ATAUDIW - Uma ferramenta de autoria para auxiliar o uso da lousa digital interativa

A utilização de recursos tecnológicos no ensino tem provocado mudanças positivas na elaboração de novas metodologias, a fim de melhorar o processo de ensino e aprendizado. Neste contexto, tecnologias como a Lousa Digital Interativa (LDI), que possibilita a utilização de conteúdos multimidiáticos, podem atuar facilitando o aprendizado, pois incorpora várias funcionalidades, como simulações, tutoriais didáticos, animações, entre outras. Porém a simples presença destes recursos tecnológicos, como é o caso da LDI no ambiente educacional não garante benefícios para o processo de aprendizado do aluno, levantando dúvidas se os recursos disponíveis são utilizados de maneira satisfatória. Sendo assim, se faz necessário refletir acerca de formas que possam possibilitar uma melhor utilização dos recursos da LDI. Ao longo desta pesquisa foi possível verificar que existem poucas ferramentas próprias para o contexto da LDI e muitas apresentam problemas de usabilidade e qualidade de conteúdo, o que pode, em muitos casos, inviabilizar o uso desta ferramenta no ambiente educacional. Sendo assim, uma forma de facilitar a elaboração de conteúdos para serem utilizados na LDI é por meio de Ferramentas de Autoria (FAs). Para verificar se a utilização de FAs promove um melhor uso da LDI foi desenvolvido, por meio desta pesquisa, uma FA para auxílio do uso da LDI, que possibilita a criação de atividades que otimiza o uso dos recursos disponibilizados pela LDI. Para avaliar o uso da ferramenta foram realizadas duas avaliações, uma com docentes para verificar a usabilidade da FA, e uma com os discentes que tencionava verificar a efetividade da FA no engajamento dos alunos. Após análise dos resultados das avaliações, notou-se que a FA pode facilitar a elaboração de atividades na LDI. Além disso foi possível verificar um maior engajamento por parte dos alunos, quando comparado com o modelo tradicional de ensino. Desse modo, a partir da pesquisa realizada foi possível constatar que empregar FAs para auxiliar na elaboração de atividades pode ser uma boa forma de proporcionar uma melhor utilização da LDI.Sociedad Argentina de Informática e Investigación Operativa (SADIO

A consensus parameter for the evaluation and management of angioedema in the emergency department

Despite its relatively common occurrence and life-threatening potential, the management of angioedema in the emergency department (ED) is lacking in terms of a structured approach. It is paramount to distinguish the different etiologies of angioedema from one another and more specifically differentiate histaminergic-mediated angioedema from bradykinin-mediated angioedema, especially in lieu of the more novel treatments that have recently become available for bradykinin-mediated angioedema. With this background in mind, this consensus parameter for the evaluation and management of angioedema attempts to provide a working framework for emergency physicians (EPs) in approaching the patient with angioedema in terms of diagnosis and management in the ED. This consensus parameter was developed from a collaborative effort among a group of EPs and leading allergists with expertise in angioedema. After rigorous debate, review of the literature, and expert opinion, the following consensus guideline document was created. The document has been endorsed by the American College of Allergy, Asthma & Immunology (ACAAI) and the Society for Academic Emergency Medicine (SAEM)

Factors Associated With Positive D-dimer Results in Patients Evaluated for Pulmonary Embolism

Objectives:  Available D-dimer assays have low specificity and may increase radiographic testing for pulmonary embolism (PE). To help clinicians better target testing, this study sought to quantify the effect of risk factors for a positive quantitative D-dimer in patients evaluated for PE. Methods:  This was a prospective, multicenter, observational study. Emergency department (ED) patients evaluated for PE with a quantitative D-dimer were eligible for inclusion. The main outcome of interest was a positive D-dimer. Odds ratio (ORs) and 95% confidence intervals (CIs) were determined by multivariable logistic regression. Adjusted estimates of relative risk were also calculated. Results:  A total of 4,346 patients had D-dimer testing, of whom 2,930 (67%) were women. A total of 2,500 (57%) were white, 1,474 (34%) were black or African American, 238 (6%) were Hispanic, and 144 (3%) were of other race or ethnicity. The mean (±SD) age was 48 (±17) years. Overall, 1,903 (44%) D-dimers were positive. Model fit was adequate (c-statistic = 0.739, Hosmer and Lemeshow p-value = 0.13). Significant positive predictors of D-dimer positive included female sex; increasing age; black (vs. white) race; cocaine use; general, limb, or neurologic immobility; hemoptysis; hemodialysis; active malignancy; rheumatoid arthritis; lupus; sickle cell disease; prior venous thromboembolism (VTE; not under treatment); pregnancy and postpartum state; and abdominal, chest, orthopedic, or other surgery. Warfarin use was protective. In contrast, several variables known to be associated with PE were not associated with positive D-dimer results: body mass index (BMI), estrogen use, family history of PE, (inactive) malignancy, thrombophilia, trauma within 4 weeks, travel, and prior VTE (under treatment). Conclusions:  Many factors are associated with a positive D-dimer test. The effect of these factors on the usefulness of the test should be considered prior to ordering a D-dimer

