Black box: the use of metaphors to treat gentle themes

Contextualização: Nos acidentes aéreos a abertura da caixa preta é fundamental para esclarecer o ocorrido. Da mesma forma, o abrir da Caixa Preta metafórica, proposto neste relato, lida com a complementaridade de temas delicados, desafiantes e inquietantes numa articulação lúcida e reflexiva. Objetivo: Estimular a reflexão sobre temas delicados de forma sensível, criativa, não impositiva. Metodologia: A ideia de Abrir a Caixa Preta é oferecer uma sequência de imagens animadas e metafóricas, associadas a algumas palavras chave, convidando a uma interação reflexiva sobre temas delicados, em especial a fragilidade e terminalidade da vida. Em um primeiro momento são apresentadas imagens e palavras que trazem uma carga emocional negativa, que vão sendo colocadas dentro de uma caixa virtual e essa fica escura, pesada e se fecha. No segundo momento são mostradas imagens e palavras complementares aos temas tratados, sugerindo leveza e uma nova maneira de encarar os desafios da vida. Resultado: Nossa experiência com essa forma de abordagem trouxe resultados significativos, que ajudaram pessoas a enfrentarem com sucesso suas dificuldades ao lidar com temas delicados, como demonstrado nas declarações pós-participação. Conclusão: Parece-nos que a utilização de metáforas, organizadas na forma proposta, é de grande valia, como coadjuvante do processo de elaboração de transtornos secundários aos traumas emocionais.Context: In a plane crash the opening of the Black Box is fundamental to clarify what happened. Similarly, the opening of the metaphorical Black Box, proposed in this report, deals with the complementarity of delicate, challenging and disturbing themes in a lucid and reflexive articulation. Objective: The objective is to encourage reflection on sensitive issues in a sensitive, creative, non-taxing way. Methods: The idea of Opening the Black Box is to offer a sequence of animated and metaphorical images, associated with some keywords, inviting a reflexive interaction on delicate subjects, especially the fragility and terminality of life. In the first moment images and words are presented that bring a negative emotional charge, which is placed inside a virtual box and this becomes heavy and closes. In the second moment are shown images and words complementary to the subjects treated, suggesting lightness and a new facing the challenges of life. Results: Our experience with this approach has brought significant results, which have helped people successfully address their difficulties in dealing with sensitive issues, as demonstrated in the post-participation statements. Conclusion: It seems to us that the use of metaphors, organized in the proposed form, is of great value, as an adjunct to the process of elaboration of disorders secondary to emotional trauma

HEMATOMA ESPONTÂNEO DE RETO ABDOMINAL: RELATO DE CASO

Introdução: O Hematoma espontâneo do músculo reto abdominal é uma condição incomum, causada pela concentração de sangue em sua própria bainha muscular e sem associação com traumas, embora outras condições tivessem sido relacionadas à entidade. O quadro clínico geralmente é inespecífico e possui semelhança com outras condições abdominais agudas, o que requer, na maioria das vezes, confirmação diagnóstica através de exame de imagem, evitando desta forma intervenções cirúrgicas desnecessárias. Objetivo: Descrever um caso clínico desta entidade pouco comum na prática médica, ocorrido e conduzido no Hospital Escola Luiz Gioseffi Jannuzzi da Faculdade de Medicina de Valença/RJ. Relato de caso: Mulher, idosa, queixando-se de dor mesogástrica e em flancos há cerca de uma semana, sem fatores desencadeantes ou de melhora, associada ao surgimento de equimoses periumbilical e em flancos há dois dias. Ao exame, havia abaulamento assimétrico em mesogástrio mais pronunciado à esquerda, sinais de Laffond e Fothergill e massa palpável volumosa, dolorosa, fixa, bem delimitada e mantida com a manobra de Smith-Bates. TC de abdome sugeriu hematoma espontâneo de reto abdominal, entidade de conduta expectante. Após manejo das demais condições clínicas, recebeu alta hospitalar em cerca de duas semanas após internação. Conclusão: O Hematoma espontâneo do músculo reto abdominal ainda é uma entidade pouco enfatizada, devido ao pequeno número de casos descritos. É importante tê-la em mente para sua correta identificação e conduta, evitando assim possíveis iatrogenias

Installation and calibration of sensors for analysis of soil humidity and temperature in eastern Amazon areas

