Journal articles: 'NASCAR (Association)' – Grafiati (2024)

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Conventional wisdom in sports is that consistency is praiseworthy and that competitors should seek momentum. A small standard deviation is the simplest measure of consistency, and a positive autocorrelation is the simplest measure of momentum. With these statistical definitions, we find that consistency is predictable for Sprint Cup drivers, but momentum is not. Simulating seasons, we find consistency reduces the variability in season-ending performances and momentum increases them. Since drivers are ordinarily seeking unlikely occurrences, consistency is harmful and momentum is beneficial. Thus, consistency is obtainable but not desirable, and momentum is desirable but not obtainable in National Association for Stock Car Auto Racing.

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Through two studies of fans who identified with the collective known as NASCAR (the National Association for Stock Car Auto Racing hereafter referred to as Nascar), we examine why stakeholders identify with collectives that are perceived as only moderately prestigious (given that high prestige has been shown, empirically, to be the primary predictor of collective identification because it enhances identifiers’ self-esteem). Our findings indicate that identifiers did not perceive Nascar to be high in prestige (compared to other similar collectives) and that their identification was predicted, primarily, by “Perceived Opportunity for Authentic Self-Expression” with Nascar. In addition, across both studies, we found that “patriotism”—a personal value that was difficult for fans to affirm elsewhere—was the most important value that fans perceived they could “self-express” when interacting with Nascar. These findings suggest that individuals may identify with moderate prestige collectives because they provide rare opportunities to express values that are part of their authentic selves, and thus, satisfy these individuals’ “needs for authenticity.”

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AbstractSpeed is the ultimate goal of racing, and materials are an increasingly important area of research for making race cars faster. The splitter, which produces front downforce, is made from Tegris, a polypropylene composite offering comparable stiffness and improved impact properties at significantly lower cost than alternative materials. Engine blocks must be cast iron, but careful control of microstructure using precision manufacturing methods produces a lighter engine block that generates more horsepower.Speed and excitement must be balanced with safety, and materials are key players here, as well. Energy-dissipating foams in the car and the barriers surrounding the tracks allow drivers to walk away uninjured from accidents. Fire-resistant polymers protect drivers from high-temperature fuel fires, and technology transfer from the National Aeronautics and Space Administration (NASA) to the National Association for Stock Car Auto Racing (NASCAR) in the form of a low-temperature carbon monoxide catalyst filters the drivers' air.Sports are an outstanding way of showing the public how materials science and engineering are relevant to their lives and interests. Materials science and engineering is just that much more exciting when it's traveling at two hundred miles an hour.

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Objective. Examine the usefulness of large-scale community-based head and neck cancer screening for reducing tobacco use in an at-risk population. Questions answered: (1) Is participating in a community-based head and neck cancer screening related to a reduction in tobacco usage? (2) Do differing factors between participants predict behavior change? Study Design. Survey based with a longitudinal follow-up component. Setting. Atlanta Motor Speedway during a National Association of Stock Car Auto Racing (NASCAR) race event. Subjects and Methods. Recruited NASCAR fans (n = 620). Initial screening and 11-question survey for 6-month telephone follow-up. Results. One hundred fifty-six participants (25%) required medical follow-up. Chi-square analysis indicated a significantly higher proportion of smokers (13%) evidenced positive findings compared to nonsmokers (8%) or past smokers (6%). Kruskal-Wallis analysis followed by Dunn’s multiple comparison post hoc test indicated smokers were from a significantly lower socioeconomic status background compared to nonsmokers. Analysis of variance indicated contacted participants reported smoking significantly fewer cigarettes per day 6 months postscreening compared to the number of cigarettes smoked at the baseline. Forty-four (59%) participants reported reducing the number of cigarettes smoked per day, and 11 participants reported quitting smoking. Conclusion. The authors have demonstrated that large-scale community-based head and neck cancer screenings can be effectively implemented in nonmedical venues. This study demonstrated that targeting education for reduction of risk factors in the NASCAR population positively affected tobacco cessation.

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Since 2011, the National Association for Stock Car Auto Racing (NASCAR) has forced drivers to pick one of three national series for which they would be eligible to compete for a season championship. Prior to this “Pick-A-Series” rule, many drivers in the premier Sprint Cup Series competed regularly in the Nationwide Series, which is a developmental division for less experienced drivers. I examined whether the removal of moonlighting Sprint Cup drivers from championship contention encouraged less aggressive driving among those who competed exclusively in the Nationwide Series. There was weak evidence that the Pick-A-Series rule reduced accident proneness among Nationwide drivers relative to Sprint Cup drivers.

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For many years, containment for errant racing vehicles traveling on oval speedways has been provided through rigid, concrete containment walls placed around the exterior of the track. However, accident experience has shown that serious injuries and fatalities may occur through vehicular impacts into these nondeformable barriers. Because of these injuries, the Indy Racing League and the Indianapolis Motor Speedway, later joined by the National Association for Stock Car Auto Racing (NASCAR), sponsored the development of a new barrier system by the Midwest Roadside Safety Facility at the University of Nebraska–Lincoln to improve the safety of drivers participating in automobile racing events. Several barrier prototypes were investigated and evaluated using both static and dynamic component testing, computer simulation modeling with LS-DYNA (a nonlinear finite element analysis code), and 20 full-scale vehicle crash tests. The full-scale crash testing program included bogie vehicles, small cars, and a full-size sedan, as well as Indy Racing League open-wheeled cars and NASCAR Winston Cup cars. A combination steel tube skin and foam energy-absorbing barrier system, referred to as the SAFER (steel and foam energy reduction) barrier, was successfully developed. Subsequently, the SAFER barrier was installed at the Indianapolis Motor Speedway in advance of the running of the 2002 Indianapolis 500 race. From the results of the laboratory testing program as well as analysis of the accidents into the SAFER barrier occurring during practice, qualification, and the race, the SAFER barrier has been shown to provide improved safety for drivers impacting the outer walls.

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PurposeThis study is a micro-level perspective of value co-creation in spectator sport. By examining sport through the value co-creation lens, the dual role of the customer as both a contributor to and a beneficiary of value is acknowledged and the importance of stakeholder interactions is emphasized. This study analyzes the extent to which two theoretically and managerially important factors—attendance frequency (i.e. first-time attendee vs repeat attendee) and resident type (i.e. local resident vs domestic traveler)—impact value creation in the recurring live sporting event setting.Design/methodology/approachData were collected from spectators who attended a National Association for Stock Car Auto Racing (NASCAR) sanctioned racing event. Multigroup structural equation modeling was performed to examine the proposed pathways, and multigroup t-tests were used to compare the model across both groups for each moderating variable. Corresponding path coefficients were then compared using Chin's (2004) recommended equations and procedures.FindingsThe study found organization-related value propositions to be the more common antecedents of value, while customer appearance had a strong negative association with hedonic value, and attendance frequency and resident type influenced certain value perceptions. Sport organizations should consider the expectations and motivations of various customer groups and provide offerings designed to meet the specific needs of different fan segments based on the spectator's experience with the sport product and the distance traveled to attend the sport event.Originality/valueThis paper advances the authors’ understanding of value creation in sport by showing how customer perceptions of value associated with the sport organization and other customers can be moderated by certain behavioral and geographic factors.

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We report recent excavations undertaken at the residential village Upanca located 1,600 m above sea level in the Nasca region of Peru in the Central Andes. Although fieldwork was initiated to evaluate the site's participation in the Early Nasca craft economy, excavations revealed a long occupation beginning in the Late Archaic (ca. 3000–1800 B.C.) and extending into the Early Intermediate period (ca. A.D. 1–750), with a principal component dating to the Early Nasca period (ca. A.D. 1–450). The Early Nasca component revealed high polychrome consumption, confirming previous assessments of Early Nasca's craft economy, and association with extensive agricultural terracing, suggesting surplus production beginning in the Early Intermediate period.

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Fatal craniovertebral junction (CVJ) injuries were the most common cause of death in high-speed motor sports prior to 2001. Following the death of a mutual friend and race car driver, Patrick Jacquemart (1946–1981), biomechanical engineer Dr. Robert Hubbard, along with race car driver and brother-in-law Jim Downing, developed the concept for the Head and Neck Support (HANS) device to prevent flexion-distraction injuries during high-velocity impact. Biomechanical testing showed that neck shear and loading forces experienced during collisions were 3 times the required amount for a catastrophic injury. Crash sled testing with and without the HANS device elucidated reductions in neck tension, neck compression, head acceleration, and chest acceleration experienced by dummies during high-energy crashes. Simultaneously, motor sports accidents such as Dale Earnhardt Sr.'s fatal crash in 2001 galvanized public opinion in favor of serious safety reform. Analysis of Earnhardt's accident demonstrated that his car's velocity parallel to the barrier was more than 150 miles per hour (mph), with deceleration upon impact of roughly 43 mph in a total of 0.08 seconds. After careful review, several major racing series such as the National Association for Stock Car Auto Racing (NASCAR) and Championship Auto Racing Team (CART) made major changes to ensure the safety of drivers at the turn of the 21st century. Since the rule requiring the HANS device in professional auto racing series was put in place, there has not been a single reported case of a fatal CVJ injury.

