Resumo: A inclusão das mulheres no mercado de trabalho é um assunto recorrente de pesquisa e um dos fenômenos verificados é denominado “teto de vidro”, que representa o grau reduzido de oportunidades de ascensão profissional dadas às mulheres. Neste trabalho, analisou-se através de dados bibliométricos o estudo deste fenômeno. Como banco de dados, utilizou-se o Web of Science, cujo impacto é reconhecido internacionalmente pela academia. Os resultados mostraram uma convergência de citações em poucos textos e a concentração de artigos em periódicos editados em países do Norte Global. Também se constatou uma alta concentração da produção científica em reduzidas redes colaborativas, lideradas por pesquisadores situados em instituições no Norte Global.

Abstract: The inclusion of women in the job market is a recurring subject of research and one of the phenomena observed is called “glass ceiling”, which represents the reduced degree of opportunities for professional advancement given to women. In this work, the study of this phenomenon was analyzed using bibliometric data. As a database, the Web of Science was used, whose impact is internationally recognized by academia. The results showed a convergence of citations in a few texts and a concentration of articles in journals published in countries in the Global North. There was also a high concentration of scientific production in small collaborative networks, led by researchers located in institutions in the Global North.

Resumen: La inclusión de las mujeres en el mercado laboral es un tema recurrente de investigación y uno de los fenómenos observados es el llamado “techo de cristal”, que representa la reducción de oportunidades de avance profesional para las mujeres. En este trabajo se analiza el estudio de este fenómeno utilizando datos bibliométricos. Como base de datos se utilizó el Web of Science, cuyo impacto es reconocido internacionalmente por la academia. Los resultados mostraron una convergencia de citas en unos pocos textos y una concentración de artículos en revistas publicadas en países del Norte Global. También hubo una alta concentración de la producción científica en pequeñas redes colaborativas, lideradas por investigadores ubicados en instituciones del Norte Global.

Abstract This article aims to offer an overview of the evolution of Luther’s political thought concerning religious tolerance. Our hypothesis is that a tolerantist political theory, i.e., one which affirms the illegitimacy of religious coercion, makes appearance in the young Luther, especially in his little tract On secular authority (1523), before being abandoned in the course of Reformation. As a second step, we try to situate this change in the broader political thinking of the Reformer and in the changing winds of the Reformation.

Resumo O objetivo deste artigo é oferecer um pequeno panorama da evolução do pensamento político de Lutero a respeito da tolerância religiosa. Nossa hipótese é que uma teoria política tolerantista, isto é, que afirma a ilegitimidade da coerção em matéria religiosa, se insinua no jovem Lutero, especialmente no panfleto Da autoridade secular (1523) para depois ser abandonada no devir da Reforma. Num segundo momento, procuramos situar essa mudança no pensamento político mais amplo do reformador e na própria marcha histórica da Reforma.

Resumo A doença renal crônica é um problema de saúde pública global e em seu estágio terminal está associada à necessidade de terapia dialítica. A grande maioria dos pacientes que necessitam realizar a terapia renal substitutiva, a fazem através da hemodiálise. Portanto, o acesso vascular é de extrema importância para a população dialítica, implicando diretamente na qualidade de vida e na morbimortalidade deste grupo de pacientes. Sendo a confecção, gerenciamento e resgate dos acessos vasculares uma das áreas de atuação do cirurgião vascular, é de grande importância a elaboração de uma diretriz que oriente o especialista no manejo mais adequado do acesso vascular para hemodiálise. Assim, o objetivo desta diretriz é apresentar um conjunto de recomendações para guiar as decisões na referenciação, avaliação, escolha, vigilância e gestão das complicações do acesso vascular para hemodiálise. dialítica substitutiva hemodiálise Portanto confecção Assim referenciação avaliação escolha

Abstract Chronic kidney disease is a worldwide public health problem, and end-stage renal disease requires dialysis. Most patients requiring renal replacement therapy have to undergo hemodialysis. Therefore, vascular access is extremely important for the dialysis population, directly affecting the quality of life and the morbidity and mortality of this patient population. Since making, managing and salvaging of vascular accesses falls within the purview of the vascular surgeon, developing guideline to help specialists better manage vascular accesses for hemodialysis if of great importance. Thus, the objective of this guideline is to present a set of recommendations to guide decisions involved in the referral, evaluation, choice, surveillance and management of complications of vascular accesses for hemodialysis. problem endstage end stage Therefore population making surgeon importance Thus referral evaluation choice

