Abstract Purpose Our research examined the impact of readability on the understandability of notes to the financial statement and investigated the influence of a glossary on understandability. Theoretical framework Previous studies have treated readability and understandability as synonymous, but understandability is a broader concept influenced by contextual complexity, syntax, and individual characteristics. Design/methodology/approach We conducted an experiment involving 111 participants in Brazil with a background in accounting. We manipulated components of the Flesch readability metric and assessed their impact on understandability, as measured by the Meaning Identification Test. Findings Enhancing the readability of financial statement notes did not improve their understandability. However, participants' overall comprehension abilities and personal characteristics were found to significantly influence understandability. Additionally, the inclusion of a glossary of technical terms had a positive impact on understandability only for users with limited prior knowledge. Practical & social implications of research Researchers should consider alternative metrics to assess understandability. Standard setters and regulators should reconsider the effectiveness of presenting a glossary. Investors can advocate for improved text quality measures and the presentation of high quality information. Originality/value Most readability studies focus on reports written in English, and they are mainly applied to Anglophone countries. Our study extends this area of research in Brazil to reports written in Portuguese. Additionally, it highlights the need to explore the relationship between readability and understandability, as traditional readability formulas may not fully capture the comprehensibility of a text. synonymous complexity syntax Designmethodologyapproach Design methodology approach 11 accounting Test However Additionally knowledge information Originalityvalue Originality value English countries Portuguese 1

Abstract This study aims to determine and compare the metabolizable energy values and metabolizability coefficients of three types of corn oil (crude, semi-refined, and acid) for broiler chickens. 240 Cobb500™ chickens were randomly allocated into metabolic cages, resulting in four treatments, ten replicates, and six birds per experimental unit. The birds fed on diets specific to each treatment. Total excreta was collected from the day 23rd to the 27th. Gross energy (GE), apparent metabolizable energy (AME), and nitrogen-corrected apparent metabolizable energy (AMEn) were calculated for each oil type. The metabolizability coefficient values of ether extracts (MCEE) were also determined. Statistical analysis was performed using Tukey test at a 5% probability. There was a significant difference in AME and MCEE values (P<0.05). Crude corn oil showed higher AME and MCEE values than acid corn oil. The findings are crude corn oil - GE: 9,330 kcal/kg, AME: 8,916.84 kcal/kg, AMEn: 8,905.60 kcal/kg, MCEE: 97.14%; semi-refined corn oil - GE: 9,480 kcal/kg, AME: 8,547.99 kcal/kg, AMEn: 8,303.46 kcal/kg, MCEE: 96.64%; acid corn oil - GE: 9,114 kcal/kg, AME: 7,197.73 kcal/kg, AMEn: 7,515.68 kcal/kg, MCEE: 96.17%. crude, (crude semirefined, semirefined semi refined, refined 24 Cobb500 Cobb cages treatments replicates unit treatment rd 27th th GE, GE , (GE) AME, (AME) nitrogencorrected nitrogen corrected AMEn (AMEn type (MCEE determined 5 probability P<0.05. P005 P P<0.05 . 0 05 (P<0.05) 9330 9 330 9,33 kcalkg kcal kg kcal/kg 891684 8 916 84 8,916.8 890560 905 60 8,905.6 97.14% 9714 97 14 9480 480 9,48 854799 547 99 8,547.9 830346 303 46 8,303.4 96.64% 9664 96 64 9114 114 9,11 719773 7 197 73 7,197.7 751568 515 68 7,515.6 9617 17 96.17% 2 Cobb50 (GE (AME P00 P<0.0 (P<0.05 933 33 9,3 89168 91 8,916. 89056 90 6 8,905. 97.14 971 1 948 48 9,4 85479 54 8,547. 83034 30 4 8,303. 96.64 966 911 11 9,1 71977 19 7,197. 75156 51 7,515. 961 96.17 Cobb5 P0 P<0. (P<0.0 93 3 9, 8916 8,916 8905 8,905 97.1 94 8547 8,547 8303 8,303 96.6 7197 7,197 7515 7,515 96.1 P<0 (P<0. 891 8,91 890 8,90 97. 854 8,54 830 8,30 96. 719 7,19 751 7,51 P< (P<0 89 8,9 85 8,5 83 8,3 71 7,1 75 7,5 (P< 8, 7, (P

