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ORIGINAL ARTICLE09-20-2024
Risk assessment for postoperative complications in patients undergoing cardiac surgical procedures
Revista Brasileira de Enfermagem. 2024;77(4):e20230127
Abstract
ORIGINAL ARTICLERisk assessment for postoperative complications in patients undergoing cardiac surgical procedures
Revista Brasileira de Enfermagem. 2024;77(4):e20230127
DOI 10.1590/0034-7167-2023-0127
Views0ABSTRACT
Objectives:
to evaluate the risk of postoperative complications in cardiac patients.
Methods:
an evaluative study using the Tuman Score on medical records of 70 adult patients who underwent cardiac surgery at a University Hospital. The R for Windows software was used for the analyses. Descriptive statistics and bivariate analysis were employed to verify the association between the risk score and complications. The relative risk between the Tuman Score and postoperative complications was obtained through Quasi-Poisson regression, with a 95% confidence interval.
Results:
the majority of the patients were male (58.57%), aged between 41-64 years (50%), who underwent myocardial revascularization (50%). These patients were associated with a lower risk of postoperative complications (p=0.003), (p=0.008), and (p=0.000), respectively. High-risk patients had pulmonary complications (RR=1.32, p=0.002) and neurological complications (RR=1.20, p=0.047).
Conclusions:
preoperative risk assessment promotes qualified care to reduce postoperative complications.
Keywords:Cardiac Surgical ProceduresCardiovascular DiseasesCardiovascular NursingPostoperative ComplicationsRisk AssessmentSee more -
EXPERIENCE REPORT09-20-2024
Researchers’ experience in data collection with families of femicide victims
Revista Brasileira de Enfermagem. 2024;77(4):e20230119
Abstract
EXPERIENCE REPORTResearchers’ experience in data collection with families of femicide victims
Revista Brasileira de Enfermagem. 2024;77(4):e20230119
DOI 10.1590/0034-7167-2023-0119
Views0See moreABSTRACT
Objectives:
to describe researchers’ experience in collecting data from families of femicide victims.
Methods:
this descriptive, qualitative study took the form of an experience report and was conducted in Manaus, Amazonas, Brazil. It involved documentary consultation, training researchers, scheduling and conducting interviews, and using a field diary to record the researchers’ perceptions and experiences.
Results:
the descriptions and photographs of the crime scene were both distressing and impactful for the researchers. The mementos of the victims (including clothing, objects, and childhood photos) shown by their families were deeply moving. Identifying with these experiences facilitated listening to the stories told by the relatives. It was essential to maintain a non-judgmental attitude, acknowledge the loss, provide support for the suffering, and demonstrate a willingness to help.
Final Considerations:
the experience encompassed both theoretical and methodological aspects that were planned and executed in data collection, fostering the development of skills and sensitivity towards the cases. Beyond knowledge and preparation, researchers are expected to exhibit ethical conduct and empathetic capacity.
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ORIGINAL ARTICLE09-20-2024
Factors associated with preventable infant mortality in 2020: a Brazilian population-based study
Revista Brasileira de Enfermagem. 2024;77(4):e20230072
Abstract
ORIGINAL ARTICLEFactors associated with preventable infant mortality in 2020: a Brazilian population-based study
Revista Brasileira de Enfermagem. 2024;77(4):e20230072
DOI 10.1590/0034-7167-2023-0072
Views0ABSTRACT
Objectives:
to identify factors associated with preventable infant deaths, classified as neonatal and post-neonatal.
Methods:
this is an epidemiological and population-based study relating to 2020. Data from the Mortality Information System (MIS) and the preventability classification proposed in the Brazilian Health System List of Causes of Deaths Preventable by Interventions were used.
Results:
prematurity, living in the North and Northeast regions and the occurrence of the event at home were associated with preventable neonatal deaths. To the avoidable post-neonatal component, death outside the hospital, low maternal education and children of brown or yellow color/race were associated.
Conclusions:
the main risk factor associated with preventable deaths was prematurity, in the case of neonatal death. Low maternal education and occurrence outside the hospital were associated with post-neonatal deaths.