Abstract: The objective of this article is to study the viability of the European Union's DigCompEdu model, which suggests that teachers' digital competence depends on professional commitment, pedagogical competencies, and the ability to develop students' digital competence. The method of analysis was based on the modeling of structural equations with a PLS (partial least squares) approach. A questionnaire was completed by 2,262 teachers from nine public universities in Andalusia, Spain. The results show the effectiveness of the European model, the possibilities offered by the methodology of structural equations, and the validation of an instrument to analyze teachers' digital competence in the university context. In this area of study, the proposed model can serve to define itineraries of teacher training, establish selection criteria, and analyze the professional development needs of university professors.

Resumen: El objetivo de este artículo es estudiar la viabilidad del modelo DigCompEdu de la Unión Europea, que sugiere que la competencia digital docente depende del compromiso profesional, competencias pedagógicas y capacidad para desarrollar la competencia digital del alumnado. El método de análisis se llevó a cabo a través del modelado de ecuaciones estructurales con enfoque PLS (mínimos cuadrados parciales). El instrumento empleado fue un cuestionario cumplimentado por 2,262 docentes de 9 universidades públicas andaluzas. Los resultados demuestran la eficacia del modelo europeo, las posibilidades que ofrece la metodología de las ecuaciones estructurales y la validación de un instrumento de análisis de la competencia digital docente en el contexto universitario. En esta línea, el modelo planteado puede servir para definir itinerarios de formación docente, establecer criterios de selección, así como analizar las necesidades de desarrollo profesional docente universitario.

Abstract Background Cardiotoxicity is the main complication related to cancer therapy. Studies indicate that global longitudinal strain is an early detector of subclinical dysfunction of the left ventricle, preceding the decline in ejection fraction (EF). However, the reproducibility of such methodology has not been tested outside specialized centers. Objectives To assess the frequency of subclinical cardiotoxicity and to compare global longitudinal strain and EF measurements during the clinical course of patients undergoing chemotherapy for breast cancer. Methods This was an observational prospective study of 78 adult women who underwent serial echocardiograms (baseline and 1, 3, and 6 months after the beginning of chemotherapy), to evaluate biplane and 3D EF and global longitudinal strain. Cardiotoxicity and subclinical dysfunction were defined according to American Society of Echocardiography/European Association of Cardiovascular Imaging criteria. Statistical significance was set at p < 0.05. Results The mean age of the patients was 50.1 ± 11.48 years. The frequency of subclinical cardiotoxicity (defined by global longitudinal strain) was 14.9% after 30 days of chemotherapy, 16.7% after 3 months, and 19.7% after 6 months, compared to 4.5%, 3%, and 6.6%, respectively, when clinical cardiotoxicity was determined according to EF. The group that developed subclinical cardiotoxicity by 30 days (group A) had a higher frequency of clinical cardiotoxicity at 3 months (p=0.028) and a lower mean biplane EF after 30 days (p= 0.036) than the group that showed no evidence of subclinical cardiotoxicity (group B). Conclusion Subclinical cardiotoxicity was frequent and began early, being associated with a drop in EF during the clinical course.

RESUMO Objetivo: Compreender as experiências e desafios dos profissionais de uma equipe de rua de Portugal no cuidado à população vulnerável na perspectiva fenomenológica de Alfred Schutz. Método: Abordagem qualitativa à luz do referencial Teórico da Sociologia fenomenológica desenvolvido em uma Equipe de rua localizada na região centro de Portugal a partir de entrevistas fenomenológicas com cinco profissionais nos meses de junho e julho de 2021. Os dados foram interpretados por meio da análise compreensiva conforme a sociologia fenomenológica de Alfred Schutz e de literatura correlata. Resultados: Emergiram três categorias: conflitos vivenciados pela equipe de rua; Frustração no cotidiano do cuidar pela equipe de rua; e, Limites na relação social com a população vulnerável. Conclusão: A equipe de rua de Portugal enfrenta desafios no cuidado a população vulnerável atendida sendo necessário habilidades da equipe para mediação de conflitos aliada a compreensão das influências das relações, no agir social.