Resumo Este estudo teve como objetivo determinar e comparar os valores de energia metabolizável e os coeficientes de metabolizabilidade de três tipos de óleo de milho (bruto, semi-refinado e ácido) em frangos de corte. Foram usados 240 frangos da linhagem Cobb500™, distribuídos aleatoriamente em gaiolas metabólicas com quatro tratamentos, 10 repetições e 6 aves por unidade experimental. As aves foram alimentadas com rações específicas para cada tratamento, e a coleta total de excretas foi realizada dos dias 23 a 27. Os valores de energia bruta (EB), energia metabolizável aparente (EMA) e energia metabolizável aparente corrigida pelo balanço de nitrogênio (EMAn) foram calculados para cada tipo de óleo. Os coeficientes de metabolizabilidade do extrato etéreo (CMEE) também foram determinados. A análise estatística dos resultados foi realizada por meio do teste de Tukey ao nível de 5% de probabilidade. Houve diferença significativa para os valores de EMA e CMEE (P<0,05). O óleo de milho bruto apresentou maiores valores EMA quando comparado ao óleo de milho ácido. O mesmo comportamento foi verificado para o CMEE (P<0,05). Os valores encontrados para os óleos foram: óleo de milho bruto - EB: 9330 kcal/kg, EMA: 8916,84 kcal/kg, EMAn: 8905,60 kcal/kg, CMEE: 97,14%; óleo de milho semi refinado - EB: 9480 kcal/kg, EMA: 8547,99 kcal/kg, EMAn: 8303,46 kcal/kg, CMEE: 96,64%; óleo de milho ácido - EB: 9114 kcal/kg, EMA: 7197,73 kcal/kg, EMAn: 7515,68 kcal/kg, CMEE: 96,17%. bruto, (bruto semirefinado corte 24 Cobb500 Cobb Cobb500™ tratamentos 1 experimental tratamento 2 27 EB, EB , (EB) (EMA EMAn (EMAn (CMEE determinados 5 probabilidade P<0,05. P005 P P<0,05 . 0 05 (P<0,05) 933 kcalkg kcal kg kcal/kg 891684 8916 84 8916,8 890560 8905 60 8905,6 97,14% 9714 97 14 948 854799 8547 99 8547,9 830346 8303 46 8303,4 96,64% 9664 96 64 911 719773 7197 73 7197,7 751568 7515 68 7515,6 9617 17 96,17% Cobb50 (EB P00 P<0,0 (P<0,05 93 89168 891 8 8916, 89056 890 8905, 97,14 971 9 94 85479 854 8547, 83034 830 4 8303, 96,64 966 91 71977 719 7 7197, 75156 751 7515, 961 96,17 Cobb5 P0 P<0, (P<0,0 89 97,1 85 83 96,6 71 75 96,1 P<0 (P<0, 97, 96, P< (P<0 (P< (P

Abstract In the community, malnutrition is manifested by the loss of muscle mass, being associated with a decrease in muscle strength, an increased risk of frailty, functional impairment and impaired healing of chronic wounds, as well as a higher incidence of infections. It is estimated that malnutrition affects one in three elderly people at home and one in three patients in elderly care institutions. Malnutrition is reversible as long as the patient has access to timely nutritional screening that identifies their nutritional risk and as long as an individualized nutritional intervention is instituted. Disease associated malnutrition continues to be perceived as a secondary problem in primary health care, so the implementation of nutritional risk screening, as a routine parameter, is the first step in improving access to nutritional care in the community. In this article, the Malnutrition Universal Screening Tool is proposed for routine nutritional screening in primary care.

Resumo Na comunidade, a malnutrição manifesta-se pela perda de massa muscular, estando associada à diminuição da força muscular, ao aumento do risco de fragilidade, ao comprometimento funcional e da cicatrização de feridas crónicas, assim como a maior incidência de infeções. Estima-se que a malnutrição afete um em cada três idosos no seu domicílio e um em cada três utentes em instituições de cuidados de idosos. A malnutrição é reversível desde que o utente tenha acesso a um atempado rastreio nutricional que identifique o seu risco nutricional e instituída uma intervenção nutricional individualizada. A malnutrição associada à doença continua a ser percecionada como um problema secundário nos cuidados de saúde primários, pelo que a implementação do rastreio do risco nutricional, como um parâmetro de rotina, é o primeiro passo na melhoria do acesso aos cuidados nutricionais na comunidade. Neste artigo, é proposta a ferramenta Malnutrition Universal Screening Tool para rastreio nutricional de rotina nos cuidados de saúde primários.

