Patterns of clozapine and other antipsychotics prescriptions in patients with treatment-resistant schizophrenia in community mental health centers in São Paulo, Brazil

Background Despite of its global underuse, clozapine is still the golden standard antipsychotic for patients with treatment-resistant schizophrenia (TRS). Objective To evaluate the patterns of clozapine and other antipsychotic drugs prescription in TRS in community mental health centers in São Paulo, Brazil. Methods A multiple-choice questionnaire was applied to fifteen psychiatrists at five centers inquiring about patients’ clinical condition, adherence to oral treatment and current antipsychotic treatment. History of previous and current antipsychotic treatment was collected through medical chart review. Results Out of 442 schizophrenia patients, 103 (23.3%) fulfilled the criteria for TRS. Fifty-eight patients (56.3%) were receiving polypharmacy; 30 (29.1%) were on atypical antipsychotic monotherapy, 14 (13.6%) were on typical antipsychotic monotherapy, 25 (24.3%) were taking depot antipsychotic medication and only 22 (21.4%) were receiving clozapine. Discussion As well as in other parts of the world, many TRS patients (78.6%) receive other drugs instead of clozapine in São Paulo, the best evidence-based medication for patients with TRS. The government should make every effort to provide medical training and the equipment and logistic support to adequately serve those who could benefit from clozapine treatment at the community health centers

Sistemas de apoio à educação a distância: uma experiência na Secretaria de Educação a Distância da UFRN

This article presents two information systems implemented at the Distance Education Secretariat of the Federal University of Rio Grande do Norte (SEDIS/UFRN) to manage information that makes up the planning of the semester and the Information Technology support. The methodology used was an adaptation of the standard information systems development lifecycle. The research strategy was a case study of the use of the system by employees, teachers, tutors and coordinators who work directly or indirectly, in undergraduate distance courses of the Secretariat of Distance Education (SEDIS/UFRN). It is considered that the solution adopted was able to support the management of information, since it directed eff orts to provide higher quality services, aligned to the needs of the participants of distance education.Key words: distance education, quality of information, information systems.Este artigo apresenta dois sistemas deinformação implementados na Secretaria de Educaçãoa Distância da Universidade Federal do RioGrande do Norte (SEDIS/UFRN) para gerenciar asinformações que compõem a Educação a distância,relativas ao planejamento do semestre letivo e aosuporte de Tecnologia da Informação (TI). A metodologiaadotada foi uma adaptação do ciclo de vidatradicional do desenvolvimento de sistemas de informação.A estratégia de pesquisa foi um estudode caso da utilização do sistema pelos funcionários,professores, tutores e coordenadores que atuam, diretaou indiretamente, nos cursos de graduação adistância da Secretaria de Educação a Distância (SEDIS/UFRN). Considera-se que a solução adotada foicapaz de apoiar a gestão das informações, visto quedirecionou os esforços para a prestação de serviçosde maior qualidade, alinhados às exigências dosparticipantes da educação a distância.  Palavras-chave: educação a distância, qualidade dainformação, sistemas de informação

Status Quo and Problems of Requirements Engineering for Machine Learning: Results from an International Survey

Systems that use Machine Learning (ML) have become commonplace for companies that want to improve their products and processes. Literature suggests that Requirements Engineering (RE) can help address many problems when engineering ML-enabled systems. However, the state of empirical evidence on how RE is applied in practice in the context of ML-enabled systems is mainly dominated by isolated case studies with limited generalizability. We conducted an international survey to gather practitioner insights into the status quo and problems of RE in ML-enabled systems. We gathered 188 complete responses from 25 countries. We conducted quantitative statistical analyses on contemporary practices using bootstrapping with confidence intervals and qualitative analyses on the reported problems involving open and axial coding procedures. We found significant differences in RE practices within ML projects. For instance, (i) RE-related activities are mostly conducted by project leaders and data scientists, (ii) the prevalent requirements documentation format concerns interactive Notebooks, (iii) the main focus of non-functional requirements includes data quality, model reliability, and model explainability, and (iv) main challenges include managing customer expectations and aligning requirements with data. The qualitative analyses revealed that practitioners face problems related to lack of business domain understanding, unclear goals and requirements, low customer engagement, and communication issues. These results help to provide a better understanding of the adopted practices and of which problems exist in practical environments. We put forward the need to adapt further and disseminate RE-related practices for engineering ML-enabled systems.Comment: Accepted for Publication at PROFES 202

Weibull function adjustment procedures for prognosing diameter distribution of eucalyptus plantations

