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RESEARCH01-01-2016
Avaliação do risco de úlceras por pressão em pacientes hospitalizados com HIV/Aids
Revista Brasileira de Enfermagem. 2016;69(1):96-101
Abstract
RESEARCHAvaliação do risco de úlceras por pressão em pacientes hospitalizados com HIV/Aids
Revista Brasileira de Enfermagem. 2016;69(1):96-101
DOI 10.1590/0034-7167.2016690113i
Views0RESUMEN
Objetivo:
evaluar el riesgo de desarrollar úlceras por presión en pacientes hospitalizados con VIH/SIDA.
Método:
estudio cuantitativo descriptivo con 35 pacientes. Caracterización epidemiológica y clínica de los pacientes en un instrumento mediante la Escala de Braden. Las variables se realizaron en forma descriptiva simple, por números absolutos.
Resultados:
la incidencia de la PU observada en 2 pacientes, y las comorbilidades fueron neumocistosis pneumocisti carinii y tuberculosis pulmonar. Se reveló que la subescala de fricción y fuerza de deslizamiento obtuvo una puntuación más baja, seguido por actividad y la nutrición, la movilidad y la humedad. La percepción sensorial obtuvo la puntuación más alta. Dos pacientes fueron clasificados como de “alto riesgo” a 6 de “alto riesgo”, 3 para “bajo riesgo” y el otro “ningún riesgo”.
Conclusión:
la calificación de riesgo, mediante el uso de escalas proporciona información objetiva para la toma de decisione de enfermería a un modo específico.
Keywords:Cuidados de EnfermagemDoença CrônicaFatores de RiscoSíndrome da Imunodeficiência AdquiridaÚlcera por PressãoSee more -
Assessment of the risk of pressure ulcer development among hospitalized HIV/Aids patients
Revista Brasileira de Enfermagem. 2016;69(1):96-101
Abstract
Assessment of the risk of pressure ulcer development among hospitalized HIV/Aids patients
Revista Brasileira de Enfermagem. 2016;69(1):96-101
DOI 10.1590/0034-7167.2016690113i
Views0See moreABSTRACT
Objective:
to assess the risk of pressure ulcer development among hospitalized HIV/Aids.
Metod:
study quantitative descriptive with 35 patients admitted to an infectious diseases hospital in Curitiba-PR-BR. Characterized clinical and epidemiological of patients using a data collection instrument and the Braden Scale. Data was compiled using Excel® and a simple descriptive analysis.
Results:
two patients were found to have pressure ulcers and the most common comorbidities associated with HIV/Aids were pneumocystis pneumonia, caused by pneumocisti cariini (16), and pulmonary tuberculosis (13). The lowest scores were obtained in the friction and shear subscale, followed by the activity, nutrition, mobility and moisture subscales. The highest score was obtained in the sensory perception subscale. Two patients were classified as ‘very high risk’, six as ‘high risk’, three as ‘low risk’, and the rest as ‘no risk’.
Conclusion:
risk assessment using scales provides objective information to assist with systemized and targeted nursing decision-making.
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Children with special health needs and family: implications for Nursing
Revista Brasileira de Enfermagem. 2016;69(1):88-95
Abstract
Children with special health needs and family: implications for Nursing
Revista Brasileira de Enfermagem. 2016;69(1):88-95
DOI 10.1590/0034-7167.2016690112i
Views0See moreABSTRACT
Objective:
to understand the family experience of children and adolescents with myelomeningocele by the discovery of chronic illness and their daily life in the realization of needed care to these people.
Method:
qualitative study, developed from October 2013 to February 2014, with family, in a pediatric hospital in Fortaleza. Data were collected through interviews and checked by analysis thematic category.
Results:
it was found that the diagnosis after the birth of the child caused fear and anguish to the families in front of the unknown and the unexpected and that over the years they started to deal with many challenges conducting the daily care due to the disease sequelae.
Conclusion:
nursing plays an important role in the lives of families, children and adolescents, through emotional support, guidelines and care inserted in the health care network.
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Evaluation of the care program implementation to people with high blood pressure
Revista Brasileira de Enfermagem. 2016;69(1):79-87
Abstract
Evaluation of the care program implementation to people with high blood pressure
Revista Brasileira de Enfermagem. 2016;69(1):79-87
DOI 10.1590/0034-7167.2016690111i
Views0See moreABSTRACT
Objective:
to evaluate the implementation of the care program for people with hypertension in Maringá-PR.