ABSTRACT The Alcantara Launch Center (ALC) is the main Brazilian access to space. It is positioned over a complex terrain, and it has some important buildings for assembling, integration and launching activities, such as the Mobile Integration Tower. Being in a region of prevalent trade winds, the flow interaction between the complex terrain and the buildings can affect the safety of operations on the platform, and the dispersion of toxic gases emitted during the launching. The main objective of this work was to study the influence of topography and buildings on the atmospheric flow of ALC using computational fluid dynamics (CFD) techniques. Three geometries were considered: simplified terrain (case 1), smooth complex terrain (case 2), and roughness complex terrain (case 3). The flow conditions over ALC were simulated using the ANSYS Fluent 19.0 CFD commercial code. The numerical simulations used a realizable ?-? to model turbulence effects and the results presented a good agreement with the in-situ field measurements for the most complex geometry (case 3). The topography clearly influences the flow pattern at ALC, with the cliff influence over the wind being the major cause for establishing the flow patterns.

RESUMO: Objetivou-se avaliar o melhor valor de balanço eletrolítico total (BET) para as variáveis de desempenho e qualidade dos ovos de galinhas poedeiras. Foram utilizadas 240 galinhas poedeiras da linhagem HyLine Brown, durante o período de 30 a 46 semanas de idade, distribuídos em um delineamento inteiramente casualizado, com cinco tratamentos (1000, 1250, 1500, 1750 e 2000 μeq/kg), oito repetições e seis aves por unidade experimental. Foram avaliados o desempenho e a qualidade dos ovos das aves com os diferentes tratamentos. Foi realizada análise de variância e, no caso de efeito significativo, foram estimadas equações de regressão considerando como variável concomitante o balanço eletrolítico (μeq/kg), usando o programa estatístico SAS (2001). As variáveis de consumo, produção, conversão alimentar por dúzia de ovos, peso final das aves, densidade do ovo, coloração da gema, Unidade Haugh, peso do albúmen, peso da casca e peso do ovo, não foram afetados pelos BET experimentais. Os valores de conversão alimentar por massa de ovos, peso de gema e uniformidade foram influenciados pelos diferentes BET. Os valores de balanço eletrolítico que propiciaram conversão alimentar mínima, melhor peso de gema e melhor uniformidade foram, respectivamente: BET=1400, BET = 1330 e BET = 1250 em μeq/kg de cargas nas rações. Conforme as equações de regressão indica-se o valor de BET de 1390 para poedeiras de 30 a 46 semanas de idade. O balanço eletrolítico da dieta afeta o desempenho e a qualidade dos ovos de galinhas poedeiras.

ABSTRACT: This study was done to determine the best value of the total electrolyte balance (BET) concerning the variables of performance and egg quality of the laying hens. We investigated 240 Hy-Line Brown laying hens, of 30 to 46 weeks of age, adopting the completely randomized experimental design, which included five treatments (1000, 1250, 1500, 1750 and 2000 μeq / kg), 8 repetitions and 6 birds per unit. The performance and quality of the birds’ eggs were evaluated in the different treatments. The results were subjected to the analysis of variance and, wherever significant effect was noted, the regression equations were estimated, taking into account the electrolyte balance (μeq / kg) as a concomitant variable, applying the SAS statistical program (2001). The consumption, production, and feed conversion variables by dozen eggs, final bird weight, egg density, yolk color, Haugh Unit, albumen weight, shell weight, and egg weight, were found to be unaffected by the experimental BET values. The values of the feed conversion per egg mass, yolk weight and uniformity were affected by the different BETs. The electrolyte balance values showing minimum feed conversion, higher yolk weight, and better uniformity were, respectively, BET = 1400, 1330, and 1250 in μeq / kg of loads at the different temperatures. From the regression equations, the value indicated was BET=1390 for the 30- to 46-week-old laying hens. The electrolyte balance of the diet was found to affect the laying hens in terms of performance and egg quality.

