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REFLECTION01-01-2015
Research lines in nursing: phylosophical and epistemological highlights
Revista Brasileira de Enfermagem. 2015;68(4):723-729
Abstract
REFLECTIONResearch lines in nursing: phylosophical and epistemological highlights
Revista Brasileira de Enfermagem. 2015;68(4):723-729
DOI 10.1590/0034-7167.2015680421p
Views0See moreRESUMEN
Objetivo:
elucidar destaques filosóficos y epistemológicos mediante consideraciones en favor de la casualidad de cuestiones en el interés de la Enfermería.
Método:
es fundamentado en las proposiciones teóricas de Johannes Hessen y de otros autores consagrados.
Resultados:
clareamiento de aspectos sustantivo e implicaciones adjetivas no sólo el interés de la investigación, resaltando los significados esenciales del asunto coincidido con las elaboraciones de disertaciones y tesis (Maestría y Doctorado de Enfermería).
Conclusión:
texto representa una contribución valiosa para esclarecer mejor detalles de la construcción del conocimiento en la temática y problemática del asunto puesto en causa.
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REFLECTION01-01-2015
Linhas de pesquisa em enfermagem: destaques filosóficos e epistemológicos
Revista Brasileira de Enfermagem. 2015;68(4):723-729
Abstract
REFLECTIONLinhas de pesquisa em enfermagem: destaques filosóficos e epistemológicos
Revista Brasileira de Enfermagem. 2015;68(4):723-729
DOI 10.1590/0034-7167.2015680421p
Views0See moreRESUMO
Objetivo:
elucidar destaques filosóficos e epistemológicos mediante considerações significativas, essenciais, em favor da causalidade de questões no interesse da Enfermagem.
Método:
abordagem fundamentada nas proposições teóricas de Johannes Hessen, com referência a outros autores expertos no tema.
Resultados:
esclarecimento de aspectos substantivos e implicações adjetivas não só no interesse da investigação, ressaltando os significados essenciais do assunto, condizente com as elaborações de dissertações de mestrado e teses de doutorado de Enfermagem.
Conclusão:
trata-se de uma contribuição valiosa para esclarecer melhor detalhes da construção do conhecimento na temática e problemática do assunto posto em causa, as linhas de pesquisa em enfermagem.
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REVIEW01-01-2015
Using the theory of meaningful learning in nursing education
Revista Brasileira de Enfermagem. 2015;68(4):713-722
Abstract
REVIEWUsing the theory of meaningful learning in nursing education
Revista Brasileira de Enfermagem. 2015;68(4):713-722
DOI 10.1590/0034-7167.2015680420i
Views0See moreABSTRACT
Objective:
to synthesize the scientific literature about the Theory of Meaningful Learning in the process of teaching and learning in nursing.
Method:
this is an integrative review conducted in the databases MEDLINE, LILACS, SciELO, BDENF and CINAHL with studies addressing the subject or aspects of the theory of meaningful learning of David Ausubel. Ten studies were included, from which six were written in Portuguese and four in English, published from 1998 to 2013.
Results:
five studies used the theory of meaningful learning, four studies cited Ausubel as the author of this theory and only two studies followed the framework for the application of the theory completely. There are only a few studies on this subject and those which explore it are not correlated with Ausubel’s theory.
Conclusion:
it is necessary to break with the dichotomy between theory and practice and promote the articulation of content with action, introducing the student as the author of their own knowledge.
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REVIEW01-01-2015
Nursing scientific production on health promotion, chronic condition, and aging
Revista Brasileira de Enfermagem. 2015;68(4):705-712
Abstract
REVIEWNursing scientific production on health promotion, chronic condition, and aging
Revista Brasileira de Enfermagem. 2015;68(4):705-712
DOI 10.1590/0034-7167.2015680419i
Views1See moreABSTRACT
Objective:
to characterize the scientific production of Postgraduate Programs Nursing in Brazil on health promotion with a focus on elderly people with chronic conditions in the period from 2006 to 2010.
Method:
integrative research developed by searching for dissertations and theses in the database of the Center for Nursing Studies and Research of the Brazilian Nursing Association published in the period from 2006 to 2010 and which focused on health promotion for elderly people with chronic conditions.
Results:
five themes emerged: “Living with the disease”; “Technologies of care”, “Potential for self-care” “Psycho-spiritual dimension”, and “Family caregiver”.
Conclusion:
it was possible to identify nursing care as a key element to promote the health of elderly people and make them more independent in their care so as to live with their limitations or disabilities, even when affected by chronic diseases.
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RESEARCH01-01-2015
Longevity according to life histories of the oldest-old
Revista Brasileira de Enfermagem. 2015;68(4):697-704
Abstract
RESEARCHLongevity according to life histories of the oldest-old
Revista Brasileira de Enfermagem. 2015;68(4):697-704
DOI 10.1590/0034-7167.2015680418i
Views0See moreABSTRACT
Objective:
to interpret life histories of the oldest-old in a community, grounded on the perspective of the Active Aging and Life Course.
Method:
this is a qualitative research. Participants included twenty seniors 80 years and older, users of a Basic Health Unit. Life histories were collected and analyzed according to the proposition of the Autobiographical Narrative Interview.
Results:
during the analytic process, elements found in the elders’ present and past arose, contributing to the development of a theoretical model: “Building longevity along the life course.”
Conclusion:
longevity is rooted in the past, strongly infl uenced by the family culture and life course; assumptions of the Active Aging are more meaningful in the informants’ present trajectory. The content of the narratives pointed to new possibilities of Gerontology Nursing intervention in Primary Care, aiming at health promotion and intervention, specially grounded on the respect to the oldest-elders’ culture.
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RESEARCH01-01-2015
Accuracy in inference of nursing diagnoses in heart failure patients
Revista Brasileira de Enfermagem. 2015;68(4):690-696
Abstract
RESEARCHAccuracy in inference of nursing diagnoses in heart failure patients
Revista Brasileira de Enfermagem. 2015;68(4):690-696
DOI 10.1590/0034-7167.2015680417i
Views0See moreABSTRACT
Objective:
to determine the accuracy of nursing diagnoses of fatigue, intolerance to activity and decreased cardiac output in hospitalized HF patients.
Method:
descriptive study applied to nurses with experience in NANDA-I and/or HF nursing diagnoses. Evaluation and accuracy were determined by calculating effi cacy (E), false negative (FN), false positive (FP) and trend (T) measures. Nurses who showed acceptable inspection for two diagnoses were selected.
Results:
the nursing diagnosis of fatigue was the most commonly mistaken diagnosis identifi ed by the nursing evaluators.
Discussion:
the search for improving diagnostic accuracy reaffi rms the need for continuous and specifi c training to improve the diagnosis capability of nurses.
Conclusion:
the training allowed the exercise of clinical judgment and better accuracy of nurses.
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RESEARCH01-01-2015
Direct cost of development and documentation of the nursing process
Revista Brasileira de Enfermagem. 2015;68(4):683-689
Abstract
RESEARCHDirect cost of development and documentation of the nursing process
Revista Brasileira de Enfermagem. 2015;68(4):683-689
DOI 10.1590/0034-7167.2015680416i
Views0See moreABSTRACT
Objective:
identify the average direct cost (ADC) of the activities performed by nursing professionals in the nursing process development and documentation at the medical clinic of a teaching hospital.
Method:
1040 activities were observed and the ADC was calculated by multiplying the time spent by professionals by the unit cost of direct labor.
Results:
the ADC of patient admission was R$ 55.57 (SD=19.44); among the activities of patient follow-up, the assessment phase documentation had the most significant ADC (R$ 17.70 – SD=14.60); the ADC of descriptive records corresponded to R$ 1.21 (SD=1.21) and the ADC of the nursing team for shift change was R$ 54.23 (SD=28.95).
Conclusion:
the study promotes visibility of the work performed by nursing professionals in the development of the nursing process, providing financial data to ensure consistent arguments for proper resources to its feasibility.
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RESEARCH01-01-2015
Health status and mental health in patients after percutaneous coronary intervention
Revista Brasileira de Enfermagem. 2015;68(4):676-682
Abstract
RESEARCHHealth status and mental health in patients after percutaneous coronary intervention
Revista Brasileira de Enfermagem. 2015;68(4):676-682
DOI 10.1590/0034-7167.2015680415i
Views0See moreABSTRACT
Objective:
to assess the association between perceived health status and the mental health of patients submitted to percutaneous coronary intervention after hospital discharge.
Method:
a quantitative and cross-sectional study involving 101 participants. The following instruments were used: a sociodemographic and clinical characterization instrument, the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), and the Hospital Anxiety and Depression Scale (HADS). Participants were divided into three groups: no anxiety and no depression (G1); anxiety or depression (G2); and both (G3). The ANOVA test was used for the intergroup comparison of means on the SF-36 domains.
Results:
There was an association between perceived health status and mental health. The participants in G1 presented higher scores in all SF-36 domains in comparison with participants in G2 and G3.
Conclusion:
Participants with no anxiety and depression presented better-perceived health status in comparison with those with anxiety or depression, or both.
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ORIGINAL ARTICLE01-10-2024
Nursing students and the internet: a reflection of digital ethics
Revista Brasileira de Enfermagem. 2024;77:e20230459
Abstract
ORIGINAL ARTICLENursing students and the internet: a reflection of digital ethics
Revista Brasileira de Enfermagem. 2024;77:e20230459
DOI 10.1590/0034-7167-2023-0459
Views0See moreABSTRACT
Objectives:
to identify how first-year nursing students use cyberspace and propose an orientation guide with criteria guiding the use of cyberspace.
Methods:
qualitative and descriptive research, carried out with 24 nursing students from a federal public institution in Rio de Janeiro. Data collection was carried out through semi-structured interviews. Data analysis occurred using IRAMUTEQ®. The research was approved by the institution’s Research Ethics Committee.
Results:
students use cyberspace to communicate, study, find “cool things”, share photos and memories. Furthermore, they are concerned about hate speech, intolerance and fake news. The good and bad sides and the types of technologies most used were also portrayed.
Final considerations:
the moral and ethical values of physical coexistence, together with awareness of individual responsibility, are the pillars for using cyberspace. The guide comes as an awareness tool.
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ORIGINAL ARTICLE01-10-2024
Maternity behind and beyond bars: analysis from the perspective of protection bioethics
Revista Brasileira de Enfermagem. 2024;77:e20220576
Abstract
ORIGINAL ARTICLEMaternity behind and beyond bars: analysis from the perspective of protection bioethics
Revista Brasileira de Enfermagem. 2024;77:e20220576
DOI 10.1590/0034-7167-2022-0576
Views0See moreABSTRACT
Objective:
to analyze how motherhood is expressed in female prison units from the perspective of Bioethics of Protection.
Method:
qualitative research with an ethnographic approach, developed in two women’s prison units. Participantes were: six mothers deprived of liberty, 15 health professionals, and nine prison officers. For data collection, semi-structured interviews and descriptive observation were used. Data analysis was based on the Content Analysis technique, thematic category.
Results:
three categories emerged: women and children violated behind bars (inequities); mothers and children in prison exacerbating imbalances, tensions and conflicts; and limits and references for resocialization.
Final Considerations:
the Bioethics of Protection proposal appears as a valid tool for the analytical direction of the process of confronting issues in the scope of public health in prison units, considering vulnerable groups and aiming at equity and human dignity.
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ORIGINAL ARTICLE01-10-2024
Self-harm in the two years of greatest restrictions during the covid-19 pandemic: a cross-sectional study
Revista Brasileira de Enfermagem. 2024;77:e20240289
Abstract
ORIGINAL ARTICLESelf-harm in the two years of greatest restrictions during the covid-19 pandemic: a cross-sectional study
Revista Brasileira de Enfermagem. 2024;77:e20240289
DOI 10.1590/0034-7167-2024-0289
Views0See moreABSTRACT
Objective:
to analyze occurrence of self-harm, sociodemographic profile of victims and referrals in the first 24 months of the COVID-19 pandemic in São Paulo.
Method:
cross-sectional study carried out by the Notifiable Diseases Information System with data on self-harm in São Paulo. The period outlined was March 2020 to February 2022. R (4.0.2) software and chi-square test were used.
Results:
there were 15,946 incidents. Victims were young, white, single, heterosexual women. There was high incidence of people with previous mental disorders more than once and without clear motivation. The method used was poisoning/intoxication. There was a considerable number of referrals to the health network, although not totalitarian.
Conclusion:
the years of greater insecurity in relation to the pandemic have given rise to self-harm cases with peculiar characteristics. Agile health policies must be applied in atypical conditions, such as pandemics, especially for adolescents/young people with previous mental disorders.
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REVIEW01-10-2024
Health of quilombola children as a challenge for the Sustainable Development Goals: a scoping review
Revista Brasileira de Enfermagem. 2024;77:e20240106
Abstract
REVIEWHealth of quilombola children as a challenge for the Sustainable Development Goals: a scoping review
Revista Brasileira de Enfermagem. 2024;77:e20240106
DOI 10.1590/0034-7167-2024-0106
Views0See moreABSTRACT
Objective:
to map the literature on quilombola children’s health and its relationship with the Sustainable Development Goals.
Method:
a scoping review, which followed the JBI protocol and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. Searches were conducted in the LILACS, BDENF, Web of Science, Scopus, MEDLINE databases and Google Scholar platform. The research protocol was registered in the Open Science Framework.
Results:
eighteen articles out of 2,055 studies were selected as relevant for this study. The articles were grouped into four axes: Access to healthcare services; Nutritional aspects of quilombola children; Health problems of quilombola children; and Care for quilombola children. The relationship between these articles and SDGs 1, 3, 4, 6 and 10 was observed.
Final considerations:
the study provided an extremely important mapping of the theme of quilombola children’s health and themes related to the Sustainable Development Goals.
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REVIEW01-10-2024
Prevalence and exposure variables of latent infection by mycobacterium tuberculosis in healthcare workers
Revista Brasileira de Enfermagem. 2024;77:e20240052
Abstract
REVIEWPrevalence and exposure variables of latent infection by mycobacterium tuberculosis in healthcare workers
Revista Brasileira de Enfermagem. 2024;77:e20240052
DOI 10.1590/0034-7167-2024-0052
Views0See moreABSTRACT
Objectives:
To identify in the scientific literature the prevalence, diagnostic methods, and exposure variables of latent infection by Mycobacterium tuberculosis in healthcare workers.
Methods:
An integrative review of the scientific literature based on the following review question: What are the available scientific evidence in the literature that address the prevalence of latent infection by Mycobacterium tuberculosis in healthcare workers and its association with possible risk factors among these workers?
Results:
Being a physician or nurse, being older, and being male were generally associated with higher prevalences. The study also showed that interferon-gamma release assays were more commonly used as a diagnostic method compared to skin tests.
Conclusions:
More studies are needed regarding the epidemiology of latent infection by Mycobacterium tuberculosis in the context of healthcare workers, aiming for higher impact actions that contribute to the reduction of tuberculosis worldwide.
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ORIGINAL ARTICLE08-07-2023
Perception of Portuguese nurses: clinical supervision and quality indicators in nursing care
Revista Brasileira de Enfermagem. 2023;76(3):e20220656
Abstract
ORIGINAL ARTICLEPerception of Portuguese nurses: clinical supervision and quality indicators in nursing care
Revista Brasileira de Enfermagem. 2023;76(3):e20220656
DOI 10.1590/0034-7167-2022-0656
Views0See moreABSTRACT
Objectives:
to describe nurses’ perception of the influence of clinical supervision on improving quality indicators in nursing care.
Methods:
exploratory research with a qualitative approach, carried out with 16 nurses using the focus group. Data processing emerged from lexicographical textual analysis, resorting to Descending Hierarchical Classification and similarity analysis.
Results:
80.0% retention of 185 text segments with six-class construction. The words were represented by four graphs (supervisor, audit, care, and process); and three subgraphs (implementation, sharing and knowledge).
Final Considerations:
in the perception of nurses, supervision influences quality indicators in nursing care.
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REVIEW08-07-2023
Early diagnosis of HIV/aids infection: concept analysis
Revista Brasileira de Enfermagem. 2023;76(3):e20220565
Abstract
REVIEWEarly diagnosis of HIV/aids infection: concept analysis
Revista Brasileira de Enfermagem. 2023;76(3):e20220565
DOI 10.1590/0034-7167-2022-0565
Views0ABSTRACT
Objectives:
to analyze the concept of “early diagnosis of HIV/Aids infection” in light of Walker and Avant’s conceptual analysis model.
