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ORIGINAL ARTICLE
Factors associated with COVID-19 death in pregnant women hospitalized in Intensive Care Units
- Milena Ricioli Ribeiro
, - Marcela de Andrade Pereira Silva ,
- Leticia Furlan de Lima Prates ,
- Rosana Rosseto de Oliveira ,
- Maria Dalva de Barros Carvalho , [ … ],
- Sandra Marisa Pelloso
08-26-2024
Abstract
ORIGINAL ARTICLEFactors associated with COVID-19 death in pregnant women hospitalized in Intensive Care Units
Revista Brasileira de Enfermagem. 2024;77(5):e20230172
08-26-2024DOI 10.1590/0034-7167-2023-0172
- Milena Ricioli Ribeiro ,
- Marcela de Andrade Pereira Silva ,
- Leticia Furlan de Lima Prates ,
- Rosana Rosseto de Oliveira ,
- Maria Dalva de Barros Carvalho ,
- Sandra Marisa Pelloso
Views0ABSTRACT
Objectives:
to evaluate the factors associated with COVID-19 death in pregnant women hospitalized in Intensive Care Units in Brazil.
Methods:
this ecological study was conducted using secondary data from Brazilian pregnant women with COVID-19 hospitalized in Intensive Care Units between March 2020 and March 2022. Univariate analysis and logistic regression were employed.
Results:
out of 3,547 pregnant women with COVID-19 hospitalized in Intensive Care Units, 811 died (22.8%). It was found that lack of COVID-19 vaccination (OR: 2.73; 95% CI: 1.83; 4.04), dyspnea (OR: 1.73; 95% CI: 1.17; 2.56), obesity (OR: 1.51; 95% CI: 1.05; 2.17), chronic cardiovascular disease (OR: 1.65; 95% CI: 1.14; 2.38), and non-white race/color (OR: 1.29; 95% CI: 1.00; 1.66) were independently and significantly associated with death.
Conclusions:
it is concluded that vaccination status, presence of comorbidities, and clinical and ethnic-racial characteristics are associated with COVID-19 death in pregnant women hospitalized in Intensive Care Units in Brazil.
Keywords:COVID-19Intensive Care UnitMaternal MortalityPregnant WomenSevere Acute Respiratory SyndromeSee more
- Milena Ricioli Ribeiro
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ORIGINAL ARTICLE
Influence of the leukoreduction moment of blood components on the clinical outcomes of transfused patients in the emergency department
- Natasha Dejigov Monteiro da Silva ,
- Ana Catharina Herbst ,
- Milena Raquel André ,
- Lilia de Souza Nogueira
08-26-2024
Abstract
ORIGINAL ARTICLEInfluence of the leukoreduction moment of blood components on the clinical outcomes of transfused patients in the emergency department
Revista Brasileira de Enfermagem. 2024;77(5):e20230293
08-26-2024DOI 10.1590/0034-7167-2023-0293
- Natasha Dejigov Monteiro da Silva ,
- Ana Catharina Herbst ,
- Milena Raquel André ,
- Lilia de Souza Nogueira
Views0ABSTRACT
Objectives:
to investigate the influence of the leukoreduction moment (preor post-storage) of blood components on the clinical outcomes of patients transfused in the emergency department.
Methods:
retrospective cohort study of patients aged 18 years or older who received preor post-storage leukoreduced red blood cell or platelet concentrate in the emergency department and remained in the institution for more than 24 hours. A generalized mixed-effects model was applied in the analyses.
Results:
in a sample of 373 patients (63.27% male, mean age 54.83) and 643 transfusions (69.98% red blood cell), it was identified that the leukoreduction moment influenced the length of hospital stay (p<0.009), but was not dependent on the transfused blood component (p=0.124). The leukoreduction moment had no effect (p>0.050) on transfusion reactions, healthcare-associated infections, or mortality.
Conclusions:
patients who received pre-storage leukoreduced blood components in the emergency department had a shorter length of hospital stay.
