Objectives: Previous studies have demonstrated that individuals with hearing loss can internalize social stigmas, resulting in several self-perceived negative connotations, such as incompetence, cognitive impairment, and social disability. This systematic review aimed to investigate the impact of the social stigma associated with hearing loss on the self-stigma experienced by adults and older adults. Design: Combinations of words and appropriate truncations were selected and adjusted specifically for each electronic database. The Population, Exposure, Comparator, Outcomes, and Study Characteristics strategy was used to delimit the scope of the review, bearing in mind the importance of a well-formulated research question. Results: A total of 953 articles were retrieved from the final search of each database. Thirty-four studies were selected for full-text reading. Thirteen were excluded, and 21 studies were ultimately included in this review. The results of this review were divided into three themes: (1) impact of social stigmas on self-stigma, (2) effect of emotions on self-stigma, and (3) other factors that impact self-stigma. The themes were related to the relationship between the individual and social perceptions reported by the participants with respect to their hearing experiences. Conclusions: Our results suggest that the impact of social stigma associated with hearing loss on the self-stigma of adults and older adults is strongly associated with the effects of aging and hearing loss, which may lead to withdrawal, social segregation, and negative self-perception.

O presente trabalho discute a influência entre as abordagens elementar e nodal na distribuição das densidades relativas, fundamentada em uma abordagem material baseada em uma microestrutura do tipo sólida isotrópica com penalização, na solução de um problema de otimização estrutural topológica. O problema de otimização estudado visa minimizar a flexibilidade da estrutura com restrição sobre o volume material. O Método dos Elementos Finitos e o Método do Lagrangiano Aumentado são utilizados para a discretização do domínio e resolver o problema de otimização. Para evitar instabilidades numéricas e alguns outros problemas recorrentes nas topologias ótimas, são aplicados à função objetivo dois funcionais regularizadores. Os resultados obtidos são comparados, analisando a dependência de malha, o fenômeno de tabuleiro de xadrez e a presença de regiões com densidades intermediárias, com um problema solucionado via abordagem nodal. Observando as topologias ótimas de ambas as abordagens e considerando o problema proposto, a abordagem elementar é menos eficiente que a abordagem nodal, pois, mesmo com um número maior de variáveis de projeto as topologias apresentam uma menor definição do contorno material, além do fato da independência de malha não ter sido obtida com o planejamento de ensaios numéricos realizado.

Funding Acknowledgements Type of funding sources: None. Background Atrial fibrillation (AF), either chronic or new onset, is common in critically ill patients. Its epidemiology and relationship with clinical outcomes, and the role of post-discharge anticoagulation, is unknown. Methods Single-center retrospective, cohort study, evaluating all patients with AF admitted to a non-cardiac intensive care unit during a 54-month period. Their clinical outcomes at short-term (hospital discharge) and long-term (2-year follow-up) were evaluated. The hazard ratio (HR) with 95% CI for the 2-year all-cause mortality was computed for the whole population with AF compared with a matched one, without AF (1:2 ratio). Results We screened 1357 patients, mean age 75±15.2 years, length of intensive care unit stay 4.7±5.1 days, hospital mortality 26%. We identified 215 (15.8%) patients with AF (66% chronic AF). The 2-year all-cause mortality was similar in patients with chronic or new onset AF (58.5% vs 50.7%, p=0.388). Only 85 patients received anticoagulation following their hospital discharge, mostly with chronic AF (74.5% vs 25.5%, p<0.001). We found no benefit from anticoagulation on the 2-year mortality rate (adjusted HR 1.09, 95% CI 0.63-1.86, p=0.6). We successfully matched 145 patients with AF with 290 controls. Mortality was higher in patients with AF, either in-hospital mortality or during long-term follow-up (mortality 53.8% vs 36.9%, HR 1.76; 95% CI 1.31-2.37, p=0.001). Conclusions Patients with AF, both chronic and new onset, had significantly worse short- and long-term outcomes. No mortality benefit was found from anticoagulation after hospital discharge in patients with AF.