ABSTRACT Purpose To use a 3D printed poly (L-lactide) acid (PLLA) and hydroxyapatite (HA) composite as a bone substitute for reconstruction of a critical bone defect in the radius of rabbits. Methods A 1.5 cm ostectomy was performed in the radial diaphysis of 60 New Zealand white rabbits. The rabbits were divided into three groups according to surgical treatment of the bone defect (group I – control, group II – bone graft, group III – 3D PLLA). Each group was divided into four subgroups with different radiographic and histopathologic evaluation times (T1 – 15 days, T2 – 30 days, T3 – 60 days, T4 – 90 days). Results The implant group had greater clinically lameness (p = 0.02), edema (p = 0.007), pain (p = 0.04) and more complications at the surgical site (p = 0.03). Histologically, this group showed greater congestion (p = 0.04), hemorrhage (p = 0.04) and inflammation. Osteogenesis was microscopically similar between days (p = 0.54) and treatments (p = 0.17), even though radiographically, more effective bone healing occurred in the graft group (II), with more callus and bone bridge formation. Conclusions The customization of a 3D PLLA/HA scaffold was successful. However, in animals receiving the polymer-ceramic composite less bone callus and bone bridge was formed compared to the graft group.

RESUMO INTRODUÇÃO: Na atualidade tem se verificado um crescimento significativo no número de doentes com suspeita de apneia obstrutiva do sono (AOS) referenciados para consulta do sono. Nesse sentido, instrumentos de rastreio e estratificação da gravidade dessa patologia têm se tornado cada vez mais relevantes. OBJETIVO: Avaliar e comparar o desempenho da escala NoSAS e Stop-Bang para o rastreio de AOS. MÉTODOS: Estudo prospectivo durante 12 meses. Avaliados todos os doentes encaminhados aos cuidados de saúde primários do centro de medicina do sono que completaram o questionário NoSAS (Neck circumference, Obesity, Snoring, Age, Sex), Stop-Bang (Snoring, Tiredness, Observed apnea, Pressure [high blood], BMI, Age, Neck circumference, Gender) e foram submetidos a polissonografia. Utilizou-se uma análise ROC (receiver operating characteristic) para encontrar as pontuações que maximizam simultaneamente a sensibilidade e especificidade para cada diagnóstico. RESULTADOS: Incluídos 294 indivíduos, 84% apresentavam AOS, sendo que em 28,8% a OAS era ligeira, 34,8% moderada e 36,4% grave. USANDO A ESCALA NOSAS PARA PREVISÃO DE AOS, AOS MODERADA A GRAVE E AOS GRAVE, A ÁREA ROC FOI: 0,770 (IC95%: 0,703-0,837), p<0,001, sensibilidade de 57,5% e especificidade de 83,0% para a pontuação 12); 0,746 (IC95%: 0,691- 0,802), p<0,001, sensibilidade de 68,2% e especificidade de 75,4% para a pontuação 13); 0,686 (IC95%: 0,622-0,749), p<0,001, sensibilidade de 71,1% e especificidade de 58,3% para a pontuação 13), respectivamente. USANDO A ESCALA STOP-BANG PARA A PREVISÃO DE AOS, AOS MODERADA A GRAVE E AOS GRAVE, A ÁREA ROC FOI: 0,862 (IC95%: 0,808-0,916), p<0,001, sensibilidade de 68,4% e especificidade de 85,1% para pontuação 5); 0,813 (IC95%: 0,756-0,861), p<0,001, sensibilidade de 77,3% e especificidade de 66,1% para a pontuação 5); 0,787 (IC95%: 0,732-0,841), p<0,001, sensibilidade de 70,0% e especificidade de 79,9% para a pontuação 6), respectivamente. CONCLUSÕES: A área ROC foi consistentemente alta para as duas escalas, confirmando a capacidade diagnóstica dos questionários NoSAS e Stop-Bang para todos os graus de gravidade de AOS. Assim, os nossos resultados sugerem que esses questionários podem ser um importante instrumento para rastreio e estratificação de doentes no diagnóstico de AOS. Globalmente, a capacidade de diagnóstico do Stop-Bang foi superior à do NoSAS.