ABSTRACT Objective: To understand the experiences and challenges faced by professionals working on a street team in Portugal in caring for the vulnerable population from the phenomenological perspective of Alfred Schutz. Method: Qualitative approach in the light of the theoretical framework of phenomenological Sociology, developed in a street team in the central region of Portugal from phenomenological interviews with five professionals in the months of June and July 2021. The interpretation of the results was analyzed through theoretical conceptions of Alfred Schutz’s phenomenological sociology and related literature. Results: Three categories emerged: Conflicts experienced by the street team; Frustration in the daily care provided by the street team; and, Limits in the social relationship with the vulnerable population. Conclusion: The street team in Portugal faces challenges in caring for the vulnerable population served,requiring team skills for conflict mediation combined with an understanding of the influences of relationships, in social action.

RESUMEN Objetivo: Comprender las experiencias y desafíos de dos profesionales de un equipo de calle en Portugal que no atienden poblaciones vulnerables en la perspectiva fenomenológica de Alfred Schutz. Método: Enfoque cualitativo a la luz del marco teórico de la sociología fenomenológica desarrollado en un equipo de calle ubicado en la región central de Portugal a partir de entrevistas fenomenológicas con cinco profesionales durante los meses de junio y julio de 2021. Los datos fueron analizados a través de la sociología fenomenológica por Alfred Schutz y literatura relacionada. Resultados: Surgieron tres categorías: conflictos vividos por el equipo de calle; Frustración no diaria de cuidar al equipo de calle; y, Límites a las relaciones sociales con poblaciones vulnerables. Conclusión: El equipo de calle en Portugal enfrenta desafíos en la atención de las poblaciones vulnerables atendidas, lo que requiere habilidades de equipo para la mediación de conflictos y las relaciones sociales.

ABSTRACT In studies of contamination by trace elements in aquatic environments, sediments constitute a key line, since by acting as traps for numerous compounds they behave as secondary sources of contamination in the marine environment, thus affecting the ecological and biogeochemical balance of the ecosystem. Due to the existing lack of knowledge about the concentration levels of pollution indicator elements in the sediments of the marine-coastal zone associated with the Nuevitas maritime terminal (Cuba), the objective of this research was to evaluate the contamination by As, Ni, Cu, Pb, Zn and Cr in sediments from that area by determining the total content, comparing it direcly to reference concentrations established in international sediment quality guidelines, and using enrichment indices. The sediments were collected during May 2016 in six stations with influence of the maritime terminal, and digested according to the EPA 3052 method. Atomic emission spectroscopy with an inductively coupled plasma source was used as a detection technique. The evaluation of the total content in sediments showed that the order of abundance of the analyzed elements was Cr > Zn > Ni > Pb > Cu > As. Concentrations that exceed the corresponding probable effect level (PEL) for most of the studied elements were detected In the sediments of stations E1, E3 and E5. Cr and Ni showed higher levels than those causing moderate biological effects (ERM). Through the enrichment factors it was verified that Ni levels in the sediments are due to natural causes and that there is a moderately severe or severe Cr enrichment in the sediments of stations E1, E3, E6 and E5, evidencing the anthropic character of such contamination.

RESUMEN En los estudios de contaminación por elementos traza en los ambientes acuáticos los sedimentos constituyen un renglón clave, ya que actúan como trampas para numerosos compuestos, afectando así el equilibrio ecológico y biogeoquímico del ecosistema. Debido al desconocimiento existente sobre los niveles de concentración de elementos indicadores de contaminación en los sedimentos de la zona marino-costera asociada a la terminal marítima de Nuevitas (Cuba), el objetivo de la presente investigación fue evaluar la contaminación por As, Ni, Cu, Pb, Zn y Cr en sedimentos de esa zona mediante la determinación de los contenidos totales, su comparación directa con concentraciones de referencia establecidas en guías internacionales de calidad de sedimentos y el empleo de índices de enriquecimiento. Los sedimentos fueron recolectados en mayo de 2016 en seis estaciones donde existe influencia de la terminal marítima, y digeridos según el método EPA 3052. Se empleó como técnica de detección espectroscopia de emisión atómica con fuente de plasma acoplado inductivamente. La evaluación del contenido total en los sedimentos mostró que el orden de abundancia de los elementos analizados fue: Cr > Zn > Ni > Pb > Cu > As. En los sedimentos de las estaciones E1, E3 y E5 se detectaron concentraciones que sobrepasan los niveles de efecto probable (PEL, por sus siglas en inglés) correspondientes a la mayoría de los elementos estudiados, destacándose el Cr y el Ni por superar los niveles causantes de efectos biológicos moderados (ERM). Se comprobó, mediante los factores de enriquecimiento, que los niveles de Ni en los sedimentos se deben a causas naturales y que existe un enriquecimiento moderadamente severo o severo de Cr en los sedimentos de las estaciones E1, E3, E6 y E5, evidenciando el carácter antrópico de dicha contaminación.