Methods:
concept analysis study based on the framework proposed by Walker and Avant, instrumented by a scoping review conducted in April 2022, following the recommendations of the Joanna Briggs Institute and checklist Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. The search was made in eight data sources, obtaining sixteen articles.
Results:
the study found homosexual intercourses, early examination, anti-HIV antibodies, CD4 count, and sexually transmitted infection as the main attributes of the concept. As antecedents: information, risky behavior, unprotected sexual relations, prevention, and access to the service. As main consequences: antiretroviral treatment, seroconversion, transmission, and consultations.
Final Considerations:
the study approached the circumstantial situations of the theme, its attributes, antecedents, and consequences, qualifying the work process based on knowledge of nursing practice.
Keywords:Acquired Immunodeficiency SyndromeAIDS SerodiagnosisEarly DiagnosisHIV InfectionsHospital UnitsSee more -
ORIGINAL ARTICLE08-07-2023
Workload assessment: cross-cultural adaptation, content validity and instrument reliability
Revista Brasileira de Enfermagem. 2023;76(3):e20220556
Abstract
ORIGINAL ARTICLEWorkload assessment: cross-cultural adaptation, content validity and instrument reliability
Revista Brasileira de Enfermagem. 2023;76(3):e20220556
DOI 10.1590/0034-7167-2022-0556
Views0See moreABSTRACT
Objectives:
to adapt, validate the content and assess the reliability of the instrument National Aeronautics and Space Administration – Task Load Index, translated into Brazilian Portuguese.
Methods:
a methodological study, divided into five steps: translation; synthesis; back-translation; assessment of the Portuguese version by an expert committee; pre-test and content validity of the final version by health professionals working in inpatient units. The Content Validity Index (CVI) (minimum 0.80) and Cronbach’s alpha (minimum 0.70) were calculated.
Results:
in the first round, in the agreement analysis of the translated version, three items did not reach the minimum CVI value. It was decided to remove the statement. The instrument title and items “performance” and “effort” were changed. There was consensus and approval of the final version in the pre-test step.
Conclusions:
the NASA Task Load Index instrument, adapted to Brazilian Portuguese, presents reliability and content validity evidence.
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REVIEW08-07-2023
Instruments for assessing foot self-care of people with diabetes: a scoping review
Revista Brasileira de Enfermagem. 2023;76(3):e20220555
Abstract
REVIEWInstruments for assessing foot self-care of people with diabetes: a scoping review
Revista Brasileira de Enfermagem. 2023;76(3):e20220555
DOI 10.1590/0034-7167-2022-0555
Views0See moreABSTRACT
Objectives:
to map, in the world literature, instruments for assessing foot self-care of people with diabetes.
Methods:
a scoping review in Scopus by Elsevier, MEDLINE via PubMed, LILACS, SciELO databases and gray literature, using the controlled words diabetic foot, self care, questionnaire. Search was carried out in February and March 2021, according to JBI recommendations and PRISMA-ScR extension.
Results:
fifteen studies made up the review, 14 articles and one thesis, published between 2000 and 2020. 16 instruments were identified: five with an emphasis on general self-care and 11 on foot self-care. Inspection, hygiene, washing and drying between the toes, lotion application and use of proper shoes and socks were the main self-care measures presented.
Final Considerations:
foot self-care is assessed by knowledge, social support and frequency with which measures are being put into practice, encouraging professional practice.
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ORIGINAL ARTICLE08-07-2023
“Educational Material on HIV”: validity of health educational technology for people living with HIV
Revista Brasileira de Enfermagem. 2023;76(3):e20220549
Abstract
ORIGINAL ARTICLE“Educational Material on HIV”: validity of health educational technology for people living with HIV
Revista Brasileira de Enfermagem. 2023;76(3):e20220549
DOI 10.1590/0034-7167-2022-0549
Views0ABSTRACT
Objectives:
to validate the educational technology “Educational Material on HIV” (INPI – BR 10 2020 003765 0).
Methods:
a methodological study with 39 expert judges in HIV/AIDS, using a 5-point Likert scale for assessment. Data were tabulated, processed and analyzed through descriptive analysis. Cronbach’s alpha and McDonald’s omega tests were performed to analyze internal consistency, and the Intraclass Correlation Coefficient, for reliability. Agreement was established by a Level Content Validity Index greater than 0.90.