Prenatal Vitamin D Supplementation and Child Respiratory Health: A Randomised Controlled Trial

PMCID: PMC3691177This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

Evaluation of Pulmonary Embolism in the Emergency Department and Consistency With a National Quality Measure: Quantifying the opportunity for improvement

Background The National Quality Forum (NQF) has endorsed a performance measure designed to increase imaging efficiency for the evaluation of pulmonary embolism (PE) in the emergency department (ED). To our knowledge, no published data have examined the effect of patient-level predictors on performance. Methods To quantify the prevalence of avoidable imaging in ED patients with suspected PE, we performed a prospective, multicenter observational study of ED patients evaluated for PE from 2004 through 2007 at 11 US EDs. Adult patients tested for PE were enrolled, with data collected in a standardized instrument. The primary outcome was the proportion of imaging that was potentially avoidable according to the NQF measure. Avoidable imaging was defined as imaging in a patient with low pretest probability for PE, who either did not have a D-dimer test ordered or who had a negative D-dimer test result. We performed subanalyses testing alternative pretest probability cutoffs and imaging definitions on measure performance as well as a secondary analysis to identify factors associated with inappropriate imaging. χ2 Test was used for bivariate analysis of categorical variables and multivariable logistic regression for the secondary analysis. Results We enrolled 5940 patients, of whom 4113 (69%) had low pretest probability of PE. Imaging was performed in 2238 low-risk patients (38%), of whom 811 had no D-dimer testing, and 394 had negative D-dimer test results. Imaging was avoidable, according to the NQF measure, in 1205 patients (32%; 95% CI, 31%-34%). Avoidable imaging owing to not ordering a D-dimer test was associated with age (odds ratio [OR], 1.15 per decade; 95% CI, 1.10-1.21). Avoidable imaging owing to imaging after a negative D-dimer test result was associated with inactive malignant disease (OR, 1.66; 95% CI, 1.11-2.49). Conclusions One-third of imaging performed for suspected PE may be categorized as avoidable. Improving adherence to established diagnostic protocols is likely to result in significantly fewer patients receiving unnecessary irradiation and substantial savings

Tissue-Associated Bacterial Alterations in Rectal Carcinoma Patients Revealed by 16S rRNA Community Profiling

Sporadic and inflammatory forms of colorectal cancer (CRC) account for more than 80% of cases. Recent publications have shown mechanistic evidence for the involvement of gut bacteria in the development of both CRC-forms. Whereas, colon and rectal cancer have been routinely studied together as CRC, increasing evidence show these to be distinct diseases. Also, the common use of fecal samples to study microbial communities may reflect disease state but possibly not the tumor microenvironment. We performed this study to evaluate differences in bacterial communities found in tissue samples of 18 rectal-cancer subjects when compared to 18 non-cancer controls. Samples were collected during exploratory colonoscopy (non-cancer group) or during surgery for tumor excision (rectal-cancer group). High throughput 16S rRNA amplicon sequencing of the V4V5 region was conducted on the Ion PGM platform, reads were filtered using Qiime and clustered using UPARSE. We observed significant increases in species richness and diversity in rectal cancer samples, evidenced by the total number of OTUs and the Shannon and Simpson indexes. Enterotyping analysis divided our cohort into two groups, with the majority of rectal cancer samples clustering into one enterotype, characterized by a greater abundance of Bacteroides and Dorea. At the phylum level, rectal-cancer samples had increased abundance of candidate phylum OD1 (also known as Parcubacteria) whilst non-cancer samples had increased abundance of Planctomycetes. At the genera level, rectal-cancer samples had higher abundances of Bacteroides, Phascolarctobacterium, Parabacteroides, Desulfovibrio, and Odoribacter whereas non-cancer samples had higher abundances of Pseudomonas, Escherichia, Acinetobacter, Lactobacillus, and Bacillus. Two Bacteroides fragilis OTUs were more abundant among rectal-cancer patients seen through 16S rRNA amplicon sequencing, whose presence was confirmed by immunohistochemistry and enrichment verified by digital droplet PCR. Our findings point to increased bacterial richness and diversity in rectal cancer, along with several differences in microbial community composition. Our work is the first to present evidence for a possible role of bacteria such as B. fragilis and the phylum Parcubacteria in rectal cancer, emphasizing the need to study tissue-associated bacteria and specific regions of the gastrointestinal tract in order to better understand the possible links between the microbiota and rectal cancer.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Programa Nacional de Apoio à Atenção Oncológica (Pronon)Associacao Beneficiente Alzira Denise Hertzog Silva (ABADHS)CIPE AC Camargo Canc Ctr, Med Genom Lab, Sao Paulo, BrazilUniv Sao Paulo, Inst Quim, Dept Bioquim, Sao Paulo, BrazilUniv Sao Paulo, Cursode Posgrad Bioinformat, Sao Paulo, BrazilAC Camargo Canc Ctr, Dept Pelv Surg, Sao Paulo, BrazilAC Camargo Canc Ctr, Dept Pathol, Sao Paulo, BrazilUniv Fed Sao Paulo, Coll Med, Dept Gynecol, Lab Mol Gynecol, Sao Paulo, BrazilHosp Sirio Libane, Ctr Oncol Mol, Sao Paulo, BrazilUniv Sao Paulo, Food Res Ctr FoRC, Fac Ciencias Farmaceut, Dept Alimentos & Nutr Expt, Sao Paulo, BrazilAC Camargo Canc Ctr, Dept Clin Oncol, Sao Paulo, BrazilAC Camargo Canc Ctr, Lab Computat Biol & Boinformat, Sao Paulo, BrazilVirginia Tech, Biocomplex Inst, Blacksburg, VA USAUniv Sao Paulo, Fac Med, Inst Psychiat, Lab Neurosci LIM Alzira Denise Hertzog Silva 27, Sao Paulo, BrazilLaboratory of Molecular Gynecology, Department of Gynecology, Medicine College, Universidade Federal de São Paulo (UNIFESP), São Paulo, BrazilFAPESP: 2015/01507-7FAPESP: 2013/07914-8CAPES: 88887.062078/2014-00CAPES: 3385/2013PRONON: 25000.055.167/2015-23Web of Scienc

