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au:PEREIRA, AFONSO CELSO

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A integração ensino-serviço-gestão-comunidade na percepção de preceptores de graduandos na Atenção Primária à Saúde
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Pereira, Afonso Luís Puig

; Zilbovicius, Celso

; Carnut, Leonardo

; de Souza Neto, Antonio Carlos

Physis: Revista de Saúde Coletiva

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2022, Volume 32 N. 3 elocation e320305

Abstract: En Pt | Text: En Pt | PDF: En | PDF: Pt

Abstract National guidelines, regulations and incentives such as the National Curricular Guidelines, Pró-Saúde and PET-Saúde, contributed to fostering an important training arrangement known as "teaching-service-management-community integration". In this context, preceptorship in primary health care (PHC) stands out. Thus, it is relevant to know, from the perspective of preceptors, what is the participation of each actor in this integration and what are the anti-pedagogical and work process barriers that make preceptorship difficult. This study aimed to understand factors that facilitate and hinder integration from the perspective of preceptors of undergraduates within the scope of PHC in the city of São Paulo-SP, Brazil. This is a qualitative, descriptive-exploratory study, which used semi-structured interviews with 14 preceptors, interpreted by thematic content analysis. As main barriers were identified: work overload, devaluation of public health, lack of pedagogical support and distance from the community in the training process. Among the contributions, interprofessional work and the approximation between educational institutions and management when planning the internship stand out. Integration has important issues to be improved from the point of view of preceptors, with a view to facilitating articulation between actors and overcoming training barriers.

Resumo Orientações, normativas e incentivos nacionais como as Diretrizes Curriculares Nacionais, o Pró-Saúde e o PET-Saúde, contribuíram para fomentar um importante arranjo formativo conhecido como "integração ensino-serviço-gestão-comunidade". Nesse contexto, a preceptoria na atenção primária à saúde (APS) se destaca. Assim, é relevante conhecer, sob a ótica de preceptores, qual é a participação de cada ator desta integração e quais são as barreiras antipedagógicas e de processo de trabalho que dificultam a preceptoria. Este estudo teve como objetivo compreender fatores facilitadores e dificultadores da integração na perspectiva de preceptores de graduandos no âmbito da APS no município de São Paulo-SP. Trata-se de um estudo qualitativo, do tipo descritivo-exploratório, que utilizou entrevistas semiestruturadas com 14 preceptores, interpretadas pela análise de conteúdo temática. Como barreiras principais foram identificadas: sobrecarga de trabalho, desvalorização da saúde pública, falta de apoio pedagógico e distanciamento da comunidade no processo formativo. Entre as contribuições, destacam-se o trabalho interprofissional e a aproximação entre as instituições de ensino e a gestão quando planejam o estágio. A integração tem importantes questões a serem aperfeiçoadas ao olhar dos preceptores, tendo em vista facilitar a articulação entre os atores e transpor as barreiras formativas.

https://doi.org/10.1590/s0103-73312022320305

A integração ensino-serviço-gestão-comunidade na percepção de preceptores de graduandos na Atenção Primária à Saúde
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Pereira, Afonso Luís Puig

; Zilbovicius, Celso

; Carnut, Leonardo

; de Souza Neto, Antonio Carlos

Physis: Revista de Saúde Coletiva

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2022, Volume 32 N. 3 elocation e320305

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.1590/s0103-73312022320305

Brazilian Nutritional Consensus in Hematopoietic Stem Cell Transplantation: Graft- versus -host disease
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Pereira, Andréa Z

; Vigorito, Afonso Celso

; Almeida, Alessandro de Moura

; Candolo, Alexandre de Almeida

; Silva, Ana Carolina Leão

; Brandão-Anjos, Ana Elisa de Paula

; Sá, Bianca Laselva de

; Souza, Catarina Lôbo Santos de

; Castro Junior, Cláudio Galvão de

; Oliveira, José Salvador Rodrigues de

; Barban, Juliana Bernardo

; Mancilha, Elaine Maria Borges

; Todaro, Juliana

; Lopes, Lilian Pinheiro

; Macedo, Maria Cristina Martins de Almeida

; Rodrigues, Morgani

; Ribeiro, Paulo Cesar

; Silva, Roberto Luiz da

; Roberto, Telma Sigolo

; Rodrigues, Thays de Cássia Ruiz

; Colturato, Vergilio Antonio Rensi

; Paton, Eduardo José de Alencar

; Barros, George Maurício Navarro

; Almeida, Rosana Ducatti Souza

; Moreira, Maria Claudia Rodrigues

; Flowers, Mary Evelyn

einstein (São Paulo)