Results:
the assessment instrument showed high internal consistency (Cronbach’s alpha of 0.89; McDonald’s omega of 0.91) with reliable values. Based on the Intraclass Correlation Coefficient, judges’ answers showed acceptable reliability, mean score 0.89 (p<0.001). Agreement among judges was greater than 0.90 in the three assessed dimensions (objectives, presentation and relevance).
Conclusions:
the technology was considered a qualified and adequate tool by the judges regarding its objectives, presentation and relevance.
Keywords:Acquired Immunodeficiency SyndromeEducational TechnologyHealth EducationHIVValidation StudySee more -
ORIGINAL ARTICLE08-07-2023
Content validity of the Post-Stroke Guidance and Follow-up Booklet
Revista Brasileira de Enfermagem. 2023;76(3):e20220532
Abstract
ORIGINAL ARTICLEContent validity of the Post-Stroke Guidance and Follow-up Booklet
Revista Brasileira de Enfermagem. 2023;76(3):e20220532
DOI 10.1590/0034-7167-2022-0532
Views0See moreABSTRACT
Objectives:
to provide sources of content validity evidence for the Post-Stroke Guidance and Follow-up Booklet.
Methods:
a quantitative-qualitative approach, using two Delphi method and content analysis rounds. The Educational Content Validation Instrument in Health was sent to 53 independent judges. A Content Validity Index above 0.90 was considered.
Results:
of the 14 nurses who participated, 64.3% have experience with stroke care, 35.7% with primary care and 64.3% with educational material production. In content analysis, judges’ suggestions were stratified into four categories: material conformation, objectivity, accuracy and perception. Spelling changes were made to the images, addition of functionality scale, adequacy of technical terms and language. The Content Validity Index in the second round showed a concordance of 0.97.
Conclusions:
the booklet presented satisfactory content validity sources of evidence.
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ORIGINAL ARTICLE08-07-2023
Construction and validity of the Interprofessional Communication in Health Scale
Revista Brasileira de Enfermagem. 2023;76(3):e20220483
Abstract
ORIGINAL ARTICLEConstruction and validity of the Interprofessional Communication in Health Scale
Revista Brasileira de Enfermagem. 2023;76(3):e20220483
DOI 10.1590/0034-7167-2022-0483
Views0See moreABSTRACT
Objectives:
to construct and validate the Interprofessional Communication Scale in Health.
Methods:
a psychometric study was carried out on a sample of 360 nurses from a hospital and university center in central Portugal. Reliability was assessed through internal consistency and construct validity through exploratory and confirmatory factor analysis.
Results:
the Interprofessional Communication in Health Scale, consisting of 27 items, is organized into 3 factors: “Teamwork”, “Conflict management” and “Leadership”, with a total variance of 51.1%. Good internal consistency was obtained, with a Cronbach’s alpha of 0.842, and adequate Goodness of Fit Index model.
Conclusions:
the Interprofessional Communication in Health Scale presents a factorial structure with adequate validity and reliability results, and may constitute a useful self-report instrument in assessing interprofessional communication in health.
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ORIGINAL ARTICLE08-07-2023
Systematization of Nursing Care: how did the concept mature?
Revista Brasileira de Enfermagem. 2023;76(3):e20220464
Abstract
ORIGINAL ARTICLESystematization of Nursing Care: how did the concept mature?
Revista Brasileira de Enfermagem. 2023;76(3):e20220464
DOI 10.1590/0034-7167-2022-0464
Views0See moreABSTRACT
Objectives:
to analyze the Systematization of Nursing Care conceptual maturation from the perspective of pragmatic utility.
Methods:
a concept analysis study. The stages were: select the concept; elaborate analytical questions; comprehensively review the literature; and determine concept structural components. Sixty-one documents were analyzed after a search carried out until October 2019.
Results:
four temporal periods of contextual changes have occurred since the emergence of ideas of a systematization in the 1960s. This first lasted until 1990. It was followed by those from 1990 to 2002, from 2002 to 2009 and from 2009 onwards. Partial conceptual maturity was identified, operationalization over the years, based on multiple definitions, and, currently, a concept of Systematization of Nursing Care with managerial and organizational attributes.
Conclusions:
the concept of Systematization of Nursing Care is partially mature, presents multiple definitions, being operationalized in uncertain connections with other concepts.
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