Soil moisture and temperature are important components to improve watershed management and natural resource planning, especially in areas where water supplies are limited during dry seasons. Thus, this study aimed to evaluate the installation and calibration of five sensors (Drill & Drop) as well as the consistency of the results obtained for moisture and soil temperature in areas of forest, pasture, forest-pasture transition and pasture-urban transition in the Itacaiúnas River Hydrographic Area (BHRI) in the Eastern Amazon. The results refer to the period from April to September 2019, showing different trends between forest and pasture areas. The data consistency analysis efficiently identified measurement errors, especially in the surface layer of the soil (10 cm). The Onça Puma and IFPA Rural stations had the highest percentages of error data 22.8% and 17.6%, respectively. On the other hand, these results may be associated with the environmental characteristics of the region, as well as the physical characteristics of the soil during each season. The soil temperature and humidity parameters were consistent with data from other meteorological variables (precipitation and mean air temperature) measured by sensors installed in the local hydrometeorological stations. Overall, the soil moisture and temperature measurements were obtained properly and are presented as quality data sources. Thus, it is expected that the results will contribute to enriching the availability of soil data in the IRB and encouraging the use of direct measurements given the quantity (and quality) of data obtained using this instrumentation.Soil moisture and temperature are important components to improve watershed management and natural resource planning. In that way, this article aimed to evaluate the installation and calibration of five sensors (Drill & Drop) as well as the consistency of the results obtained for moisture and soil temperature in areas of forest, pasture, forest-pasture transition, and pasture-urban transition in the Itacaiúnas River Hydrographic Area (IRB) in the Eastern Amazon. The results are from April to September 2019, showing different trends between forest and pasture areas. The data consistency analysis efficiently identified measurement errors, especially in the soil’s surface layer (10 cm). The highest percentage of error data occurred in the Onça Puma and IFPA rural stations, with 22.8% and 17.6%. On the other hand, these results may be associated with the environmental characteristics of the region, as well as the soil’s physical characteristics during each season. The soil temperature and humidity parameters were consistent with data from other meteorological variables (precipitation and mean air temperature) measured by sensors installed in the local hydrometeorological stations. Generally, the temperature and soil moisture measurements were obtained properly and are presented as quality data sources. Thus, it is expected that the results will contribute to enriching the availability of soil data in the IRB and encourage the use of direct measurements given the quantity (and quality) of data obtained using this instrumentation

Left ventricular diastolic function in morbidly obese patients in the preoperative for bariatric surgery

FUNDAMENTO: Obesidade é uma doença crônica, multifatorial, associada a aumento do risco cardiovascular, especialmente a insuficiência cardíaca diastólica. OBJETIVO: Avaliar a função diastólica do ventrículo esquerdo em obesos graves em pré-operatório para cirurgia bariátrica, relacionando com os fatores de risco cardiovascular e a estrutura cardíaca. MÉTODOS: Trata-se de um estudo transversal, com 132 pacientes candidatos a cirurgia bariátrica, submetidos a avaliação ecocardiográfica transtorácica e dos fatores de risco cardiovascular, sendo: 97 mulheres (73,5%), idade média de 38,5 ± 10,5 anos e IMC de 43,7 ± 7,2 Kg/m². Foram divididos em três grupos: 61 com função diastólica normal, 24 com disfunção diastólica leve e 47 com disfunção diastólica moderada/grave, dos quais 41 com disfunção diastólica moderada (padrão pseudonormal) e seis com disfunção diastólica grave (padrão restritivo). RESULTADOS: Hipertensão arterial sistêmica, idade e gênero foram diferentes nos grupos com disfunção diastólica. Os grupos com disfunção tiveram maior diâmetro do átrio esquerdo, do ventrículo esquerdo, volume do átrio esquerdo em quatro e duas câmaras, índice de volume atrial esquerdo e índice de massa do ventrículo esquerdo corrigido para a superfície corpórea e para altura. CONCLUSÃO: A elevada frequência de disfunção diastólica do ventrículo esquerdo na fase pré-clínica em obesos graves justifica a necessidade de uma avaliação ecocardiográfica criteriosa, com o objetivo de identificar indivíduos de maior risco, para que medidas de intervenção precoce sejam adotadas. _________________________________________________________________________________________ ABSTRACT: BACKGROUND: Obesity is a chronic and multifactorial disease, associated with increased cardiovascular risk, especially diastolic heart failure. OBJECTIVE: To evaluate left ventricular diastolic function in morbidly obese patients in the pre-operative for bariatric surgery, correlating it with cardiovascular risk factors and heart structure. METHODS: This is a cross-sectional study with 132 patients eligible for bariatric surgery submitted to transthoracic echocardiography assessment and of cardiovascular risk factors, as follows: 97 women (73.5%), mean age 38.5 ± 10.5 years and BMI of 43.7 ± 7.2 kg / m². Patients were divided into three groups: 61 with normal diastolic function, 24 with mild diastolic dysfunction and 47 with moderate/severe diastolic dysfunction, of which 41 with moderate diastolic dysfunction (pseudonormal pattern) and six with severe diastolic dysfunction (restrictive pattern). RESULTS: Hypertension, age and gender were different in the groups with diastolic dysfunction. Groups with dysfunction had higher left atrial diameter, left ventricular diameter, left atrial volume in four and two chambers, left atrial volume index and left ventricular mass index corrected for body surface area and height. CONCLUSION: The high frequency of left ventricular diastolic dysfunction in the preclinical phase in morbidly obese patients justifies the need for careful echocardiographic assessment, aiming at identifying individuals at higher risk, so that early intervention measures can be carried out

Photography-based taxonomy is inadequate, unnecessary, and potentially harmful for biological sciences

The question whether taxonomic descriptions naming new animal species without type specimen(s) deposited in collections should be accepted for publication by scientific journals and allowed by the Code has already been discussed in Zootaxa (Dubois & Nemésio 2007; Donegan 2008, 2009; Nemésio 2009a–b; Dubois 2009; Gentile & Snell 2009; Minelli 2009; Cianferoni & Bartolozzi 2016; Amorim et al. 2016). This question was again raised in a letter supported by 35 signatories published in the journal Nature (Pape et al. 2016) on 15 September 2016. On 25 September 2016, the following rebuttal (strictly limited to 300 words as per the editorial rules of Nature) was submitted to Nature, which on 18 October 2016 refused to publish it. As we think this problem is a very important one for zoological taxonomy, this text is published here exactly as submitted to Nature, followed by the list of the 493 taxonomists and collection-based researchers who signed it in the short time span from 20 September to 6 October 2016

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost