ABSTRACT The global reemergence of measles in 2018–2019 reinforces the relevance of high-coverage immunization to maintain the disease elimination. During an outbreak in the Sao Paulo State in 2019, several measles cases were reported in individuals who were adequately vaccinated according to the current immunization schedule recommends. This study aimed to assess measles IgG antibody seropositivity and titers in previously vaccinated adults. A cross-sectional study was conducted at CRIE-HC-FMUSP (Sao Paulo, Brazil) in 2019. It included healthy adults who had received two or more Measles-Mumps-Rubella vaccines (MMR) and excluded individuals with immunocompromising conditions. Measles IgG antibodies were measured and compared by ELISA (Euroimmun®) and chemiluminescence (LIASON®). The association of seropositivity and titers with variables of interest (age, sex, profession, previous measles, number of measles-containing vaccine doses, interval between MMR doses, and time elapsed since the last MMR dose) was analyzed. A total of 162 participants were evaluated, predominantly young (median age 30 years), women (69.8%) and healthcare professionals (61.7%). The median interval between MMR doses was 13.2 years, and the median time since the last dose was 10.4 years. The seropositivity rate was 32.7% by ELISA and 75.3% by CLIA, and a strong positive correlation was found between the tests. Multivariate analyses revealed that age and time since the last dose were independently associated with positivity. Despite being a single-center evaluation, our results suggest that measles seropositivity may be lower than expected in adequately immunized adults. Seropositivity was higher among older individuals and those with a shorter time since the last MMR vaccine dose.

Resumen: Introducción: el bloqueo subaracnoideo es la modalidad de anestesia que más se utiliza en cesárea electiva, pero conlleva el riesgo de inestabilidad hemodinámica materna (hipotensión y bradicardia). El uso de vasopresores como efedrina en bolo o norepinefrina en infusión permite controlar la presión arterial, pero no existe suficiente evidencia para guiar la elección del agente específico. Objetivos: comparar la frecuencia de eventos de inestabilidad hemodinámica en mujeres sometidas a cesárea electiva con bloqueo subaracnoideo tratadas con efedrina o con norepinefrina. Material y métodos: realizamos un ensayo clínico fase IV, pragmático, de etiqueta abierta y de no inferioridad. Los desenlaces primarios fueron el número de eventos de bradicardia e hipotensión, y también se registraron eventos de náusea, vómito, eventos adversos graves y puntaje de Apgar. Resultados: el uso de norepinefrina redujo el riesgo de hipotensión en 71%, de náusea en 93% y de emesis en 67%. No se observaron diferencias en los eventos de bradicardia ni en el puntaje de la escala de Apgar. Conclusión: la norepinefrina no es inferior a la efedrina para el manejo terapéutico de la hipotensión materna asociada a bloqueo subaracnoideo en cesárea electiva.

Abstract: Introduction: subarachnoid spinal block is the form of anesthesia more commonly used for elective cesarean section, though it carries the risk of maternal hemodynamic instability (hypotension or bradycardia). Vasopressors, such as ephedrine in bolus or infused norepinephrine, prevent this adverse event, though the evidence to guide vasopressor choice is insufficient. Objectives: to compare the frequency of hemodynamic instability events in women undergoing elective cesarean section with subarachnoid spinal block treated with ephedrine or norepinephrine. Material and methods: we performed a pragmatic, open-label, non-inferiority, phase IV clinical trial, in which the primary outcomes were the number of bradycardia and hypotension events. We also studied the number of nausea and vomiting events, severe adverse events, and Apgar scores. Results: infused norepinephrine reduced 71% the risk of hypotension, 93% the risk of nausea, and 67% the risk of vomiting. There were no differences in the number of bradycardia events or Apgar scores. Conclusion: norepinephrine is non-inferior to ephedrine to treat maternal hypotension due to subarachnoid spinal block in elective cesarean section.