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Objectives: To explore what naswar (smokeless tobacco) users know aboutthe effects of naswar on their oral and general health. Methods: This cross sectional surveywas undertaken in the city of Peshawar, Pakistan. Sample size of 96 participants based on 95%C.I with interval width of 10% was used for this study. Only male naswar users were included.Keeping in mind the resources and time constraints the participants were purposely sampled.All the participants were consented before being included in the sample. Survey tool whichincluded open, closed and semi structured questions was self-administered. Findings: 42.7%(95% CI: 32.8-52.6%) of the respondents considered naswar, either harmless or resultingin minor side effects. There was lack of awareness of the existence of oral and lung canceramong a significant proportion (41% with 95% CI: 31.8-58.5%) of participants. In response toa question about harmful effects of naswar use, vast majority of the respondents mentionedone or the other form of oral (non serious) or tooth problems. Only 10.41% (95%CI: 4.3-16.5%)mentioned its association with cancer and none mentioned about the risk of cardiovasculardisease. Conclusion: Our survey appears to indicate that level of awareness of naswar usersin Peshawar is poor. We recommend to the government of NWFP to make an effort to educatethe people about the harmful effects of naswar use.

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Objectives: To determine the relationship of Naswar with different tumour grading in squamous cell carcinoma. Study Design: Comparative cross-sectional study using non-probability, consecutive sampling. Setting: Department of Oral Pathology, Rehman College of Dentistry, Peshawar, Khyber Pakhtunkhwa, Pakistan. Period: January 2017 till June 2017. Material & Methods: 60 cases of oral squamous cell carcinoma were included. Half the cases (30) had a history of Naswar use while the other half (30) had no history of Naswar use. Data was analysed using SPSS v 22. Results: This study included 60% male and 40% female cases, ranging from 40 years to 80 years (mean = 57.6 + 11 years). Majority of patients 80% had well differentiated squamous cell carcinoma, while the rest (20%) had poorly differentiated. Distribution of male and female across both groups was equal (p 0.598). Both the groups were comparable in terms of grade of tumour (p 0.519). Conclusion: Naswar use was not associated with any particular histological grade of oral squamous cell carcinoma in our study. However, further research is needed to explore this association.

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Abstract Introduction Smokeless tobacco (SLT) is a significant contributor to tobacco-related harm in Pakistan but its control has lags behind that of combustible tobacco. We assessed the compliance of Naswar’s (a widely used SLT product in the Southeast Asia) packaging and sales practices with the national legislations and relevant articles of the WHO framework convention on tobacco control (FCTC). Aims and Methods A cross-sectional observational audit was conducted in three districts of Pakistan. We recruited 286 general point of sale (GPOS) and exclusive Naswar sellers (ENS) through a multistage cluster sampling strategy. Data were gathered on packaging and labeling practices of Naswar and advertisem*nt and promotion practices inside and outside the shops. Statistical tests for association between the dependent variable-advertisem*nt practices, and independent variables-area and vendor types were conducted. Results We analyzed 133 and 49 unique Naswar products sold in 229 GPOS and by 57 ENS, respectively. None of the local products had any written or pictorial health warning. More than half of retailers used one or two methods of advertising Naswar inside the shops while only 9% advertised outside the shops. ENS were more likely to be noncompliant with tobacco advertisem*nt and promotion compared with GPOS. Conclusions The study presents first insights on the compliance of Naswar packaging and sale practices with local regulations and WHO FCTC provisions in Pakistan. Almost all products were on display in the shops and none of the local products had any health warning or contents disclosure on the packages. Implications Naswar is a form of SLT used extensively in Pakistan, Central Asia, and Pashtun populations across the globe. This study provides an important insight into the Naswar retail environment in a geographical setting where the use of Naswar is endemic. The study brings to fore previously unreported issues like an urban–rural disparity, and differences between exclusive and nonENS, with regards to Naswar advertisem*nt and promotion. These findings have potential implication on the implementation of tobacco control retail policies. The lack of health warnings and free display of Naswar brands call for alignment of tobacco control efforts with the FCTC.

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Introduction: Obstructive Sleep Apnea (OSA) is a condition with recurrent collapses of the pharyngeal region that result in partial or total reduction in airflow. Its diagnosis and severity depends on the Apnea-Hypopnea Index (AHI), data from the polysomnography exam (PSG). Its pathophysiology includes anatomical disorders of the upper airways that can be assessed through Flexible Nasofibroscopy (FN). Objective: To identify the alterations present in the tests of FN and PSG in patients with OSA and correlate with the AHI. Methods: Cross-sectional study, with data collected from reports of the FN and PSG exams of 81 patients with OSA, seen at an otorhinolaryngology clinic in Tubarão - SC. It was verified the association between the outcome –AHI- and other exposure variables - sociodemographic and clinical. Results: Among the 81 patients, 75.31% were male, 41.98% had mild apnea, 30.86% moderate and 27.16% severe apnea. There was no correlation between FN findings and AHI (p> 0.05). There was a difference between the mean age, number of obstructive episodes per hour of sleep and minimum saturation between the groups with severe and mild apnea (p <0.05). Patients with severe apnea had a higher percentage of sleep phase one and a shorter REM sleep time compared to the mild apnea group (p <0.05). A positive correlation was obtained between: obstructive episodes with sleep stage 1 (p <0.01) and age (p <0.05); between minimum saturation and sleep stage 3 (p <0.05). There was an inverse correlation between obstructive episodes with minimal saturation (p <0.001), with sleep stage 3 (p <0.01) and with REM sleep (p <0.01); between age and minimum saturation (p <0.01). Conclusion: OSA directly interferes with sleep architecture. The present study did not find association between upper airway alterations and OSA severity.

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Abstract Introduction Provision of alternate livelihoods to smokeless tobacco (SLT) supply chain (SC) actors can help in curtailing SLT business and its consumption. We explored the reasons for SC actors’ engagement in Naswar (SLT used in South Asia) business and their willingness to switch to other alternatives. Aims and Methods We conducted an equal-status concurrent mixed-methods study in four districts of Khyber Pakhtunkhwa province of Pakistan. We surveyed 286 general points of sale (GPOS) and exclusive Naswar (EN) vendors through multistage cluster sampling. Additionally, we interviewed 15 tobacco farmers interpretively, being distinct from other SC actors. We assessed the association between vendors’ willingness to switch and their awareness about tobacco-harms, profit margin, Naswar as a family business, length of business, education level, and shop type using logistic regression. Qualitative data assessed the farmer’s viable alternatives to switch and were analyzed using deductive–inductive thematic analysis. Results Product demand—77% and profit margins—75% were the main drivers for selling SLT by EN vendors. Half of the GPOS and 25% EN vendors expressed willingness to stop Naswar’s sale. Vendors aware of tobacco-harms were more willing to switch, but less likely to switch if Naswar was perceived to bring “good profit.” Farmers were mainly cultivating tobacco because of profitability, family-run farm, and perceived land-suitability for tobacco. Lack of government support was main constraint for farmers looking to switch. Conclusions A considerable portion of Naswar SC actors in Pakistan are willing to switch to viable alternatives, with profitability of alternatives, support from authorities, and social obligations as key considerations in doing so. Implications This study highlights that good profit margins in the Naswar business, lack of awareness of tobacco-related health harms, and absence of the government’s support are key detriments to switching to alternative businesses among Naswar SC actors in Pakistan. These findings are the first to come out in the context of both Pakistan and Naswar product, making a case for policy interventions focusing on tax increases, awareness campaigns about tobacco-harms, and a proactive role by the government to provide support for the security of livelihoods to those tobacco SC actors who want to switch to other alternatives.

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Low birth weight is appointed as a strong indicator of the health conditions of the population. Objective: evaluate the prevalence of low birth weight and identify factors associated to the low birth weight in a public maternity of a university hospital of Goiânia, Goiás Methods: This is a cross-sectional study conducted from January to July 2011. The association between variables and birth weight was performed by using the Mantel-Haenszel test and factors associated with low birth weight were estimated using logistic regression or fisher test whether appropriated. Results: The results showed a prevalence of children with low birth weight of 34.0%. After multivariate analysis, preterm birth (OR = 18.6, p = 0.000) remained significantly associated to low birth weight. Conclusions: Investment in the quality of maternal and child health is recommended, since these risk factors can be avoided or minimized through a quality attention. Prevalência e fatores associados ao baixo nascer em uma maternidade PÚBLICA O baixo peso ao nascer é apontado como forte indicador das condições de saúde da população. Objetivo: avaliar a prevalência de baixo peso ao nascer e identificar os fatores associados ao baixo peso ao nascer em uma maternidade pública de referência no município de Goiânia-Goiás. Métodos: Trata-se de um estudo de corte transversal, realizado no período de janeiro a julho de 2011. Associação entre as variáveis e o peso ao nascer foi realizada através do teste de Mantel Haenszel e os fatores associados ao baixo peso foram estimados utilizando regressão logística. Resultados: prevalência de crianças com baixo peso de nascimento de 34,0%. Após análise multivariada, o nascimento pré-termo (OR= 18,6; p=0,000) manteve-se significativamente associado ao baixo peso ao nascer. Conclusões: recomenda-se o investimento na qualificação da assistência materno-infantil, visto que muitos destes fatores de risco podem ser evitados ou minimizados por meio de uma atenção de qualidade.