Investigating the association between obesity and asthma in 6- to 8-year-old Saudi children:a matched case-control study

Background: Previous studies have demonstrated an association between obesity and asthma, but there remains considerable uncertainty about whether this reflects an underlying causal relationship. Aims: To investigate the association between obesity and asthma in pre-pubertal children and to investigate the roles of airway obstruction and atopy as possible causal mechanisms. Methods: We conducted an age- and sex-matched case–control study of 1,264 6- to 8-year-old schoolchildren with and without asthma recruited from 37 randomly selected schools in Madinah, Saudi Arabia. The body mass index (BMI), waist circumference and skin fold thickness of the 632 children with asthma were compared with those of the 632 control children without asthma. Associations between obesity and asthma, adjusted for other potential risk factors, were assessed separately in boys and girls using conditional logistic regression analysis. The possible mediating roles of atopy and airway obstruction were studied by investigating the impact of incorporating data on sensitisation to common aeroallergens and measurements of lung function. Results: BMI was associated with asthma in boys (odds ratio (OR)=1.14, 95% confidence interval (CI), 1.08–1.20; adjusted OR=1.11, 95% CI, 1.03–1.19) and girls (OR=1.37, 95% CI, 1.26–1.50; adjusted OR=1.38, 95% CI, 1.23–1.56). Adjusting for forced expiratory volume in 1 s had a negligible impact on these associations, but these were attenuated following adjustment for allergic sensitisation, particularly in girls (girls: OR=1.25; 95% CI, 0.96–1.60; boys: OR=1.09, 95% CI, 0.99–1.19). Conclusions: BMI is associated with asthma in pre-pubertal Saudi boys and girls; this effect does not appear to be mediated through respiratory obstruction, but in girls this may at least partially be mediated through increased risk of allergic sensitisation

SPECT cerebral na doença de Huntington antes e após terapia com olanzapina: relato de caso

Olanzapine, an atypical antipsychotic drug, was administered to a patient with Huntington's disease (HD) with marked choreiform movements. Brain SPECT with 99mTc-HMPAO was performed before and after treatment. Brain SPECT imaging has been performed in patients with HD in order to determine the status of basal ganglia perfusion. The use of brain SPECT with 99mTc-HMPAO before and after treatment in patients with HD has not been yet reported. The marked hypoperfusion of the basal ganglia on brain SPECT performed before therapy with olanzapine improved significantly after treatment.Olanzapina, um antipsicótico atípico, foi administrada a uma paciente com doença de Huntington (DH) com acentuados movimentos coreicos. O SPECT cerebral com HMPAO-99mTc foi realizado antes da paciente iniciar qualquer tratamento e após tratamento com olanzapina. O SPECT cerebral tem sido realizado em pacientes com DH para avaliar a perfusão dos núcleos da base. O uso do SPECT cerebral com HMPAO-99mTc antes e após terapia em pacientes com DH ainda não foi relatado. A acentuada hipoperfusão observada nos núcleos da base na imagem de SPECT cerebral, obtida antes da terapia com olanzapina, melhorou de forma significativa após o tratamento.86386