Keywords:Blood TransfusionClinical EvolutionEmergency Medical ServiceLeukocyte Reduction ProceduresTransfusion ReactionSee more
- Natasha Dejigov Monteiro da Silva
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ORIGINAL ARTICLE
Leadership styles and personal values of professors at a school of nursing
- Chennyfer Dobbins Abi Rached ,
- Bianca Batista de Siqueira ,
- Bruna Franco Massa ,
- Caroline da Silva Fonseca Paulo ,
- Sofia de Souza Cruz
08-26-2024
Abstract
ORIGINAL ARTICLELeadership styles and personal values of professors at a school of nursing
Revista Brasileira de Enfermagem. 2024;77(5):e20230333
08-26-2024DOI 10.1590/0034-7167-2023-0333
- Chennyfer Dobbins Abi Rached ,
- Bianca Batista de Siqueira ,
- Bruna Franco Massa ,
- Caroline da Silva Fonseca Paulo ,
- Sofia de Souza Cruz
Views0See moreABSTRACT
Objectives:
to identify professors’ leadership styles and personal values.
Methods:
a quantitative, descriptive-exploratory study. Population was made up of professors in doctoral category 1 at a public university in the state of São Paulo. Data collection took place from June to August 2021. Sociodemographic characterization was extracted, and the Leadership Team Values Assessment was applied. Data were analyzed using measures of central tendency.
Results:
population included 13 professors. The level that represents authentic leadership was the most prevalent. The commitment, positive attitude and trust values stood out. The level portrayed by visionary leadership was the least identified.
Conclusions:
professors’ personal values provide a theoretical basis for guiding and analyzing professors’ leadership styles. Leadership in the educational context must be recognized and studied to promote a more comprehensive and effective approach to developing and improving educational leaders.
- Chennyfer Dobbins Abi Rached
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EDITORIAL
Sexual abuse, abortion and public health in Brazil: when moral judgment accentuates inequities
- Ricardo de Mattos Russo Rafael ,
- Livia Angeli-Silva ,
- Ivone Evangelista Cabral ,
- Roberta Georgia Sousa dos Santos
08-19-2024
Abstract
EDITORIALSexual abuse, abortion and public health in Brazil: when moral judgment accentuates inequities
Revista Brasileira de Enfermagem. 2024;77:e77suppl0401
08-19-2024DOI 10.1590/0034-7167.202477suppl0401
- Ricardo de Mattos Russo Rafael ,
- Livia Angeli-Silva ,
- Ivone Evangelista Cabral ,
- Roberta Georgia Sousa dos Santos
Views0Here is an academic-political editorial that aims to call on the scientific field to reflect on the dangers of decisions regarding the right to abortion under moral rules, since there is no evidence that such a perspective translates into practices of care, protection of childhood and gender equity – elements that are so urgent and […]See more - Ricardo de Mattos Russo Rafael
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ORIGINAL ARTICLE
Bioethical issues in the family health strategy: Considerations for nursing care management
- Ieda Carla Almeida dos Santos de Souza Pastana ,
- Gabriela Arantes Wagner ,
- Geisa Colebrusco de Souza Gonçalves ,
- Mariana Cabral Schveitzer
08-19-2024
Abstract
ORIGINAL ARTICLEBioethical issues in the family health strategy: Considerations for nursing care management
Revista Brasileira de Enfermagem. 2024;77:e20220818
08-19-2024DOI 10.1590/0034-7167-2022-0818
- Ieda Carla Almeida dos Santos de Souza Pastana ,
- Gabriela Arantes Wagner ,
- Geisa Colebrusco de Souza Gonçalves ,
- Mariana Cabral Schveitzer
Views0See moreABSTRACT
Objective:
To understand the bioethical issues involved in the care management of nurses working in the Family Health Strategy.
Method:
A qualitative study was conducted through five focus groups with 36 nurses selected in the sample. Thematic content analysis was performed based on the bioethical framework, and the synthesis was presented in a conceptual map.
Results:
Bioethical issues were identified in the nursing care practice, related to both specific bioethical themes and the peculiarities of the work. Additionally, challenges and facilitators that interfere with addressing these issues were identified.
Final considerations:
Understanding the bioethical issues involved in the care management of nurses was possible with the theoretical support of different bioethical perspectives. The identified issues relate to persistent and current themes in the field of bioethics. However, some aspects intrinsic to daily practice are still imperceptible to professionals, contributing to the difficulty of discussing bioethics in this care model.