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In the developed countries, functions of the central government policy on regulation of small business are for the most part concentrated in local administration bodies. Practices of these countries need to be considered in creating the regulatory system focused on the development of small business and its social responsibility. The theoretical principles for the process of regulation of the development of social responsibility of small business are extended. A brief review of the most widespread models for socially responsible business is made, dependent on national and cultural peculiarities. It is demonstrated that the Ukraine’s integration in the European economic area, apart from corporate social responsibility of large business, requires implementation of social responsibility of small business. It is substantiated that the regulation of the development of small business and its social responsibility, if implemented on the continuous basis, will create highly performing small business sector in Ukraine, contributing in the production output, revenue collection, and employment. A system approach to the regulation of the development of social responsibility of small business is proposed, which is based on interactions of three parties: state power bodies and local self-government bodies; the center for promotion of small business, associating small enterprises; public associations and professional unions. It is substantiated that the system approach to the regulation of the development of social responsibility of small business should be based on interactions in organizational, consultative and educational, social, financial and investment areas.

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This essay discusses the use of "Fascism" word in Raduan Nassar's novel A Cup of Rage. It addresses the elasticity given to the term, via George Orwell (2017), as well as the links that such a concept has with, for instance, Liberalism and Marxism, in the light of Atílio Boron (2003). Once this is done, the essay focuses on the use of the term in the novel, namely: how it distances itself from the sophisticated elaboration that swarms the unusual associations of Nassarian writing. This would bring up what Barthes (2004) would call the “virtuality of language”, and what Antonio Candido (2006) highlights as "private semantic operation".

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Objective: to evaluate the association between adolescence and cesarean section in women aged 10-19 years compared with those found in ages between 19 and 25 years, patients in a hospital, and determine its association with sociodemographic variables and neonatal in terms of prematurity, and Apgar low birth weight. Materials and Methods: a case-control study was performed using a simple random sampling, considering the calculation of a statistical sample. a total of 1,304 cases and 2,608 controls were included. First time mom patients treated at an institution x over a period of three years, to determine associations of risk through analysis of hypothesis testing is included. Results: the risk of caesarean section in teenagers is (OR 1.13, 95% CI 1.10 to 1.51). In addition, it was determined that there is an increased risk of low birth weight (OR 9.4, 95% CI 7.59 to 11.76), with no difference in adolescents in the risk of Apgar down score at minute and 5 minutes later. Conclusion: there is an increased risk of low birth weight and require termination of pregnancy via cesarean in adolescents compared to young adults, especially if they are under 14. It is necessary to promote campaigns to prevent teenage pregnancy, as the main measure of control over these population.KEYWORDS: abdominal delivery, childbirth, complications of pregnancy, teenage pregnancy, teenagers. Adolescencia materna y su asociación con la realización de cesáreaRESUMEN Objetivo: evaluar la asociación entre adolescencia y la realización de cesárea en mujeres de 10 a 19 años, en comparación con las que se encuentran en edades entre 19 y 25 años, atendidas en un hospital X, y determinar su asociación con variables sociodemográficas y neonatales en términos de prematurez, Apgar y bajo peso al nacer. Materiales y Métodos: se realizó un estudio de casos y controles, mediante un muestreo simple aleatorio, teniendo en cuenta el cálculo de una muestra estadística. Se incluyeron un total de 1.304 casos y 2.608 controles. Se incluyeron pacientes primigestantes atendidas en una institución X en un período de tres años, para determinar asociaciones de riesgo mediante análisis de contraste de hipótesis. Resultados: el riesgo de cesárea en adolescentes es de (OR 1,13, IC 95% 1,10-1,51). Además, se determinó que en las adolescentes existe un riesgo mayor de bajo peso al nacer (OR 9,4, IC 95% 7,59-11,76), sin diferencia en cuanto al riesgo de Apgar bajo al minuto y los 5 minutos. Conclusión: existe un mayor riesgo de presentar bajo peso neonatal y requerir terminación de la gestación por vía cesárea en adolescentes, en comparación con las adultas jóvenes, especialmente si son menores de 14 años. Se requiere promover campañas para evitar el embarazo adolescente, como principal medida de control sobre esta población.PALABRAS CLAVE: parto abdominal, parto, complicaciones del embarazo, embarazo en adolescencia, adolescentes. Mãe adolescente e sua associação com cesariana SUMÁRIO Objetivo: avaliar a associação entre a adolescência ea cesariana em mulheres com idade entre 10 a 19 anos, em comparação com aqueles encontrados na faixa etária entre 19 e 25 anos, servido em um hospital, e determinar associação STI com variáveis neonatais e sociodemográficos em termos de prematuridade, Apgar e baixo peso ao nascer. Materiais e Métodos: um estudo de caso-controle foi realizado utilizando amostragem aleatória simples, Considerando o cálculo de uma amostra estatística. Um total de 1.304 casos e 2.608 controles foram incluídos. Primigestas pacientes tratados em uma instituição x ao longo de um período de três anos, para determinar associações de risco através da análise dos testes de hipóteses está incluído. Resultados: o risco de cesariana em adolescentes é (ou CI 1,13, 95% 1,10-1,51). Além disso, determinou-se que há um aumento do risco de baixo peso ao nascer (OR 9,4, IC 95% 7,59-11,76), não havendo diferença em adolescentes no risco de baixo índice de Apgar no minuto 5 minutos. Conclusão: há um aumento do risco de baixo peso ao nascer e exigem a interrupção da gravidez através de cesariana em adolescentes em comparação com adultos jovens, especialmente se eles estão sob 14. É necessário promover campanhas de prevenção da gravidez na adolescência, como a principal medida de controle sobre a população.PALAVRAS-CHAVE: parto abdominal, parto, complicações da gravidez, gravidez na adolescencia, adolescentes.

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In this study were identified and quantified the risk factors associated to live births with low birth weight in Rio Grande do Sul, in 2011 using data from the Information System on Live Births. The prevalence of low birth weight (LBW) was 8.1%. By adjusting logistic regression, two models were proposed. For the first one, the predictors significant risk variables at 5% were: mothers aged 35 or more; nulliparous; with elementary school II or high school; legally separated or divorced; mothers who did not receive prenatal care; birth that occurred outside the hospital; prematurity; female and who had congenital anomaly. The protective effects variables were teenage mothers and who did not work outside the home. The type of delivery was included in the second model proposed, which was more appropriate to estimate the probability of a live birth born underweight. It was possible to conclude that it is important to consider effective actions to vulnerable groups aiming to reduce LBW rates, examining the strong association with infant mortality rates.

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Objective: To identify smokeless tobacco as a risk factor in the development of head and neck cancers and to assess the role of ethnicity in the use of smokeless tobacco in developing head and neck cancers. Study Design: Case-control study. Place and Duration of Study: Department of Medical Oncology, Jinnah Postgraduate Medical Center, Karachi Pakistan, from Dec 2018 to Jun 2019. Methodology: Three hundred patients, aged 18-85 years of either gender were included in the study. Cases were the patients visiting Oncology OPD with biopsy-proven head and neck cancers (HNCs). Controls were patients presenting at the same hospital for a routine checkup. We interviewed participants by using a pre-designed proforma. Results: The mean age of the cases and controls were reported as 49.26±13.51 years and 40.12±14.89 years, respectively. Majority of the participants were consuming pan (37.0%), gutka (22.6%), tobacco (21.3%), betel nut (19.6%), naswar (12.0%) and mainpuri (9.0%). The participants who consumed tobacco (OR:2.95), gutka (OR:2.39), mainpuri (OR:4.89), pan (OR:2.06) and betel nut (OR:2.28) were times more likely to develop HNCs than those who did not consume tobacco, gutka, mainpuri, pan and betel nut (p<0.05). Among Urdu speaking, the participants who consumed tobacco (OR: 2.49), pan (OR:10.35), and betel nut (OR:3.34), had times more likely to develop HNCs than those who did not consume tobacco, pan and betel nut. Conclusion: Mainpuri, naswar, betel quid, and betel nut significantly affect the oral health of people and are potential risk factors for the development of risk factors.

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AbstractLong-distance exchange of exotic preciosities, while it can occur in any sociopolitical context, may be associated with both chiefly formation and state hegemony. In the south central Andes, shared stylistic elements in early complex societies of Paracas-Nasca on the Peruvian south coast and Pukara in the altiplano suggest their contact via intermediate areas. Unfortunately, interpretations of the interaction of these great traditions tend to neglect indigenous sociopolitical development in regions between the two culture areas. Recent systematic survey in one such intermediate region, Peru's Moquegua Valley, has shed light on an indigenous pre-Tiwanaku culture with distinctive regional settlement patterns, complex mortuary practices, and a local ceramic tradition known as Huaracane (385 cal B. C-cal A. D. 340). Surface collections and test excavations confirm a minimal presence of exotic Pukara and Paracas-Nasca ceramics and textiles in association with elite local residential contexts and a late Huaracane mortuary tradition known as “boot tombs” that appears after 170 cal B. C. As there is no general emulation of foreign styles, domestic activities, or practices, an agency-oriented local perspective is favored over globalist colonial or clientage models to explain the role of exotica in a climate of competitive sociopolitical development.

