RESUMO

Objective: Several health games have been developed for pediatric patients in recent years but few for children with atopic dermatitis (AD). As this chronic disease requires changes in daily habits, this study aimed to develop and validate the content of a board health game for children with AD. Material and Methods: This is a content development and validation study of DermatrilhaTM, a board health game about AD. The instrument aims to promote interactions between children with AD and health care providers and offers the exchange of experiences, feelings, and knowledge about the disease in a playful way. The five stages of development of the board game were (a) planning, (b) development, (c) preparation of content validation questionnaires, (d) evaluation by a committee of experts, and (e) pretest with the target audience. Results: The expert committee group consisted of 20 professionals: 5 physicians specialized in pediatric dermatology, 5 psychologists specialized in health psychology, 5 designers with experience in illustration, and 5 early childhood educators. The target audience consisted of 25 children aged 7-12 years with AD. The evaluation of the expert committee found 0.95 in the general content validity index and 0.92 in the target audience, thus exceeding 0.80 in all items. Conclusion: The board health game Dermatrilha has proven to be a psychoeducational tool for the therapeutic education of children with AD, enabling the exchange of experiences, feelings, and knowledge about the disease among peers and health care providers.

RESUMO

Genomic profiling and other new technologies have increased the volume and complexity of information available for guiding clinical decision-making in precision oncology. Consequently, there is a need for multidisciplinary expert teams, in the form of molecular tumor boards (MTBs), who can translate this information into a therapeutic plan, including matching patients to suitable clinical trials. Virtual MTBs (vMTBs) can help to overcome many of the challenges associated with in-person MTBs, such as limited time availability, access to appropriate experts or datasets, or interactions between institutions. However, real-world experience from vMTBs is lacking. Here, we describe oncologists' vMTB experiences and the value of working with multicenter and/or multinational vMTBs. We also address knowledge gaps and barriers that could affect the implementation of vMTBs in routine clinical practice. Case studies from Argentina, Turkey, and Portugal illustrate the value of informed clinical decision-making by vMTBs, including expansion of therapeutic options for patients, faster time to treatment, and the resulting improvement in patient outcomes or impact of vMTB discussions on patients. With the uptake of comprehensive genomic profiling and the evolution of some cancers now being conceptualized as a collection of rare diseases with small patient populations based on molecular profiling, the importance of MTBs has increased in modern cancer management. However, an adjustment in clinical decision-making by healthcare professionals is required and evidence of the added value of vMTBs is lacking. Existing vMTBs and recommendations from participating oncologists could point toward a structured evaluation and analysis of this new platform.

Assuntos

RESUMO

Determining the moment for harvesting the tropical peanut with a focus on superior seed quality is not an easy task. Particularities such as indeterminate flowering, underground fruiting and uneven maturation further increase this technical challenge. It is in this context that we aim to investigate harvest indicators based on the maturation and late maturation phases of tropical peanuts to obtain seeds with superior physiological and health quality. The plants were grown in field conditions and their development stages were carefully monitored until seed production. The water content, dry weight, germination capacity, desiccation tolerance, vigor, longevity, and seed pathogens were evaluated throughout these stages. We showed that seeds from early stages (R5 and R6) did not fully tolerate desiccation and were highly sensitive to pathogen contamination after storage (Aspergillus, Penicillium, and Bacteria). At late stages (R7, R8, and R9), the seeds had optimized vigor, longevity and bioprotection against fungi and thermal stress. The peanut maturation scale for tropical agriculture provides unique harvesting guidelines that make it possible to monitor the plants' development stages with a focus on producing superior quality seeds.

RESUMO

PURPOSE: Genitourinary (GU) multidisciplinary tumour boards (GUMTBs) are key components of patient care, as they might lead to changes in treatment plan, improved survival, and increased adherence to guidelines. However, there are no guidelines on how GUMTBs should operate or how to assess their quality of performance. METHODS: A systematic literature review was conducted to identify criteria and indicators to evaluate quality in GUMTBs. A scientific committee-comprising 12 GU cancer specialists from seven disciplines-proposed a list of criteria and developed indicators, evaluated in two rounds of Delphi method. Appropriateness and utility of indicators were scored using a 9-point Likert scale. Consensus was defined as at least two-thirds of Delphi respondents selecting a score sub-category that encompassed the median score of the group. RESULTS: Forty-five criteria were selected to evaluate the quality of GUMTBs covering five dimensions: organisation, personnel, protocol and documentation, resources, and interaction with patients. Then, 33 indicators were developed and evaluated in the first round of Delphi, leading to a selection of 26 indicators in two dimensions: function, governance and resources, and GUMTB sessions. In the second round, consensus was reached on the appropriateness of all 26 indicators and on the utility of 24 of them. Index cards for criteria and indicators were developed to be used in clinical practice. CONCLUSIONS: Criteria and indicators were developed to evaluate the quality of GUMTBs, aiming to serve as a guide to improve quality of care and health outcomes in patients with GU cancer.