ABSTRACT Introduction: Complications related to biliary anastomosis are recognized as the first cause of post-liver transplantation morbidity and can negatively affect patient survival. Objective: To evaluate the behavior of long-term survival in patients with post-transplant biliary complications. Methods: An observational, longitudinal, and retrospective study was carried out in 152 patients with liver transplantation between 1999-2019, the following were excluded: patients with survival less than 72 hours, retransplants and patients with hepatic artery thrombosis. The variables studied were age and sex of the recipients, pre-transplant etiology, MELD index (Model for End Stage Liver Desease), biliary anastomosis technique, type of biliary complication, time of onset and treatment used. The categorical variables were related using the Chi square statistical test and Fisher's exact test, with significant differences when p <0.05; In the study of quantitative variables, the T-Student test was applied and Kaplan - Meier curves were used for survival analysis. Results: They were significantly related to the presence of biliary complication, a higher MELD index score (p = 0.008) and the end-to-end anastomosis technique (p = 0.039). Early biliary complications (66.7%) and anastomotic stenosis (58.7%) predominated. Treatment by endoscopic retrograde cholangiopancreatography (ERCP) was the most used (68.2%). Patients with biliary complications had a mean survival of 10.9 years (95% CI 8.75-13.19), while patients without it had a mean of 9 years (95% CI 7.03 -10.98); there was no significant difference (p = 0.24). Conclusions: Biliary complications were an important cause of post-transplant morbidity, but without affecting patient survival.

RESUMEN Introducción: Las complicaciones relacionadas con la anastomosis biliar son reconocidas como la primera causa de morbilidad postrasplante hepático y pueden repercutir de manera negativa en la supervivencia de los pacientes. Objetivo: Evaluar el comportamiento de la supervivencia a largo plazo en los pacientes con complicaciones biliares postrasplante. Métodos: Se realizó un estudio observacional, longitudinal y retrospectivo en 152 pacientes con trasplante hepático entre 1999 y 2019. Se excluyeron: pacientes con supervivencia menor de 72 horas, retrasplantes y pacientes con trombosis de la arteria hepática. Las variables estudiadas fueron edad y sexo de los receptores, causa pretrasplante, escala Model for End Stage Liver Desease, usada a nivel mundial para determinar el estado de la enfermedad hepática y asignar órganos a los candidatos a trasplante, técnica de anastomosis biliar, tipo de complicación biliar, tiempo de aparición y terapéutica empleada. Las variables categóricas se relacionaron mediante la prueba estadística chi cuadrado y prueba exacta de Fisher, con diferencias significativas cuando p< 0,05; en el estudio de las variables cuantitativas se aplicó la prueba t - Student y para el análisis de la supervivencia se utilizaron curvas de Kaplan-Meier. Resultados: Se relacionaron de forma significativa con la presencia de complicación biliar, una puntuación mayor de la escala de valores de Model for End Stage Liver Desease (p=0,008) y la técnica de anastomosis término-terminal (p=0,039). Predominaron las complicaciones biliares precoces y la estenosis anastomótica. El tratamiento por colangiopancreatografía retrógrada endoscópica fue el más empleado. Los pacientes con complicación biliar tuvieron una media de supervivencia de 10,9 años (IC del 95 % 8,75-13,19), mientras que los pacientes sin ésta, tuvieron una media de nueve años (IC del 95 % 7,03-10,98); no existió diferencia significativa (p=0,24). Conclusiones: Las complicaciones biliares constituyeron una causa importante de morbilidad postrasplante, pero sin afectar la supervivencia de los pacientes.

ABSTRACT The development of Personal Learning Environments and their promotion from the subjects as a strategy for the integration of ICT is essential for the development of the digital skills necessary for performance in today's society. The diversity of teaching-learning contexts means that there is more than one way for the integration of ICT in the classroom. The present article aims to present a structure for the didactic design of activities that promote the creation and development of PLE in students. For the validation of the proposal, the criteria of 10 experts who evaluate the design structure and the activities created from said structure are analyzed. The results show a high degree of agreement both in the aspects related to the structure and contextualization and in the characteristics of the activities you design. From the results, the possibility of using the proposed structure as patterns for the creation of activities is verified, thus constituting a valuable instrument in terms of achieving motivating activities that develop a culture of use of ICTs based on learning.

RESUMEN El desarrollo de los Entornos Personales de Aprendizaje y su fomento desde las asignaturas como estrategia de integración de las TIC resulta imprescindible para el desarrollo de las competencias digitales necesarias para el desempeño en la sociedad actual. La diversidad de contextos de enseñanza-aprendizaje hace que no exista una receta única para la integración de las TIC en las aulas. El presente artículo tiene como objetivo presentar una estructura para el diseño didáctico de actividades que potencien la creación y desarrollo de Entornos Personales de Aprendizaje (PLE por sus siglas en inglés) en los estudiantes. Para la validación de la propuesta se analiza el criterio de 10 expertos que evalúan la estructura de diseño y las actividades creadas a partir de dicha estructura. Los resultados demuestran un elevado grado de acuerdo tanto en los aspectos relacionados con la estructura y contextualización como en las características de las actividades diseñas. A partir de los resultados se constata la posibilidad de utilizar la estructura propuesta como patrones para la creación de actividades, constituyendo así un valioso instrumento en función de lograr actividades motivadoras, que desarrollen una cultura de uso de las TIC en función del aprendizaje.

Resumo A tecnologia digital, como um dos elementos da Sociedade do Conhecimento, assume um papel determinante nos sistemas educativos, onde o papel do professor é fundamental. Nesse sentido, diferentes instituições defendem a importância do ensino de competências digitais, propondo modelos e marcos conceituais. Neles, classificam-se os conhecimentos e as competências que os professores devem desenvolver, combinando capacidades tecnológicas, profissionais, organizacionais e pedagógicas, com diferentes dimensões e descritores. O objetivo deste artigo é comparar e avaliar a viabilidade do DigCompEdu European Digital Competence Framework for Teachers (JRC) e do Common Framework for Teaching Digital Competence (INTEF). Para tal, opta-se por realizar uma reflexão teórica sobre os referidos enquadramentos e posterior estudo Delphi com o coeficiente de competência do perito (CCP). Participaram 335 pessoas, das quais 275 (82,1%) foram consideradas especialistas (CCP ≥ 0,8). Os resultados indicam que, embora sejam muito semelhantes, o European DigCompEdu Teaching Digital Competence Framework é o mais endossado por especialistas. Por fim, apresenta-se a ideia de que ambas são propostas viáveis para desenvolver o ensino de competências digitais por meio de roteiros de treinamento personalizados.

Abstract Digital technology, as one of the elements of the Knowledge Society, assumes a determining role in educational systems, where the role of teachers is fundamental. Along these lines, different institutions support the importance of teaching digital skills, proposing models and conceptual frameworks. In them, the knowledge and skills that teachers must develop are classified, combining technological, professional, organizational and pedagogical capacities, with different dimensions and descriptors. The objective of this article is to compare and evaluate the feasibility of the DigCompEdu European Digital Competence Framework for Teachers (JRC) and the Common Framework for Teaching Digital Competence (INTEF). To do this, it is decided to carry out a theoretical reflection on said frameworks and a subsequent Delphi study with the coefficient of expert competence (CEC). 335 people participated, of which 275 (82.1%) were considered experts (CEC ≥ 0.8). The results indicate that, although they are very similar, the European DigCompEdu Teaching Digital Competence Framework is the most endorsed by experts. Finally, the idea that both are viable proposals to develop teaching digital skills through personalized training itineraries is presented.

ABSTRACT The evaluation of segregating populations in plant breeding programs is an onerous and time-consuming process. Early identification of populations with genetic potential can be done by m + a methodology. However, the possibility of a modification in the traditional methodology in order to make it more efficient, that is, faster and cheaper, was envisaged. Thus, the objective of this study was to compare the genetic gains obtained by both methodologies, the traditional one and the proposed modification. For this, ten segregating bean-cowpea populations were evaluated at two distinct levels of homozygous F3:4 and F3:5. Genetic values were predicted by two different statistical genetic models. This was possible due to the methodology proposed here to present a much shorter execution time than the traditional methodology. Thus, with a shorter evaluation time, the breeding program manager can plan the evaluation of a larger number of populations in a short time.