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ZusammenfassungNach Durchführung prospektiv-randomisierter Studien liegen für die Karotis-Thrombendarteriektomie (KarotisTEA) höhergradiger Karotisstenosen gesicherte Indikationen auf dem Evidenzlevel Ia mit dem Empfehlungsgrad A vor. Dies betrifft sowohl >50%ige symptomatische als auch >60%ige asymptomatische Stenosen (NASCET-Kriterien). In Subgruppen-Analysen aus NASCET konnten klinische und morphologische Variablen identifiziert werden, die auf ein besonders hohes Risiko eines karotisbedingten Schlaganfalls im natürlichen Verlauf hinweisen. Patienten mit folgenden Variablen profitieren daher besonders von der Karotis-TEA: Stenosegrad >90%, schlechter Kollateralkreislauf, kontralateraler Karotisverschluss, Plaque-Ulzerationen, Tandemstenosen, intraluminale Thromben, nicht-lakunärer Hirninfarkt, Lebensalter >75 Jahre, komplexes klinisches Risikoprofil, Hemisphären-TIA (vs. Amaurosis fugax), männliches Geschlecht. Der präventive Effekt der Karotis-TEA kann jedoch nur unter Beachtung eines niedrigen perioperativen Schlaganfallbzw. Letalitätrisikos realisiert werden. Nach Empfehlungen der American Heart Association (AHA) darf das perioperative Risiko 3% bei asymptomatischen Stenosen ohne kontralaterale Stenose, 5% bei asymptomatischen Stenosen mit hochgradiger kontralateraler Stenose oder Verschluss und 6% bei symptomatischen >50%ige Stenosen (NASCET-Kriterien) nicht überschreiten. Die Ergebnisse der Qualitätssicherung Karotis-TEA der Deutschen Gesellschaft für Gefäßchirurgie (DGG) zeigen, dass diese maximal akzeptablen Obergrenzen zum Teil deutlich unterschritten werden. Vor diesem Hintergrund stellt das Stenting von Karotisstenosen einen klinischen Heilversuch dar, der nur nach interdisziplinärem Konsil und/oder i. R. randomisierter Studien zulässig ist.

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Object. In the second National Acute Spinal Cord Injury Study (NASCIS II) investigators evaluated several standard neurological parameters but not functional activity. This has led to questions concerning the clinical importance of the increase in neurological recovery observed following administration of methylprednisolone (MP) within 8 hours of acute spinal cord injury (SCI). The safety of the therapy has also been questioned. Methods. Both neurological and functional recovery were assessed in NASCIS III, a trial that followed an almost identical protocol to NASCIS II. In the current analysis locally weighted scatterplot smoothing (LOESS) nonparametric regression is used to model the extent of recovery in the Functional Independence Measure (FIM) that is predicted by improvement in the NASCIS/American Spinal Cord Injury Association motor scores that were documented in NASCIS III 1 year after SCI, and the models are applied to the extent of motor recovery demonstrated in NASCIS II. The models predict improvement in FIM that would be expected from the motor function recovery observed in NASCIS II. Estimates are provided overall and for patients with complete and incomplete neurological loss at time of injury. The authors review recent evidence obtained from randomized studies documenting adverse effects that may result from high-dose MP therapy. The relationship between motor function and FIM is strongly nonlinear and dependent on initial level of injury and degree of injury severity. In the best statistical model, the expanded motor score could be used to explain 77.2% of the variability in the FIM. Based on the mean MP-related 3.6-unit improvement in the motor score for patients with complete injuries and 7.3 for those with incomplete injuries owed to MP in NASCIS II, 18.6% of patients would improve six or more FIM points and 9% nine or more points, respectively. In those with complete neurological injury, the mean motor improvement of 3.6 predicted that 63.9% of the patients would improve three or more FIM points and 12.1% six or more points to a maximum of eight points. Of those with incomplete neurological injury, a 7.3 mean improvement in motor function predicted that 27.4% would gain six or more FIM points and that 21% would gain nine or more points to a maximum of 15 points. Analysis of the current best evidence from SCI and other randomized surgical trials in which high-dose MP has been administered provides no grounds for concern about commonly studied adverse effects. Conclusions. The extent of MP therapy—related motor function recovery observed in NASCIS II predicted clinically important recovery in the FIM. Reasons to be cautious with regard to this prediction include the lack of robustness in statistical modeling, some loss of validity in the FIM, and considerable heterogeneity in the SCI population. Whatever functional activity is ascribed to high-dose MP therapy, it is does not appear to be associated with risk of adverse outcomes.

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The trends of development of digital marketing were investigated using statistical data on Internet users in U.S., obtained from a study performed by Pew Research Center at the beginning of 2019, and in Ukraine, obtained from a study performed by the research holding Factum Group Ukraine on the initiative of International Association of Ukraine in ІІІ quarter 2018 and 2019. The data were collected by the following criteria: age, gender, education, region and finances. Data analysis for the two countries showed the same result. The technological awareness of the society increases every year, which leads to more efficient management, sales, transportation and financial services for the consumers/clients of the enterprise. Indicators also show that both children and adults, people living in the city and in the countryside, people who are financially independent and people with both middle and low income, people with higher education and professional primary education, they all use the Internet. For communication, making purchases, doing research etc. Society has gone digital and businesses need to adapt by changing their management practices. Marketers are creating ways to promote businesses by leveraging new technology. Marketing plays a key role in the digital revitalization of any enterprise. It is through digital marketing that consumers and businesses learn about certain events (legal, economic, social, religious, etc.), and not only are they being informed, they can also inform others. Mobile devices, the Internet, local area networks, digital television and other media can also be used to collect information and conduct marketing research.

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The article’s objective is to investigate using of environmental marketing in marketing strategies at company level through creating the concept of social responsibility of business, which has the social character and global implications, because the problems related with breaking environmental balance by production activities in a region or country have anthropogenic consequences for the whole world. Environmental technologies have been widely used in marketing strategies of companies, with large numbers of well known companies and corporations taking advantage of environmental or “green” marketing. But in Ukraine this trend is still at the early phase due to difficult social, economic and political conditions. Data is provided about the number of polluting companies on the Ukrainian territory, giving evidence of bad climate for investors that otherwise might invest in resource saving and environmentally friendly production technologies. Even the notions of “environmental economy” or “green economy” are new to Ukraine and not found in the official documents, although the strategic goals of economic development, outlined in Ukraine for the forthcoming 10 to 12 years, have something common with the objectives to transition to “green” economy. Yet, a change has already visible in the creation of a new “green movement”, a public association propagating environmental modernization of companies and standing for preservation of environment in region, city or village. In view of the above, using of environmental marketing is investigated by case of companies operating on consumer markets of Ukraine. The analysis of marketing activities of companies in promoting environmental innovation shows that it has good chances for further expansion. The study demonstrates that the environmental awareness of the population is growing, with some individuals displaying higher concern with preservation of own health and the environment, and these expectations can be met by the market of environmental goods, which is turning into a highly competitive and attractive niche.

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Background: Oral squamous cell carcinoma (OSCC) may arise from premalignant oral lesions (PMOL) in most cases. Minichromosome maintenance 3 (MCM3) is a proliferative marker that has been investigated as a potential diagnostic biomarker in the diagnosis of oral cancer. Objectives: To evaluate the association of MCM3 expression, its clinicopathologic parameters and to identify snuff (also called naswar) as a potential risk factor for changes in MCM3 expression in PMOL and OSCC. Methodology: Immunohistochemistry (IHC) of MCM3 was performed on 32 PMOL, 32 OSCC and 16 normal controls after optimization of IHC methodology. Histoscore (0–300) was used as a scoring system and seven different cut-offs were identified for analyses. Data were analyzed using various statistical tests. Results: Among the seven cutoffs, 40% strong positive cells were found to be a better cut-off as they were associated with many pathological variables (Broder’s grade, Aneroth’s grade, and mitotic activity). The differential MCM3 expression in oral lesions (PMOL and OSCC) was statistically significant (p = 0.03). Moreover, MCM3 expression is raised with increased duration and frequency of snuff use. Conclusion: High MCM3 expression is associated with disease progression and is a potential indicator of malignant transformations from PMOL to OSCC. Moreover, the use of snuff is associated with MCM3 over-expression.

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Given that the economic and social recovery of Ukraine is largerly conditional on its integration in the international economic system and effective involvement in the international division of labor, the article’s objective is to analyze preconditions and problems specific to the Ukraine’s integration in the global economic area. Intergration-specific aspects and problems in operation of the transport infrastructure and mining industry of Ukraine, strong and weak sides of Ukraine on the global energy market, the potentials of Ukraine in the agrarian sector are highlighted. It is emphasized that a priority mechanism for increasing the share of Ukraine’s trade on the European agrarian market is Free Trade Zone with EU, but a factor constraining growth in the agricultural exports of Ukraine to EU is failure of the most part of domestic producers to comply with technical, sanitary etc. terms for exporters to EU. The analysis covers statistical data on foreign trade of Ukraine in goods and services in 2016–2018, the commodity structure of Ukraine’s foreign trade in 2018, key indicators of the international trade of Ukraine in 2016–2018. It, above all, shows the negative balance of the Ukrainian foreign trade, which tendency is upward. The tradability index for the Ukrainian economy fell in this period from 81.0% до 79.9%, giving evidence of the decreasing participation of Ukraine in the international division of labor. The essential factors underlying the negative balance of foreign trade in goods are highlighted; measures to reduce the negative balance of foreign trade are proposed. The data showing the progress in Ukraine’s implementation of Association Agreement with EU are summed up. It is concluded that in spite of a series of steps towards the openness of Ukraine for the global market, the processes involved in the formation of the national foreign economic relations mechanism have been contradictory and ineffective. It calls for optimization of regulatory forms for foreign economic relations and implementation of a mechanism complying with the current terms of international economic relations.