Keywords:Epidemiological StudiesHealth Care QualityHealth Information SystemsInfant MortalityVital StatisticsSee more -
EDITORIAL09-09-2024
Potential of Artificial Intelligence in Evidence-Based Practice in Nursing
Revista Brasileira de Enfermagem. 2024;77(5):e770501
Abstract
EDITORIALPotential of Artificial Intelligence in Evidence-Based Practice in Nursing
Revista Brasileira de Enfermagem. 2024;77(5):e770501
DOI 10.1590/0034-7167.2024770501
Views0Evidence-based practice (EBP) has established itself as a fundamental pillar in nursing, driving effective clinical decision-making based on high-quality scientific research. The primary goal of EBP is to ensure that patients receive the most appropriate and safe care, based on the best available evidence. In this context, knowledge synthesis methods are essential tools for EBP, […]See more -
REVIEW09-06-2024
Parents’ or legal guardians’ beliefs and attitudes about childhood vaccination: a scoping review
Revista Brasileira de Enfermagem. 2024;77(4):e20240126
Abstract
REVIEWParents’ or legal guardians’ beliefs and attitudes about childhood vaccination: a scoping review
Revista Brasileira de Enfermagem. 2024;77(4):e20240126
DOI 10.1590/0034-7167-2024-0126
Views0See moreABSTRACT
Objective:
to map scientific evidence about perceptions, beliefs, knowledge and attitudes of parents or legal guardians of children under 5 years of age regarding routine childhood vaccination.
Methods:
a scoping review, conducted in accordance with the JBI framework. The searches were carried out in the PubMed/MEDLINE, Web of Science, Scopus and LILACS databases. A total of 5,535 studies were returned and 77 were selected, which met the inclusion criteria.
Results:
perceptions related to interaction with healthcare professionals and services, with family organization and structure, with social interaction and public policies, cultural, religious and personal beliefs, knowledge about vaccination schedule, vaccination and immunization process and sources of information are the main factors mapped and which can positively or negatively influence parents’ or legal guardians’ attitudes towards vaccinating children.
Conclusions:
the findings allow us to identify factors related to parents’ perception and beliefs about childhood vaccination.
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ORIGINAL ARTICLE09-06-2024
Construction and validation of an instrument for event-related sterility of processed healthcare products
Revista Brasileira de Enfermagem. 2024;77(4):e20240021
Abstract
ORIGINAL ARTICLEConstruction and validation of an instrument for event-related sterility of processed healthcare products
Revista Brasileira de Enfermagem. 2024;77(4):e20240021
DOI 10.1590/0034-7167-2024-0021
Views0See moreABSTRACT
Objective:
To construct and validate an instrument to assess events related to maintaining the sterility of processed healthcare products.
Methods:
This methodological study developed the instrument through analysis by a panel of experts, focusing on the integrity of commonly used packaging: spunbond-meltblown-spunbond and medical-grade paper. The instrument was analyzed using the Content Validity Index and Content Validity Ratio (≥ 0.80) and modified Kappa (≥ 0.74). The instrument underwent pre-testing.
Results:
Six experienced professionals participated in the expert panel. After two rounds, the final version of the instrument contained five dimensions. In the pre-test, 30 nursing professionals participated, of whom 86.67% considered the instrument good, and 90% found it understandable.
Conclusion:
The construction and validation followed literature recommendations. The instrument is available, aiding in the safe use of processed healthcare products.
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ORIGINAL ARTICLE09-06-2024
Reflective practice of nurse residents in the teaching-learning process in teaching hospitals
Revista Brasileira de Enfermagem. 2024;77(4):e20230540
Abstract
ORIGINAL ARTICLEReflective practice of nurse residents in the teaching-learning process in teaching hospitals
Revista Brasileira de Enfermagem. 2024;77(4):e20230540
DOI 10.1590/0034-7167-2023-0540
Views0See moreABSTRACT
Objective:
To analyze reflective practice in the teaching-learning process of nurses in residency programs in teaching hospitals in Minas Gerais, Brazil.
Methods:
Case study, based on the reflective practice framework, conducted in two teaching hospitals. Observation and interviews were conducted with first and second-year residents, and five participants were included for in-depth analysis, with their data subjected to frequency distribution analysis and Critical Discourse Analysis.
Results:
In 519 observed activities, elements of reflection were identified in 22.2%, especially active listening and expression of doubts. Discourses indicated practice as the best moment for teaching-learning due to its potential to generate reflections. Learning by doing and case discussion were considered potential strategies for reflective learning.