This study evaluated the prognosis of the diameter distribution of forest stands of Eucalyptus spp., Using the Weibull probability density function, with two and three parameters and two systems of equations for forest prognosis (Systems I and II), the System I made by a larger number of stand variables. We used data of 791 permanent plots measured at ages 25-122 months. The two-parameter function was fitted by maximum likelihood methods and linear approach and the three parameters only by the maximum likelihood method. The quality of the settings of the Weibull function was assessed using the Kolmogorov-Smirnov test (α = 0.01). To adjust the equation systems have randomly selected 551 plots and to validate the data, the 240 remaining installments. The quality of the adjustments of system equations was evaluated from the distribution of residuals charts, correlation coefficient (r), square root of the mean error (RQEM), average percentage differences (MDP) and bias. The f.d.p. Weibull three parameters set by the maximum likelihood method making use of System II is the most suitable procedure for the prognosis of clonal stands of Eucalyptus urophylla and Eucalyptus grandis unthinned.This study evaluated the prognosis of the diameter distribution of forest stands of Eucalyptus spp., using the Weibull probability density function, with two and three parameters and two systems of equations for forest prognosis (Systems I and II), the System I made by a larger number of stand variables. We used data of 791 permanent plots measured at ages 25-122 months. The two-parameter function was fitted by maximum likelihood methods and linear approach and the three parameters only by the maximum likelihood method. The quality of the settings of the Weibull function was assessed using the Kolmogorov-Smirnov test (α = 0.01). To adjust the equation systems were randomly selected 551 plots and to validate the data, the 240 remaining installments. The quality of the adjustments of system equations was evaluated from the distribution of residuals charts, correlation coefficient (r), square root of the mean error (RQEM), average percentage differences (MDP) and bias. The f.d.p. Weibull three parameters set by the maximum likelihood method making use of System II is the most suitable procedure for the prognosis of clonal stands of Eucalyptus urophylla and Eucalyptus grandis unthinned

Cytomegalovirus infection in transplant recipients

Cytomegalovirus infection is a frequent complication after transplantation. This infection occurs due to transmission from the transplanted organ, due to reactivation of latent infection, or after a primary infection in seronegative patients and can be defined as follows: latent infection, active infection, viral syndrome or invasive disease. This condition occurs mainly between 30 and 90 days after transplantation. In hematopoietic stem cell transplantation in particular, infection usually occurs within the first 30 days after transplantation and in the presence of graft-versus-host disease. The major risk factors are when the recipient is cytomegalovirus seronegative and the donor is seropositive as well as when lymphocyte-depleting antibodies are used. There are two methods for the diagnosis of cytomegalovirus infection: the pp65 antigenemia assay and polymerase chain reaction. Serology has no value for the diagnosis of active disease, whereas histology of the affected tissue and bronchoalveolar lavage analysis are useful in the diagnosis of invasive disease. Cytomegalovirus disease can be prevented by prophylaxis (the administration of antiviral drugs to all or to a subgroup of patients who are at higher risk of viral replication) or by preemptive therapy (the early diagnosis of viral replication before development of the disease and prescription of antiviral treatment to prevent the appearance of clinical disease). The drug used is intravenous or oral ganciclovir; oral valganciclovir; or, less frequently, valacyclovir. Prophylaxis should continue for 90 to 180 days. Treatment is always indicated in cytomegalovirus disease, and the gold-standard drug is intravenous ganciclovir. Treatment should be given for 2 to 3 weeks and should be continued for an additional 7 days after the first negative result for viremia

The ITASAT – The Lessons Learned from the Mission Concept to the Operation

The ITASAT Project was initiated as an effort of the Brazilian Space Agency (AEB), the Technological Institute of Aeronautics (ITA) and the National Institute of Space Research (INPE) to train human resources to the Aerospace sector due to the lack of experience of the students in practical projects in the aerospace segment in Brazil. In this effort students were challenged to design, build and operate a satellite in a hands-on project. Along the project years several changes happened on the satellite configuration, going through a 100 kg satellite to a 6U CubeSat and this last configuration was designed, assembled and tested. In December ITASAT was launched and since its launch has been tracked and operated by the ground operation team. In this paper we will discuss the lessons learned during the project, since the decision to change the satellite size and re-thinking the scope of the project objectives, focusing on system engineering, Assembly Integration and Testing (AIT), Verification and Validation (V&V) and ground operations. The paper will present the challenges of the group of students in this hands-on project, the mistakes and hits along the project phases

First report of severe acute respiratory syndrome coronavirus 2 detection in two asymptomatic cats in the state of Pernambuco, Northeastern Brazil

Background and Aim: Despite worldwide case reports, including Brazilian cases, no frequency study on infection of pets by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been conducted to date in Brazil. Accordingly, the present study was aimed to assess dogs and cats belonging to positive owners in Recife, Northeastern Brazil. Materials and Methods: This was a longitudinal prospective study on dogs and cats in the city of Recife whose owners were in isolation at home due to a confirmed laboratory diagnosis of SARS-CoV-2 through reverse-transcriptase polymerase chain reaction (RT-qPCR). Oral and rectal swabs from the pets were tested for the presence of SARS-CoV-2-specific RNA by means of RT-qPCR. Results: Among the pets tested, 0/16 dogs and 2/15 cats were positive for SARS-CoV-2. Interestingly, the two positive cats were owned by two unrelated asymptomatic veterinary students, which, therefore, post a warning to veterinarians worldwide. Conclusion: The findings herein indicate that cats may act as sentinels for human cases, particularly sharing households with asymptomatic human cases. Although with small sampling and convenient recruiting, the presence of infected cats by SARS-CoV-2 was most likely due to close cat-human contact with positive owners, posting a human-animal health threat when pets share the same bed and interact with owners without protection, particularly during owner self-isolation. Thus, infected owners should follow the same human preventive guidelines with their pets to avoid spreading infection

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt