazil. Background nonvitamin non vitamin Kdependent K dependent NOAC, , (NOAC) nonvalvular valvular (NVAF thromboembolism However realworld real world population Objective settings nonpreselected preselected Brazil Methods multicenter prospective 3 1 9 enrollment oneyear one year up 6 Bleeding Conclusion care (NOAC

Resumo Fundamento: Os ensaios clínicos demonstraram a segurança da Edoxabana, um anticoagulante oral não dependente de vitamina K (NOAC), e a sua eficácia na prevenção de acidente vascular cerebral e embolia sistémica em pacientes com fibrilação atrial não valvar (FANV) e também na prevenção e tratamento de tromboembolismo venoso. No entanto, pesquisas adicionais são necessárias para avaliar a segurança e a eficácia da Edoxabana em um cenário real na população brasileira. Objetivo: A fim de compreender os riscos e benefícios do uso da Edoxabana em cenários clínicos de rotina, o estudo EdoBRA está sendo conduzido para obter informações sobre a segurança e eficácia do uso da Edoxabana em pacientes não pré-selecionados com FANV no Brasil. Métodos: O estudo EdoBRA é um estudo multicêntrico, prospectivo e observacional, realizado em 36 centros no Brasil. São elegíveis para este estudo pacientes com FANV, ≥ 18 anos de idade, tratados com Edoxabana disponível comercialmente, que iniciaram o tratamento por pelo menos 14 dias e não mais do que 90 dias antes da data de inclusão no estudo, e que não estão participando de nenhum outro estudo de intervenção. Ao todo, 700 pacientes devem ser inscritos e acompanhados por um ano, com coletas de dados programadas para o período basal e 3, 6 e 12 meses após a inscrição no estudo. O objetivo primário de segurança é o sangramento clinicamente relevante (de acordo com critérios da Sociedade Internacional de Trombose e Hemostasia - ISTH), e o objetivo secundário de eficácia são desfechos cardiovasculares relevantes relacionados à FANV. Conclusão: O estudo observacional EdoBRA gerará informações adicionais relevantes sobre a Edoxabana enquanto NOAC em diversos aspectos do manejo de pacientes no atendimento clínico de rotina, como perfil de segurança e efetividade em pacientes com FANV no Brasil. Fundamento NOAC, , (NOAC) (FANV venoso entanto brasileira Objetivo rotina préselecionados pré selecionados Brasil Métodos multicêntrico 3 1 idade comercialmente 9 intervenção todo 70 ano ISTH, ISTH ISTH) Conclusão (NOAC 7

ABSTRACT Objetives: The incidence of posttransplant diabetes and the elevated cardiovascular (CV) risk among transplant recipients are on the rise. Glucagon-like peptide agonists have the potential to mitigate the effects of immunosuppressive drugs, addressing both hyperglycemia and weight gain. This makes them appealing for use in this population, given their CV and renoprotective benefits. Nevertheless, there is insufficient substantial evidence regarding their efficacy in diabetic kidney transplant recipients (KTR). Methods: The objective of this retrospective study was to assess the effectiveness and safety of glucagon-like peptide agonists in KTR. The primary focus was to evaluate their impact on various parameters, such as hemoglobin A1c levels, body mass index (BMI), lipid panel, hemoglobin levels, renal allograft function (estimated glomerular filtration rate [eGFR]), and urinary protein-to-creatinine ratio. Results: During a median observation period of 18 months, this investigation included 64 renal transplant patients. Median eGFR at baseline was 61.9 mL/min/1.73 m2 and remained stable throughout the follow-up. Median HbA1cdecreased from 7.5 to 7% (95%CI; p < 0.002). A significant improvement in BMI and lipid panel were also observed. We did not observed significant changes regarding median creatinine and urinary protein:creatinine ratio levels. No side effects justified discontinuation of the drug. Conclusion: This study shows that the use of glucagon-like peptide agonists is feasible and well-tolerated in KTR, with no significant side effects observed. Subsequent studies are needed to explore whether glucagon-like peptide agonists can effectively improve allograft survival in these patients. Objetives (CV rise Glucagonlike Glucagon like drugs gain population benefits Nevertheless KTR . (KTR) Methods glucagonlike glucagon parameters Ac c levels BMI, , (BMI) estimated eGFR, [eGFR]) proteintocreatinine protein Results 1 months 6 patients 619 61 9 61. mLmin173 mLmin mL min 73 mL/min/1.7 m followup. followup follow up. up follow-up HbAcdecreased HbA cdecreased 75 7 5 7. 95%CI 95CI CI 95 (95%CI 0.002. 0002 0.002 0 002 0.002) proteincreatinine drug Conclusion welltolerated well tolerated (KTR (BMI [eGFR] mLmin17 mL/min/1. 000 0.00 00 [eGFR mLmin1 mL/min/1 0.0 mL/min/ 0. mL/min