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Abstract Objectives: estimate the strength of association between neonatal near miss and the nega-tive outcomes in the child’s first year of life. Methods: a prospective cohort study on neonatal survivors originating from a national survey “Nascer no Brasil (Born in Brazil), 2011-2012.” Main exposure: neonatal near miss (NNM). Negative outcomes: breastfeeding, hospitalization, and post neonatal death (tele-phone interview). For each outcome, the odds ratio (OR) were estimated by univariate (p<0.2) and multivariate (p<0.05) logistic regression models. Results: among 15,675 children 3.3% were neonatal near miss. Neonatal near miss was associated, after adjusting, to: weaning (OR=1.8); hospitalization after hospital discharge (OR=2.2); remained hospitalized (OR=65.6) and post neonatal death (OR=52.4) The increased OR after adjusting revealed negative confounding, such as “remained hospitalized since childbirth” (ORcrude=21.1 and ORadjusted=65.6). Conclusions: although neonatal near miss reflects a good quality of health care, avoiding neonatal death, these survivors have higher risk of negative outcomes in the first year of life.

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P152 Background: Leukoaraiosis (LA) is a frequent finding on CT scans of patients with vascular risk factors and cerebrovascular disease, particularly in those with lacunar stroke. Both conditions appear to be linked by a common pathophysiological mechanism, namely small vessel disease. Objective: To characterize the relationship between lacunar stroke and LA, and to correlate with the risk of recurrent lacunar stroke. Patients & Methods: Baseline CT scans of NASCET participants with stroke as the index event were assessed for the presence and severity of LA by two readers independently unaware of clinical data. Results: Four groups based on the type of index stroke and on the presence of LA were formed: a) no lacunar stroke & no LA (n=437), 2) non lacunar stroke & LA (n=153), c) lacunar stroke & no LA (n=365), d) lacunar stroke & LA (n=76). Baseline characteristics different among the groups were: age >65 years (53, 76, 56, 63% respectively p<0.001), hyperlipidemia (30, 20, 37, 29% respectively p=0.002), smoking (42, 28, 41, 45, 42% respectively p=0.02) and degree of carotid stenosis 50–99% (52, 44, 45, 34% respectively p=0.01). Patients with LA were 2.9 times more likely to have multiple lacunes on CT (p=0.001). The risk of lacunar stroke at 5 years increased across the four groups (5, 8, 10 and 11% respectively p=0.02), after adjusting for all baseline characteristics. Conclusions: The presence of leukoaraiosis in lacunar stroke patients is associated with higher number of lacunar infarcts and strongly predicts the likelihood of developing a subsequent lacunar stroke. Our findings support the hypothesis that both conditions are caused by the same pathological entity in this patient population.

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Abstract Objectives: to describe the profile of Brazilian Advanced Maternal Age (AMA) women (> 35 years) according to parity, as well as to analyze the role of parity in the relationship between AMA and mode of delivery. Methods: this is a cross-sectional study, based on the “Nascer no Brasil” (Born in Brazil) survey. The data were collected in 2011/2012. The chi-square test was performed to verify the association between parity and maternal, prenatal and delivery characteristics, maternal habits, pre-pregnancy diseases, maternal complications and obstetric history. Results: of the 2,510 puerperal AMA women, 20.2% were nulliparous, 54.4% had one or two previous births and 25.4% had three or more previous births. The nulliparous women had higher schooling, higher economic class and adequate BMI, were white; and had better maternal habits when compared to multiparous. However, they were also more submitted to cesarean section, although without reported complications. Conclusions: one cannot speak of AMA pregnant women as a hom*ogeneous group in Brazil. There are inequalities that can be revealed via parity, since nulliparous women have maternal characteristics, habits and access to prenatal care and childbirth that are more advantageous than multiparous women.

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Mounting evidence indicates an association between adipokines and inflammation-related atherosclerosis. Here, we sought to investigate the association of vaspin and omentin with clinical characteristics and outcomes of patients with acute cerebral ischemia (ACI). Consecutive ACI patients were evaluated within 24 h from symptom-onset. Stroke aetiology was classified using TOAST criteria. Adipokines were assayed using quantikine enzyme immunoassay commercially available kits. Stroke severity was assessed by NIHSS-score, and ipsilateral carotid stenosis (≥50% by NASCET criteria) by ultrasound and CT/MR angiography. Major cerebrovascular events were assessed at three months. We included 135 ACI patients (05 (78%) and 30 (22%) with acute ischemic stroke and transient ischemic attack, respectively; mean age ± SD: 59 ± 10 years; 68% men; median NIHSS-score: 3 (IQR:1–7)). Omentin was strongly correlated to admission stroke severity (Spearman rho coefficient: +0.303; p < 0.001). Patients with ipsilateral carotid stenosis had higher omentin levels compared to patients without stenosis (13.3 ± 8.9 ng/mL vs. 9.5 ± 5.5 ng/mL, p = 0.014). Increasing omentin levels were independently associated with higher stroke severity (linear regression coefficient = 0.290; 95%CI: 0.063–0.516; p = 0.002) and ipsilateral carotid stenosis (linear regression coefficient = 3.411; 95%CI: 0.194–6.628; p = 0.038). No association of vaspin with clinical characteristics and outcomes was found. Circulating omentin may represent a biomarker for the presence of atherosclerotic plaque, associated with higher stroke severity in ACI patients.

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Background:Spondyloarthritis (SpA) and Familial Meditaerranean fever (FMF) may co-exist in certain populations, and have some overlapping manifestations (oligo-arthritis, hip involvement). Their association may impact disease phenotype and may affect disease management.Objectives:To evaluate the association of SpA and FMF and its impact on disease phenotype and management.Methods:A systematic literature search was conducted with the keywords spondyloarthritis and familial mediterranean fever from Janurary 1990 to January 2020 in PubMed and using manual cross-reference methods.Results:The search retrieved 74 articles, out of which 37 articles were relevant to the study question; most of the articles were case reports, with some large cohort studies of FMF and SpA (Flowchart in Figure 1).In large FMF cohorts, the prevalence of SpA was higher compared to the general population (7.5-13%, OR around 10). M694V was a risk factor for SpA. These FMF-SpA patients were older at diagnosis, had lower fever attacks, and higher disease duration, inflammatory back pain, chronic arthritis, enthesopathy, persistent inflammation and higher resistance to Colchicine. In case series, they were responsive to anti-TNF therapy.In large SpA cohorts, MEFV mutation, particularly M694V, was found in 15-35% (even without associated FMF). In most cohorts, MEFV mutation carriers didn’t have any distinct disease phenotype, except for some reports of higher ESR, more hip involvement, higher BASFI and higher BASDAI. Genome-wide association studies and case reports suggest an implication for IL-1 and thus a role for Anakinra therapy in these patients.Conclusion:In FMF or SpA patients with resistance to conventional therapy, the evaluation of disease association should be performed as it may have significant impact on disease management.References:[1]Li et al, Plos Genetics 2019. Watad et al, Frontiers Immunol 2019. Atas et al, Rheumatol Int 2019. Cherqaoui et al, JBS 2017. Zhong et al. Plos One 2017. Ornek et al, Arch Rheumatol 2016. Cinar et al, Rheumatol Int 2008. Durmur et al, JBS 2007.Figure 1.Flowchart of the systematic literature search (Spondyloarthritis, Familial Mediterranean Fever; January 1990-2020).Disclosure of Interests:Nelly Ziade Speakers bureau: Abbvie, Janssen, Lilly, Novartis, Pfizer, Roche, Sanofi, Aref Nassar: None declared

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BackgroundSpondyloarthritis includes an heterogeneous group of rheumatisms characterized by their strong association with HLA-B27 (1). The association between SpA and HLA-B 27 is one of the strongest known associations between an HLA allele and disease (2). Several studies have highlighted the importance of this association for diagnosis, predicting disease phenotype and prognosis of spondyloarthritis (SpA) (1.2).ObjectivesThe aim of the present study is to determine the prevalence of HLAB27 in Moroccan SpA patients and to analyze the correlation between HLAB27 status and different disease parameters.MethodsIt is a multicenter cross-sectional study including 256 SpA patients. Demographic, clinical, paraclinical and therapeutic parameters of the disease were collected. Disease activity was assessed by BASDAI and ASDAS-CRP scores. Patients were classified into two groups: HLAB27(+) and HLAB27(-). A comparison regarding HLA-B27 status was performed using the Mann-Whitney and Chi2 T-student tests. The significance threshold was set at p<0.05.Results256 SpA patients were included in the study, 241 patients have HLAB27 status of which 114 (44.5%) were HLAB27-positive. 46.6% of men and 40.9% of women were HLAB27-positive. 233 patients had axial SpA of which 110 patients (47.21%) were HLAB27-positive. The mean age was 39.58 ±12.89 years. The HLAB27-positive group had a longer diagnostic delay (p= 0.008) with a mean of 4 years. 46 patients had a family history of SpA of which 25.4% were HLAB27-positive and 11.8% HLAB27-negative (p=0.007). The HLAB27-positive patients had more axial manifestations (96.5% vs. 85.9%; p=0.01). While peripheral involvement was more noted in the HLAB27-negative group (90.6% vs 35.1%; p<0.001). Enthesopathy was more observed in the HLAb27-positive group (78% vs 62.2%; p=0.001). HLAB27-positive patients had more active disease defined by ASDAS-CRP (3.13±1.23 vs. 2.24±1.14; p<0.001). Only one case of uveitis was noted in the HLAb27-negative group versus 27 cases in the HLAB27-positive group (p<0.001). 33 HLAB27-positive patients had radiographic coxitis (33 vs16, p=0.002). The bDMARDS were more prescribed in the HLAB27-positive patients (58.8% vs 35.4%; p=0.009).ConclusionIn our study, the prevalence of HLAB27 was close to the MENA region (3). The presence of HLAB27 is related to an earlier disease onset, higher activity, to the presence of coxitis and uveitis and consequently more use of biotherapy in this group (HLAB27-positive).References[1]Arévalo M, Gratacós Masmitjà J, Moreno M, Calvet J, Orellana C, Ruiz D, Castro C, Carreto P, Larrosa M, Collantes E, Font P; REGISPONSER group. Influence of HLA-B27 on the Ankylosing Spondylitis phenotype: results from the REGISPONSER database. Arthritis Res Ther. 2018 Oct 3;20(1):221.[2]Kavadichanda CG, Geng J, Bulusu SN, Negi VS, Raghavan M. Spondyloarthritis and the Human Leukocyte Antigen (HLA)-B*27 Connection. Front Immunol. 2021 Mar 8;12:601518.[3]Slimani S, Hamdi W, Nassar K, Kalla AA. Spondyloarthritis in North Africa: an update. Clin Rheumatol. 2021 Sep;40(9):3401-3410.Disclosure of InterestsNone declared

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OBJECTIVE: To analyze the maternal characteristics and type of prenatal care associated with peregrination before childbirth among pregnant women in a northeastern Brazilian state. METHODS: Quantitative and transversal study, with descriptive and analytical approaches, part of the Nascer em Sergipe research held between June 2015 and April 2016. A total of 768 puerperal women proportionally distributed across all maternities of the state (n = 11) were evaluated. Data were collected in interviews and from prenatal records. The associations between antepartum peregrination and the exposure variables were described in absolute and relative frequencies, crude and adjusted odds ratios and their respective confidence intervals. RESULTS: Antepartum peregrination was reported by 29.4% (n = 226) of the interviewees, most of whom sought care in a single service before the current one (87.6%; n = 198). It should be noted that antepartum peregrination was less frequent among women aged ≥ 20 years old (OR = 0.50; 95%CI 0.34–0.71), with high education level (OR = 0.42; 95%CI 0.31–0.59) and a paid job (adjusted OR = 0.59; 95%CI 0.41–0.82), who had been instructed during prenatal care about the referral maternity for childbirth (adjusted OR = 0.88; 95%CI 0.42–0.92), and who used the private service to receive prenatal (adjusted OR = 0.44; 95%CI 0.18–0.86) or childbirth (adjusted OR = 0.96; 95%CI 0.66–0.98) care. No statistical evidence of associations between gestational characteristics and the occurrence of peregrination was observed. CONCLUSIONS: Antepartum peregrination suffers interference from the mother’s socioeconomic characteristics, the type of prenatal care received and the source of funding for childbirth.

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O livro “Avaliação de competências no internato: atividades profissionais confiabilizadoras essenciais para a prática médica” nasceu de um projeto colaborativo interinstitucional, que articulou dezenas de professores de duas escolas médicas – da Universidade Federal do Rio Grande do Sul (UFRGS) e da Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) –, motivados a aprimorar os processos de avaliação do internato médico, em sintonia com teorias e práticas da educação baseada em competências. Disponível para acesso livre no Lume – Repositório Digital da Universidade Federal do Rio Grande do Sul, trata-se de uma obra oportuna e relevante, primeiramente pelo pioneirismo em oferecer aos preceptores e alunos do internato médico, assim como todo interessado em educação de profissionais de saúde, no contexto brasileiro, um apanhado consistente do que são as EPAs aplicáveis à transição da graduação para a prática médica. Mas, sobretudo, por apresentar uma adaptação à realidade brasileira, cuidadosa e detalhada, das diretrizes da iniciativa “The Core Entrustable Professional Activities (EPAs) for Entering Residency”, publicada pela Association of American Medical Colleges, em 2014, que se refere a treze EPAs consideradas essenciais, com acréscimo de mais duas, adaptadas de “Entrustable Professional Activities for the Transition from Medical School to Residency”, proposta pela Association of Faculties of Medicine of Canada, em 2016.

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POR QUE DISCUTIR O ESTUDO RIVER? Como Presidente do Comitê Executivo do estudo RIVER, é um prazer discutir os resultados deste ensaio clínico randomizado,100% brasileiro, apresentado na sessão de Late Breaking Clinical Trials do congresso da American Heart Association (AHA) 2020. Os resultados principais foram publicados no New England Journal of Medicine , o que demonstra a força e a maturidade da cardiologia brasileira em gerar resultados com impacto clínico internacional. O estudo RIVER avaliou o tratamento com rivaroxabana em pacientes com fibrilação atrial e bioprótese mitral. Este foi um projeto colaborativo, liderado por um Comitê executivo acadêmico. O estudo nasceu na SOCESP e teve a égide e apoio científico desta sociedade para sua condução. As operações do estudo foram conduzidas pelo Instituto de Pesquisa do HCor. O estudo foi financiado pelo programa PROADI-SUS e pela Bayer. Descritores: Válvula Mitral; Fibrilação Atrial; Rivaroxabana

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IntroductionHeadaches, dizziness and memory loss of unspecific causes are the most common non-acute ischemia symptoms in the ageing population, which are often associated with cerebral small vessel disease (CSVD) imaging markers; however, there is insufficient evidence concerning their association with the development of cognitive decline. This study aims to investigate risk factors, clinical course, cerebral and retinal imaging changes, proteomics features of non-symptomatic ischaemia symptomatic patients with cognitive decline.Methods and analysisThe Non-Acute Symptomatic Cerebral Ischemia Registration study is a multicentre, registry-based, prospective observational study, is designed to investigate the cognitive decline in non-acute ischaemia symptomatic patients. We will recruit 500 non-acute ischaemia symptomatic patients from four tertiary hospitals in China. For this study, non-acute ischaemia symptoms will be defined as headaches, dizziness and memory loss. Patients with headaches, dizziness or memory loss over 50 years of age will be included. Clinical features, cognitive assessment, cerebral and retinal imaging data, and a blood sample will be collected after recruitment. Patients will be followed up by structured telephone interviews at 1, 2, 3, 4, 5 years after recruitment. This study will improve our knowledge of the development of cognitive decline in non-acute ischaemia symptomatic patients and factors affecting the cognitive outcomes, which will eventually elucidate underlying pathways and mechanisms of cognitive decline in these patients and facilitate the optimisation of individualised interventions for its prevention and treatment.Ethics and disseminationEthics approval is obtained from The Biomedical Research Ethics Committee of West China Hospital, Sichuan University (Reference No. 2016 (335)). We will present our findings at national and international conferences and peer-reviewed journals in stroke and neurology.Trial registration numberChiCTR-COC-17013056.

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The third decade of the Association of Muslim Social Scientists' (AMSS)existence witnessed the collective effort by some of its members to identify majorareas for inclusion in its research agenda. Besides taking stock of past performance,the main determinants included those recent events in the ummah whichhave affected it as a whole and the ensuing problems calling for immediateattention.Following established tradition, the AMSS and one of its sister professionalorganizations, the Association of Muslim Scientists and Engineers (AMSE),convened their conferences at the same time and place.This year's banquet speaker was H.R.H. Crown Prince Hasan bin Talalof Jordan, whose address was delivered in his absence by Mohammad A.Hamadan, former Minister of Education of Jordan. The main thrust of PrinceHasan's address was the need for cooperation among the ummah's varioussegments in the service of professional and human resource development. TheIsma'il and Lamya al Fariiqi Memorial Lecture was given by Zafar I. Ansari,Director General, Islamic Research Center, Islamabad, Pakistan. The AMSEkeynote speaker was Ali Nayfeh, Virginia Polytechnic Institute and State University,Blacksburg, VA. Nayfeh suggested practical ways of fostering scientificand technological advancement in the ummah through intra-ummah as well asinternational collaboration.The main program consisted of seventeen thematic panels organized intoeleven sessions. The opening session was chaired by Sayyid M. Syeed, GeneralSecretary of the AMSS. It consisted of the welcome speeches of S. ImtiazAhmad, Conference Chair and President of the Islamic Society of NorthAmerica (ISNA); Sulayman Nyang, President of the AMSS; and MohammadZohdy, President of the AMSE. The Convention Chair also read out the felicitousmessages received from the White House, the State House, and the localgovernment. The program preview was given by its co-chairs, Mumtaz Ahmadand Dilnawaz Siddiqui (AMSS), and Sayed A. Nassar (AMSE).The second session had two concurrent panels: 1) "History of Muslim Communitiesin North America;' organized and moderated by Salahuddin Malik,State University of New York (SUNY ) at Brockport, Brockport, NY, and 2)'J\ndragogy: Education of Adults;' which was chaired by Mushtaqur Rahman,University oflowa at Ames, Ames, IA. The history panel featured Anwar Dil,U.S. International University, San Diego, CA, who traced the history of Muslim ...

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Considerando a importância, pertinência e eficácia do estudo de temáticas relacionadas com as culturas clássicas para ampliação do repertório histórico, social e cultural, bem como do desenvolvimento do pensamento crítico e da ampliação das competências linguísticas de seus estudantes, e tendo em vista a aproximação entre universidade, educação básica e comunidade, uma previsão da constituição federal brasileira, do PNE – Plano Nacional de Educação 2014-2024 e do PDI – Plano de Desenvolvimento Institucional da FURB – Universidade de Blumenau, o projeto Paideia teve por objetivo promover um curso de iniciação ao estudo da cultura e do idioma grego antigo na cidade de Blumenau, Santa Catarina. O curso nasceu de uma parceria entre o LABEAM – Laboratório Blumenauense de Estudos Antigos e Medievais da FURB e da ETEVI – Escola Técnica do Vale do Itajaí e, a partir do método Aprendendo Grego, da Joint Association of Classical Teachers, permitiu que acadêmicos de graduação e pós-graduação de todas as áreas do saber da Universidade, estudantes da ETEVI, da rede de educação básica dos ensinos fundamental e médio da região, membros da comunidade do Vale do Itajaí e demais interessados pudessem ter a oportunidade de estudar, em nível básico e introdutório, a cultura e o idioma grego antigo. Este artigo tem por objetivo socializar de forma problematizadora os resultados do projeto.