Method:
it is an evaluative research of cross-sectional design. Data were collected through structured interviews with 63 nurses between April and June 2013.
Results:
as missing or insufficient, there were: transportation for outside activities; work equipment; educational materials; training resources; inclusion of the family in the care plan; risk classification of individuals; determination of therapy from the risk classification and referral of the patient to medical and/or specialized tests.
Conclusion:
in addition to qualifying structure, there are: the need to identify people with hypertension as risk factors, perform risk stratification and systematic care planning, establishing an advanced clinical practice, such as support for self-care and management cases, accomplish with existing protocols and develop collective actions based on information systems.
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Evaluation of quality of life of visually impaired
Revista Brasileira de Enfermagem. 2016;69(1):72-78
Abstract
Evaluation of quality of life of visually impaired
Revista Brasileira de Enfermagem. 2016;69(1):72-78
DOI 10.1590/0034-7167.2016690110i
Views0ABSTRACT
Objective:
to evaluate the quality of life of visually impaired using WHOQOL-100.
Method:
exploratory, descriptive, and quantitative study, performed between April and May 2013 with 20 visually impaired of the Blind Association of Ceará, through interviews.
Results:
the analysis showed that males predominated (80%), 41-55 years (40%), students (50%) and personal income than the minimum wage (70%). Participants were self-rated with good quality of life (68.75%). The facets with the highest rates were personal relationships (74.06%), sexual activity (66.88%) and spirituality/religion/personal beliefs (65%). With lower rates were financial (43.44%), physical environment: pollution/noise/traffic/climate (46.88%), physical security and protection (37.19%), transport (35.63%) and medication or treatment dependency (8.25%).
Conclusion:
these results reflect the importance of the nurse to perform health education actions promoting the empowerment, autonomy and guaranteed of access in society for this clientele.
Keywords:Education of Visually Impaired PersonsNursingNursing CareQuality of LifeVisually Impaired PersonsSee more -
Coping strategies for oncology nurses in high complexity
Revista Brasileira de Enfermagem. 2016;69(1):67-71
Abstract
Coping strategies for oncology nurses in high complexity
Revista Brasileira de Enfermagem. 2016;69(1):67-71
DOI 10.1590/0034-7167.2016690109i
Views0See moreABSTRACT
Objective:
to identify the coping strategies of oncology services of nurses in highly complex hospital care before the person with cancer.
Method:
it is a qualitative research, with 18 nurses in inpatient oncology units and/or outpatient chemotherapy in two cities in southern Brazil, sampled by a snowball and carrying out semi-structured interviews. Data were submitted to thematic analysis.
Results:
three categories emerged that show strategies such as denial and resignation in care, for support in the health team and the plurality and multiplicity of perspectives on the care, including the patient and his family and the search for personal and professional improvement.
Conclusion:
coping strategies are expressed in the cultural understanding of what it means to have cancer or not and management of health institutions for nurses to work with satisfaction. The service in education is a major factor in the development of ethical competence.
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Implementation of fast tests for syphilis and HIV in prenatal care in Fortaleza – Ceará
Revista Brasileira de Enfermagem. 2016;69(1):62-66
Abstract
Implementation of fast tests for syphilis and HIV in prenatal care in Fortaleza – Ceará
Revista Brasileira de Enfermagem. 2016;69(1):62-66
DOI 10.1590/0034-7167.2016690108i
Views0See moreABSTRACT
Objective:
to describe the implementation of the Fast Test (FT) of syphilis and HIV in prenatal care in primary healthcare units in Fortaleza, Ceará.
Method:
a descriptive study with a quantitative approach. There were training supervisions carried out in 24 units between May and August 2014, and the inclusion criterion was to have at least one trained professional.
Results:
the physical space, the availability, validity and the performance of FT in prenatal were analyzed. The data were presented in simple frequency tables. It was identified adequate space in 79.2% of the units, availability of FT in 62.5%, performing the tests in 37.5%, and of these, 55.6% doing these procedures in routine prenatal care.
Conclusion:
the primary units have difficulties in implementing FT in syphilis and HIV in the prenatal routine. This activity is seen as an effective strategy to reduce vertical transmission of these infections.