Abstract The aim of this study was to evaluate the osseointegration of a hydrophilic surface (blasting + acid etching + immersion in isotonic solution) in comparison with that of a control surface (blasting + acid etching) using an experimental model of low-density bone. To perform the study, 24 rabbits were submitted to the installation of 4 implants in the iliac bone bilaterally: 2 implants with a control surface and 2 implants with a hydrophilic surface. The rabbits were euthanized at 2, 4, and 8 weeks after implant installation. After euthanasia, one implant from each surface was used to perform the removal torque analysis, and the other implant was used for the execution of non-decalcified histological sections and evaluation of the bone implant contact (% BIC) as well as the fraction of bone tissue area between the implant threads (% BBT). The implants with a hydrophilic surface presented higher %BIC (42.92 ± 2.85% vs. 29.49 ± 10.27%) and % BBT (34.32 ± 8.52% vs. 23.20 ± 6.75%) (p < 0.05) in the 2-week period. Furthermore, the hydrophilic surface presented higher removal torque in the 8-week period (76.13 ± 16.00 Ncm2 vs. 52.77 ± 13.49 Ncm2) (p<0.05). Implants with a hydrophilic surface exhibited acceleration in the process of osseointegration, culminating in greater secondary stability in low-density bone than in implants with a control surface.

Resumo O objetivo deste estudo foi avaliar a osseointegração de uma superfície hidrofílica (jateamento + ataque ácido + imersão em solução isotônica) em comparação com uma superfície controle (jateamento + ataque ácido) usando um modelo experimental de osso de baixa densidade. Para realizar o estudo, 24 coelhos foram submetidos a instalação de 4 implantes bilateralmente no osso ilíaco: 2 implantes com superfície controle e 2 implantes com superfície hidrofílica. Os coelhos foram eutanasiados com 2, 4 e 8 semanas após a instalação dos implantes. Após a eutanásia, um implante de cada superfície foi usado para avaliar o torque de remoção, e o outro implante foi utilizado para execução de cortes histológicos não descalcificados e avaliação de contato osso implante (% BIC) bem como a fração da área tecido ósseo entre as roscas do implante (% BBT). Os implantes com superfície hidrofílica apresentaram maior %BIC (42.92 ± 2.85% vs. 29.49 ± 10.27%) e % BBT (34.32 ± 8.52% vs. 23.20 ± 6.75%) (p < 0.05) no período de 2 semanas. Além disso, a superfície hidrofílica apresentou maior torque de remoção no período de 8 semana (76.13 ± 16.00 Ncm2 vs. 52.77 ± 13.49 Ncm2) (p<0.05). Implantes com a superfície hidrofílica apresentaram aceleração no processo de osseointregração, culminando em melhor estabilidade secundária no osso de baixa densidade em relação a implantes com superfície controle.

Abstract The insertion of new distributed energy resources, such as distributed generation (DG), energy storage systems (ESS), demand response (DR), and microgrids (MG), is emerging, bringing new challenges to the current distribution network. In this regard, the active distribution networks (I) with multi-microgrids concept appears. The present paper proposes a hierarchical (master-slave problem) computational model to achieve optimal coordinated operation of multi-microgrids connected to an I. Day-ahead operation planning of an I was formulated as a multiperiod non-linear optimal power flow model, resulting in a non-linear optimization problem, additionally, the day-ahead operation planning of MGs was formulated as a multiperiod linearized optimal power flow resulting in a mixed-integer linear optimization problem. Numerical results on four different test-system microgrids connected to a 359-nodes ADNs test-system belonging to a Brazilian distribution company show the effectiveness of the proposed model and solution strategy. Three cases have been tested: with a maximum load-shedding restriction, without this restriction, and considering insertion of DG. Besides, the hierarchical model can evaluate how much losses and load shedding take effect without integrated operation and expansion planning of emerging distributed networks. This study showed the importance of analyzing the systemic impact of integrating multi-MGs and I synergistic operation interactions, resulting in improvements in the voltage quality levels, operation costs, and power losses. The results showed that, including DG in the system, the costs were reduced by 13,48% compared to the case base.

Abstract The optimization of microgrids present challenges such as managing distributed energy resources (DERs) and the high reliance on intermittent generation such as PV and wind turbines, which present an aleatory behavior. The most popular techniques to deal with the uncertainties are stochastic optimization, which comes with a high computational burden, and adaptive robust optimization (ARO), which is often criticized for the conservativeness of its solutions. In response to these drawbacks, this work proposes a mixed-integer linear programming (MILP) model using a data-driven robust optimization approach (DDRO) solved by a two-stage decomposition using the column-and-constraint generation algorithm (C&CG). The DDRO model uses historic data to create the bounds of its uncertainty set, eliminating the conservativeness created by the arbitrary definition of the uncertainty set that is seen in ARO while maintaining a low computational burden. The DDRO model applied was not previously utilized in MGs, only in bulk power systems. A benchmark MG system was simulated for a 24-hour period without uncertainties, with uncertainties using ARO (15% uncertainty budget) and with uncertainties and DDRO. The operational costs without uncertainty were $124,600,60, while the ARO approach rose those costs by 32.5% ($ 165,137.18). Finally, the DDRO approach managed to keep the costs in $ 126,934.54, a mere 1.8% increase from the base case without uncertainty. All simulations were performed in less than 1 minute. The results confirm a) the advantages of bounding the uncertainty set with historical data instead of an arbitrary definition of bounds and b) the fast-converging times of DDRO.

ABSTRACT Analyzing the impact of harvest-time drying data is crucial for successful storage and maintaining regulatory seed quality. This study aimed to assess the performance of fixed and mobile dryers using machine learning techniques. Data were collected from convective dryers, including the total number of dryers used, drying time (in hours), moisture percentages at the product’s entrance and exit, and the humidity difference between them. The study employed the Filtered Clusterer model, which utilizes the Simple K-Means technique and the Resample filter to group data based on similarities. The findings indicated distinct differences between fixed and mobile drying systems, with well-defined variations within each system. The algorithm, combined with the applied filters, proved effective in unsupervised classification by identifying and reducing inter-cluster similarity within the fixed system, thereby creating distinct classes within the dataset. In conclusion, the algorithm successfully clustered the scattered dataset and accurately classified and minimized inter-cluster similarity within the fixed system. Conversely, the mobile system exhibited low drying efficiency.

RESUMO Analisar os efeitos de dados de secagem em época de safra é primordial para o sucesso do armazenamento, além de manter a qualidade fisiológica das sementes. O objetivo com este trabalho foi avaliar o desempenho de secagem em secadores fixo e móveis através de aprendizado de máquinas. Os dados foram coletados de secadores convectivos, com base em: i) total de secadores trabalhados; ii) tempo de duração de secagem (horas); iii) percentual de umidade na entrada e saída do produto (%); e iv) diferenças de umidade entres ambas (%). Foi utilizado o modelo Filtered Clusterer, baseado na técnica Simple K-Means e filtro Resample, para agrupar dados com base em suas similaridades. Os resultados apresentados demonstram que o sistema de secagem é distinto entre os equipamentos fixo e móvel, com diferenças bem definidas dentro dos sistemas de secagem estabelecidos. O algoritmo juntamente com os filtros demonstrou ser eficiente na classificação não supervisionada, identificando e minimizando similaridade inter-cluster do sistema fixo definindo em classes distintas dentro do conjunto de dados. Conclui-se, que o conjunto de dados dispersos são agrupados de modo que o algoritmo classifica e minimiza similaridade inter-cluster do sistema fixo com alta precisão. Por outro lado, o desempenho da secagem em sistema móvel apresentou baixa eficiência.

ABSTRACT Objective A comparative analysis of the association between sedentary behavior versus physical activity levels and tumor staging in women with breast cancer. Methods The present research adopted a cross-sectional study design to recruit a total of 55 adult and elderly women newly diagnosed with breast cancer for data collection and analysis. Inclusion criteria involved patients in procession of a formal approval for participation in the study by the treating physician and those not hitherto subjected to the first cycle of chemotherapy. Results Physical activity levels did not influence the pathological stage of breast cancer (p=0.26) or histological tumor grade (p=0.07) in the analyzed subjects. However, there was a significant association between physical activity levels and responsiveness to hormones (epidermal growth factor receptor (HER2), p<0.05) in the analyzed subjects. Significant difference was detected in the histological tumor grade in relation to the mean time spent sitting during the weekend (p<0.05). However, sedentary behavior had no influence on the tumor stage (p>0.05). Conclusion Physical activity levels did not influence the tumor stage and histological tumor grade. Sedentary behavior had a significant influence on the histological tumor grade.

Abstract Poly(vinyl chloride) (PVC) resins constitute the third most important plastic materials available commercially, in terms of worldwide volume production, and can be manufactured through several polymerization mechanisms, including free radical, ionic and redox polymerization processes. Approximately 80% of the worldwide commercial PVC production is performed through suspension polymerization processes in batch mode, due to intrinsic problems of continuous suspension polymerization processes, such as polymer incrustation in reaction vessels, transport equipment and pipes. For this reason, the present review provides an extensive bibliometric survey, including papers and patents, on attempts to develop continuous polymerization process technologies for PVC manufacture. Particularly, the present survey characterizes the degree of maturity and the main bottlenecks of continuous PVC processes that have been frequently overlooked in the technical literature.

ABSTRACT Introduction: Metacarpal fractures are common and can be treated surgically using Kirschner wires (K-wires) or intramedullary fixation with compression screws (IMCS). Objectives: Analyze the postsurgical results from treating the metacarpal extra-articular fractures through the retrograde Kirschner wire technique, and compare it with the intramedullary compression screw fixation. Methods: Retrospective and quantitative studies were to analyze patients’ medical records, and a postsurgical evaluation questionnaire was given to the patients, who were divided into K-wire and IMCS. Results: The period of immobilization with a splint took six weeks for the K-wire group and four weeks for the IMCS group. The average time for consolidation took, respectively, fifty-seven days and forty-seven days. The first group could restart their activities twenty-two days after the other, and the average force value of the treated hand, when compared with its contralateral, was 93.9% and 95.4%, respectively. Between the operated hand and its contralateral, there was a difference of 16° in the total measures of the metacarpophalangeal and interphalangeal joint's range of movement among the K-wire group and 5° among the IMCS group. Conclusion: The patients who participated in this study showed excellent results after surgery, and both treatments were proven to be safe and reliable. Evidence level III; Retrospective comparative study .

RESUMO Introdução: Fraturas dos metacarpos são frequentes e podem ser tratadas de forma cirúrgica com os fios de Kirschner (FK) e Fixação Intramedular com Parafuso de Compressão (FIPC). Objetivo: Analisar os resultados pós-operatórios do tratamento das fraturas extra-articulares dos metacarpos pela técnica retrógrada com fios de Kirschner e comparar com a fixação intramedular utilizando parafuso de compressão. Métodos: Estudo retrospectivo, quantitativo, com análise de prontuários, utilizando questionários de avaliação pós-operatória em dez pacientes divididos em dois grupos: FIPC e FK. Resultados: O período de imobilização com tala nos grupos FK e FIPC foram de seis e quatro semanas respectivamente, já o tempo médio para consolidação foi de 57 e 47 dias respectivamente. O grupo FK retornou as atividades laborais após os FIPC. O valor médio de força na mão acometida comparada a contralateral foi de 93,9% no grupo FK, e no FIPC de 95,4%. Medidas da soma de amplitude de movimento das articulações metacarpofalangeanas e interfalangeanas no grupo FK obtiveram diferença média entre as mãos operada e a contralateral de 16°, já na FIPC observou-se 5°. Conclusão: Os pacientes estudados apresentaram excelentes resultados pós-operatórios e ambos os tratamentos provam ser seguros e confiáveis. Nível de evidência III; Estudo retrospectivo comparativo .

ABSTRACT State parks are integral protection units created to protect ecosystems. However, anthropic activities may have been previously performed before their creation, forming transitional areas. Studies that evaluate the modifications of edaphic properties in these environments are scarce. The aim of this study was to evaluate the changes in soil properties and litter stock in areas of eucalyptus-forest ecotones. Litter stock (Stocklitter) and total soil organic carbon content and stock (TOCsoil), weighted mean diameter (MWD), origin of aggregates (biogenic or physicogenic) and respective content of total organic carbon (TOCBio and TOCPhy), total organic carbon (TOCAG), soil organic matter chemical fractions [fulvic acid (FAC), humic (HAC), and humin (HUMC)], and particulate, mineral-associated, free light and intra-aggregate light (POC, MAOC, FLFC, and ILFC) soil organic matter, fertility, and glomalin-related soil protein (GRSP) fractions were evaluated in aggregates (layer 0.00-0.10 m) in areas of eucalyptus-forest ecotone (Eco), preserved forest fragment (For), and eucalyptus plantation (Euc), in Nova Baden State Park, Lambari–MG. In the Euc and Eco areas, the highest Stocklitter content was found. Higher values of TOCsoil, TOCAG, GRSP, and MWD were observed in the Euc area. In the biogenic aggregates, the highest content of TOCBio, HAC, HUMC, POC, MAOC, FLFC, and ILFC was determined in detriment of the physicogenic ones. The dynamics of edaphic properties in the Eco area showed greater similarity with the For area than in the Euc area. In general, all vegetation covers contribute to the maintenance of soil quality.

ABSTRACT Purpose: To evaluate the viability of the porcine vas deferens as a realistic microsurgical training model for vasectomy reversal Methods: The model uses swine testicles (vas deferent), which are usually discarded in large street markets since they are not part of Brazilian cuisine. The spermatic cord was carefully dissected, and the vas deferens were isolated, measuring 10 cm in length. A paper quadrilateral with 5 cm2 was built to delimit the surgical training field. The objective of the model is to simulate only the microsurgical step when the vas deferens are already isolated. The parameters analyzed were: feasibility for reproducing the technique, patency before and after performing the vasovasostomy, cost of the model, ease of acquisition, ease of handling, execution time, and model reproducibility. Results: The simulator presented low cost. All models made were viable with a texture similar to human, with positive patency obtained in 100% of the procedures. The internal and external diameters of the vas deferens varied between 0.2-0.4 mm and 2-3 mm, respectively, with a mean length of 9 ± 1.2 cm. The total procedure time was 43.28 ± 3.22 minutes. Conclusions: The realistic model presented proved to be viable for carrying out vasectomy reversal training, due to its low cost, easy acquisition, and easy handling, and providing similar tissue characteristics to humans.

ABSTRACT Objective: To describe contents, structure and origin of social representations about falls by elderly people, the peridomiciliary structural conditions that predispose to falls, and to relate the implications of these empirical evidence on the routine of the elderly in the architectural context. Method: Convergent mixed method by triangulation. Qualitative approaches(structural, n=195 and procedural, n=40of the Theory of Social Representations) and quantitative (descriptive sectional, n=183) were used. Elderly people enrolled in primary care were interviewed at home in 2018. Analysis techniques: categorical-thematic, prototypical, statistical, and deductive according to Leininger. Results: Categories of analysis: 1) Peridomicile: fall scenario and 2) Aging and vulnerability: risk of falls in peridomicile. The following environmental characteristics were precursors to falls: uneven floors, holes, unevenness and objects in the pathway. Feelings and behaviors allocated in the possible central core are associated, justifying falls, and determining their causes. Conclusion: There was an association between the peridomiciliary architectural environment and the predictive characteristics of the risk of falls.