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<b><i>Introduction:</i></b> Little is known regarding long-term stroke outcomes in patients with substance use disorder (SUD). Based on anecdotal data, some individuals use illicit drugs, particularly opioids, in an attempt to reduce stroke mortality, disability, or recurrence. This study is aimed to assess the effect of SUD on stroke outcomes. <b><i>Methods:</i></b> Patients were recruited from the Mashhad Stroke Incidence Study, a population-based study of stroke in Iran. For a period of 1 year, all patients with first-ever stroke (FES) were recruited and then followed up for the next 5 years. Disability and functional dependency were defined using modified Rankin Scale (&#x3e;2) and Barthel Index (&#x3c;60), respectively. We compared the cumulative rates of mortality in follow-up points using the log-rank test. We used multivariable logistic, Cox regression and competing risk models to assess adjusted hazard ratio (aHR) with 95% confidence interval (CI) of stroke disability, functional dependency, mortality, and recurrence among those with a history of SUD. <b><i>Results:</i></b> 595 FES patients (mean age of 64.6 ± 14.8 years) were recruited in this study. Eighty-one (13.6%) were current substance users, including opium (<i>n</i> = 68), naswar (<i>n</i> = 5, 6.1%), hashish (<i>n</i> = 1), heroin (<i>n</i> = 1), and (<i>n</i> = 7) others. The frequency of vascular risk factors was similar between the SUD and non-SUD groups, except for a higher rate of cigarette smoking in the SUD group (<i>p</i> &#x3c; 0.001). After adjusting for various sociodemographic variables, vascular risk factors, and the severity of stroke at admission, SUD increased the 3-month (aHR: 1.60, CI: 1.01–2.49), 1-year (aHR: 1.73, CI: 1.20–2.65), and 5-year (aHR: 1.72, CI: 1.23–2.35) poststroke mortality risk. We did not observe a significant change in the risk of stroke recurrence, disability, and functional dependency in those with a history of SUD. <b><i>Conclusion:</i></b> SUD increased the hazard ratio of stroke mortality with no effect on the disability rate. The public should be advised about the potential harm of substance abuse.

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In this paper we report that the assembly of interendothelial junctions containing the cell type-specific vascular endothelial cadherin (VE-cadherin or cadherin-5) is a dynamic process which is affected by the functional state of the cells. Immunofluorescence double labeling of endothelial cells (EC) cultures indicated that VE-cadherin, alpha-catenin, and beta-catenin colocalized in areas of cell to cell contact both in sparse and confluent EC monolayers. In contrast, plakoglobin became associated with cell-cell junctions only in tightly confluent cells concomitantly with an increase in its protein and mRNA levels. Furthermore, the amount of plakoglobin coimmunoprecipitated with VE-cadherin, increased in closely packed monolayers. Artificial wounding of confluent EC monolayers resulted in a major reorganization of VE-cadherin, alpha-catenin, beta-catenin, and plakoglobin. All these proteins decreased in intensity at the boundaries of EC migrating into the lesion. In contrast, EC located immediately behind the migrating front retained junctional VE-cadherin, alpha-catenin, and beta-catenin while plakoglobin was absent from these sites. In line with this observation, the amount of plakoglobin coimmunoprecipitated with VE-cadherin decreased in migrating EC. These data suggest that VE-cadherin, alpha-catenin, and beta-catenin are already associated with each other at early stages of intercellular adhesion and become readily organized at nascant cell contacts. Plakoglobin, on the other hand, associates with junctions only when cells approach confluence. When cells migrate, this order is reversed, namely, plakoglobin dissociates first and, then, VE-cadherin, alpha-catenin, and beta-catenin disassemble from the junctions. The late association of plakoglobin with junctions suggests that while VE-cadherin/alpha-catenin/beta-catenin complex can function as an early recognition mechanism between EC, the formation of mature, cytoskeleton-bound junctions requires plakoglobin synthesis and organization.

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Mario Bunge nasceu em Buenos Aires, em 21 de setembro de 1919. Realizou seus estudos na Universidade Nacional de la Plata, obtendo seu doutorado em ciências físico-matemáticas em 1952. Foi professor de Física Teórica e Filosofia em Buenos Aires, entre 1956 a 1966. Em seguida, tornou-se professor de Lógica e Metafísica na Universidade McGill, em Montreal, onde trabalha desde 1966. Bunge recebeu vinte e quatro doutorados Honoris Causa, sendo membro da American Association for the Advancement of Science (desde 1984) e da Royal Society of Canadá (desde 1992). Em 1982, Bunge foi premiado com o Prêmio Príncipe das Astúrias, em 2009 com a bolsa Guggenheim e, em 2014, com o prêmio Ludwig Von Bertalanffy em Complexity Thinking. É autor de dezenas de livros, entre os quais estão Metascientific Queries (Charles C. Thomas, 1959); Intuition and Science (Prentice-Hall, 1962; Greenwood Press, 1975); The Myth of Simplicity. (Prentice-Hall, 1963). Scientific Research, 2 volumes (Springer, 1967); Foundations of Physics (Springer, 1967); Philosophy of Science: From Problem to Theory, Vol. 1 (Transaction Publishers, 1998); Philosophy of Science: From Explanation to Justification, Vol. 2(Transaction Publishers, 1998); Scientific Realism: Selected Essays by Mario Bunge. Ed. Martin Mahner (Amherst, NY: Prometheus Books, 2001); El problema mente – cerebro (Madrid: Tecnos, 2002); Emergence and Convergence (Toronto: University of Toronto Press, 2003), entre outros.

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The second joint congress of l’Association des Médicins Biochimistes du Québec (AMBQ) and the Canadian Association of Medical Biochemists (CAMB) was held this year from October 7 to 9 in Montreal. The setting was the picturesque Hôtel Place d’Armes, which is situated in the historic Old Montreal district. There were over 60 attendees comprising both Specialists and Medical residents-in-training and representing the breadth of Canada from the Atlantic to the Pacific. The scientific committee composed of Dr. Jean. Dubé (Centre Hospitalier U. de Sherbrooke), Dr. Bernard Fruteau-de-Laclos (Centre Hospitalier AUQ), Dr. Élaine Letendre (Centre Hospitalier U. de Montreal), Dr. Bassam A. Nassar (Capital Health) and Dr. Claude Petitclerc (CHUM) arranged a series of informative and interesting scientific sessions. Day 1 saw a training session for the medical residents conducted by Dr. Yves Giguère (Centre Hospitalier de l’U. Laval) on Prenatal Screening. A meeting of the specialty committee of the Royal College for Medical Biochemistry followed this. A major topic of this meeting was the re-alignment of the training requirements. Day 2 began with the business meeting of the AMBQ. The scientific sessions began later that day with a session on “Pharmacotoxicology and the Role of the Laboratory” chaired by Drs. Andre Mattman (B.C. Children & Women’s Health Centre) and Bassam A. Nassar. The first speaker, Dr. Margaret Thompson (Hospital for Sick Children), in her talk “Clinical Toxicology – for the Laboratory” reviewed the role of the Ontario Poison Centre, which may serve as a model for the rest of the country. This was followed by Dr. Zulfikarali Verjee (HSC), who is clearly a master of the subject, with his talk, “Challenges in Urine Drug Screens: Ongoing Issues”. The morning session ended with Dr. Andre Mattman’s presentation “Heavy Metal Toxins – How and Why to Test in the Clinical Laboratory”. Day 3 moderated by Dr. Élaine Letendre (CHUM) focused on risk factors for cardiovascular disease. The first speaker in the morning was Dr. Jacques Genest Jr. (McGill University Health Centre) who reviewed the new Canadian guidelines for the diagnosis and treatment of dyslipidemias. He described in detail the thinking behind the new guidelines. This was followed by a presentation by Dr. Allan Jaffe (Mayo Clinic) who gave the audience a most authoritative description of the soon to be introduced fourth generation high sensitivity assays for troponins. These assays will have a marked impact on the assessment of cardiac damage perhaps even more so than the original introduction of the troponins. The afternoon featured three speakers discussing the pro and cons of high-sensitivity C-reactive protein for the assessment of cardiovascular disease. Dr. Jean Grégoire (Institut de cardiologie de Montréal) presented the pro side of the debate reviewing in particular the recent Jupiter trial. Dr. James Brophy (MUHC) presented the con side of the debate in a most entertaining manner. He even had the audience performing stretching exercises! It was left to Dr. Jean Bergeron (CHUL) to provide a balanced view of the two preceding speakers. The last day, Day 4, was primarily dedicated to oral and poster presentations by the residents. A jury consisting of Drs. Jean Dubé (CHUS), Yves Guigère (CHUL), and Joël Girouard (CHUL) had the “difficult” task of awarding prizes to the best oral and to the best poster presentations. The winners this year were Dr. Alexis Blaass (U. de Montréal) for the oral presentation entitled “Characterization of a new LCAT mutation causing familial LCAT deficiency (FLD) and the role of APOE as a modifier gene of the FLD phenotype” and Dr. Adell Elsharif (McMaster U.) for the poster presentation entitled “Method Validation Study to Evaluate the Analytical Performance of the STAT–SITE Meter for the Measurement of Serum Beta-Hydroxybutyrate”. The scientific portion of the conference ended with a most comprehensive presentation on smoking cessation, both clinical approaches and therapeutics by Dr. Joanne Provencher (Hôpital Laval). Dr. Provencher reminded us that smoking cessation by an individual could be achieved with the correct support. The day and the congress ended with a business meeting of the CAMB chaired by the out going president, Dr. Bassam A. Nassar. A new executive was elected: Dr. Elizabeth MacNamara (SMBD-Jewish General Hospital, president), Dr. Yves Guigère (CHUL, vice-president), Dr. Andrew Don-Wauchope (McMaster U. Health Sciences Centre, secretary-treasurer), Dr. Andre Mattman (BCCWHC, councilor), Dr. Brian M. Gilfix (MUHC, councilor), Dr. John Heathcote (Vancouver, councilor), and Dr. Datlily Ooi (Children’s Hospital of Eastern Ontario, councilor), We all look forward to next year’s combined meeting which is again slated to take place in Montreal in October.

