DESENHO UNIVERSAL DA APRENDIZAGEM NO COTIDIANO DOS PROFESSORES DO ENSINO FUNDAMENTAL II: PONDERAÇÕES

Curriculum flexibility for students with autism from the sixth to the ninth grade should be part of the reflections and teaching practices of teachers who work in this segment. These students, autistic and all students with disabilities, as well as all the subjects that make up each classroom are entitled to a schooling that seeks to implement and guarantee the acquisition process and curricular knowledge referring to each grade/school year. In order to achieve this objective, this article presents the perspective of work through the Universal Design of Learning, where it is possible to contemplate all learning barriers in an inclusive way. For this descriptive study with a qualitative approach, a questionnaire was applied containing ten questions based on the initial training and practices of teachers of Elementary School II in the city of Juiz de Fora-MG, the sample consisted of 14 subjects. The results indicated that, in initial training, these teachers did not have any discipline that addressed curricular adaptations. Concludes this knowledge was acquired in training in contexts. Most of these teachers are aware of Universal Design for Learning, but have not effectively appropriated in fact, and do not use its assumptions in their daily curriculum planning.La flexibilización curricular para alumnos con autismo del sexto al noveno grado debe ser parte de las reflexiones y prácticas docentes de los docentes que actúan en este segmento. Estos alumnos, autistas y todos los alumnos con discapacidad, así como todas las asignaturas que componen cada aula tienen derecho a una escolarización que busca implementar y garantizar el proceso de adquisición y conocimientos curriculares referentes a cada grado/año escolar. Para lograr este objetivo, este artículo presenta la perspectiva del trabajo a través del Diseño Universal del Aprendizaje, donde es posible contemplar todas las barreras del aprendizaje de manera inclusiva. Para este estudio descriptivo con enfoque cualitativo, se aplicó un cuestionario que contiene diez preguntas basado en la formación inicial y las prácticas de los profesores de la Escuela Primaria II en la ciudad de Juiz de Fora-MG, la muestra estuvo compuesta por 14 sujetos. Los resultados indicaron que, en la formación inicial, estos docentes no tenían ninguna disciplina que aborda las adaptaciones curriculares. Se concluyó que este conocimiento fue adquirido en la formación en contextos. La mayoría de estos docentes conocen el Diseño Universal del Aprendizaje, pero no se han apropiado efectivamente de sus perspectivas para, de hecho, utilizar sus supuestos en su planificación curricular diaria.As flexibilizações curriculares para alunos com autismo do sexto ao nono ano devem fazer parte das reflexões e práticas docentes dos professores que atuam neste segmento. Estes alunos, autistas e todos os alunos com deficiências, assim como todos os sujeitos que compõem cada sala de aula tem direito a uma escolarização que busquem efetivar e garantir o processo de aquisição e conhecimentos curriculares referentes a cada série/ano escolar. Para se atingir este objetivo apresenta-se neste artigo a perspectiva de trabalho através do Desenho Universal da Aprendizagem, onde é possível contemplar todas as barreiras de aprendizagem de forma inclusiva. Para este estudo descritivo com abordagem qualitativa foi aplicado um questionário contendo dez perguntas fundamentadas na formação inicial e nas práticas de professores do Ensino Fundamental II da cidade de Juiz de Fora-MG, a amostra foi composta por 14 sujeitos. Os resultados indicaram que, na formação inicial, esses professores não tiveram nenhuma disciplina que abordasse as adaptações curriculares.  Conclui-se que estes conhecimentos foram adquiridos em formações em contextos. A maioria destes professores, conhecem o Desenho Universal da Aprendizagem, mas não se apropriaram efetivamente de suas perspectivas para, de fato, utilizarem seus pressupostos em seu cotidiano de planejamento curricular

Isatuximab plus atezolizumab in patients with advanced solid tumors: results from a phase I/II, open-label, multicenter study

