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With the advent of smart grid theory, distribution networks can include different microgrids (MGs). Therefore, to achieve the desired technical and economic objectives in these networks, there is a need for bilateral coordination between their operators. In the following, by defining an energy management problem for them, it is predicted that the mentioned goals can be achieved. Therefore, this paper presents the hybrid flexible-securable operation (HFSO) of a smart distribution network (SDN) with grid-connected multi-microgrids using a two-layer coordinated energy management strategy. In the first layer, the microgrid (MG) operator is coordinated with sources, storages, and demand response operators. This layer models the HFSO method in the grid-connected MGs, which is based on minimizing the difference between the sum of operating cost of nonrenewable distributed generations and cost of energy received from the SDN, and the sum of flexibility and security benefits. It is constrained to AC optimal power flow, flexibility and voltage security constraints, operation model of sources and storages, and demand response. The second layer concerns coordination between the MG operators and the SDN operator. Its formulation is the same as that of the first layer, except that the HFSO model is used in the SDN according to MGs power daily data obtained from the first layer problem. The strategy converts the mixed-integer nonlinear programming to linear one to obtain the optimal solution with low calculation time and error. Moreover, stochastic programming models the uncertainties of load, energy price, and renewable power. Eventually, numerical results confirm the capability of the scheme to improve technical and economic indices simultaneously. As a result, by expecting the optimal operation for sources, storage, and responsive loads, it succeeded to enhance energy loss, voltage profile, and voltage security of the mentioned networks by up to 30%, 22%, and 5%, respectively, compared to power flow studies. In addition, there was enhancement in economic and flexibility status of the SDN and MGs.

We performed a systematic review and meta-analysis to investigate the effects of facilitated tucking position during painful procedure in pain management of preterm infants. We searched MEDLINE, PEDro, SciELO and the Cochrane Library (until June 2019) for randomized controlled trials. An α value ≤ 0.05 was considered significant. Heterogeneity among studies was examined with Cochran’s Q and I2 statistic, in which values greater than 40% were considered indicative of high heterogeneity and random-effects model was chosen. Analyses were performed with Review Manager 5.3. Fifteen studies met the eligibility criteria, including 664 preterm infants. The meta-analyses showed a significant reduction in pain of − 1.02 (95% CI − 1.7 to − 0.4, N = 216) during endotraqueal suctioning for participants in the facilitated tucking position group (FTPG) compared with routine care group. The meta-analyses showed a non-significant difference in pain − 0.3 (95% CI − 2.05 to − 1.4, N = 88) during heel stick for participants in the FTPG compared with oral glucose group. The meta-analyses showed a non-significant difference in pain for participants in the FTPG compared with oral opioid group 0.2 (95% CI − 1.4 to 1.8, N = 140).Conclusion: Facilitated tucking position may improve the pain during painful procedures.What is Known:• Exposure of premature babies to painful procedures is associated with changes in brain development, regardless of other factors.• Facilitated tucking reduces the expression of pain in premature infants.What is New:• Facilitated tucking position was efficient in pain management of preterm infants when compared to routine care.• Facilitated tucking compared to opioid or oral glucose did not achieve a significant reduction in pain intensity.

Soil is one of the environmental elements to influence Cerrado vegetation. Aluminum toxicity of Cerrado soils is well known, but the importance of water availability is still to be understood, especially in Cerrado under wetter climates. We studied the association between Cerrado physiognomies (cerrado sensu stricto and cerradão) and morphological, chemical, physical, and physical-hydrical soil attributes at southwestern São Paulo State, Brazil. Characterization of soil morphology, classification and sample collection for particle-size distribution, and chemical and water-retention analyses were carried out in 15 permanent plots, where vegetation was characterized floristically and structurally. Simple correlation and canonical correspondence analyses were performed with soil data. Classification of soils (U.S. Soil Taxonomy) with very low clay contents was not able to separate soils under cerraddo—forestry physiognomy—from those under cerrado sensu stricto—savannic physiognomy, even though it tends to distinguish soils under greater biomass from those under lower biomass physiognomies. High soil acidity of all studied soils and increased at the sites with greater contents of organic matter, mainly with the cerradão physiognomy, precluded Al toxicity as a cause of the physiognomic gradient within Cerrado. Clay content, microporosity, and residual and saturation moisture were the most significant soil attributes to correlate directly with the cerradão physiognomy, indicating that water availability is the main factor explaining the physiognomic gradient of Cerrado vegetation in a local scale, where climate and soil fertility do not vary spatially.

