Uma Iniciativa Nacional de Melhoria da Qualidade em Cardiologia: O Programa de Boas Práticas em Cardiologia no Brasil

Resumo Fundamento Apesar de progresso significativo na melhoria da qualidade do tratamento de doenças cardiovasculares, lacunas persistem em termos de falha na adesão às recomendações de diretrizes. Objetivo Este estudo avalia os efeitos da implementação de um programa de melhoria da qualidade adaptado do Programa Get with the guidelines® da American Heart Association sobre a adesão às diretrizes para síndrome coronária aguda (SCA), fibrilação atrial (FA) e insuficiência cardíaca (IC). Métodos Avaliamos dados demográficos, medidas de qualidade, e desfechos em curto prazo em pacientes com SCA, FA, e IC incluídos no programa Boas Práticas em Cardiologia (BPC) entre 2016 e 2022. Resultados Este estudo incluiu 12167 pacientes em 19 hospitais no Brasil. A idade média foi 62,5 [53,8-71] anos, 61,1% eram do sexo masculino, 68,7% apresentaram hipertensão, 32% diabetes mellitus, e 24,1% dislipidemia. Os escores médios compostos tiveram desempenho sustentável entre o período inicial e o último trimestre do seguimento: 65,8±36,2% a 73± 31,2% para FA (p=0,024); 81,0± 23,6% a 89,9 ± 19,3% para IC (p<0,001), e de 88,0 ± 19,1 a 91,2 ± 14,9 para SCA (p<0,001). Conclusões O programa BPC é um programa de melhoria de qualidade no Brasil, em que dados em tempo real, obtidos usando métricas de diretrizes de cardiologia, foram implementados, resultando em uma melhora global no manejo da FA, IC e SCA

Carbon dioxide recycling in two Amazonian tropical forests

Recycling of respiratory CO2 was calculated with a previously developed model using stable isotope ratios and concentration values of ambient CO2. Measurements were taken at two different tropical forests in the Amazon basin during the dry season. One forest (Reserva Ducke) was characterized by a closed canopy with lower wind speeds, while the other (Fazenda Vitoria) had a relatively open canopy and higher wind speeds. The closed canopy forest had up to 39% of its respiratory CO2 recycled at 18 m above the forest floor. Percent recycling in this forest was related to wind speed at the date of collection. Calculations of recycling on the open canopy forest gave values ranging from 0 to negative. This forest may have ambient CO2 contamination from charcoal kilns in a nearby town. Thus, calculations of recycling based on isotopic composition of ambient CO2 for this forest may be incorrect

The relationship between 18O/16O and 13C/12C ratios of ambient CO2 in two Amazonian tropical forests

Oxygen and carbon isotopic compositions of ambient carbon dioxide in two tropical forests in the Amazonian basin were determined at the beginning and the end of the dry season. One site, Fazenda Vitoria, is typical of a seasonal forest with a pronounced dry season from May to November whereas the other site, Reserva Ducke, has a milder dry season. Samples collected at night revealed that in the beginning of the dry season, when the forest is still relatively wet, isotopic exchange between carbon dioxide and wet surfaces or fog is possible. Oxygen isotope ratios of ambient carbon dioxide collected during the day were correlated with the carbon isotope ratios. These correlations are representative of the mixing line between tropospheric and respired CO2. The mixing lines were used to extrapolate the δ18O values of soil-respired CO2. These values were compared with those derived from the isotopic composition of bulk soil water (as reflected by plant stem water) and a diffusion isotopic effect of 8.8°/∞. It was observed that δ18O values of respired CO2 derived by extrapolation were greater than those calculated by using δ18O values of bulk soil water and the associated diffusion isotope effect. The results show that in tropical forests, assumptions used in previous studies of temperate regions to derive the oxygen isotopic composition of respired CO2 do not hold

Contribution of transpiration to forest ambient vapour based on isotopic measurements

Using a simple isotope mixing model, we evaluated the relative proportion of water vapour generated by plant transpiration and by soil evaporation at two sites in the Amazon basin. Sampling was carried out at two different soil covers (forest and pasture), in a seasonal tropical rainforest at eastern Amazon where major deforestation is the result of land-use change, and compared to a less seasonal central Amazon forest. In both forests, vapour from transpiration was responsible for most, if not all, of the water vapour generated in the forest, while it could not be detected above the grassy pastures. Thus the canopy transpiration may be a major source of water vapour to the forest and perhaps to the atmosphere during the dry season. The results are discussed in relation to predictive models based on net radiation that usually are not able to distinguish between transpiration and evaporation. © 1997 Blackwell Science Ltd

Environment and cooperation: cooperative values as an assumption of sustainability

In addition to establishing an understanding of the meaning of environment, the work clarifies that the environmental damage resulting value gives the minimization of the man dedicated to nature. In this regard, bearing in mind the environmental crisis confrontation served humanity, the future is viewed with doubt. It also offers, the alternative cooperative established by the Declaration of Rio and cooperative values is presented as a precondition for sustainability.Received: 06.06.10Accepted: 25.06.10</p

Implementation of a Best Practice in Cardiology (BPC) Program Adapted from Get With The Guidelines®in Brazilian Public Hospitals: Study Design and Rationale.