SUMMARY INTRODUCTION: Currently there has been significant growth in the number of patients with suspected obstructive sleep apnea (OSA) referred to sleep clinics. In this sense, screening and stratification methods of the severity of this pathology have become increasingly relevant. OBJECTIVE: To evaluate the performance of the NoSAS and STOP-Bang scores in the screening of OSA in a sleep clinic. METHODS: Prospectively, for 12 months, all patients referred by primary care physicians to our sleep unit for clinical evaluation and who underwent in-lab polysomnography (PSG), also completed the NoSAS score (Neck circumference, Obesity, Snoring, Age, Sex) and STOP-Bang (Snoring, Tiredness, Observed apnea, Pressure (high blood), BMI, Age, Neck circumference, Gender). A ROC (receiver operating characteristic) analysis was used to find the scores that simultaneously maximize sensitivity and specificity for each diagnosis. RESULTS: Of the 294 individuals included, 84% had OSA, of which 28.8% were mild, 34.8% moderate, and 36.4% were severe. USING THE NOSAS SCORE FOR PREDICTING OSA, MODERATE TO SEVERE OSA, AND SEVERE OSA, THE ROC AREA WAS: 0.770 (95% CI: 0.703-0.837), p<0.001, sensitivity of 57.5%, and specificity of 83.0% for a score of 12; 0.746 (95% CI: 0.691-0.802), p<0.001, sensitivity of 68.2% and specificity of 75.4% for a score of 13; 0.686 (95% CI: 0.622-0.749), p<0.001, sensitivity of 71.1% and specificity of 58.3% for a score of 13, respectively. USING THE STOP-BANG SCORE FOR PREDICTING OSA, MODERATE TO SEVERE OSA, AND SEVERE OSA, THE ROC AREA WAS: 0.862 (95% CI: 0.808-0.916), p<0.001, sensitivity of 68.4% and specificity of 85.1% for a score of 5; 0.813 (95% CI: 0.756-0.861), p<0.001, sensitivity of 77.3% and specificity of 66.1% for a score of 5; 0.787 (95% CI: 0.732-0.841), p<0.001, sensitivity of 70.0% and specificity of 79.9% for a score of 6, respectively. CONCLUSIONS: The ROC area was consistently high for both scores confirming the diagnostic ability of the NoSAS and STOP-Bang questionnaires for all OSA severities. Thus, our results suggest that these questionnaires may be a powerful tool for the screening and stratification of patients in the diagnosis of OSA. Overall, the diagnostic ability of the STOP-Bang was higher than the NoSAS.

RESUMO Relatamos um caso de um paciente submetido a facectomia por facoemulsificação sob bloqueio anestésico peribulbar, sem intercorrências per-operatória, que apresentou no primeiro dia de pós-operatório baixa visual significativa. À fundoscopia observou-se palidez em aspecto de mácula em cereja. A angiofluoresceinografia não demonstrou sinais de oclusão vascular e a tomografia de coerência óptica mostrou aumento da refletividade das camadas internas da retina, sugerindo espessamento e edema local. No caso descrito foi aventada hipótese diagnóstica de oclusão arterial retiniana transitória.

ABSTRACT We here in report the case of a patient subjected to cataract surgery through phacoemulsification under local anesthetic block, without intra-operative complications. The patient presented important visual impairment in the first post-operative day. Fundoscopy showed pallor resembling cherry-red spots at the macula. Fluorescein angiography did not depict signs of vascular occlusion and the spectral-domain optical coherence tomography showed increased reflectivity in the inner layers of the retina, thus suggesting local thickening and edema. The current case led to the diagnostic hypothesis of transient retinal arterial occlusion.

Abstract Introduction Brazilian Telehealth Program was instituted by the Ministry of Health in 2007. Its initial structure was composed by nine telehealth centers administered by public higher education institutions. No standards, processes, applications or quality indicators had been defined since its creation. All this, combined with the decentralization of the centers, led each one of them to develop their own system, with different programming languages and architectures. The lack of regulation and integration of the information with the Ministry of Health made it difficult to evaluate the program. In this context, this paper describes the specification, implementation and validation of an architecture, entitled SMART, to integrate the various telehealth platforms developed by the centers. Such architecture aims to standardize information so that the Ministry of Health can monitor and evaluate the results of Telehealth actions. Methods SMART’s architecture consists of four main components: a web tool for data manipulation; a web service to receive the center’s production data; a component responsible for converting the received data into decision support data; and a component that collects data from external sources to compose the data warehouse. Results The architecture was validated with performance tests, which were executed under extreme workloads. The results of the experiments were summarized in order to attest SMART’s effectiveness. Conclusion The analysis of the results obtained on real data shows that the project’s performance remained stable under the workloads and its high quality was proven due to the absence of errors during the experiments.

Abstract Introduction According to the World Health Organization, about 9.2% of the 28 million newborns worldwide are stillborn. Besides, about 358,000 women died due to complications related to pregnancy in 2015. Part of these deaths could have been avoided with improving prenatal care agility to recognize problems during pregnancy. Based on that, many efforts have been made to provide technologies that can contribute to offer better access to information and assist in decision-making. In this context, this work presents an architecture to automate the classification and referral process of pregnant women between the basic health units and the referral hospital through a Telehealth platform. Methods The Telehealth architecture was developed in three components: The data acquisition component, responsible for collecting and inserting data; the data processing component, which is the core of the architecture implemented using expert systems to classify gestational risk; and the post-processing component, in charge of the delivery and analysis of cases. Results Acceptance test, system accuracy test based on rules and performance test were realized. For the tests, 1,380 referral forms of real situations were used. Conclusion On the results obtained with the analysis of real data, ILITIA, the developed architecture has met the requirements to assist medical specialists on gestational risk classification, which decreases the inconvenience of pregnant women displacement and the resulting costs.

The objective of this study was to evaluate the performance of F1 (Holstein × Zebu) cows in lactation according to different levels of substitution of soybean meal for a protein equivalent non-protein nitrogen originated from slow-release urea (SRU). Eight F1 (Holstein × Zebu) cows in the first third of lactation, with an average milk yield of 12.7 kg (±3.1 kg)/day and a live weight of 552 kg (±30 kg), were used. The experimental design was composed of two simultaneous 4 × 4 Latin squares, with the following treatments: 100% soybean meal and 0% SRU; 66% soybean meal and 34% SRU; 34% soybean meal and 66% SRU; and 0% soybean meal and 100% SRU. Sorghum silage, used as roughage, was supplied together with the concentrate. Feed intake and digestibility as well as milk yield and milk composition were measured. The obtained data were subjected to analysis of variance, adopting a 5% probability level. No intake variable showed significant differences among the treatments, and the mean values for the intakes of dry matter (DM), crude protein (CP) and neutral detergent fiber (NDF) were 18.35 2.62 and 5.85 kg/day, respectively. The results for apparent digestibility also did not show differences among treatments, with DM, CP and NDF averaging 58.16, 58.64 and 36.21%, respectively. Milk yield and composition were similar among the treatments. The average 4%-fat-corrected milk yield was 13.39 kg/animal day. Intake, digestibility and milk yield and composition variables are not changed according to the substitution of the soy protein for slow-release urea. Thus, for average-milk-yield crossbred.animals, this substitution depends on economic variables only.

We investigated the effect of adding titanium dioxide nanoparticles (TiO2) to ethylene vinyl acetate (EVA) copolymer, containing 28% vinyl acetate groups, on the crystallinity and miscibility of the copolymer. Films of EVA/TiO2 containing 0.25%-1% TiO2, relative to the total weight of EVA, were prepared from their solution. The obtained films were characterized by X-ray diffraction, low-field nuclear magnetic resonance, and differential scanning calorimetry. The addition of TiO2 to the EVA copolymer was proved to cause changes in the crystallinity and mobility of the polymer chains of EVA, due to new intermolecular interactions and nanostructure organization.

INTRODUÇÃO: O e-learning surgiu como uma forma complementar de ensino, trazendo consigo vantagens como o aumento da acessibilidade da informação, aprendizado personalizado, democratização do ensino e facilidade de atualização, distribuição e padronização do conteúdo. Neste sentido, o presente trabalho tem como objeto apresentar uma ferramenta, intitulada de ISE-SPL, cujo propósito é a geração automática de sistemas de e-learning para a educação médica, utilizando para isso sistemas ISE (Interactive Spaced-Education) e conceitos de Linhas de Produto de Software. MÉTODOS: A ferramenta consiste em uma metodologia inovadora para a educação médica que visa auxiliar o docente da área de saúde na sua prática pedagógica por meio do uso de tecnologias educacionais, todas baseadas na computação aplicada à saúde (Informática em Saúde). RESULTADOS: Os testes realizados para validar a ISE-SPL foram divididos em duas etapas: a primeira foi feita através da utilização de um software de análise de ferramentas semelhantes ao ISE-SPL, chamado S.P.L.O.T; e a segunda foi realizada através da aplicação de questionários de usabilidade aos docentes da área da saúde que utilizaram o ISE-SPL. CONCLUSÃO: Ambos os testes demonstraram resultados positivos, permitindo comprovar a eficiência e a utilidade da ferramenta de geração de softwares de e-learning para o docente da área da saúde.