RESUMO Objetivos: A incidência de diabetes pós-transplante e o aumento do risco cardiovascular entre os receptores de transplante estão em ascensão. Os agonistas do receptor de peptídeo semelhante ao glucagon têm o potencial de mitigar os efeitos dos medicamentos imunossupressores, abordando tanto a hiperglicemia quanto o aumento de peso, o que os torna atrativos para uso nesta população, dadas as suas vantagens cardiovasculares e renoprotetoras. No entanto, a evidência atual é insuficiente sobre a sua eficácia em receptores de transplante renal diabéticos (RTRD). Métodos: O objetivo deste estudo retrospectivo foi avaliar a eficácia e segurança dos agonistas do peptídeo semelhante ao glucagon-1 em RTRD. O foco principal foi avaliar o seu impacto em vários parâmetros, tais como níveis de hemoglobina A1c, índice de massa corporal (IMC), perfil lipídico, níveis de hemoglobina, função do enxerto renal (taxa de filtração glomerular estimada [TFGe]) e relação proteína-creatinina urinária. Resultados: Durante um período de observação mediano de 18 meses, esta investigação incluiu 64 pacientes transplantados renais. A TFGe mediana no início foi de 61,9 mL/min/1,73 m2 e permaneceu estável durante o acompanhamento. A mediana da HbA1c diminuiu de 7,5 para 7% (IC95%; p < 0,002). Também foi observada uma melhoria significativa no IMC e no perfil lipídico. Não foram observadas mudanças significativas nos níveis medianos de creatinina e relação proteína:creatinina urinária. Nenhum efeito colateral justificou a descontinuação do medicamento. Conclusão: Este estudo mostra que o uso de agonistas do peptídeo semelhante ao glucagon é viável e bem tolerado em RTRD, sem efeitos colaterais significativos observados. Estudos subsequentes são necessários para explorar se esta terapêutica pode melhorar efetivamente a sobrevida do aloenxerto nesses pacientes. Objetivos póstransplante pós ascensão imunossupressores peso população renoprotetoras entanto RTRD . (RTRD) Métodos glucagon1 1 glucagon- parâmetros A1c Ac c IMC, , (IMC) lipídico taxa [TFGe] proteínacreatinina proteína urinária Resultados meses 6 renais 619 61 9 61, mLmin173 mLmin mL min 73 mL/min/1,7 m acompanhamento HbAc HbA 75 7 5 7, IC95% IC95 IC (IC95% 0,002. 0002 0,002 0 002 0,002) medicamento Conclusão observados (RTRD (IMC [TFGe mLmin17 mL/min/1, IC9 (IC95 000 0,00 00 mLmin1 mL/min/1 (IC9 0,0 mL/min/ (IC 0, mL/min

ABSTRACT Introduction: Considering the rising occurrence of posttranplant diabetes and the elevated cardiovascular burden among transplant recipients, the utilization of SGLT2 inhibitors (SGLT2i) in this group is appealing because of their cardiovascular and renoprotective benefits. Nevertheless, there is a scarcity of evidence for diabetic kidney transplant recipients (DKTRs) owing to concerns about potential renal graft damage and adverse effects. Methods: This retrospective study was devised to assess the effectiveness and safety of SGLT2i in kidney transplant recipients (KTRs). The main focus was on evaluating their impact on parameters such as haemoglobin A1c levels, body mass index (BMI), lipid panel, haemoglobin levels, renal allograft function (estimated glomerular filtration rate) and urirnary protein-to-creatinine ratio. Results: A total of 75 renal transplant patients were included in this investigation. The study spanned a median observation period of 18 (2.0–71.0) months. Median estimated glomerular filtration rate at baseline was 61,9 (26–120) mL/min/1.73 m2 and remained stable throughout the follow-up. Median HbA1cdecreased from 7.5 to 7.0% (95% CI; p<0,002). A significant improvement in BMI (95% CI; p<0,001) and lipid panel (95% CI; p<0,05) were also observed. Median haemoglobin rate at baseline was 13,5g/dL and modestly improved at end of follow-up to 13,7g/dL (p=0,12). Regarding urinary protein:creatinine ratio, levels slightly but not significantly rose [+0.05 g/g (p=0,9)]. In a post-hoc subgroup analysis, the rate of urinary tract infections was low (10%). No other side effects were observed during the treatment course. Conclusions: This study demonstrates that the administration of SGLT2i is viable and well-tolerated, with no notable side effects observed in KTRs. However, the question of whether SGLT2i can effectively lower cardiovascular mortality and enhance allograft survival in these patients remains to be explored in subsequent studies. Introduction SGLT SGLTi i (SGLT2i benefits Nevertheless DKTRs (DKTRs Methods KTRs . (KTRs) Ac c BMI, , (BMI) proteintocreatinine protein creatinine ratio Results 7 investigation 1 2.0–71.0 20710 2 0 71 (2.0–71.0 months 619 61 9 61, 26–120 26120 26 120 (26–120 mLmin173 mLmin mL min 73 mL/min/1.7 m followup. followup follow up. up HbAcdecreased HbA cdecreased 5 7. 70 7.0 95% 95 (95 CI p<0,002. p0002 p p<0,002 002 p<0,002) p<0,001 p0001 001 p<0,05 p005 05 135gdL gdL 13 5g dL g 137gdL 7g p=0,12. p012 p=0,12 12 (p=0,12) proteincreatinine +0.05 005 [+0.0 gg p=0,9. p09 p=0,9 (p=0,9)] posthoc post hoc analysis 10%. 10 10% (10%) course Conclusions welltolerated, welltolerated well tolerated, tolerated well-tolerated However studies (KTRs (BMI 2.0–71. 2071 (2.0–71. 6 26–12 2612 (26–12 mLmin17 mL/min/1. (9 p000 p<0,00 00 p<0,0 p00 p01 p=0,1 (p=0,12 +0.0 [+0. p0 p=0, (p=0,9) (10% 2.0–71 207 (2.0–71 26–1 261 (26–1 mLmin1 mL/min/1 ( p<0, (p=0,1 +0. [+0 p=0 (p=0,9 (10 2.0–7 20 (2.0–7 26– (26– mL/min/ p<0 (p=0, +0 [+ p= (1 2.0– (2.0– (26 mL/min p< (p=0 + [ 2.0 (2.0 (2 (p= 2. (2. (p