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2020, Volume 18 elocation eAE4799

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO O Consenso Brasileiro de Nutrição no Transplante de Células Tronco Hematopoiéticas: doença do enxerto contra o hospedeiro foi aprovado pela Sociedade Brasileira de Transplante de Medula Óssea, com a participação de 26 centros brasileiros de transplante de células-tronco hematopoiéticas. O Consenso descreve as principais condutas nutricionais em casos de doença do enxerto contra o hospedeiro, a principal complicação do transplante de células-tronco hematopoiéticas.

ABSTRACT The Brazilian Consensus on Nutrition in Hematopoietic Stem Cell Transplantation: Graft- versus -host disease was approved by Sociedade Brasileira de Transplante de Medula Óssea , with the participation of 26 Brazilian hematopoietic stem cell transplantation centers. It describes the main nutritional protocols in cases of Graft- versus -host disease, the main complication of hematopoietic stem cell transplantation.

https://doi.org/10.31744/einstein_journal/2020ae4799 1552 downloads

Analysis of the Ki-67 index in the vaginal epithelium of castrated rats treated with tamoxifen
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Nery-Aguiar, Afif Rieth

; Aguiar, Yousef Qathaf

; Conde Júnior, Airton Mendes

; Alencar, Airlane Pereira

; Tavares, Cleciton Braga

; Lopes-Costa, Pedro Vitor

; Nazário, Afonso Celso

; da Silva, Benedito Borges

Clinics

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feb 2016, Volume 71 N. 2 Pages 90 - 93

Abstract: En | Text: En | PDF: En

OBJECTIVES: Vaginal atrophy and breast cancer are common conditions in postmenopausal women and tamoxifen is the standard endocrine treatment for hormone-sensitive tumors. The present study aimed to assess the effect of tamoxifen on Ki-67 protein expression in the vaginal epithelium of castrated rats. MATERIAL AND METHODS: Forty Wistar-Hannover adult, virgin, castrated rats were randomly divided into two groups, group I (control, n=20) and group II (tamoxifen, n=20), receiving 0.5 ml of propylene glycol and 250 µg of tamoxifen diluted in 0.5 ml of propylene glycol, respectively, daily by gavage for 30 days. On the 31st day, the rats were euthanized and their vaginas were removed and fixed in 10% buffered formalin for the immunohistochemical study of Ki-67 protein expression. Data were analyzed by the Levene and Student’s t tests (p<0.05). RESULTS: The mean index of Ki-67 expression in the rat vagina of groups I and II was 4.04±0.96 and 26.86±2.19, respectively (p<0.001). CONCLUSIONS: According to the results of the present study, tamoxifen, at the dose and treatment length used, induced a significant increase in the cell proliferation of the vaginal mucosa in castrated rats, as evaluated by Ki-67 protein expression.

https://doi.org/10.6061/clinics/2016(02)07 2161 downloads

Linfonodos axilares em pacientes com câncer de mama: avaliação ultrassonográfica
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Pinheiro, Denise Joffily Pereira da Costa

; Elias, Simone

; Nazário, Afonso Celso Pinto

Radiologia Brasileira

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aug 2014, Volume 47 N. 4 Pages 240 - 244

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

O estadiamento axilar nas pacientes portadoras de câncer de mama inicial é fator essencial no planejamento terapêutico. Atualmente este é realizado durante o tratamento cirúrgico, mas há uma tendência em buscar técnicas pré-operatórias e de menor morbidade para avaliação dos linfonodos axilares. A ultrassonografia é um exame amplamente usado para esta finalidade e muitas vezes associado a punção aspirativa por agulha fina ou por agulha grossa. Entretanto, os critérios ultrassonográficos de suspeição para linfonodos axilares não apresentam valores preditivos significativos, gerando resultados discrepantes em estudos sobre sensibilidade e especificidade do método. O objetivo deste trabalho é realizar uma revisão na literatura médica sobre a ultrassonografia no estadiamento axilar e as principais alterações morfológicas do linfonodo metastático.

Axillary staging of patients with early-stage breast cancer is essential in the treatment planning. Currently such staging is intraoperatively performed, but there is a tendency to seek a preoperative and less invasive technique to detect lymph node metastasis. Ultrasonography is widely utilized for this purpose, many times in association with fine-needle aspiration biopsy or core needle biopsy. However, the sonographic criteria for determining malignancy in axillary lymph nodes do not present significant predictive values, producing discrepant results in studies evaluating the sensitivity and specificity of this method. The present study was aimed at reviewing the literature approaching the utilization of ultrasonography in the axillary staging as well as the main morphological features of metastatic lymph nodes.

https://doi.org/10.1590/0100-3984.2013.1689 50762 downloads

Monitoring of BCR-ABL levels in chronic myeloid leukemia patients treated with imatinib in the chronic phase: the importance of a major molecular response
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Machado, Melissa Pereira

; Tomaz, Juarez Pires

; Lorand-Metze, Irene

; Souza, Cármino Antonio de

; Vigorito, Afonso Celso

; Delamain, Marcia Torresan

; Bendit, Israel

; Pereira, Noemi Farah

; Pagnano, Katia Borgia Barbosa

Revista Brasileira de Hematologia e Hemoterapia

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jun 2011, Volume 33 N. 3 Pages 211 - 215

Abstract: En | Text: En | PDF: En

BACKGROUND: Real time PCR has become the most common technique to monitor BCR-ABL transcript levels of patients treated with kinase inhibitors. The aim of this study was to evaluate BCR-ABL levels of chronic myeloid leukemia patients treated with imatinib in the chronic phase and correlate the response to therapy and event-free survival. METHODS: BCR-ABL levels were measured in peripheral blood cell samples using Real time PCR at diagnosis and then every 3 months after starting therapy with imatinib. Major molecular response was defined as a three-log reduction from the standardized baseline value. Major molecular response values were adjusted to international scale using a conversion factor of 1.19. The results are reported as a BCR-ABL/ABL ratio (%). RESULTS: Hematological, major cytogenetic and complete cytogenetic responses were achieved by 57 (95%), 45 (75%) and 38 (63%) patients, respectively. Twenty-four out of sixty patients achieved a major molecular response (40%) in a median time of 8.5 months. Overall survival and event free survival were higher for patients with (100%) versus patients without (77%) a complete cytogenetic response (p-value = 0.01) at 48 months. Patients with complete cytogenetic response and major molecular response had a higher event free survival compared to patients with complete cytogenetic response but without major molecular response (p-value = 0.007). CONCLUSION: In conclusion, the prognostic impact of achieving complete cytogenetic response and a major molecular response and also the importance of molecular monitoring in the follow-up of chronic myeloid leukemia patients were demonstrated.

https://doi.org/10.5581/1516-8484.20110056 4023 downloads Cited 2 times in SciELO

Microbiologia do meato médio na rinossinusite crônica
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Araujo, Elisabeth

; Dall, Celso

; Cantarelli, Vladmir

; Pereira, Alexandre

; Mariante, Afonso Ravanello

Revista Brasileira de Otorrinolaringologia

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aug 2007, Volume 73 N. 4 Pages 549 - 555

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Este foi um estudo prospectivo que visou identificar a microbiologia do meato médio em pacientes com rinossinusite crônica (RSC) e compará-la com a de indivíduos sadios. MATERIAL E MÉTODOS: Foram incluídos 134 pacientes RSC e 50 voluntários sadios, que constituíram o grupo controle. As amostras foram coletadas endoscopicamente e submetidas a exames pelo método de Gram com contagem leucocitária e culturas para aeróbios, anaeróbios e fungos. RESULTADOS: Nos pacientes com RSC foram cultivados 220 microorganismos, dentre os quais os mais freqüentes foram o Staphylococcus aureus, presente em 31% das amostras, e o Staphylococcus coagulase-negativo (SCN) em 23%. Gram-negativos ou facultativos foram isolados em 37% das amostras, anaeróbios em 12%, e fungos em 14%. Ao exame bacterioscópico evidenciou-se alguns ou numerosos leucócitos em 74% das amostras com culturas positivas. Nos indivíduos sadios o SCN foi isolado em 40% das amostras e o Staphylococcus aureus em 18%. Em 12% dos indivíduos a cultura para fungos foi positiva, e o exame direto negativo. Todas as culturas anaeróbias foram estéreis. Quanto à contagem leucocitária todos apresentaram nenhum ou raros leucócitos. CONCLUSÃO: Os grupos apresentaram resultados semelhantes quanto à microbiologia, entretanto, diferiram em relação à contagem leucocitária, o que auxilia na diferenciação um microorganismo infectante de um colonizante.