- Ieda Carla Almeida dos Santos de Souza Pastana
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ORIGINAL ARTICLE
The use of individual tracking programs in public health: a bioethics dilemma
- Ricardo Jardim Neiva ,
- João Felício Rodrigues Neto ,
- Ana Paula Oliveira Nascimento Alves ,
- Patrícia de Sousa Fernandes Queiroz ,
- Leila das Graças Siqueira , [ … ],
- Renê Ferreira da Silva-Júnior
08-19-2024
Abstract
ORIGINAL ARTICLEThe use of individual tracking programs in public health: a bioethics dilemma
Revista Brasileira de Enfermagem. 2024;77:e20230041
08-19-2024DOI 10.1590/0034-7167-2023-0041
- Ricardo Jardim Neiva ,
- João Felício Rodrigues Neto ,
- Ana Paula Oliveira Nascimento Alves ,
- Patrícia de Sousa Fernandes Queiroz ,
- Leila das Graças Siqueira ,
- Clara Cynthia Melo e Lima ,
- Francisca Souza Santos Dias ,
- Renê Ferreira da Silva-Júnior
Views0See moreABSTRACT
Objective:
to understand the bioethical perspectives on mobile tracking device use.
Methods:
theoretical study based on action research, carried out with eight graduate students from a public university. A focus group was used, with a thematic content analysis methodology with a codebook structure, approved by the Research Ethics Committee.
Results:
from the analysis, there was a concern about using devices after the pandemic ended. Using or not the device, rights inherent to humans, legislation and effectiveness of methods deepen interpretations, moving participants from a personalistic conception of the topic to a vision focused on professional implications about the methods.
Final considerations:
the debate on the impact of using technological devices on health, especially those that imply restriction of rights that refer to individuals’ private life, involves a discussion of a professional nature, in addition to requirement for clear rules on the topic.
- Ricardo Jardim Neiva
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EDITORIAL
Abuso sexual, aborto e saúde pública no brasil: quando o julgamento moral acentua as iniquidades
- Ricardo de Mattos Russo Rafael ,
- Livia Angeli-Silva ,
- Ivone Evangelista Cabral ,
- Roberta Georgia Sousa dos Santos
08-19-2024
Abstract
EDITORIALAbuso sexual, aborto e saúde pública no brasil: quando o julgamento moral acentua as iniquidades
Revista Brasileira de Enfermagem. 2024;77:e77suppl0401
08-19-2024DOI 10.1590/0034-7167.202477suppl0401pt
- Ricardo de Mattos Russo Rafael ,
- Livia Angeli-Silva ,
- Ivone Evangelista Cabral ,
- Roberta Georgia Sousa dos Santos
Views0Eis aqui um editorial acadêmico-político que tem como objetivo convocar o campo científico a refletir sobre os perigos das decisões relativas ao direito ao aborto sob réguas morais, uma vez que não há evidências de que tal perspectiva se traduza em práticas de cuidado, proteção à infância e equidade de gênero – elementos tão urgentes […]See more - Ricardo de Mattos Russo Rafael
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ORIGINAL ARTICLE
Mental health of parents of children and adolescents who require special health care
- Eliana Roldão dos Santos Nonose ,
- Rosane Meire Munhak da Silva ,
- Eliane Tatsch Neves ,
- Débora Falleiros de Mello ,
- Adriana Zilly , [ … ],
- Regina Aparecida Garcia de Lima
07-29-2024
Abstract
ORIGINAL ARTICLEMental health of parents of children and adolescents who require special health care
Revista Brasileira de Enfermagem. 2024;77(3):e20230457
07-29-2024DOI 10.1590/0034-7167-2023-0457
- Eliana Roldão dos Santos Nonose ,
- Rosane Meire Munhak da Silva ,
- Eliane Tatsch Neves ,
- Débora Falleiros de Mello ,
- Adriana Zilly ,
- Aline Cristiane Cavicchioli Okido ,
- Regina Aparecida Garcia de Lima
Views0See moreABSTRACT
Objective:
To identify the manifestations presented by parents of children and adolescents who require special health attention that can impact their mental health.
Methods:
exploratory, qualitative research, based on the concept of vulnerability, with data collection carried out through interviews with 18 parents of children and adolescents with special health care needs, hospitalized in the pediatric ward of a hospital in Paraná, between May/2017 and May/ 2018. Data analyzed by inductive thematic analysis.
Results:
parents experienced situations of vulnerability when providing care at home, with repercussions on their mental health, expressed by manifestations of lack of protection, anxiety and depression.