INTRODUCTION: E-learning, which refers to the use of Internet-related technologies to improve knowledge and learning, has emerged as a complementary form of education, bringing advantages such as increased accessibility to information, personalized learning, democratization of education and ease of update, distribution and standardization of the content. In this sense, this paper aims to present a tool, named ISE-SPL, whose purpose is the automatic generation of E-learning systems for medical education, making use of ISE systems (Interactive Spaced-Education) and concepts of Software Product Lines. METHODS: The tool consists of an innovative methodology for medical education that aims to assist professors of healthcare in their teaching through the use of educational technologies, all based on computing applied to healthcare (Informatics in Health). RESULTS: The tests performed to validate the ISE-SPL were divided into two stages: the first was made by using a software analysis tool similar to ISE-SPL, called S.P.L.O.T and the second was performed through usability questionnaires to healthcare professors who used ISE-SPL. CONCLUSION: Both tests showed positive results, allowing to conclude that ISE-SPL is an efficient tool for generation of E-learning software and useful for teachers in healthcare.

INTRODUÇÃO: Diversos estudos demonstraram as vantagens clínicas da utilização dos instrumentos de alta resolução em cirurgia, com a redução do tempo operatório, fácil manuseio e efetividade nas incisões, assim como menor geração de fumaça e danos térmicos teciduais. OBJETIVO: Demonstrar a viabilidade técnica de reutilização das pinças de alta resolução para corte e coagulação teoricamente recomendadas para uso único. MÉTODO: Foi avaliada a eficácia da limpeza, garantia do processo de esterilização e qualidade funcional do material. O processo foi aplicado em quatro pinças da marca Ligasure- Valleylab. Cada uma foi identificada com fitas autoclaváveis de cores diferentes para rastreamento. Duas foram submetidas diretamente à limpeza após a primeira utilização e nas outras duas foi coletado, antes desta limpeza, material para a primeira cultura. Todas as pinças passaram por processo de limpeza antes da esterilização. Em seguida foram esterilizadas em peróxido de hidrogênio. Após o processo de esterilização foi colhida, de cada pinça, cultura em meio de solução fisiológica. Após esta coleta todas as pinças foram testadas por um cirurgião quanto à sua atuação em uma amostra de carne bovina. Randomicamente, a cada teste o pesquisador contaminava uma pinça com cepas de Pseudomonas aeroginosa, Staphylococcus aureus e Candida albicans. Este processo foi repetido por quatro vezes. O material foi encaminhado ao laboratório e semeado em meio de cultura passível de identificação microbiológica. Para controle de qualidade todos os testes biológicos, químicos e certificados de qualidade dos produtos utilizados no processo foram anexados. RESULTADOS: Os resultados de todas as culturas foram negativos e a funcionabilidade preservada nas quatro reutilizações. CONCLUSÃO: Quanto à funcionabilidade, as pinças podem ser utilizadas por no mínimo até quatro vezes, que foi o número de vezes testado neste experimento. Portanto, ela pode ser utilizada por cinco vezes, sendo a primeira vinda de fábrica e mais quatro após reprocessamento.