This was a prospective study which assessed endoscopically collected middle meatus secretions in patients with chronic rhinosinusitis (CRS) and compared those findings with microbiological data of healthy individuals. METHODS: Middle meatus samples were collected from 134 CRS patients. In the laboratory, samples were Gram stained for microscopic examination with white blood cels (WBCs) count and also send for aerobic, anaerobic and fungal cultures. Fifty volunteers served as control. RESULTS: In CRS patients a total of 220 microorganisms were isolated. The most frequent microorganisms were Staphylococcus aureus (31%), coagulase-negative Staphylococcus (CNS) (23%). Gram-negative or facultative microorganisms were isolated in 37% of the samples, anaerobes in 12% and fungi in 14%. Seventy four percent of the samples with positive cultures presented many or few WBC. In the control group, 76% of cultures were positive for aerobes and 12% for fungi. No anaerobes were isolated. There were rare or no WBC in the fifty samples. The most frequent microorganisms were CNS (40%), Staphylococcus aureus (18%). CONCLUSION: The microbiology of the middle meatus is similar in CRS patients and healthy individuals. Despite this, there was an important difference between the WBC count in these two groups, which helps to distinguish an infective from a saprophitic microorganism.

5873 downloads Cited 2 times in SciELO

Impact on hospital mortality and morbidity of right ventricular involvement among patients with acute left ventricular infarction
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Pereira, Afonso Celso

; Franken, Roberto Alexandre

; Sprovieri, Sandra Regina Schwarzwälder

; Golin, Valdir

Sao Paulo Medical Journal

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2006, Volume 124 N. 4 Pages 186 - 191

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

CONTEXTO E OBJETIVO: O risco das principais complicações em pacientes com infarto do ventrículo esquerdo (VE) associado ao comprometimento do ventrículo direito (VD) ainda é incerto. O objetivo deste estudo foi avaliar o impacto do envolvimento do ventrículo direito na morbidade e na mortalidade hospitalar em pacientes com infarto agudo do ventrículo esquerdo. TIPO DE ESTUDO E LOCAL: Estudo prospectivo de coorte, realizado no Serviço de Emergência do Hospital Central da Irmandade da Santa Casa de Misericórdia de São Paulo. MÉTODOS: Participaram do estudo 183 pacientes com infarto agudo do miocárdio: 145 com infarto do VE e 38 com infarto do VE associado ao VD (VE + VD). Foram comparados entre os grupos a presença das complicações e óbitos no período hospitalar. RESULTADOS: 21% dos pacientes estudados apresentavam infarto VE + VD. Predominou o comprometimento da parede dorsal e/ou inferior (ECG) no grupo com VE + VD (p < 0.0001). A freqüência da classe IV de Killip no momento da admissão e 24 h após foi maior no grupo VE + VD, assim como as complicações elétricas, hemodinâmicas, entre outras, e óbitos. A probabilidade de complicações em pacientes com infarto VE + VD foi 9.7 vezes maior (odds ratio, OR = 9.7468; 95% intervalo de confiança, IC 95% 2.8673 a 33.1325; p < 0.0001) e de óbito 5.1 vezes superior (OR = 5.1313; 95% IC 2.2795 a 11.5510; p = 0.0001) em relação aos pacientes com infarto isolado do VE. CONCLUSÕES: Pacientes com infarto VE com envolvimento do VD apresentam risco aumentado de morbidade e mortalidade precoces.