Final considerations:
It is important that health professionals seek to expand actions to promote care and reduce situations that generate threats, insecurities, concerns and damage to the health of parents, which can impact and further weaken care for children and adolescents who need attention especially health.
- Eliana Roldão dos Santos Nonose
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Nurse-midwives reconfiguring care in the scope of labor and births in COVID-19 times
- Paolla Amorim Malheiros Dulfe ,
- Valdecyr Herdy Alves ,
- Audrey Vidal Pereira ,
- Bianca Dargam Gomes Vieira ,
- Diego Pereira Rodrigues , [ … ],
- Maria Bertilla Lutterbach Riker Branco
04-14-2021
Abstract
Nurse-midwives reconfiguring care in the scope of labor and births in COVID-19 times
Revista Brasileira de Enfermagem. 2021;74:e20200863
04-14-2021DOI 10.1590/0034-7167-2020-0863
- Paolla Amorim Malheiros Dulfe ,
- Valdecyr Herdy Alves ,
- Audrey Vidal Pereira ,
- Bianca Dargam Gomes Vieira ,
- Diego Pereira Rodrigues ,
- Giovanna Rosário Soanno Marchiori ,
- Maria Bertilla Lutterbach Riker Branco
Views0See moreABSTRACT
Objectives:
to analyze how the nurse-midwives of maternity wards that were fields of practice for an improvement course in obstetrics have reorganized care in the context of labor and birth amidst the COVID-19 pandemic.
Methods:
this is a descriptive, exploratory and qualitative study carried out with nine nurse-midwives who are preceptors and collaborators in maternity wards that were fields of practice for an improvement course, between February and April 2020, through a semi-structured interview through WhatsApp®. Content analysis was used to treat the information.
Results:
the pandemic brought the need to reorganize work, with a focus on service training and maintenance of good practices in labor and birth, whose movement was intensely experienced, interfering in nurse-midwives’ mental health.
Conclusion:
nurse-midwives have faced the pandemic with concerns about maintaining safe care, focused on practices based on updated scientific evidence.
- Paolla Amorim Malheiros Dulfe
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EDITORIAL
The era of precision medicine and its impact on nursing: paradigm shifts?
Revista Brasileira de Enfermagem. 2021;74(5):e740501
07-28-2021
Abstract
EDITORIALThe era of precision medicine and its impact on nursing: paradigm shifts?
Revista Brasileira de Enfermagem. 2021;74(5):e740501
07-28-2021DOI 10.1590/0034-7167.2021740501
Views0INTRODUCTIONThe large investment and development of research in genomics and molecular biology in the last two decades, especially after the conclusion of the Human Genome Project (HGP), has generated many expectations regarding its impact on the transformation from the conventional medicine paradigm to the precision medicine paradigm(–). The term precision medicine (PM) was used for […]See more -
ORIGINAL ARTICLE
Knowledge and health promotion practice of Family Health Strategy nurses
- Nathália Cristina do Carmo da Silva ,
- Karen Sayuri Mekaro ,
- Rebeca Isis de Oliveira Santos ,
- Sílvia Carla da Silva André Uehara
07-06-2020
Abstract
ORIGINAL ARTICLEKnowledge and health promotion practice of Family Health Strategy nurses
Revista Brasileira de Enfermagem. 2020;73(5):e20190362
07-06-2020DOI 10.1590/0034-7167-2019-0362
- Nathália Cristina do Carmo da Silva ,
- Karen Sayuri Mekaro ,
- Rebeca Isis de Oliveira Santos ,
- Sílvia Carla da Silva André Uehara
Views0See moreABSTRACT
Objectives:
to analyze the knowledge and health promotion practice carried out by Family Health Strategy nurses.
Methods:
a descriptive study and qualitative approach. The study was conducted with 18 Family Health Strategy nurses from the city of São Carlos. Data were collected through semi-structured interviews and analyzed through thematic analysis. The study was approved by the Research Ethics Committee.
Results:
the data revealed that nurses had difficulties to conceptualize health promotion, and it is common to describe the definition of disease prevention. Nurses also reported developing group activities for health promotion; however, individual actions and consultations were still predominant.
Final Considerations:
it is necessary to develop sustainable strategies for collective health-promoting activities, in addition to strengthening multidisciplinary work and Continuing Education actions.
