L'imagerie cérébrale au service de la rééducation

International audienc

Contributions to the debate on the revision of the concept of cultural landscape: ICOMOS BRAZIL’s National Scientific Committee

The concept of landscape is polysemic and transdisciplinary, a basic condition for the recognition, planning and management of cultural landscapes, with a view to their integrated, shared and sustainable preservation. The recent extensions of the concept of cultural heritage have brought with them a breadth, diversity and complexity that prove to be counter-hegemonic, demanding greater participation and socio-cultural integration. The construction of the concept of cultural landscape has had in Brazil important thinkers, Charters and Regulations such as the Chancela del Landscape Cultural , the Portaria 375 or the Federal Constitution itself, in addition to various local initiatives and the declaration as World Heritage Sites of places like Rio, Pampulha or Paraty. The Constitution in its article 216 establishes as Brazilian cultural heritage tangible and intangible assets , highlighting that they must be taken not only individually but as a whole. Considering the conceptual revision in debate, the Brazilian committee reaffirms PRINCIPLES for a new approach and application of the concept of Cultural Landscape. The EPISTEMOLOGICAL ADVANCE makes us consider the systemic and complex character and its relationships, interactions, meanings, and interpretations. MAN - NATURE INTERACTION must be expressed through society. The DIVERSITY OF OBJECTIVES AND THEMES, built by groups associated with cultural practices and places, are considered true palimpsests. TERRITORIES AND TERRITORIAL SYSTEMS characterize the locus, sharing ecological or cultural functions and processes. SUSTAINABLE DEVELOPMENT integrates conservation, requalification, and protection actions, considering an INTEGRAL AND INTEGRATED APPROACH to the landscape in its MATERIAL, INTANGIBLE AND NATURAL DIMENSIONS. The DYNAMICITY and evolutionary character of cultural landscapes implies the recognition of their TRANSFORMATIONS and their PUBLIC INTEREST, harmonizing public-private interactions, and the need for INTEGRATED, SHARED AND PARTICIPATORY MANAGEMENT. The Landscape is a fundamental piece to incorporate the Cultural Heritage in the policies of development and protection of the territory. Français: Le concept de paysage est polysémique et transdisciplinaire, condition de base pour la reconnaissance, l\u27aménagement et la gestion des paysages culturels, en vue de leur préservation intégrée, partagée et durable. Les extensions récentes du concept de patrimoine culturel ont apporté avec elles une ampleur, une diversité et une complexité qui s\u27avèrent contre-hégémoniques, exigeant une plus grande participation et une intégration socioculturelle. La construction du concept de paysage culturel a eu au Brésil d\u27importants penseurs, Lettres et Règlements tels que la Chancela del Landscape Cultural , la Portaria 375 ou la Constitution fédérale elle-même, en plus de diverses initiatives locales et de la déclaration, PatrimoineMundial, de lieux comme Rio, Pampulha ou Paraty. L\u27article 216 de la Constitution établit comme patrimoine culturel brésilien les « biens corporels et immatériels », soulignant qu\u27ils doivent être pris non seulement individuellement mais « dans son ensemble ». Face à cette révision conceptuelle, le comité brésilien réaffirme les PRINCIPES d\u27une nouvelle approche et application du concept de paysage culturel. L\u27AVANCE ÉPISTEMOLOGIQUE nous fait considérer le caractère systémique et complexe et ses relations, interactions, significations et interprétations. L\u27INTERACTION HOMME - NATURE doit s\u27exprimer à travers la société dans son ensemble. La DIVERSITÉ DES OBJECTIFS ET DES THÈMES, construits par des groupes associés à des pratiques et des lieux culturels, sont considérés comme de véritables palimpsestes. TERRITOIRES ET SYSTÈMES TERRITORIAUX caractérisent le locus, partageant des fonctions et des processus écologiques ou culturels. LE DÉVELOPPEMENT DURABLE intègre des actions de conservation, de requalification et de protection, en considérant une APPROCHE INTÉGRÉE ET INTÉGRÉE du paysage dans ses DIMENSIONS MATÉRIELLES, IMMATÉRIELLES ET NATURELLES. La DYNAMICITÉ et le caractère évolutif des paysages culturels impliquent la reconnaissance de leurs TRANSFORMATIONS et de leur INTÉRÊT PUBLIC, harmonisant les interactions public-privé, et la nécessité d\u27une GESTION INTÉGRÉE, PARTAGÉE ET PARTICIPATIVE. Le Paysage est une pièce fondamentale pour intégrer le Patrimoine Culturel dans les politiques de développement et de protection du territoire. Español: El concepto de paisaje es polisémico y transdisciplinario, condición básica para el reconocimiento, planificación y gestión de los paisajes culturales, con miras a su preservación integrada, compartida y sostenible. Las recientes ampliaciones del concepto de patrimonio cultural han traído consigo una amplitud, diversidad y complejidad que demuestran ser contrahegemónicas, exigiendo una mayor participación e integración sociocultural. La construcción del concepto de paisaje cultural ha tenido en Brasil importantes pensadores, Cartas y Reglamentos como la “Chancela del Paisaje Cultural”, la “Portaria 375” o la propia Constitución Federal, además de diversas iniciativas locales y la declaración, Patrimonio Mundial, de sitios como Rio, Pampulha o Paraty. El artículo 216 de la Constitución establece como patrimonio cultural brasileño “los bienes de carácter material e inmaterial”, destacando que deben ser tomados no solo individualmente sino “en conjunto”. Frente a esta revisión conceptual, el comité brasileño reafirma PRINCIPIOS para un nuevo abordaje y aplicación del concepto de Paisaje Cultural. El AVANCE EPISTEMOLÓGICO nos hace considerar el carácter sistémico y complejo y sus relaciones, interacciones, significados e interpretaciones. La INTERACIÓN HOMBRE- NATURALEZA debe expresarse a través de la sociedad en conjunto. La DIVERSIDAD DE OBJETIVOS Y TEMAS, construidos por grupos asociados a prácticas culturales y lugares, se consideran verdaderos palimpsestos. TERRITORIOS Y SISTEMAS TERRITORIALES caracterizan el locus, compartiendo funciones y procesos, ecológicos o culturales. El DESARROLLO SOSTENIBLE integra conservación, acciones de recualificación y protección, considerando un ENFOQUE INTEGRAL E INTEGRADO del paisaje en sus DIMENSIONES MATERIAL, INTANGIBLE Y NATURAL. La DINAMICIDAD y el carácter evolutivo de los paisajes culturales implica el reconocimiento de sus TRANSFORMACIONES y de su INTERÉS PÚBLICO, armonizando las interacciones público–privado, y la necesidad de una GESTIÓN INTEGRADA, COMPARTIDA Y PARTICIPATIVA. El Paisaje se constituye en pieza fundamental para incorporar el Patrimonio Cultural en las políticas de desarrollo y protección del territorio

Quality Of General Life In The Medicine Course Students

Objective: To evaluate the general quality of life in medical students. Method: This is a cross-sectional observational study of 320 students from the Federal University of Mato Grosso do Sul, located in Campo Grande, Brazil, who answered the WHOQOL-BREF quality of life assessment instrument. Results: The medical students evaluated having a good general quality of life and good satisfaction with their health. According to the domains, the psychological domain was smaller than the social relationships and environment domains. The students had a difference in the values of the WHOQOL-BREF scores only between the psychological and the environment domains and lower values in the men, in the physical and psychological domains. During the years of the course, there was a difference between the domains only for the 3rd grade of the course, with lower scores for the psychological domain. In each domain, the values of the WHOQOL-BREF scores were higher in the second grade compared to the 5th grade in the social relationships domain, and in the environmental domain. The 1st grade had lower values than the 6th grade. Conclusion: Medical students have a positive characterization of the quality of life, although it is less in the psychological domain, by the frequency of negative feelings not enjoying life or concentrating in a satisfactory way. Female students are more fragile in the psychological and physical domain than male students. Keywords: Quality of life; Medical students; Medical Education

Patrimônio e desenvolvimento: as políticas de patrimônio cultural nos anos 1960

This article aims at analyzing aspects of 1960s Brazilian cultural heritage policies, highlighting changes related to the articulation of concepts such as development, culture and heritage within the Directory of National Historical and Artistic Heritage - DPHAN, today Institute of National Historical and Artistic Heritage (IPHAN). It discusses the effects of industrialization, urban growth and development improvement measures on heritage concepts and policies, analyzing initiatives that focus on preserving cultural assets acknowledged as national historical and artistic heritage and enhancing their economical potential. The discussion emphasizes notions and understandings on heritage and preservation that had substantial bearing on preservation measures carried on by DPHAN from the 1960s on regarding the identification, valorization and protection of cultural heritage, as well as the disciplinary and institutional debates this Directory proposed.O objetivo deste artigo é analisar especificidades dos anos 1960 no que diz respeito às políticas de patrimônio, destacando algumas mudanças de entendimentos, noções e propostas, notadamente referentes às relações entre desenvolvimento, cultura e patrimônio trabalhadas pelo Instituto do Patrimônio Histórico e Artístico Nacional, então Diretoria do Patrimônio Histórico e Artístico Nacional (DPHAN). Para tanto, vai-se partir das discussões e debates desse momento acerca dos efeitos da industrialização, do crescimento urbano e das políticas desenvolvimentistas sobre as políticas de patrimônio a partir dessa década, analisando as iniciativas voltadas à patrimonialização de bens culturais, à preservação do acervo que compunha o patrimônio histórico e artístico nacional e ao fomento de suas potencialidades econômicas. Na discussão proposta neste artigo, priorizar-se-ão os entendimentos e ações de preservação da DPHAN relacionados a identificação, valoração e proteção dos bens culturais, assim como os diálogos disciplinares e institucionais que a diretoria procurou estabelecer

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

L'imagerie cérébrale au service de la rééducation

International audienc

L'imagerie cérébrale au service de la rééducation

International audienc

L'imagerie cérébrale au service de la rééducation

International audienc

L'imagerie cérébrale au service de la rééducation

International audienc

L'imagerie cérébrale au service de la rééducation

International audienc