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Evaluating child care in the Family Health Strategy
Revista Brasileira de Enfermagem. 2016;69(1):54-61
Abstract
Evaluating child care in the Family Health Strategy
Revista Brasileira de Enfermagem. 2016;69(1):54-61
DOI 10.1590/0034-7167.2016690107i
Views0See moreABSTRACT
Objective:
to evaluate the healthcare provided to children under two years old by the Family Health Strategy.
Method:
evaluative, quantitative, cross-sectional study that used the Primary Care Assessment Tool – Child Version for measuring the access, longitudinality, coordination, integrality, family orientation and community orientation.
Results:
a total of 586 adults responsible for children under two years old and linked to 33 health units in eleven municipalities of the state of Minas Gerais, Brazil, were interviewed. The evaluation was positive for the attributes longitudinality and coordination, and negative for access, integrality, Family orientation and community orientation.
Conclusion:
there are discrepancies between health needs of children and what is offered by the service; organizational barriers to access; absence of counter-reference; predominance of curative and long-standing and individual preventive practices; verticalization in organization of actions; and lack of good communication between professionals and users.
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Modified early warning score: evaluation of trauma patients
Revista Brasileira de Enfermagem. 2016;69(5):906-911
Abstract
Modified early warning score: evaluation of trauma patients
Revista Brasileira de Enfermagem. 2016;69(5):906-911
DOI 10.1590/0034-7167-2015-0145
Views0ABSTRACT
Objective:
to identify the severity of patients admitted to an emergency trauma.
Method:
A cross-sectional and retrospective study with 115 trauma patients classified as orange (Manchester System), from June 2013 to July 2014. The data were presented as mean and standard deviation, in addition to the Pearson Chi-square test, One-Way ANOVA and Tukey tests.
Results:
from the sample, 81.7% were male with mean age of 39.46±19.71 years. Higher incidence of major trauma (48.7%) and traumatic brain injury (37.4%). At the end of the outcome and MEWS, most cases that had score 1 to 3 were referred to the operating room and the ICU.
Conclusion:
the start point of MEWS was 2 to 3 points, with significant increase in the severity of the situation of patients seen after 6 hours, and approximately half of the individuals underwent surgery, indicating that the scale is a good predictor of severity.
Keywords:EmergenciesEmergency Medical ServicesExposureMeasures of AssociationRisk or OutcomeSeverity of Illness IndexSee more -
Occupational health nurses: interdisciplinary experience in occupational health
Revista Brasileira de Enfermagem. 2016;69(5):897-905
Abstract
Occupational health nurses: interdisciplinary experience in occupational health
Revista Brasileira de Enfermagem. 2016;69(5):897-905
DOI 10.1590/0034-7167-2015-0113
Views0ABSTRACT
Objective:
to analyze the relationship of occupational health nurses with the other members of the Specialized Service in Safety Engineering and Occupational Medicine (SESMT) and characterize joint actions of these professionals in occupational health.
Method:
qualitative, exploratory, and descriptive study with 34 professionals of seven companies from the South Macroregion of the state of Rio Grande do Sul. Interviews and observations were conducted for content analysis of Bardin.
Results:
the SESMTs are multidisciplinary and intersectoral workers. Nurses have working relations of an interpersonal, technical/legal, and management of logistics/organizational nature, influenced by the technical division of work and by the division in the work environment of the staff, which distances areas, generates conflicts, and fragments the actions of the service.
Conclusion:
SESMT faces challenges to develop a work befitting their legal objectives, once staff and companies need to understand the importance of interdisciplinarity for the success of actions on the workers’ health and safety.
Keywords:InterrelationshipOccupational Health NursingOccupational Health ServicesWorkWorkers' HealthSee more -
Translation and adaptation of a pediatric early warning score
Revista Brasileira de Enfermagem. 2016;69(5):888-896
Abstract
Translation and adaptation of a pediatric early warning score
Revista Brasileira de Enfermagem. 2016;69(5):888-896
DOI 10.1590/0034-7167-2015-0096
Views0See moreABSTRACT
Objective:
to translate and adapt the BPEWS for the Portuguese language, with the purpose of verifying its applicability in the Brazilian context studied.
Method:
methodological study guided by international and nationally accepted recommendations for translation and adaptation of health measurement instruments. Stages of conceptual, item, semantic, operational and pre-test equivalence are described for obtaining the BPEWS Portuguese version to be used in Brazil.