- Nathália Cristina do Carmo da Silva
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Quality of life and falls in elderly people: a mixed methods study
- Thainara Lopes da Silva ,
- Vanessa Vieira da Motta ,
- Willian José Garcia ,
- Cristina Arreguy-Sena ,
- Paulo Ferreira Pinto , [ … ],
- Elenir Pereira de Paiva
05-21-2021
Abstract
Quality of life and falls in elderly people: a mixed methods study
Revista Brasileira de Enfermagem. 2021;74:e20200400
05-21-2021DOI 10.1590/0034-7167-2020-0400
- Thainara Lopes da Silva ,
- Vanessa Vieira da Motta ,
- Willian José Garcia ,
- Cristina Arreguy-Sena ,
- Paulo Ferreira Pinto ,
- Pedro Miguel Santos Dinis Parreira ,
- Elenir Pereira de Paiva
Views0ABSTRACT
Objective:
to assess elderly people’s quality of life, understanding the social representations of falls.
Methods:
a convergent mixed methods research carried out at homes, with a sample of 134 elderly people. A structured questionnaire was used, covering sociodemographic variables and factors that indicated frailty and risk of falling. For quality of life assessment, Medical Outcomes Study Short-Form 36 and Theory of Social Representations, Abric’s structural approach were used, with data treated by dictionary of equivalent terms, processed in Evoc 2000, converging analytically according to Neuman.
Results:
quality of life impairment was identified in terms of physical, emotional and functional capacity. The elements of the possible central nucleus were fall, fear, and bruised-broken-bone.
Final considerations:
quality of life impairment can contribute to increase the number of falls, which has been shown to be an event present in elderly people’s lives through evocations. Understanding elderly people’s individual demands allows planning actions.
Keywords:Accident PreventionAccidental FallsCommunity Health NursingHealth Services for the AgedQuality of LifeSee more
- Thainara Lopes da Silva
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REFLECTION
In defense of the Unified Health System in the context of SARS-CoV-2 pandemic
Revista Brasileira de Enfermagem. 2020;73:e20200247
07-10-2020
Abstract
REFLECTIONIn defense of the Unified Health System in the context of SARS-CoV-2 pandemic
Revista Brasileira de Enfermagem. 2020;73:e20200247
07-10-2020DOI 10.1590/0034-7167-2020-0247
Views0See moreABSTRACT
Objective:
To discuss the political and structural conditions for establishing the Unified Health System (UHS – Sistema Único de Saúde, SUS) in coping with the SARS-CoV-2 pandemic.
Methods:
Theoretical-reflection study.
Results:
At the first moment named “The global and the local in facing the SARS-CoV-2 pandemic” is presented the health crisis that took place worldwide and the government actions to combat COVID-19. A second moment named “Between dismantling actions and resistance, the UHS is the best way to face the SARS-CoV-2 pandemic”, reflects on the neoliberal attacks on the health system and how it resists, remaining the main pandemic response strategy.
Conclusion:
The strengthening of democracy and the defense of the UHS are the way out of the crisis. It is believed that this reflection generates – in everyone who deals with caretaking – the political action, the ethical attitude, the desire for valorization and the spirit of struggle in defense of the UHS and human life.
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Historicity of nursing graduate studies in Brazil: an analysis of the Sociology of the Professions
- Fernanda Alves dos Santos Carregal ,
- Biannka Melo dos Santos ,
- Helena Pereira de Souza ,
- Fernanda Batista Oliveira Santos ,
- Maria Angélica de Almeida Peres , [ … ],
- Maria Itayra Coelho de Souza Padilha
08-20-2021
Abstract
Historicity of nursing graduate studies in Brazil: an analysis of the Sociology of the Professions
Revista Brasileira de Enfermagem. 2021;74(6):e20190827
08-20-2021DOI 10.1590/0034-7167-2019-0827
- Fernanda Alves dos Santos Carregal ,
- Biannka Melo dos Santos ,
- Helena Pereira de Souza ,
- Fernanda Batista Oliveira Santos ,
- Maria Angélica de Almeida Peres ,
- Maria Itayra Coelho de Souza Padilha
Views0See moreABSTRACT
Objectives:
to analyze the scientific productions about the history of graduate studies in Brazilian nursing in the light of Eliot Freidson’s Sociology of the Professions.
Methods:
an integrative review, carried out in the databases indexed in Virtual Health Library. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations were followed. Thematic content analysis and Eliot Freidson’s concepts were adopted.
Results:
two categories emerged: “Institutionalization of graduate courses in Brazilian nursing”, highlighting the historical process of professionalization in nursing through transition from empirical to professional care, subsidized by the monopoly of the construction of one’s own knowledge; “The scientific production of graduate nursing in Brazil”, showing the strengthening of a new generation of nurse researchers, given the greater scientificity in teaching due to implementation of graduate studies.
Final Considerations:
the analyzes present the historicity of graduate studies’ institutionalization, supporting the understanding of professionalization outlines of Brazilian nursing.
- Fernanda Alves dos Santos Carregal
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ORIGINAL ARTICLE
Binge drinking and overweight in brazilian adults – CUME Project
- Luís Paulo Souza e Souza ,
- Aline Elizabeth da Silva Miranda ,
- Helen Hermana Miranda Hermsdorff ,
- Carla Silvana de Oliveira e Silva ,
- Dulce Aparecida Barbosa , [ … ],
- Adriano Marçal Pimenta
06-01-2020
Abstract
ORIGINAL ARTICLEBinge drinking and overweight in brazilian adults – CUME Project
Revista Brasileira de Enfermagem. 2020;73:e20190316
06-01-2020DOI 10.1590/0034-7167-2019-0316
- Luís Paulo Souza e Souza ,
- Aline Elizabeth da Silva Miranda ,
- Helen Hermana Miranda Hermsdorff ,
- Carla Silvana de Oliveira e Silva ,
- Dulce Aparecida Barbosa ,
- Josefina Bressan ,
- Adriano Marçal Pimenta
Views0See moreABSTRACT
Objective:
To verify the association between heavy episodic alcohol consumption [binge drinking (BD)] and overweight in 2,909 adults from the Cohort of Universities of Minas Gerais (CUME Project) baseline, Brazil.
Method:
Cross-sectional study in which sociodemographic, anthropometric (BMI ≥ 25 kg/m2 = overweight) and dietary intake data were collected. This study evaluated the occurrence and monthly frequency of BD (≥ 4 drinks at one time for women; ≥ 5 drinks at one time for men, in the last 30 days).
Results:
The prevalence of BD and overweight were 41.3% and 40.8%, respectively. BD increased the prevalence of overweight by 19%, and, BD exposure by ≥ 5 days / month increased it by 31%.
Conclusion:
BD on a single or multiple occasion during the month was associated with a higher prevalence of overweight. Therefore, such a lifestyle should be considered in weight gain prevention strategies.
- Luís Paulo Souza e Souza
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REVIEW
Allocation of resources for health care in COVID-19 pandemic times: integrative review
- Karla Rona da Silva ,
- Fernanda Gonçalves de Souza ,
- Fátima Ferreira Roquete ,
- Shirlei Moreira da Costa Faria ,
- Bruno César Ferreira Peixoto , [ … ],
- Adriane Vieira
09-18-2020
Abstract
REVIEWAllocation of resources for health care in COVID-19 pandemic times: integrative review
Revista Brasileira de Enfermagem. 2020;73:e20200244
09-18-2020DOI 10.1590/0034-7167-2020-0244
- Karla Rona da Silva ,
- Fernanda Gonçalves de Souza ,
- Fátima Ferreira Roquete ,
- Shirlei Moreira da Costa Faria ,
- Bruno César Ferreira Peixoto ,
- Adriane Vieira
Views0See moreABSTRACT
Objective:
To analyze information on resource allocation in the context of the COVID-19 pandemic, published in indexed scientific journals, from December 2019 to March 2020.
Methods:
This is an integrative literature review, which took place in March 2020. All databases were investigated and studies were found only in MEDLINE. After applying the established criteria, six articles were selected.
Results:
It was evident that the allocation of resources is carried out as the demands emerge. The fragility in presenting scientific-methodological evidence that can guide decision makers for assertive allocation of available resources is highlighted. The results showed that studies on this subject are incipient and need to be expanded.
Final considerations:
The need for health organizations and area authorities to be better prepared for the proper use of available resources, with allocation based on scientific evidence and maximization of resources is indicated.
- Karla Rona da Silva
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