ABSTRACT Evapotranspiration is the second largest component of the hydrological cycle after rainfall precipitation in semiarid regions such as northwestern Mexico. In this study, we partitioned the evapotranspiration (ET) flux using stable isotopes of water in the soil-plant-atmosphere continuum in combination with eddy covariance flux measurements. We considered three methods for determining the isotopic composition of transpiration (δ T ): (1) isotopic steady state, (2) non-steady state, and (3) non-steady state weighting the relative importance of dominant species cover and accounting for the relative values of stomatal conductance. Three approaches of T/ET partitioning were estimated during several wet and dry days at the study site in Sonora, Mexico. The total ET flux was variable across years due to differences in precipitation amount between years. ET was lower during the drier-year and reached higher values during the wetter-year. Soil evaporation (E) dominated ET soon after large rain events (40 to 70 mm d-1 [DOY-196 and DOY-197] in 2008) but showed a rapid decrease in dominance as the soil surface dried. Estimated values of T/ET based on an isotopic mass balance were in the same range independent of three methods used. The mean T/ET ratio across all the periods studied was in the range of other studies in semiarid ecosystems and global trends with values of ~0.67 ± 0.02. This work contributes to a better understanding of the surface atmosphere interactions in semi-arid regions.

RESUMEN La evapotranspiración es el segundo componente más grande del ciclo hidrológico, después de la precipitación, en regiones semiáridas como el noroeste de México. En este estudio, separamos el flujo de evapotranspiración (ET) usando isótopos estables de agua en el continuo suelo-planta-atmósfera en combinación con mediciones de flujo de covarianza de vórtices. Consideramos tres métodos para determinar la composición isotópica de la transpiración (δ T ): 1) estado isotópico estable (ISS), 2) estado isotópico no estable (NSS), y 3) estado isotópico no estable ponderando la importancia relativa (RI) de la cobertura de especies dominantes y teniendo en cuenta los valores relativos de conductancia estomática. Se estimaron tres enfoques de separación T/ET durante varios días húmedos y secos en el sitio de estudio en Sonora, México. El flujo de ET total fue variable a lo largo de los años debido a las diferencias en la cantidad de precipitación entre años. ET fue menor durante el año más seco y alcanzó valores más altos durante el año más húmedo. La evaporación del suelo (E) dominó la ET poco después de grandes eventos de lluvia (40 a 70 mm d-1 [DOY-196 y DOY-197 en 2008]), pero mostró una rápida disminución a medida que se secaba la superficie del suelo. Los valores estimados de T/ET basados en un balance de masa isotópico estaban en el mismo rango, independientemente de los tres métodos utilizados. La relación T/ET media en todos los periodos estudiados estuvo en el rango de otros estudios en ecosistemas semiáridos y tendencias globales con valores de ~0.67 ± 0.02. Este trabajo contribuye a una mejor comprensión de las interacciones de la atmósfera superficial en las regiones semiáridas.

Resumo Objetivo Compreender a percepção das crianças acerca da punção venosa por meio do brinquedo terapêutico e compreender de que forma o brinquedo terapêutico pode contribuir para o procedimento de punção venosa e na interação entre a criança e o enfermeiro. Métodos Trata-se de um estudo com abordagem qualitativa. Realizada nos setores pediátricos de Enfermaria, Cirurgia e Terapia Intensiva de um hospital universitário do Rio de Janeiro, com sete crianças entre quatro e 11 anos de idade, através de uma entrevista audiogravada submetida à análise temática. A pesquisa foi aprovada pelo Comitê de Ética e Pesquisa da instituição coparticipante, sob nº do parecer 2.544.589. Resultados Ao dramatizar na boneca, manusear os materiais hospitalares e deduzir o propósito final, esse mundo imaginário e repleto de conceitos equivocados torna-se uma experiência positiva tanto para a criança quanto para o enfermeiro. A interação através da brincadeira permite que elas tenham maior esclarecimento sobre o procedimento e maior receptividade à equipe de enfermagem, bem como a novos procedimentos que venham a ser realizados. Conclusão Esse estudo deu voz a essas crianças como sujeitos do cuidado na medida que há a ruptura da visão técnico centrada, favorecendo assim o protagonismo infantil. A realização desse estudo possibilitou ressaltar a importância de incorporar o brinquedo terapêutico no processo de cuidar da enfermagem pediátrica, demonstrando seu potencial efeito terapêutico.

Abstract Objective To understand children’s perception of venipuncture through therapeutic toy and how therapeutic toy can contribute to the venipuncture procedure and child-nurse interaction. Methods This is a study with a qualitative approach. It was held in pediatric nursing, surgery and intensive care sectors of a university hospital in the city of Rio de Janeiro, with seven children between four and 11 years old. It occurred through an audio-recorded interview submitted to thematic analysis. The research was approved by the Research Ethics Committee of the co-participating institution, under Opinion 2.544.589. Results By dramatizing the doll, handling hospital supplies, and deriving the ultimate purpose, this imaginary world full of misconceptions becomes a positive experience for both children and nurses. The interaction through toy allows them to have more clarity about the procedure and greater receptivity to the nursing staff, as well as new procedures that may be performed. Conclusion This study gave voice to these children as subjects of care, as there is a rupture of the technical-centered vision, favoring children protagonism. This study made it possible to emphasize the importance of incorporating the therapeutic toy in pediatric nursing care, demonstrating its potential therapeutic effect.

Resumen Objetivo Comprender la percepción de los niños acerca de la venopunción a través del juguete terapéutico y comprender de qué forma el juguete terapéutico puede contribuir con el procedimiento de venopunción y con la interacción entre el niño y el enfermero. Métodos Se trata de un estudio con enfoque cualitativo. Fue realizado en los sectores pediátricos de Enfermería, Cirugía y Terapia Intensiva de un hospital universitario de Rio de Janeiro, con siete niños entre 4 y 11 años de edad, a través de una entrevista que fue grabada y sometida a un análisis temático. El estudio fue aprobado por el Comité de Ética e Investigación de la institución coparticipante, bajo el n° de informe 2.544.589. Resultados Al dramatizar en la muñeca, manipular los materiales hospitalarios y deducir el propósito final, ese mundo imaginario y repleto de conceptos equivocados se transforma en una experiencia positiva tanto para el niño, como para el enfermero. La interacción a través del juego permite a los niños tener más claridad sobre el procedimiento y mayor receptividad con el equipo de enfermería, así como con nuevos procedimientos que puedan llegar a realizarse. Conclusión Este estudio les dio voz a los niños como sujetos de cuidado en la medida en que hay una ruptura de la visión centrada en lo técnico, lo que favorece el protagonismo infantil. La realización de este estudio permitió destacar la importancia de incorporar el juguete terapéutico en el proceso de cuidado de la enfermería pediátrica y demostró su potencial efecto terapéutico.

Abstract: OBJECTIVE: Euploid blastocyst rate comparison between ovarian stimulation in follicular vs luteal phase performed in the same menstrual cycle in patients with poor ovarian response. MATERIALS AND METHODS: Clinical, prospective and comparative study conducted at Centro de Reproducción Arcos S.C., “Nascere”, during january-july, 2019. Patients with PGT-A indication and poor ovarian response according to Bologna criteria were included. Under a short GnRH-antagonist protocol, stimulations, both in follicular and luteal phase were performed using rFSH/rLH (2:1) from day 3 of the cycle and 5 days after the first oocyte retrieval. In addition, ovulation trigger with an GnRH agonist was used, finally, on day 5-6 of embryo development, trophoctoctoderm biopsy was performed. RESULTS: In this study, 20 patients were included; when comparing follicular phase vs luteal phase, we found that fertilization rate was 79% (95%CI 29-46) vs 55% (95%CI 34-53), blastocysts rate was 42% (95%CI 19-44) vs 45% (95%CI 24-55) and euploid embryo rate was 100% (95%CI 44-53) vs 70% (95%CI 38-46). Only the oocyte recovery rate in metaphase II showed significant differences between both phases 40% (IC 95% 18-37) vs 59% (IC 95% 31-59), p=0.0333. CONCLUSION: Biphasic ovarian stimulation (follicular/ luteal) in the same menstrual cycle (DuoStim) resulted in a higher metaphase II ooctye recovery rate during the luteal phase in comparison with the follicular phase. However, the rates of blastocysts and euploid blastocysts were similar between both phases.

Resumen: OBJETIVO: Comparar la tasa de blastocistos euploides obtenida después de la estimulación ovárica en fase folicular con la fase lútea en un mismo ciclo menstrual en pacientes con deficiente respuesta ovárica. MATERIALES Y MÉTODOS: Estudio clínico, prospectivo y comparativo llevado a cabo en el Centro de Reproducción Arcos, Nascere, entre los meses de enero a julio de 2019. Se incluyeron pacientes con pobre respuesta ovárica según los criterios de Bologna y con indicación de PGT-A. Las estimulaciones en fase folicular y lútea se efectuaron con antagonista de la GnRH y FSHr/LHr (2:1) a partir del día 3 del ciclo y 5 días después de la primera recuperación de los ovocitos. Para completar el proceso de maduración ovocitaria se utilizaron análogos de GnRH, se tomó una biopsia de trofoectodermo en día 5-7. RESULTADOS: Se estudiaron 20 pacientes. Al comparar la fase folicular con la lútea la tasa de fertilización fue de 79% (IC95%: 29-46) vs 55% (IC95%: 34-53), la tasa de blastocistos 42% (IC95%: 19-44) vs 45% (IC95%: 24-55) y la tasa de blastocistos euploides 100% (IC95%: 44-53) vs 70% (IC95%: 38-46), respectivamente. Solo la tasa de recuperación de ovocitos en metafase II mostró diferencias significativas entre ambas fases 40% (IC95%: 18-37) vs 59% (IC95%: 31-59), p = 0.0333 en la fase folicular y lútea, respectivamente. CONCLUSIONES: La estimulación ovárica bifásica (folicular-lútea), en el mismo ciclo menstrual (DuoStim), resultó en mayor tasa de recuperación de ovocitos en metafase II durante la fase lútea. Sin embargo, las tasas de desarrollo embrionario a día 5-6 (blastocistos) y de embriones euploides fueron similares entre ambas fases.

RESUMO Objetivo: A tirosinemia tipo III (TT III) é a forma mais rara das tirosinemias e o espectro clínico desta entidade não está totalmente esclarecido. O envolvimento neurológico é variável, incluindo o atraso cognitivo ou transtorno do déficit de atenção com hiperatividade (TDAH). Descrevemos o caso de dois irmãos que foram diagnosticados com TT III em idades diferentes. Descrição dos casos: O caso índice foi diagnosticado no contexto do rastreio endócrino-metabólico neonatal, tendo iniciado imediatamente dieta hipoproteica, com redução consistente dos níveis de tirosina. Por volta dos três anos, foi detectado um comportamento hiperativo, tendo iniciado dois anos depois tratamento para o TDAH. Aos sete anos, apresenta leve melhora de comportamento e da atenção e avaliação cognitiva levemente inferior ou pouco abaixo quando comparado a crianças da mesma faixa etária, apesar de manter níveis aceitáveis de tirosina. A sua irmã, com história de TDAH desde os cinco anos, foi diagnosticada de TT III aos oito anos no contexto do rastreio de familiares. Apesar de iniciar tratamento dietético, nenhum efeito foi notado em termos de comportamento e a doente apresenta leve atraso cognitivo. Comentários: Este é o primeiro caso clínico descrito de irmãos com TT III que iniciaram terapêutica dietética com dieta hipoproteica em diferentes fases da vida, com melhor avaliação em termos neurológicos e comportamentais no doente que iniciou tratamento mais precocemente.

ABSTRACT Objective: Tyrosinemia type III (HT III) is the rarest form of tyrosinemia, and the full clinical spectrum of this disorder is still unknown. The neurological involvement varies, including intellectual impairment and attention deficit disorder with hyperactivity (ADHD). We report the case of two siblings diagnosed with HT III at different ages. Case description: The index case was diagnosed by newborn screening for endocrine and metabolic disorders, starting a low-protein diet immediately, with a consistent decrease in tyrosine levels. By the age of three, the child displayed a hyperactive behavior, starting treatment for ADHD two years later. At seven years of age, he shows a slight improvement in terms of behavior and attention span and has a cognitive performance slightly lower than his peers, despite maintaining acceptable tyrosine levels. His sister, who had a history of ADHD since age five, was diagnosed with HT III after family screening at the age of eight. Despite initiating a dietetic treatment, her behavior did not improve, and she has a mild intellectual impairment. Comments: This is the first case report describing siblings with HT III who underwent nutritional treatment with a low-protein diet in different phases of life, with a better neurological and behavioral evaluation in the patient who started treatment earlier.