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Background and Objectives: The burden of stroke in Sri Lanka is on the increase with the current demographic transition toward an ageing population. However, the association of symptomatic extracranial carotid artery stenosis (CAS) in ischemic stroke has not been prospectively evaluated in a Sri Lankan cohort of ischemic stroke patients. Globally population-based studies have estimated about 15% of ischemic strokes are caused by large vessel occlusions. It is commonly believed that the prevalence of significant extracranial CAS is low in Sri Lanka compared to western populations. The purpose our study is to systematically analyses and assess this long held notion and to search for other associated causative factors. Methods: The study population comprised of 164 acute ischemic stroke patients admitted consecutively to the National hospital of Sri Lanka over a period of 3 months. Carotid artery duplex scans were done by a single well-trained operator within 2 weeks of presentation and degree of CAS was classified as low (<50%), moderate (50-69%), severe (>70%) and complete occlusion according to NASCET criteria. Factors associated with CAS were identified by stepwise multiple logistic regression analysis. Results: Out of 164 ischemic stroke patients 104 (63.4%) were male and 60 (36.6%) were female. The mean age of stroke patients was 62.2+- 14.21 years. 139 (84.8%) had low grade stenosis, 10 (6.1%) had moderate stenosis, 7 (4.2%) had severe stenosis and 8 (4.9 %) had complete stenosis of carotid artery. Older age and presence of previous TIAs were significantly associated with CAS. Gender, hypertension, diabetes mellitus, hypercholesterolemia, IHD, previous stroke, previous TIA, previous use of antiplatelets, family history of stroke, previous use of statins and presence of carotid bruit were not significantly associated. Conclusion: Extracranial carotid artery occlusion previously considered a rare cause of ischemic stroke in Sri Lanka was found to be having prevalence similar to western populations in this study with over 15% having significant stenosis. Hence, we emphasize that early carotid doppler studies must be performed in all ischemic strokes at least within two weeks and necessary interventions carried out where it is deemed necessary.

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P144 Background: High serum creatinine (SCr) is a predictor of mortality in patients with hypertension, myocardial infarction (MI), and stroke. In men it is associated with stroke. Objective: Examine the relationship between SCr and the risk of stroke, MI, and vascular death (VD) in patients with symptomatic internal carotid artery (ICA) stenosis. Methods: Data from 1977 male NASCET patients with baseline SCr measurements were analyzed. Results: Increased levels of SCr were associated with older age and a higher prevalence of hypertension, history of MI or angina, and intermittent claudication. No association was found between the level of SCr and a history of diabetes or hyperlipidemia or with the type and location of prior cerebrovascular ischemic events. The Kaplan-Meier risk for the outcomes of stroke at 5 years, MI at 5 years, and the combined outcome of stroke, MI, or VD at 5 years increased with increasing levels of SCr (all at a p< 0.001, table). This increased risk was unconfounded and remained statistically significant after adjusting for all baseline characteristics using Cox proportional hazards regression model. The causes of stroke were similar in all SCr level groups (70% large artery, 22% lacunar, 8% cardioembolic). The risk of death from any cause at 5 years increased with increased SCr levels, cardiac disorders were the predominant cause of death. Conclusion: A mild to moderate elevation of serum creatinine level is an independent risk factor for stroke, MI, and VD in male patients with recent ischemic symptoms attributable to carotid artery stenosis.

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Legalization of recreational cannabis in Ontario included the legalization of flower and herbs (Phase 1, October 2018), and was followed by the deregulation of cannabis retailers and sales of edibles (Phase 2, February 2020). Research on the impact of cannabis legalization on acute care utilization is nascet; no research has investigated potential age, gender, and geographically vulnerable subgroup effects. Residents living in Northern Ontario not only have higher levels of substance use problems, but also have inadequate access to primary healthcare. Our study investigated the impact of Ontario’s recreational cannabis policy (including Phase 1 and 2) on cannabis-attributable emergency department (ED) visits, and estimated the impact separately for different age and gender groups, with additional analyses focused on Northern Ontarians. We created a cohort of adults (18 and over) eligible for provincial universal health insurance with continuous coverage from 2015–2021 (n = 14,900,820). An interrupted time series was used to examine the immediate impact and month-to-month changes in cannabis-related ED visits associated with Phase 1 & 2 for each subgroup. While Northern Ontario has higher rates of cannabis-related ED visits, both Northern and Southern Ontario show similar patterns of changes. Phase 1 was associated with significant increases in adults 25–64, with the strongest increases seen in women 45–64. Month-to-month trends were flattened in most groups compared to pre-legalization. Phase 2 was associated with significant immediate increases for adults aged 18–44 in both genders, but the increases were larger in women than men. No significant month-to-month changes were detected in this period. While current preventive efforts are largely focused on reducing cannabis-related harms in youths and younger adults, our results show that adults 25–64, particularly women, have been significantly impacted by cannabis policies. Further research on gender-specific cannabis dosage and targeted interventions for adult women should be investigated. Legalization did not appear to have a differential impact on Northern versus Southern Ontario, but higher rates of ED visits in the North should be addressed.

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AbstractThe enamel defects, hypoplasia and hypo mineralization, are classified as dental anomalies of structure, being frequently found in deciduous and permanent dentitions, since the permanent teeth and second deciduous molars finish their total mineralization after the age of three. The aim of the present study was to identify the presence of hypo mineralization and/or enamel hypoplasia and to associate it with respiratory problems in infant patients. Of the 90 patients evaluated, it was found that 23 male children (57.5%) and 22 female children (44%) had defects in the structure of tooth enamel. Most children were born by cesarean operation (64.4%), with no complications during birth (90.0%), 12.2% of children had dental anomalies (agenesis, ectopic canine, ankylosis, fusion, conoid tooth, and macrodontia, only 7 children showed an association between dental anomalies and enamel defects. Regarding respiratory problems that occurred up to 3 years of age, 38.9% had an episode of asthma, bronchitis, sinusitis, rhinitis, or pneumonia, and 55% had similar results at the current age. There was a positive association (Chi-square tests) between the presence of changes in the structure of tooth enamel and the presence of respiratory problems up to 3 years of age (p <0.001). It is concluded, therefore, that the presence of respiratory problems in early childhood, can interfere in amelogenesis, providing disturbances for the formation of normal enamel, causing defects or irregularities in the surface of the dental enamel, such as hypoplasias and hypo mineralization. Keywords: Dental Enamel Hypoplasia. Dental Enamel. Tooth Abnormalities. ResumoOs defeitos de esmalte, hipoplasia e hipomineralização, são classificados como anomalias dentárias de estrutura, sendo encontrados com frequência nas dentições decídua e permanente, já que os dentes permanentes e segundos molares decíduos finalizam sua total mineralização após os três anos de idade. O objetivo do presente estudo foi identificar a presença de hipomineralização e/ou hipoplasia de esmalte, e associá-la com problemas respiratórios no paciente infantil. Dos 90 pacientes avaliados, constatou-se que 23 crianças do gênero masculino (57,5%) e 22 do gênero feminino (44%) apresentaram defeitos na estrutura do esmalte dentário. A maioria das crianças nasceu de parto cesária (64,4%), sem complicação no parto (90,0%), 12,2% das crianças apresentaram anomalias dentárias (agenesia, canino ectópico, anquilose, fusão, dente conóide e macrodontia), somente 7 crianças apresentaram associação entre anomalias dentárias e defeitos de esmalte. Em relação à problemas respiratórios ocorrido até aos 3 anos de idade 38,9% apresentaram algum episódio de asma, bronquite, sinusite, rinite ou pneumonia e 55% apresentaram resultados semelhantes na idade atual. Houve associação positiva (Testes Qui Quadrado) entre a presença de alterações na estrutura do esmalte dentário e presença de problemas respiratórios até os 3 anos de idade (p<0,001). Conclui-se, portanto, que a presença de problemas respiratórios na primeira infância, podem interferir na amelogênese, proporcionando distúrbios para formação do esmalte normal, causando defeitos ou irregularidades na superfície do esmalte dentário, como hipoplasias e hipomineralizações. Palavras-chave: Hipoplasia do Esmalte Dentário. Esmalte Dentário. Anormalidades Dentárias.