Results:
the BPEWS version translated and adapted for Brazilian Portuguese (BPEWS-Br) identified, in the pilot study, that 26.6% of children were presenting warning signs for clinical deterioration.
Conclusion:
the BPEWS-Br seems to be applicable for the context studied, and its use might help nurses in the recognition and documentation of warning signs for clinical deterioration in hospitalized Brazilian children.
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Validation of the Nursing Activities Score in Portuguese intensive care units
Revista Brasileira de Enfermagem. 2016;69(5):881-887
Abstract
Validation of the Nursing Activities Score in Portuguese intensive care units
Revista Brasileira de Enfermagem. 2016;69(5):881-887
DOI 10.1590/0034-7167-2016-0147
Views0See moreABSTRACT
Objective:
to describe the process of adaptation and validation of the Nursing Activities Score to the Portuguese context.
Method:
this was a pilot study of adaptation and validation of the Nursing Activities Score with a sample consisting of 67 patients hospitalized in the intensive care units of three Portuguese hospitals. The construct validity was assessed through factor analysis procedures and the internal consistency of the items was measured through the Cronbach’s alpha coefficient.
Results:
a mean workload value of 63.04% (SD = 14.25; Median = 61.30) was obtained. Psychometric data revealed a Cronbach’s alpha of 0.71 in the total scale, indicating an acceptable accuracy. Confirmatory factor analysis suggested an appropriate adjustment between the model and the data (χ2(199) = 214.5, p = 0.214; CFI = 0.95; RMSA = 0.035).
Conclusion:
in the present study, the Portuguese version of the Nursing Activities Score was found to be a valid instrument, enabling a safe assessment of the workload of nurses.
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Managing educational practices for qualified nursing care in cardiology
Revista Brasileira de Enfermagem. 2016;69(5):872-880
Abstract
Managing educational practices for qualified nursing care in cardiology
Revista Brasileira de Enfermagem. 2016;69(5):872-880
DOI 10.1590/0034-7167-2015-0032
Views0See moreABSTRACT
Objective:
to understand significances attributed by nurses who manage nursing care to the individual affected by cardiovascular disease to relations, interactions and associations of the educational practices in a cardiovascular reference hospital. To elaborate a theoretical explanatory model based on significances attributed in the light of the complex thinking.
Method:
qualitative study, which used Theory Based on Data (TBD) as methodological reference. Twenty-two professionals of nursing participated in the study.
Results:
the results indicate need of professional qualification to ensure the safety of patients, institutional support for the realization of educational practices, attitude of openness and availability of dialogue of the health professionals and other institutional conformations for the workers’ development.
Conclusion:
the study presents a new space for the nurse’s action that can be used to qualify and optimize the nursing practice, as it provides visibility to management and care in health institutions.
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Clinical validation of nursing diagnosis “Willingness for improved infant development”
Revista Brasileira de Enfermagem. 2016;69(5):855-863
Abstract
Clinical validation of nursing diagnosis “Willingness for improved infant development”
Revista Brasileira de Enfermagem. 2016;69(5):855-863
DOI 10.1590/0034-7167-2015-0131
Views0See moreABSTRACT
Objective:
to conduct the clinical validation of nursing diagnosis “Willingness for improved infant development”.
Method:
a cross-sectional study, conducted in a Centro de Saúde da Família (Family Health Care center), with 45 healthy breastfed infants. The instrument for collecting the data was prepared based on the literature and validated by nurses. It contained the following variables: sociodemographic, gestational, and obstetrical variables; breastfed infant’s nutritional profile; evaluation of the defining characteristics of the proposed nursing diagnosis.
Results:
all the defining characteristics were found to have high sensitivity values (>90%), positive predictive values (>65%), negative predictive values (>66%); however, low specificity values (<32%). In this study, the defining characteristics we found to have estimates (>0.50) within the ROC curve, which provides good sensitivity and specificity.
Conclusion:
this study verified the structural elements of the proposed nursing diagnosis to be relevant in the clinical context, which justifies the need for its being employed with children, taking into account its contribution to improving nursing care.
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Oral drugs at a hospital unit: adequacy for use via enteral feeding tubes
Revista Brasileira de Enfermagem. 2016;69(5):847-854
Abstract
Oral drugs at a hospital unit: adequacy for use via enteral feeding tubes
Revista Brasileira de Enfermagem. 2016;69(5):847-854
DOI 10.1590/0034-7167-2015-0081
Views0See moreABSTRACT
Objective:
to describe the profile of standardized oral drugs at a hospital unit and assess their adequacy for use via enteral feeding tubes, according to recommendations from the literature.
Method:
descriptive study, with data on drugs collected from the Pharmacy Service Dispensing System. Specific recommendations for the use of these drugs via enteral feeding tubes were found after searches in literary databases, books, manuals, guidelines and package insert collections.
Results:
among the 236 dispensed oral drugs, 86% were in solid form; of those, 32 were “non-crushable”, with the liquid form available at the institution. Twenty-eight drugs with potential interactions with enteral nutrition were identified. Sixty percent of those presented specific recommendations on their administration via enteral feeding tube.
Conclusion:
the joint participation of multidisciplinary nutritional therapy and care teams and the implementation of programs for continuous training are suggested strategies for the prevention of potential problems in the administration of drugs in the hospital setting.
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Nursing actions in primary care and the control of diseases preventable through vaccines
Revista Brasileira de Enfermagem. 2015;68(5):803-809
Abstract
Nursing actions in primary care and the control of diseases preventable through vaccines
Revista Brasileira de Enfermagem. 2015;68(5):803-809
DOI 10.1590/0034-7167.2015680506i
Views0See moreABSTRACT
Objective:
to discuss the actions performed by nurses in the control and eradication of diseases preventable with vaccines in healthcare setting, according to the National Primary Health Care Policy.
Method:
qualitative research supported by the social phenomenology of Schutz. It had as its setting a Family Health Clinic, located in the city of Rio de Janeiro (Brazil), with ten nurses. The data collection occurred through interviews.
Results:
nurses’ actions aimed at the control and eradication of preventable diseases mainly involve updating a vaccination card, administering the vaccine, and guiding the user of the Health Unit, with the purpose of preventing diseases. The National Primary Care Policy and all manuals from the Ministry of Health recognize the importance of focusing on the service user.
Conclusion:
the user’s lifestyle must be considered, and his access to services aiming at the expansion of the control of diseases preventable with vaccines should be promoted.
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Children with neuropsychomotor development delay: music therapy promoting quality of life
Revista Brasileira de Enfermagem. 2015;68(5):797-802
Abstract
Children with neuropsychomotor development delay: music therapy promoting quality of life
Revista Brasileira de Enfermagem. 2015;68(5):797-802
DOI 10.1590/0034-7167.2015680505i
Views0See moreABSTRACT
Objective:
to identify the influence of music therapy on the behavior and quality of life of children with neuropsychomotor development delay (NPMDD).
Method:
experimental research, with applications of music therapy (in a group of children) held in the specialized association in Cruz das Almas – Bahia, composed of 17 children with NPMDD aged 5 to 12 years. The behavior of children involving emotional, physical, social and school aspects was observed.
Results:
there was an evolution in all aspects, being this improvement significant to Emotional Capacity and School Capacity domains, showing the beneficial effects of music therapy.
Conclusion:
music therapy becomes a treatment option for children with NPMDD, improving their quality of life.
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Spirituality, religion and personal beliefs of adolescents with cancer
Revista Brasileira de Enfermagem. 2015;68(5):791-796
Abstract
Spirituality, religion and personal beliefs of adolescents with cancer
Revista Brasileira de Enfermagem. 2015;68(5):791-796
DOI 10.1590/0034-7167.2015680504i
Views0See moreABSTRACT
Objective:
to examine adolescents’ perception about spirituality, religion and personal beliefs in their lives due to cancer and a possible strategy for coping with the disease.
Method:
qualitative research, both descriptive and exploratory. The data were collected by means of a personal semi-structured interview, and the categories were analyzed by content analyzes.
Results:
nine adolescents who were undergoing cancer treatment at one of the two institutions located Uberaba, Brazil, participated in the study. Based on the analysis and interpretation of results, it was possible to systematize them according to four categories: spiritual history of the individual; faith and belief; importance of spirituality in their lives, and the community acting as a spiritual supporter. Most adolescents referred to spirituality as being an important tool for dealing with the disease, especially concerning religious rituals and community support.