PurposeTo compare the diagnostic performance of 18-FDG-PET/MR and PET/CT for the N- and M- staging of breast cancer.Methods and materialsTwo independent readers blinded to clinical/follow-up data reviewed PET/MR and PET/CT examinations performed for initial or recurrent breast cancer staging in 80 consecutive patients (mean age = 48 ± 12.9 years). The diagnostic confidence for lesions in the contralateral breast, axillary/internal mammary nodes, bones and other distant sites were recorded. Sensitivity, specificity, positive (PPV) and negative predictive values (NPV) were calculated. The standard of reference included pathology and/or follow-up > 12 months.ResultsNine of 80 patients had bone metastases; 13/80 had other distant metastases, 44/80 had axillary, 9/80 had internal mammary and 3/80 had contralateral breast tumours. Inter-reader agreement for lesions was excellent (weighted kappa = 0.833 for PET/CT and 0.823 for PET/MR) with similar reader confidence for the two tests (ICC = 0.875). In the patient-per-patient analysis, sensitivity and specificity of PET/MRI and PET/CT were similar (p > 0.05). In the lesion-per-lesion analysis, the sensitivity of PET/MR and PET/CT for bone metastases, other metastases, axillary and internal mammary nodes, contralateral tumours and all lesions together was 0.924 and 0.6923 (p = 0.0034), 0.923 and 0.923 (p = 1), 0.854 and 0.812 (p = 0.157), 0.9 and 0.9 (p = 1), 1 and 0.25 (p = 0.083), and 0.89 and 0.77 (p = 0.0013) respectively. The corresponding specificity was 0.953 and 1 (p = 0.0081), 1 and 1 (p = 1), 0.893 and 0.92 (p = 0.257), 1 and 1 (p = 1), 0.987 and 0.99 (p = 1) and 0.96 and 0.98 (p = 0.0075) respectively.ConclusionsReader confidence, inter-reader agreement and diagnostic performance per patient were similar with PET/MR and PET/CT. However, for all lesions together, PET/MR had a superior sensitivity and lower specificity in the lesion-per-lesion analysis.Key Points• N and M breast cancer staging performance of PET/MR and PET/CT is similar per patient.• In a lesion-per-lesion analysis PET/MR is more sensitive than PET/CT especially for bone metastasis.• Readers’ diagnostic confidence is similar for both tests.

On the latest 60 years the degradation and fragmentation of native habitats have been modifying the landscape in the eastern Brazilian Amazon. The adaptive plasticity of an organism has been crucial for its long-term survival and success in these novel ecosystems. In this study, we investigated the response of four endangered species of large terrestrial mammals to the variations in the quality of their original habitats, in a context of high anthropogenic pressure. The distribution of the Myrmecophaga tridactyla (Giant anteater), Priodontes maximus (Giant armadillo), Tapirus terrestris (Lowland tapir) and Tayassu pecari (White-lipped peccary) in all sampled habitats suggests their tolerance to degradation. However, the survival ability of each species in the different habitats was not the same. Among the four species, T. pecari seems to be the one with the least ability to survive in more altered environments. The positive influence of the anthropogenically altered habitats on abundances of three of the four species studied, as observed at the regeneration areas, can be considered as a potential indication of the ecological trap phenomenon. This study reinforces the importance of the forest remnants for the survival of endangered mammal species, in regions of high anthropogenic pressure, as in the eastern Brazilian Amazon.

The occurrence of leprosy reactions, a common event during treatment, may be mostly related to the action of multidrug therapy on Mycobacterium leprae. The clinical and laboratory monitoring of patients with reactions is important, since collecting data that assists in predicting the risk of reactions may help to prevent disability. This was a sectional study, in order to correlate clinical and laboratory diagnosis with the number of reactions during treatment. Spearman's correlation was used to verify the degree of association between the assessed variables. This study was conducted with 211 patients with leprosy reactions during treatment of M. leprae. The borderline tuberculoid group was the most prevalent clinical form (74/211; 35.1%) and the type one reaction showed the highest frequency (136/211; 64.5%). It was observed that 73.5% (155/211) of reactions occurred within 3 months of the initiation of multidrug therapy. The diagnostic values, including the bacterial indices (BIs) of dermal smears (r = 0.21, p < 0.05) and skin biopsies (r = 0.20; p < 0.05), showed a positive correlation with the number of reactions during treatment. This research showed a positive correlation between bacillary load markers and the number of leprosy reactions. This study provided scientific support to future research aiming to elucidate the influence of antigenic load on the number of leprosy reactions during treatment.

Background Chronic obstructive pulmonary disease (COPD) is a disease with a high socioeconomic burden for the global population. Identifying those individuals with a higher potential to develop the disease is essential for reducing its incidence. Methods This is an observational, longitudinal study that uses data from the 1978/1979 Ribeirão Preto City birth cohort (São Paulo State, Brazil). The study included 895 individuals who participated at the age of 23–25 and 37–38 years. Asthmatics were diagnosed by methacholine bronchial challenge test and were excluded from the analysis. A multiple linear regression was performed to evaluate the association of active smoking, passive smoking, body mass index (BMI), C-reactive protein (CRP) levels, and respiratory symptoms with FEV1 variation between ages. Results The analysis showed an association between BMI, CRP levels, and active smoking with FEV1 fall. Active smoking increased FEV1 decline by 1.95%. For each 1 kg/m² increase in BMI, there was a 0.28% loss in FEV1, while an increase in CRP level of 1 mg/dL was associated to a 0.76% additional FEV1 decline. Conclusion In addition to the well-known relationship between smoking and pulmonary function decline, there was also an association with BMI and CRP levels, suggesting the hypothesis that a metabolic process may contribute to the development of COPD.