INTRODUCTION: Several studies have demonstrated the clinical benefits of the use of high resolution instruments in surgery, with reduction in the operative time, easy handling and effectiveness in the incisions, as well as lower smoke generation and thermal tissue damage. AIM: To demonstrate the technical feasibility of reusing devices of high resolution for cutting and coagulation, theoretically recommended for single use. METHOD: Was evaluated the efficacy of cleaning, sterilization process and functional quality of the material. The process was applied in four tweezers brand Ligasure - Valleylab. Each was identified with ribbons of different colors autoclavable for tracking. Two were submitted directly to the cleaning after the first use and from the other two were collected samples of this cleaning for the first culture. All tweezers passed through the cleaning process prior to sterilization. Then were sterilized in hydrogen peroxide. After the sterilization process, was taken material from the devices and put it on saline solution for culture. After, the tweezers were tested by a surgeon to analyze its performance in a sample of beef. Randomly at each test the researcher contaminated tweezers with strains of Pseudomonas aeruginosa, Staphylococcus aureus and Candida albicans. This process was repeated four times. The material was sent to the laboratory and seeded in culture medium capable of microbiological identification. For quality control tests all biological, chemical and quality certification of products used in the process were attached. RESULTS: The results of all cultures were negative, and functionality was preserved in the four reuses. CONCLUSION: As to the functionality, the tweezers may be used at least four times, the number of times tested in this experiment. Therefore, it can be used for five times, the first coming from the factory and four more after reprocessing.

FUNDAMENTO: Os indivíduos com insuficiência renal crônica terminal estão sujeitos a um elevado estresse cardíaco pelo carácter repetitivo e intermitente da terapia dialítica. As alterações na sístole elétrica ventricular induzidas pela necessária terapia dialítica são um contributo importante na predição da ocorrência de morte súbita arrítmica na insuficiência renal crônica terminal. OBJETIVO: O objetivo principal desta investigação é avaliar o comportamento da repolarização ventricular em face da terapia dialítica, mediante o estudo do intervalo QTc e dispersão do QTc. MÉTODOS: A amostra em estudo inclui 47 indivíduos sujeitos a hemodiálise (61,7% do sexo masculino e 38,3% do sexo feminino) com idade média de 66,79 ± 13,16 anos. Todos os indivíduos foram sujeitos a três eletrocardiogramas realizados em três momentos durante a terapia dialítica (pré, durante e após a sessão), sendo posteriormente analisada a sístole elétrica ventricular. RESULTADOS: Ocorreu um aumento do intervalo QTc máximo e da dispersão do QTc associado à terapia dialítica. Aliado ao aumento desses intervalos ocorreu um aumento do número de indivíduos com critérios eletrocardiográficos para hipertrofia ventricular esquerda, registando-se no período pós-diálise uma média superior do intervalo QTc máximo (473 ± 27,63 mseg) e da dispersão do QTc (58,95 ± 18,87 mseg) desses indivíduos, comparativamente aos indivíduos sem HVE, 455,21 ± 26,85 mseg e 44 ± 16,41 mseg, respectivamente. CONCLUSÃO: O presente estudo confirmou um aumento do intervalo QTc e da dispersão do QTc associado à terapia dialítica. Esse aspecto reforça a dependência da repolarização ventricular em relação ao equilíbrio hídrico e eletrolítico e sugere um perfil de maior vulnerabilidade arrítmica associada à terapia dialítica.

BACKGROUND: Patients with end-stage kidney disease (ESKD) experience elevated cardiac stress because of the repetitive and intermittent character of dialysis. Changes in ventricular electrical systole induced by necessary dialysis significantly contribute to predict sudden death due to arrhythmia in ESKD. OBJECTIVE: The major objective of this study was to assess the behavior of ventricular repolarization in dialysis by analyzing QTc interval and QTc dispersion. METHODS: This study sample consisted of 47 patients undergoing hemodialysis (61.7% males and 38.3% females), whose mean age was 66.79±13.16 years. All of them underwent three electrocardiograms performed before, during and after one dialysis session. Ventricular electrical systole was analyzed later. RESULTS: An increase in maximum QTc interval and QTc dispersion associated with dialysis was observed. In addition, an increase in the number of individuals meeting the electrocardiographic criteria for left ventricular hypertrophy (LVH) was observed. After dialysis, higher means of the maximum QTc interval (473 ± 27.63 mseg) and of the QTc dispersion (58.95 ± 18.87 mseg) were observed in individuals with LVH as compared with those in individuals without LVH (455.21 ± 26.85 mseg and 44 ± 16.41 mseg, respectively). CONCLUSION: This study confirmed an increase in the QTc interval and QTc dispersion associated with dialysis. That emphasizes the dependence of ventricular repolarization on fluid and electrolyte balance, and suggests a profile of higher vulnerability to arrhythmia associated with dialysis .