RESUMEN Objetivo: Describir contenido, estructura y origen de las representaciones sociales sobre las caídas de los ancianos, las condiciones estructurales peridomiciliares que predisponen a las caídas; y relacionar las implicaciones de estas evidencias empíricas sobre el cotidiano de los ancianos en el contexto arquitectónico. Método: Mixto convergente por triangulación. Enfoque cualitativo: estructural (n=195) y procedimental (n=40) de la Teoría de las Representaciones Sociales y cuantitativo: descriptivo seccional (n=183). Se entrevistó en domicilio a ancianos inscritos en atención primaria (2018). Técnicas de análisis: categórico-temático, prototípico, estadístico y deductivo según Leininger. Resultados: Categorías de análisis: 1) Peridomicilio: escenario de caída y 2) Envejecimiento y vulnerabilidad: riesgo de caídas en peridomicilio. Las siguientes características ambientales fueron precursoras de caídas: pisos irregulares, agujeros, desniveles y objetos en el camino. Se asocian sentimientos y comportamientos alojados en el posible núcleo central, justificando las caídas y apuntando a sus causas. Conclusión: Hubo asociación entre el ambiente arquitectónico peridoméstico y las características predictivas del riesgo de caídas.

RESUMO Objetivo: Descrever conteúdos, estrutura e origem das representações sociais sobre queda apresentadas por pessoas idosas e condições estruturais peridomiciliares que predispõem à queda e relacionar as implicações dessas evidências empíricas na rotina de idosos no contexto arquitetônico. Método: Misto convergente por triangulação. Utilizaram-se as abordagens qualitativa (estrutural, n=195 e processual, n=40 da Teoria das Representações Sociais) e quantitativa (seccional descritiva, n=183). Foram entrevistados idosos no domicílio adscritos à atenção primária, em 2018. Técnicas de análise: categorial-temática, prototípica, estatística e dedutiva segundo Leininger. Resultados: Categorias de análise: 1) Peridomicílio: cenário de queda e 2) Envelhecimento e vulnerabilidade: risco de queda no peridomicílio. Apresentaram-se como características ambientais precursoras de quedas: pisos irregulares, buracos, desníveis e objetos no percurso. Sentimento e comportamentos alocados no possível núcleo central se associam, justificando as quedas e objetivando suas causas. Conclusão: Evidenciou-se a associação entre o ambiente arquitetônico peridomiciliar e as características preditoras do risco de quedas.

ABSTRACT. This study evaluated an alternative heating-stirring system in the determination of in vitro ruminal digestibility of dry matter (IVRDMD) of forages using the Tilley and Terry (TT) method. For this purpose, the IVRDMD of three forage species (Marandu, Tifton 85, and Mombasa) was determined by incubating 500 mg of each dried and ground (1 mm) forage in 50-mL rumen inoculum during 48h, followed by quantification of the incubation residue. Two heating-stirring systems were used: i) heating in a water bath at 39°C with manual stirring every two hours (i.e., traditional system); and ii) heating in an oven with controlled temperature at 39°C and automatic agitation (44 rpm; alternative system); there was no effect of the interaction between the heating-stirring system and the type of forage (p = 0.829) on the IVRDMD of forages. The type of heating-stirring system (p = 0.422) did not affect the IVRDMD of forages. Nevertheless, the IVRDMD values of Marandu grass (system i = 598.7 g kg-1 vs system ii = 599.4 g kg-1) were greater (p < 0.001) than Tifton 85 (system i = 392.1 vs g kg-1 vs system ii = 370.7 g kg-1) and Mombasa (system i = 397.4 g kg-1; system ii = 369.7 g kg-1) grasses. In conclusion, the obtained data indicate that the alternative heating-stirring system produces similar results to those obtained using the traditionally heating-stirring system during the determination of the IVRDMD of forages.