Resumo A publicação da lei que criou a titulação de organização social foi precedida de debates sobre o consensualismo no âmbito da Administração Pública, uma corrente interpretativa do direito administrativo que advoga movimentos de horizontalidade entre poder público e privado. Para avaliar a implementação de políticas públicas relacionadas à execução dos direitos humanos – no caso deste artigo, o direito humano à saúde –, realizamos uma pesquisa documental com análise dos 30 contratos de gestão firmados entre organizações sociais de saúde e a Secretaria Municipal de Saúde de São Paulo (SMS-SP), vigentes até 2014. A análise permitiu verificar que o modelo é fortemente influenciado pelas diretrizes do Sistema Único de Saúde (SUS). No caso das relações público-privadas, foi possível concluir que o modelo não é aplicado aos serviços de saúde de maneira idêntica se inserido em maior ou menor grau na política de saúde a depender da escolha do gestor. Por fim, a estrutura homogênea de parte dos contratos, invariável mesmo com relação aos objetos contratados, permitiu descartar a hipótese de que esses instrumentos contam com maior consenso entre o poder público e o parceiro privado. Não havia grande margem de negociação de cláusulas entre os contratados. Abstract The social organization creation law was preceded by debates about consensualism inside the Public Administration, an interpretative school of thought of administrative law that advocates horizontal movements between Public and Private sector. In order to evaluate the implementation of public policies related to the execution of human rights – in the case of this research, the right to health –, we conducted a documentary research with an analysis of the 30 management contracts signed between social health organizations and the Municipal Health Office of São Paulo from 2006 to 2014. The analysis showed that the model is strongly influenced by SUS guidelines. In the case of public-private relations, it was possible to conclude that the model is not applied to health services in an identical way, inserted to a greater or lesser extent in health policy depending on the manager’s choice. Finally, the homogeneous structure of part of the contracts, which is invariable even in relation to the contracted objects, allowed us to discard the hypothesis that these instruments have a greater consensus between the Government and the private partner. There was not much scope for negotiating clauses between contractors.

In August 2012, the Brazilian Ministry of Health introduced inactivated polio vaccine (IPV) as part of sequential polio vaccination schedule for all infants beginning their primary vaccination series. The revised childhood immunization schedule included 2 doses of IPV at 2 and 4 months of age followed by 2 doses of oral polio vaccine (OPV) at 6 and 15 months of age. One annual national polio immunization day was maintained to provide OPV to all children aged 6 to 59 months. The decision to introduce IPV was based on preventing rare cases of vaccineassociated paralytic polio, financially sustaining IPV introduction, ensuring equitable access to IPV, and preparing for future OPV cessation following global eradication. Introducing IPV during a national multivaccination campaign led to rapid uptake, despite challenges with local vaccine supply due to high wastage rates. Continuous monitoring is required to achieve high coverage with the sequential polio vaccine schedule.

Objective Self-etching dental adhesives bond with dentin through chemical reactions with calcium. This study assessed bond strength (BS) using microtensile (µTBS) and microshear (µSBS) tests on sound and post-radiotherapy dentin, with dental adhesives containing different functional monomers. Methods Sound dentin (SD) and post-radiotherapy irradiated dentin (ID) were tested with two adhesive systems: Clearfil SE Bond (SE, 10-MDP-based) and FL Bond II (FL, containing carboxylic and phosphonic monomers with S-PRG bioactive particles). The tests occurred initially (24 h) and six months later; fracture mode was also analyzed (40x). Ninety-six human molars were randomly assigned ( n  = 12), and half were irradiated with a 70 Gy radiation dose. For µTBS test, teeth were bonded, restored and sectioned them into beams (0.64 mm 2 ). The µSBS test used filled transparent cylindrical matrices with resin composite and light-cured them after dental adhesive applications. Three-way ANOVA and Tukey’s test ( p  < 0.05) analyzed the data. Results µTBS showed a significant substrate x adhesive interaction ( p  < 0.001), while µSBS was significant for all factors ( p  = 0.006). SE and FL performed better on SD and ID, respectively, in the µTBS test. As for µSBS, SE showed higher values on ID ( p  < 0.05). Lower BS values occurred for SD-FL and ID-SE after six months. Conclusion Dental adhesive performance varied based on substrate type and test method. FL was more stable for ID in µTBS, while SE excelled in µSBS. Clinical relevance As post-radiotherapy irradiated dentin becomes more vulnerable, self-etching systems based on functional monomer and bioactive ingredients may exhibit appropriate bonding to this altered substrate.