Assuntos

RESUMO

This prospective exploratory study conducted from January 2023 through May 2023 evaluated the ability of ChatGPT to answer questions from Brazilian radiology board examinations, exploring how different prompt strategies can influence performance using GPT-3.5 and GPT-4. Three multiple-choice board examinations that did not include image-based questions were evaluated: (a) radiology and diagnostic imaging, (b) mammography, and (c) neuroradiology. Five different styles of zero-shot prompting were tested: (a) raw question, (b) brief instruction, (c) long instruction, (d) chain-of-thought, and (e) question-specific automatic prompt generation (QAPG). The QAPG and brief instruction prompt strategies performed best for all examinations (P < .05), obtaining passing scores (≥60%) on the radiology and diagnostic imaging examination when testing both versions of ChatGPT. The QAPG style achieved a score of 60% for the mammography examination using GPT-3.5 and 76% using GPT-4. GPT-4 achieved a score up to 65% in the neuroradiology examination. The long instruction style consistently underperformed, implying that excessive detail might harm performance. GPT-4's scores were less sensitive to prompt style changes. The QAPG prompt style showed a high volume of the "A" option but no statistical difference, suggesting bias was found. GPT-4 passed all three radiology board examinations, and GPT-3.5 passed two of three examinations when using an optimal prompt style. Keywords: ChatGPT, Artificial Intelligence, Board Examinations, Radiology and Diagnostic Imaging, Mammography, Neuroradiology © RSNA, 2023 See also the commentary by Trivedi and Gichoya in this issue.

Assuntos

RESUMO

PURPOSE: Breast cancer is the most common malignancy accounting for 11.7% of all cancer cases, with a rising incidence rate. Various diagnostic methods, including 18F-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT), play a crucial role in breast cancer diagnosis and staging. However, the unnecessary use of advanced imaging techniques such as PET/CT in early-stage breast cancer can have negative effects on both economics and patients. We aimed to investigate the impact of PET/CT on the management decisions of early-stage breast cancer patients by the breast cancer tumor board. METHODS: A retrospective analysis was performed on a cohort of 81 patients with early-stage breast cancer who were evaluated by breast cancer tumor board from January 2015 to December 2020. Demographic, clinical, and radiographic data, along with surgical procedures and treatment options, were documented and analyzed. RESULTS: The results showed that 18F-FDG PET/CT had a moderate impact on treatment decisions of breast cancer tumor board, as only treatment decisions were changed in 14,86% of the patients. The surgical procedure decision of breast cancer tumor board changed in 12.35% of patients, while 87.65% of patients had consistent decisions before and after PET/CT. Pathological assessments revealed invasive ductal carcinoma as the most prevalent tumor type, and molecular subtypes were predominantly luminal B. PET/CT use had limited impact on surgical procedures and did not significantly alter treatment decisions of breast cancer tumor board in this early-stage breast cancer cohort. CONCLUSIONS: In conclusion, this study highlights the importance of adherence to the guidelines and appropriate use of PET/CT in early-stage breast cancer management. PET/CT should be reserved for cases where it is clinically warranted, considering the potential economic burden and minimal impact on treatment decisions of breast cancer tumor board in this patient population.

RESUMO

Este texto expone una reflexión académica sobre el proceso de renovación de la política pública de comunitaria en Bogotá (Colombia) realizada durante 2020 y 2022. Inicialmente, se presentan las consideraciones conceptuales sobre las cuales se cimienta el trabajo en relación con las políticas de comunicación, la comunicación comunitaria y el problemático cruce entre estos conceptos. Luego, intenta describir y analizar las tensiones originadas en el interior de la Mesa Distrital de Comunicación Comunitaria en el marco de la fase preparatoria de la política pública. Y finalmente se sugieren algunas ideas o desafíos producto de la experiencia, que bien podrían ser asumidos en las futuras etapas del proyecto político. Entre ellas cabe destacar la urgente necesidad de redefinir la comunicación comunitaria, a partir de las prácticas ejercidas por los medios comunitarios y el actual momento histórico, porque solo así sería posible identificar el carácter de la comunicación y el sentido de la política pública en el actual proceso de reconstrucción.

Summary This text aims to present an academic reflection on the process of renewal of the public community policy in Bogota - Colombia, which will be carried out between 2020 and 2023. Initially, it presents the conceptual considerations on which the work is based in relation to communication policies, community communication, and the problematic crossover between these concepts. Then, it attempts to describe and analyze the tensions originated within the Mesa Distrital de Comunicación Comunitaria, in the framework of the preparatory phase of the public policy. And, finally, it suggests some ideas or challenges resulting from the experience, which could well be assumed in the future stages of the political project. Among them, it is worth highlighting the urgent need to redefine community communication, based on the practices exercised by community media and the current historical moment, because, only in this way, it would be possible to identify the character of communication and the meaning of public policy in the current reconstruction process.

RESUMO

Generation, power conversion and subsequent integration of renewable energy generation systems, such as solar photovoltaic or wind, require an efficient power conversion system that can provide sufficient quality energy according to technical standards (e.g. IEEE 519-2022). In this context, this paper focuses on the analysis, design and experimental validation of a multilevel voltage source inverter (VSI) scheme based on H-bridge cells with a modular and scalable structure for its application in power electronic converter circuits. The designed and assembled experimental setup is a versatile platform for testing experimentally varied control strategies and power converter configurations, such as the number of levels (3, 5, 7 levels) and phases (single-phase or three-phase). Therefore, the hardware design process proposed for the H-bridge cell and the measurement and conditioning circuits for voltage and current signals necessary for implementing the control algorithms are explained in detail. Moreover, a quantitative analysis of the operation of the design was carried out from measurements made with the experimental platform to verify its correct operation. Among the analysed parameters, the generated harmonics level stands out, quantified by calculating the total harmonic distortion and the mean square error between the reference signals and the measured values.

RESUMO

BACKGROUND: Microbiota and tight junction proteins (TJPs) are components of the gut barrier, and are considered stress targets that have deleterious effects on intestinal homeostasis. OBJECTIVES: This study aimed to evaluate the effects of chronic immobilization stress on selected small intestine homeostasis parameters. MATERIAL AND METHODS: Female BALB/c mice were divided into a stress group that underwent short-term immobilization for 2 h per day for 4 consecutive days, and a non-stressed control group (n = 6 per group). Proximal and distal small intestine samples were excised to assess colony-forming units per gram (CFU/g) of total bifidobacteria in selective agar plates, luminal albumin was assessed using immune-enzymatic assay, pro-inflammatory cytokines were evaluated using reverse transcription-quantitative polymerase chain reaction (RT-qPCR), and TJPs (pore-forming, claudin (Cld)-2; pore-sealing, Cld-4; ambiguous, Cld-7, -12 and -15) were assessed with RT-qPCR and western blotting. RESULTS: Compared with the control group, the stress group had lower body weight and energy intake. In the distal region, the stressed mice had lower bifidobacteria count and messenger ribonucleic acid (mRNA) expression of Cld-2, Cld-4 and Cld-12, though they had more albumin and higher interleukin (IL)-6 mRNA expression. Within the proximal region, the stressed mice had higher mRNA expression of tumor necrosis factor alpha (TNF-α), interferon gamma (IFN-γ), IL-6, Cld-7, Cld-12, and Cld-15, along with lower levels of IL-10 and Cld-4. However, mRNA and protein expression of TJPs were discordant. CONCLUSIONS: These findings indicate divergent stress-induced outcomes in the small intestine, evidenced by the elicitation of a pro-inflammatory response and decreased anti-inflammatory response in the duodenum, and by increased albumin transudation and decreased bifidobacterial growth in the distal region.

Assuntos

RESUMO

Integrating renewable energies, such as wind or photovoltaic, requires an electronic power converter, the three-phase Voltage Source Inverter (VSI) the most common for such function. This paper presents a modular design of signal acquisition and control hardware (current and voltage) for the commercial SEMIKRON SKS35F VSI converter and a Texas Instruments TMS320F28335 DSP. Consequently, the proposed modular and open-source design allows its application in control systems of a VSI converter for isolated or grid-connected systems, applied to power generation based on renewable sources. The proposed scheme allows for a personalised design since it uses an open architecture to implement its own control algorithms that allow it to adapt to the application's particular needs, unlike closed-architecture commercial equipment. Detailed electronic printed circuit board designs for implementation are shown on paper. Finally, the experimental tests' results that validate the proposed design's correct functioning are presented.