RESUMO Introdução: Considerando o aumento da incidência de diabetes pós-transplante e o elevado impacto cardiovascular entre os receptores de transplantes, este facto faz com que o uso de inibidores de SGLT2 nesse grupo seja atrativo devido aos seus benefícios cardiovasculares e renoprotetores. No entanto, há escassez de evidência nos receptores de transplante renal com diabetes devido a preocupações com possíveis danos ao enxerto renal e efeitos adversos. Métodos: Este estudo retrospectivo foi elaborado para avaliar a eficácia e segurança dos inibidores de SGLT2 em receptores de transplante renal (KTRs). O foco principal foi avaliar o seu impacto em parâmetros como níveis de hemoglobina A1c, índice de massa corporal (IMC), perfil lipídico, níveis de hemoglobina, função do enxerto renal (taxa de filtração glomerular estimada) e relação proteína/creatinina urinária. Resultados: Um total de 75 pacientes receptores de transplante renal foram incluídos em nossa investigação. O estudo abrangeu um período de observação mediano de 18 (2,0–71,0) meses. A taxa média de filtração glomerular estimada no início foi de 61,9 (26–120) mL/min/1,73 m2 e permaneceu estável durante o acompanhamento. A mediana da HbA1c diminuiu de 7,5 para 7,0% (IC 95%; p<0,002). A melhora significativa no IMC (IC 95%; p<0,001) e no perfil lipídico (IC 95%; p<0,05) também foram observados. A taxa média de hemoglobina no início foi de 13,5g/dL e melhorou modestamente no final do acompanhamento para 13,7g/dL (p=0,12). Em relação à relação proteína/creatinina urinária, os níveis aumentaram ligeiramente, mas não significativamente [+0,05 g/g (p=0,9)]. Numa análise de subgrupo post-hoc, a taxa de infecções do trato urinário foi baixa (10%). Nenhum outro efeito colateral foi observado durante o curso do tratamento. Conclusões: Este estudo demonstra que a administração de inibidores de SGLT2 é viável e bem tolerada, sem efeitos colaterais notáveis em receptores de transplante renal. No entanto, a questão de saber se a inibição do SGLT2 pode efetivamente reduzir a mortalidade cardiovascular e melhorar a sobrevida do enxerto nesses pacientes permanece a ser explorada em estudos subsequentes. Introdução póstransplante pós transplantes SGLT renoprotetores entanto adversos Métodos KTRs. KTRs . (KTRs) A1c Ac c IMC, , (IMC) proteínacreatinina proteína creatinina urinária Resultados 7 investigação 1 2,0–71,0 20710 2 0 71 (2,0–71,0 meses 619 61 9 61, 26–120 26120 26 120 (26–120 mLmin173 mLmin mL min 73 mL/min/1,7 m HbAc HbA 5 7, 70 7,0 IC 95% 95 p<0,002. p0002 p p<0,002 002 p<0,002) p<0,001 p0001 001 p<0,05 p005 05 observados 135gdL gdL 13 5g dL g 137gdL 7g p=0,12. p012 p=0,12 12 (p=0,12) ligeiramente +0,05 005 [+0,0 gg p=0,9. p09 p=0,9 (p=0,9)] posthoc, posthoc post hoc, hoc post-hoc 10%. 10 10% (10%) tratamento Conclusões tolerada subsequentes (KTRs (IMC 2,0–71, 2071 (2,0–71, 6 26–12 2612 (26–12 mLmin17 mL/min/1, p000 p<0,00 00 p<0,0 p00 p01 p=0,1 (p=0,12 +0,0 [+0, p0 p=0, (p=0,9) (10% 2,0–71 207 (2,0–71 26–1 261 (26–1 mLmin1 mL/min/1 p<0, (p=0,1 +0, [+0 p=0 (p=0,9 (10 2,0–7 20 (2,0–7 26– (26– mL/min/ p<0 (p=0, +0 [+ p= (1 2,0– (2,0– (26 mL/min p< (p=0 + [ ( 2,0 (2,0 (2 (p= 2, (2, (p