Background There are substantial opportunities to improve the quality of cardiovascular care in developing countries through the implementation of a quality program. Objective To evaluate the effect of a Best Practice in Cardiology (BPC) program on performance measures and patient outcomes related to heart failure, atrial fibrillation and acute coronary syndromes in a subset of Brazilian public hospitals. Methods The Boas Práticas em Cardiologia (BPC) program was adapted from the American Heart Association's (AHA) Get With The Guidelines (GWTG) Program for use in Brazil. The program is being started simultaneously in three care domains (acute coronary syndrome, atrial fibrillation and heart failure), which is an approach that has never been tested within the GWTG. There are six axes of interventions borrowed from knowledge translation literature that will address local barriers identified through structured interviews and regular audit and feedback meetings. The intervention is planned to include at least 10 hospitals and 1,500 patients per heart condition. The primary endpoint includes the rates of overall adherence to care measures recommended by the guidelines. Secondary endpoints include the effect of the program on length of stay, overall and specific mortality, readmission rates, quality of life, patients' health perception and patients' adherence to prescribed interventions. Results It is expected that participating hospitals will improve and sustain their overall adherence rates to evidence-based recommendations and patient outcomes. This is the first such cardiovascular quality improvement (QI) program in South America and will provide important information on how successful programs from developed countries like the United States can be adapted to meet the needs of countries with developing economies like Brazil. Also, a successful program will give valuable information for the development of QI programs in other developing countries. Conclusions This real-world study provides information for assessing and increasing adherence to cardiology guidelines in Brazil, as well as improvements in care processes. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

Comparative analysis of human and bovine teeth: radiographic density

Since bovine teeth have been used as substitutes for human teeth in in vitro dental studies, the aim of this study was to compare the radiographic density of bovine teeth with that of human teeth to evaluate their usability for radiographic studies. Thirty bovine and twenty human teeth were cut transversally in 1 millimeter-thick slices. The slices were X-rayed using a digital radiographic system and an intraoral X-ray machine at 65 kVp and 7 mA. The exposure time (0.08 s) and the target-sensor distance (40 cm) were standardized for all the radiographs. The radiographic densities of the enamel, coronal dentin and radicular dentin of each slice were obtained separately using the "histogram" tool of Adobe Photoshop 7.0 software. The mean radiographic densities of the enamel, coronal dentin and radicular dentin were calculated by the arithmetic mean of the slices of each tooth. One-way ANOVA demonstrated statistically significant differences for the densities of bovine and human enamel (p < 0.05) and for bovine and human coronal dentin (p < 0.05). No statistically significant differences were found for the bovine and human radicular dentin (p > 0.05). Based on the results, the authors concluded that: a) the radiographic density of bovine enamel is significantly higher than that of human enamel; b) the radiodensity of bovine coronal dentin is statistically lower than the radiodensity of human coronal dentin; bovine radicular dentin is also less radiodense than human radicular dentin, although this difference was not statistically significant; c) bovine teeth should be used with care in radiographic in vitro studies

O Instituto de Antropologia Social (EUA, Brasil e México): um artefato da resposta antropológica ao "esforço de guerra" The Institute of Social Anthropology (USA, Brazil and Mexico): an anthropological contribuition to the "war effort"

O presente trabalho trata do estabelecimento de escritórios do Instituto de Antropologia Social da Smithsonian Institution (SI) no México e no Brasil. A presença da SI dependia de acordos diplomáticos que requeriam aceitação pelos países hospedeiros. O trabalho focaliza documentos, tais como entrevistas e registros institucionais, analisados segundo a relação entre discursos e práticas envolvidos na resposta antropológica ao esforço de guerra. Tal análise pressupõe um entendimento de conceitos empregados na época como "antropologia aplicada", "estudos de área", "estudos de comunidade" e definições usadas especificamente por antropólogos da SI, como "bem limitado" e "choque cultural". O método comparativo mostra-se relevante para entender o que se passava nos dois países. No México, negociações políticas e outros fatores retardaram a criação do Instituto. No Brasil, o processo envolveu disputas interinstitucionais. O exame dessas interações leva à análise da maneira hierárquica como o Instituto era apresentado.<br>This paper examines the establishment of offices of the Smithsonian Institute of Social Anthropology (ISA) in Mexico and Brazil. The Smithsonian's presence depended on diplomatic agreements that required acceptance from the host countries. The article analyzes written documents such as interviews and institutional records to explore the relationship between the discourses and practices involved in the anthropological contribution to the US war effort. This analysis presumes a basic understanding of concepts used at the time, such as 'applied anthropology,' 'area studies' and 'community studies,' as well as definitions specifically used by the Smithsonian's anthropologists, such as 'limited good' and 'culture shock.' The comparative method is relevant to understanding what happened in the two countries. In Mexico, political negotiations and other factors delayed its implantation. In Brazil the process involved inter-institutional disputes. A closer look at these interactions leads to an analysis of the hierarchic interrelationships involved in the creation of the Institute