CONTEXT AND OBJECTIVE: There is uncertainty regarding the risk of major complications in patients with left ventricular (LV) infarction complicated by right ventricular (RV) involvement. The aim of this study was to evaluate the impact on hospital mortality and morbidity of right ventricular involvement among patients with acute left ventricular myocardial infarction. DESIGN AND SETTING: Prospective cohort study, at Emergency Care Unit of Hospital Central da Irmandade da Santa Casa de Misericórdia de São Paulo. METHODS: 183 patients with acute myocardial infarction participated in this study: 145 with LV infarction alone and 38 with both LV and RV infarction. The presence of complications and hospital death were compared between groups. RESULTS: 21% of the patients studied had LV + RV infarction. In this group, involvement of the dorsal and/or inferior wall was predominant on electrocardiogram (p < 0.0001). The frequencies of Killip class IV upon admission and 24 hours later were greater in the LV + RV group, along with electrical and hemodynamic complications, among others, and death. The probability of complications among the LV + RV patients was 9.7 times greater (odds ratio, OR = 9.7468; 95% confidence interval, CI: 2.8673 to 33.1325; p < 0.0001) and probability of death was 5.1 times greater (OR = 5.13; 95% CI: 2.2795 to 11.5510; p = 0.0001), in relation to patients with LV infarction alone. CONCLUSIONS: Patients with LV infarction with RV involvement present increased risk of early morbidity and mortality.

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Comparative study of smokers, ex-smokers, and nonsmokers who have experienced myocardial infarction
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Nozawa, Diogo

; Franken, Roberto Alexandre

; Ribeiro, Karina de Cássia Braga

; Pereira, Afonso Celso

; Sprovieri, Sandra Regina Schwarzwälder

; Golin, Valdir

Arquivos Brasileiros de Cardiologia

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dec 2003, Volume 81 N. 6 Pages 589 - 591

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

OBJETIVO: Avaliar o impacto do tabagismo sobre a morbimortalidade intrahospitalar dos pacientes vítimas de infarto agudo do miocárdio e verificar sua associação a outros fatores de risco cardiovasculares e dados clínicos. MÉTODOS: Foram analisados, por meio de um estudo prospectivo de coortes, 121 pacientes, 54 fumantes, 35 ex-fumantes e 32 não fumantes. RESULTADOS: Houve associação pelo teste do qui-quadrado (p<0,05) entre tabagismo e os fatores de risco sexo, idade, diabetes. Entre as variáveis de morbimortalidade, houve apenas diferença estatiticamente significante (OR=9,5; IC de 95%) de edema agudo de pulmão, maior no grupo ex-fumante do que no grupo não fumante. CONCLUSÃO: Houve associação entre o tabagismo e alguns fatores de risco cardiovasculares, mas, não houve diferenças estatísticas de morbimortalidade entre os grupos estudados, exceto na variável edema agudo de pulmão.

OBJECTIVE: To assess the impact of smoking on in-hospital morbidity and mortality in patients who have experienced acute myocardial infarction and to assess the association between smoking and other cardiovascular risk factors and clinical data. METHODS: A prospective cohort study analyzed 121 patients, including 54 smokers, 35 ex-smokers, and 32 nonsmokers. RESULTS: Using the chi-square test (P<0.05), an association between smoking and the risk factors sex, age, and diabetes was documented. Among the morbidity and mortality variables, only acute pulmonary edema showed a statistically significant difference (OR=9.5; 95% CI), which was greater in the ex-smoker group than in the nonsmoker group. CONCLUSION: An association between smoking and some cardiovascular risk factors was observed, but no statistical difference in morbidity and mortality was observed in the groups studied, except for the variable acute pulmonary edema.

5364 downloads

10.