Conclusion:
Know-in-action reflection was evidenced as the predominant formative aspect for residents, with few opportunities for reflection on reflection-in-action.
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ORIGINAL ARTICLE09-06-2024
Middle-Range theory of the nursing diagnosis of sedentary lifestyle in young adults
Revista Brasileira de Enfermagem. 2024;77(4):e20230516
Abstract
ORIGINAL ARTICLEMiddle-Range theory of the nursing diagnosis of sedentary lifestyle in young adults
Revista Brasileira de Enfermagem. 2024;77(4):e20230516
DOI 10.1590/0034-7167-2023-0516
Views0See moreABSTRACT
Objective:
To construct a middle-range theory for the nursing diagnosis of Sedentary Lifestyle in young adults.
Methods:
A methodological study for the validation of a nursing diagnosis based on a Middle-Range Theory, carried out in six stages: definition of the approach; definition of theoretical-conceptual models; definition of main concepts; development of a pictorial scheme; construction of propositions; establishment of causal relationships and evidence for practice. The theory construction was operationalized through an integrative review and supported by Roy’s adaptation model.
Results:
Three essential attributes were identified; 10 antecedents; 7 clinical consequences; a pictogram, 9 propositions, and 11 causal relationships and evidence for practice.
Conclusion:
The middle-range theory for the nursing diagnosis of Sedentary Lifestyle in young adults was constructed, expanding the understanding of this phenomenon, to be applied in clinical practice by nurses.
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RESEARCH01-01-2016
Leads for potentializing groups in Primary Health Care
Revista Brasileira de Enfermagem. 2016;69(5):964-971
Abstract
RESEARCHLeads for potentializing groups in Primary Health Care
Revista Brasileira de Enfermagem. 2016;69(5):964-971
DOI 10.1590/0034-7167-2015-0102
Views0ABSTRACT
Objective:
to analyze the aspects that potentialize groups in Primary Health Care according to their coordinators and participants.
Method:
This is a descriptive study with a qualitative approach, conducted with a health promotion group affiliated with a Family Health Unit. The data were collected by means of focus groups with participants and community workers who were submitted to thematic content analysis.
Results:
the analysis gave rise to three thematic categories: The group is our medicine; Healthy living and learning; and Priceless leadership.
Conclusion:
the leads identified during the study were as follows: group organization involves investment in motivation and leadership by the coordinators; production of grouping and cohesion is a result of participants and coordinators meeting together, interspersed with dialog, things said and left unsaid that the subjects expressed in the group dynamic; the sense of belonging guarantees their placement in the group based on the recognition of their knowledge and affective, social and health needs.
Keywords:Group ProcessesGroup StructureHealth PromotionNursing in Community HealthPrimary Health CareSee more -
RESEARCH01-01-2016
Intimate partner violence in adolescence: an analysis of gender and generation
Revista Brasileira de Enfermagem. 2016;69(5):946-955
Abstract
RESEARCHIntimate partner violence in adolescence: an analysis of gender and generation
Revista Brasileira de Enfermagem. 2016;69(5):946-955
DOI 10.1590/0034-7167-2016-0408
Views0ABSTRACT
Objective:
to analyze the intimate partner violence in adolescence from the perspective of gender and generation.
Method:
Quantitative, descriptive, and exploratory research. 111 adolescents participated in this study, with ages from 15 to 19 years old.
Results:
We found that 91% of participants have perpetrated and 90.1% have undergone at least one of the natures of violence. The intimate partner violence in adolescence constitutes a form of gender violence, and gender constructions have determined the suffered and perpetrated aggressions, possibly also determining the naturalization and legitimization of such aggressions. The inequality of power between generations may determine greater vulnerability of youngsters to the phenomenon.
Conclusion:
The historical and social construction of masculinity and femininity and the power inequalities set by these constructions converge with the power inequality between generations. Thus, gender and generation are determinants of intimate partner violence in adolescence, as well as of the vulnerability of adolescents to this phenomenon.
Keywords:AdolescentAdolescent HealthGender and HealthIntimate Partner ViolenceViolence Against WomenSee more -
RESEARCH01-01-2016
Hospitalization anxiety in children: conceptual analysis
Revista Brasileira de Enfermagem. 2016;69(5):940-945
Abstract
RESEARCHHospitalization anxiety in children: conceptual analysis
Revista Brasileira de Enfermagem. 2016;69(5):940-945
DOI 10.1590/0034-7167-2015-0116
Views0See moreABSTRACT
Objective:
to analyze the concept “hospitalization anxiety in children”, identifying its antecedents, attributes, and consequences, with the objective of clarifying its meaning.
Method:
we used a conceptual analysis model, whose objective is to clarify the meaning of terms.
Results:
we identified the concept antecedents and its attributes, classified as biological and psychological needs, which are essential characteristics of “hospitalization anxiety in children”. This process consequences have also been identified. We proceeded to the analysis of the characteristics with emphasis on the impacts of the hospitalization process on the child and on the family.
Conclusion:
based on the conceptual analysis of the phenomenon, it was possible to identify the antecedents, attributes, and consequences of Hospitalization Anxiety in children. We recommend the continuation of the study validating the essential characteristics presently identified as a way to join knowledge gathered and professional practice.
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RESEARCH01-01-2016
Stroke: patient characteristics and quality of life of caregivers
Revista Brasileira de Enfermagem. 2016;69(5):933-939
Abstract
RESEARCHStroke: patient characteristics and quality of life of caregivers
Revista Brasileira de Enfermagem. 2016;69(5):933-939
DOI 10.1590/0034-7167-2015-0064
Views0See moreABSTRACT
Objective:
to investigate the association between the domains of health-related quality of life of family caregivers and sociodemographic characteristics of individuals with stroke sequelae.
Method:
descriptive, cross-sectional, quantitative research, conducted with 136 family caregivers of individuals with stroke sequelae by means of home interviews from April to June 2013.
Results:
we found that caregivers of individuals aged under 65 years, married, with 10 to 12 years of formal education, presented higher scores, respectively, in the domains ‘Social aspects’, ‘Emotional aspects’, and ‘Mental health’. However, caregivers of patients with higher degree of disability obtained lower score in the ‘Mental Health’ domain.
Conclusion:
the results foster reflection on the need of including the family caregivers of individuals with stroke sequelae in the planning of care provided by health professionals.
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RESEARCH01-01-2016
A quasi-experimental nursing study on pain in comatose patients
Revista Brasileira de Enfermagem. 2016;69(5):927-932
Abstract
RESEARCHA quasi-experimental nursing study on pain in comatose patients
Revista Brasileira de Enfermagem. 2016;69(5):927-932
DOI 10.1590/0034-7167-2015-0121
Views0See moreABSTRACT
Objective:
to verify whether comatose patients feel pain during the bed bath nursing procedure.
Method:
nineteen patients aged 61 ± 17.39 years participated in the study. A quantitative analysis was conducted on the P substance (PS) in the saliva collected before and during a bed bath, using the ELISA method. Program Graph Pad Prisma 6 was used to analyze the data. The verification of normality was made through the Shapiro Wilk test, which determined the choice for the Wilcoxon nonparametric test.
Results:
the study showed a statistically significant increase (∆= 5.62%, p<0.001) in the PS level of the patients studied during the nursing procedure.
Conclusion:
when caring for comatose patients during a bed bath, professionals cause or add painful stimuli; therefore, they feel pain.
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RESEARCH01-01-2016
Quality of nursing care: instrument development and validation
Revista Brasileira de Enfermagem. 2016;69(5):920-926
Abstract
RESEARCHQuality of nursing care: instrument development and validation
Revista Brasileira de Enfermagem. 2016;69(5):920-926
DOI 10.1590/0034-7167-2015-0151
Views0See moreABSTRACT
Objectives:
to describe the development and validation process of a scale to measure the nurses’ perception of the activities that contribute to nursing care quality.
Method:
methodological study based on a literature review, the opinion of experts and the experience of study investigators. An instrument was designed containing six dimensions and 25 items, applied as a questionnaire to 775 nurses from a hospital in northern Portugal, from May to July 2014. The instrument validation used an exploratory factor analysis and an internal consistency assessment of each factor/dimension.
Results:
the factor analysis indicated the need to adjust the original composition of the scale, which then received one more dimension, totaling seven dimensions and the same 25 items, and presented a high internal consistency (Cronbach’s alpha of 0.940).
Conclusion:
the final version of the scale presents adequate psychometric properties, with potential use in future studies.
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ORIGINAL ARTICLE12-04-2023
30-Year High Cardiovascular Risk Incidence and its Determinants: CUME Study
Revista Brasileira de Enfermagem. 2023;76(6):e20220544
Abstract
ORIGINAL ARTICLE30-Year High Cardiovascular Risk Incidence and its Determinants: CUME Study
Revista Brasileira de Enfermagem. 2023;76(6):e20220544
DOI 10.1590/0034-7167-2022-0544
Views0See moreABSTRACT
Objective:
Estimate the incidence of the 30-year high cardiovascular risk and its determinants among graduates of federal universities in Minas Gerais.
Methods:
This is a prospective cohort of 2,854 adults aged 20 to 59. The incidence of the outcome was calculated using the Framingham equation and its determinants were determined through multivariate Cox regression.
Results:
After an average of 2.62 years, the incidence of high cardiovascular risk was 8.09 and 20.1 cases per 1,000 person-years, for females and males respectively. Being male (HR: 2.34; 95% CI: 1.58 – 3.46), employment (HR: 2.13; 95% CI: 1.13 – 3.99), high consumption of processed foods (HR: 2.44; 95% CI: 1.21 – 4.90), and being physically active (HR: 0.63; 95% CI: 0.41 – 0.98) were associated with high cardiovascular risk.
Conclusions:
Among highly educated adults, being male, employment, and high consumption of processed foods are predictors of high cardiovascular risk, while being physically active acts as a protective factor.
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ORIGINAL ARTICLE12-04-2023
“Fala-M@no-COVID-19”: technological development of a health navigation program for men during the pandemic
Revista Brasileira de Enfermagem. 2023;76(6):e20220534
Abstract
ORIGINAL ARTICLE“Fala-M@no-COVID-19”: technological development of a health navigation program for men during the pandemic
Revista Brasileira de Enfermagem. 2023;76(6):e20220534
DOI 10.1590/0034-7167-2022-0534
Views0See moreABSTRACT
Objective:
to develop a care-educational technology similar to a health navigation program for men during the COVID-19 pandemic.
Methods:
a methodological and qualitative study of a care-educational technology of health navigation program, structured by Program Development Cycle, with 16 patient navigators and 10 professional navigators. It used reflective thematic content analysis and an adaptation model for data processing.
Results:
the ; navigation program was developed by: I) Observation of reality, problem mapping, needs assessment: content selection, creation of domains and questions; II) Theoretical-conceptual and methodological definition, creation of product under the elaboration of care plans, based on theory, process and taxonomies by a flowchart of operationalization of actions; and III) Self-assessment: qualitative research with professional navigators.
Final considerations:
the technology developed, with theoretical and methodological support, allowed to derive a viable navigation program compatible with reality based on the audience’s needs.
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The Medical Healing of Souls: a strategy for welcoming post-pandemic mental health
Revista Brasileira de Enfermagem. 2023;76(6):e20220331
Abstract
The Medical Healing of Souls: a strategy for welcoming post-pandemic mental health
Revista Brasileira de Enfermagem. 2023;76(6):e20220331
DOI 10.1590/0034-7167-2022-0331
Views0See moreABSTRACT
Objective:
to reflect on the applicability of the Medical Healing of Souls (MHS) by health professionals as a welcoming strategy in post-pandemic mental health.
Methods:
a theoretical and reflective study, based on Viktor Frankl’s philosophy, based on the book “The Doctor and the Soul, From Psychotherapy to Logotherapy” and scientific literature.
Results:
the study was structured in two discursive approaches: MHS in the field of health; The applicability of MHS in post-pandemic mental health care.
Final considerations:
MHS can be used in mental health care, in health emergencies, promoting a more humane performance of health professionals, facilitating the integration of inevitable suffering into a meaningful life.
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ORIGINAL ARTICLE12-04-2023
Translation, cross-cultural adaptation and validity study of the “Play Nicely Program: The Healthy Discipline Handbook” for use in Brazil
Revista Brasileira de Enfermagem. 2023;76(6):e20220281
Abstract
ORIGINAL ARTICLETranslation, cross-cultural adaptation and validity study of the “Play Nicely Program: The Healthy Discipline Handbook” for use in Brazil
Revista Brasileira de Enfermagem. 2023;76(6):e20220281
DOI 10.1590/0034-7167-2022-0281
Views0See moreABSTRACT
Objective:
to describe the translation, cross-cultural adaptation and validity process of the “Play Nicely Program: The Healthy Discipline Handbook” for use in Brazil.
Methods:
a methodological study that followed the translation, back-translation, expert committee assessment, and pre-test steps. The Content Validity Index (CVI) was calculated for both the judge population and the pre-test population. Four translators, seven expert judges in the field of child health and thirty participants in the pre-test, including parents, teachers and healthcare professionals, participated in the study.
Results:
in experts’ analysis (98.4%), a value of 100% of adequate assessments was obtained, and in the target population’s analysis (89.5%), there were 100% of adequate assessments. In both analyses, suggested adaptations were made.
Conclusios:
cross-cultural adaptation and content validity into Brazilian Portuguese of the “Play Nicely Program: The Healthy Discipline Handbook” were considered adequate for application in the target population.
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ORIGINAL ARTICLE12-04-2023
Emergency units and COVID-19: Burnout, and empathy reported by nursing professionals and perceived by patients
Revista Brasileira de Enfermagem. 2023;76(6):e20210869
Abstract
ORIGINAL ARTICLEEmergency units and COVID-19: Burnout, and empathy reported by nursing professionals and perceived by patients
Revista Brasileira de Enfermagem. 2023;76(6):e20210869
DOI 10.1590/0034-7167-2021-0869
Views0See moreABSTRACT
Objective:
To investigate Burnout Syndrome and empathy self-reported by the nursing staff and empathy perceived by the patient.
Method:
Cross-sectional study in a public emergency unit in São Paulo (from October/2020 to March/2021). The nursing staff answered the Maslach Burnout Inventory and the Consultation and Relational Empathy Measure-Nurses (Brazilian version), whereas adult patients answered the Consultation and Relational Empathy Measure (Brazilian version). Descriptive and inferential analysis, with a 5% significance level.
Results:
A total of 92 professionals and 271 patients participated. Most professionals reported impact of COVID-19 (80; 86.96%) and, among them, increased Burnout Syndrome (93; 75%), but with low emotional exhaustion (71; 74%), low depersonalization (59; 78%) and high level of professional accomplishment (72; 83%). Most reported impact and increased empathy, and the results reported by professionals and patients (mean and standard deviation) were: 39.89 (6.44) and 38.25 (9.45), respectively.
Conclusion:
The professionals reported a low level of Burnout Syndrome and a high level of empathy in pandemic.
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ERRATUM11-27-2023
ERRATUM
Revista Brasileira de Enfermagem. 2023;76(5):e2023n5e05
Abstract
ERRATUMERRATUM
Revista Brasileira de Enfermagem. 2023;76(5):e2023n5e05
DOI 10.1590/0034-7167.20237605e05
Views0In the article “Performance of Family Health Strategy Nurses in LGBT+ Healthcare”, with DOI number: , published in Revista Brasileira de Enfermagem, 2023;76(4): e20220514, authored:Where it read:[…]See more -
ORIGINAL ARTICLE11-27-2023
Mental suffering in family daily life: a temporal journey according to Merleau-Ponty
Revista Brasileira de Enfermagem. 2023;76(5):e20230258
Abstract
ORIGINAL ARTICLEMental suffering in family daily life: a temporal journey according to Merleau-Ponty
Revista Brasileira de Enfermagem. 2023;76(5):e20230258
DOI 10.1590/0034-7167-2023-0258
Views0See moreABSTRACT
Objectives:
to describe the family’s experience in relation to daily life with a family member experiencing mental suffering.
Methods:
a qualitative, descriptive, phenomenological study grounded in Merleau-Ponty’s ontology of experience was conducted in ten households in a city in the state of Bahia, Brazil, where 24 participants of the Intersubjectivity Wheels reside. The descriptions produced were subjected to the Ambiguity Analytics technique.
Results:
the descriptions were categorized into: absence as a creative power of the sense of “being” and “not being a family”; and exclusion and acceptance as expressions of mental suffering in the family context.
Final Considerations:
the experience of mental suffering in the family’s daily life is marked by ambiguous feelings, such as joy and sadness, disappointment and satisfaction, lack of love and love. However, experiencing these feelings can mobilize the desire to “become” a family, increase the sense of autonomy and independence, and drive the formation of new family configurations.
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