Conclusion:
spirituality creates hope for adolescents, which helps them to cope with cancer-related diffi culties and contribute to the search for the meaning of life.
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Coping strategies of nursing students for dealing with university stress
Revista Brasileira de Enfermagem. 2015;68(5):783-790
Abstract
Coping strategies of nursing students for dealing with university stress
Revista Brasileira de Enfermagem. 2015;68(5):783-790
DOI 10.1590/0034-7167.2015680503i
Views0See moreABSTRACT
Objective:
to identify the coping strategies used by nursing students in a university in southern Brazil, establishing the relationship between the sociodemographic and academic variables examined.
Method:
an exploratory, descriptive, quantitative study, carried out with 146 nursing students, through application of the Coping Strategies Inventory. For the data analysis, descriptive statistics, analysis of variance and regression analysis were used.
Results:
it was found that the coping strategy most used by nursing students is escape. A connection was also detected between the academic dissatisfaction variable and the use of negative coping strategies.
Conclusion:
it was noted that students satisfi ed with the course used positive coping strategies targeting the problem, whereas dissatisfi ed students used negative strategies focusing on the emotion.
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Unemployment and psychological distress in nurses
Revista Brasileira de Enfermagem. 2015;68(5):775-782
Abstract
Unemployment and psychological distress in nurses
Revista Brasileira de Enfermagem. 2015;68(5):775-782
DOI 10.1590/0034-7167.2015680502i
Views0See moreABSTRACT
Objective:
to assess psychological distress in nurses searching for their first job, especially symptoms of depression, and identify the factors that caused mental suffering, and how these nurses cope with the situation.
Method:
this was a qualitative study carried out with unemployed nurses who had graduated less than two years before the time of the study, and were residents of the town of Assis in the Brazilian state of São Paulo. Data were gathered by means of semi-structured interviews, content analysis, and application of the Beck Depression Inventory psychometric scale.
Results:
of the 14 nurses that participated, three had scores on the psychometric scale indicative of depression. Participants reported psychological distress related to unemployment, poor university education, and surplus labor due to the large number of graduates and lack of jobs, as well as a culture of employment centered on professionals’ social networks. The unemployed nurses did not have effective ways of coping.
Conclusion:
unemployment promoted psychological distress among the new nurses, especially symptoms of depression, without effective means of coping.
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Newborn blood spot screening: to expand or not to expand?
Revista Brasileira de Enfermagem. 2015;68(5):771-772
Abstract
Newborn blood spot screening: to expand or not to expand?
Revista Brasileira de Enfermagem. 2015;68(5):771-772
DOI 10.1590/0034-7167.2015680501i
Views0“The principal constraint on what we can detect in newborn screening is fast becoming what we choose to detect: rather than what is limited for us by technical feasibility or cost”().Technological advances are providing the medical world an opportunity to extend the number of conditions newborn babies are screened for. Tandem mass spectrometry (TMS, also […]See more -
Teste de triagem neonatal: expandir ou não expandir?
Revista Brasileira de Enfermagem. 2015;68(5):771-772
Abstract
Teste de triagem neonatal: expandir ou não expandir?
Revista Brasileira de Enfermagem. 2015;68(5):771-772
DOI 10.1590/0034-7167.2015680501i
Views0“A principal restrição sobre o que podemos detectar no teste de triagem neonatal está rapidamente se tornando o que escolhemos detectar em vez daquilo que nos é limitado por razão de viabilidade técnica ou custo”().Os avanços tecnológicos estão conferindo ao mundo médico uma oportunidade de aumentar o número de patologias para as quais os recém-nascidos […]See more -
REVIEW01-01-2015
International Classification for Nursing Practice – ICNP®: application to the Brazilian reality
Revista Brasileira de Enfermagem. 2015;68(4):730-731
Abstract
REVIEWInternational Classification for Nursing Practice – ICNP®: application to the Brazilian reality
Revista Brasileira de Enfermagem. 2015;68(4):730-731
DOI 10.1590/0034-7167.2015680422i
Views0The author and organizer, Telma Ribeiro Garcia, added her theoretical and practical knowledge to those of a dozen other authors for the creation of the book “International Classification for Nursing Practice – ICNP®: application to the Brazilian reality”. She is a retired professor of the Department of Public Health Nursing and Psychiatry at the Federal […]See more
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