Hipotermia acidental em um país tropical
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Golin, Valdir

; Sprovieri, Sandra Regina Schwarzwälder

; Bedrikow, Rubens

; Pereira, Afonso Celso

; Melhado, Vânia Elizabeth Ramos

; Salles, Mauro José Costa

; Azevedo, Paulo Roberto Cavallaro

Revista da Associação Médica Brasileira

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sep 2003, Volume 49 N. 3 Pages 261 - 265

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

OBJETIVOS: Estudar a presença, forma de apresentação e as conseqüências da hipotermia em nosso meio. MÉTODOS: Estudo prospectivo em hipotérmicos atendidos no Serviço de Emergência de Clínica Médica da Santa Casa de São Paulo, com 212 pacientes com hipotermia leve, moderada e grave, entre 1987 a 2001, a maioria constituída por alcoólatras crônicos e moradores de rua. Foram analisados os resultados quanto ao sexo, faixa etária, temperatura central, eletrocardiograma, comorbidades e mortalidade. RESULTADOS: A hipotermia predominou no sexo masculino em 75,9%. Quanto à faixa etária prevaleceu a idade entre 30 e 59 anos. Em 70,3% dos pacientes a temperatura central foi inferior a 32ºC, sendo que em 26,4% destes, a temperatura foi menor que 28ºC. A associação com quadros infecciosos ocorreu em 76,8% dos casos. Os pacientes com hipotermia leve responderam melhor à terapêutica (96,8%) quando comparados com os hipotérmicos moderados (72,1%) e graves (87,5%). A onda de Osborn esteve presente em 42,6% dos pacientes. A mortalidade geral foi de 38,2%. CONCLUSÕES: A hipotermia acidental em serviços de emergência de país tropical é fato inegável. O socorrista deve estar atento e treinado para o reconhecimento desta doença de alta morbidade e mortalidade. A mortalidade aumenta com a presença de doenças associadas, particularmente processos infecciosos, desnutrição e alcoolismo crônico.

OBJECTIVE: This paper has by objective to study the hypothermia's presence, presentation form and consequences in our environment. METHODS: A prospective study in hypothermic patients assisted in the Medical Clinic Emergency Service of Santa Casa of São Paulo, with 212 patients with mild, moderate and serious hypothermia from 1987 to 2001, the most part of them constituted by chronic alcoholics and homeless. The results were analyzed in reference to sex, age group, central temperature, electrocardiogram, co-morbidity and mortality. RESULTS: The hypothermia prevailed in the male sex with 75.9%. As age group prevailed the age between 30 and 59 years. In 70.3% of the patients the central temperature went lower than 32°C, and in 26.4% of these, the temperature was lower than 28°C. The association with infectious processes happened in 76.8% of the cases. The patients with mild hypothermia answered better at therapeutics (96.8%) when compared with the moderate hypothermic (72.1%) and serious (87.5%) patients. The Osborn's wave was present in 42.6% of the patients. The general mortality was 38.2%. CONCLUSIONS: The accidental hypothermia in Emergency Services from Tropical Country is an undeniable fact. The paramedic and medics should be alert and trained to recognize this disease of high morbidity and mortality. The mortality increases with the presence of associated diseases, particularly infectious processes, malnutrition and chronic alcoholism.

9372 downloads

11.

Iatrogenia em cardiologia
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Pereira, Afonso Celso

; Franken, Roberto Alexandre

; Sprovieri, Sandra Regina Schwarzwalder

; Golin, Valdir

Arquivos Brasileiros de Cardiologia

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jul 2000, Volume 75 N. 1 Pages 75 - 78

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

O termo iatrogenia vem do grego e refere-se a qualquer alteração patológica provocada no paciente pela má prática médica. Infelizmente, o risco de sua ocorrência convive constantemente no manuseio das doenças cardíacas. Podem ser considerados dois tipos de iatrogenia: iatrogenia de ação, ou decorrente da ação médica, e iatrogenia de omissão, relacionada à falta de ação do médico. As iatrogenias ocorrem em todas as fases do ato médico, desde a relação com o paciente, passando pelo diagnóstico, tratamento, até a prevenção das doenças. O presente artigo comenta as iatrogenias no campo das doenças cardíacas e cita alguns exemplos de como ocorrem.

The word iatrogeny derives from the Greek and concerns any disorder caused to the patient by inaproppriate medical practice. Unfortunately, the rise of an iatrogenic disease is related to the daily handline of cardiac disease. There are two types of iatrogeny: that caused by a medical action and omission iatrogeny, caused by the lack of a medical action. Iatrogeny occurs in all steps of medical practice starting with the patient-doctor relationship including diagnosis treatment and finally prevention of diseases. This article makes a brief commentary about iatrogenic heart disease and mentions some examples of it.

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