Atezolizumab; Isatuximab; Solid tumorsAtezolizumab; Isatuximab; Tumores sólidosAtezolizumab; Isatuximab; Tumors sòlidsBackground The anti-CD38 antibody isatuximab is approved for the treatment of relapsed/refractory multiple myeloma, but there are no data on its efficacy in solid tumors. This phase I/II study (NCT03637764) assessed the safety and activity of isatuximab plus atezolizumab (Isa + Atezo), an anti-programmed death-ligand 1 (PD-L1) antibody, in patients with immunotherapy-naive solid tumors: epithelial ovarian cancer (EOC), glioblastoma (GBM), hepatocellular carcinoma (HCC), and squamous cell carcinoma of the head and neck (SCCHN). Patients and methods Phase I assessed safety, tolerability, pharmacokinetics, pharmacodynamics, and the recommended phase II dose (RP2D) of isatuximab 10 mg/kg intravenously (i.v.) every week for 3 weeks followed by once every 3 weeks + atezolizumab 1200 mg i.v. every 3 weeks. Phase II used a Simon’s two-stage design to assess the overall response rate or progression-free survival rate at 6 months (GBM cohort). Interim analysis was carried out at 6 months following first dose of the last enrolled patient in each cohort. Pharmacodynamic biomarkers were tested for CD38, PD-L1, tumor-infiltrating immune cells, and FOXP3+ regulatory T cells (Tregs) in the tumor microenvironment (TME). Results Overall, 107 patients were treated (EOC, n = 18; GBM, n = 33; HCC, n = 27; SCCHN, n = 29). In phase I, Isa + Atezo showed an acceptable safety profile, no dose-limiting toxicities were observed, and RP2D was confirmed. Most patients experienced ≥1 treatment-emergent adverse event (TEAE), with ≤48.5% being grade ≥3. The most frequent TEAE was infusion reactions. The study did not continue to stage 2 based on prespecified targets. Tumor-infiltrating CD38+ immune cells were reduced and almost cleared after treatment. Isa + Atezo did not significantly modulate Tregs or PD-L1 expression in the TME. Conclusions Isa + Atezo had acceptable safety and tolerability. Clinical pharmacodynamic evaluation revealed efficient target engagement of isatuximab via treatment-mediated reduction of CD38+ immune cells in the TME. Based on clinical data, CD38 inhibition does not improve responsiveness to PD-L1 blockade in these patients.This work was sponsored by Sanofi (no grant number)

Family caregiver mistreatment of the elderly : prevalence of risk and associated factors

The detection of elder mistreatment is emerging as a public health priority; however, abusive behaviors exercised by caregivers are little known and rarely detected among primary health care professionals. This study aims to estimate the prevalence of risk of abuse against community-residing elderly with moderate to severe dependency whose caregivers are relatives. In addition, we aim to describe the association between such a risk and socio-demographic variables, cognitive and dependency state of the victim, and the scale of the caregiver's anxiety, depression, and burden. Cross-sectional study developed in 72 Primary Health Care teams from Barcelona, Spain. Participants were caregivers and their dependent care recipients (N = 829). Home interviews included the Caregiver Abuse Screen (CASE); self-reported abuse from care recipient; activities of daily living and cognitive state of the care recipient; anxiety and depression in caregivers and Caregiver Burden Scale. The relationship prior to the dependency, positive aspects of caregiving, and social support for the caregiver were also assessed. Multivariate analysis was performed using logistic regression with risk of abuse as dependent variable. Caregivers were mainly women (82.8%) with a mean age of 63.3 years. Caregivers and care recipients lived in the same household in 87.4% of cases, and 86.6% had enjoyed a good previous relationship. Care recipients were women (65.6%), with a mean age of 84.2 years, and 64.2% had moderate to severe cognitive impairment. CASE demonstrated a prevalence of 33.4% (95% CI: 30.3-36.7) of abuse risk by the caregiver. Logistic regression showed as statistically significant: caregiver burden (OR = 2.75; 95% CI: 1.74-4.33), caregiver anxiety (OR = 2.06; 95% CI: 1.40-3.02), caregiver perception of aggressive behavior in the care recipient (OR = 7.24; 95% CI: 4.99-10.51), and a bad previous relationship (OR = 4.66; 95% CI: 1.25-17.4). Prevalence of risk of abuse is high among family caregivers. Our study has found risk factors in family caregivers that are preventable to an extent, namely: anxiety and feelings of burden. It is essential to become aware of these risk factors and their causes to intervene and help primary as well secondary prevention

Caminhos e vertentes: os sentimentos reprimidos pelos profissionais de saúde da linha de frente da pandemia pela COVID-19

The aim was to identify the feelings repressed by health professionals in the face of the COVID-19 pandemic. Experience report carried out by nursing interns at a municipal health center in the city of Rio de Janeiro. The performance of this practice enabled the opportunity to listen to health professionals from different areas of expertise, in which it was possible to identify the feelings repressed by them during the COVID-19 pandemic. The experience of six students from the penultimate period of the nursing graduation was narrated who, while fulfilling the mandatory internship time at a municipal health center, came across overworked professionals, with a high demand for services due to the consequences of the COVID pandemic -19. The physical and mental burden of health professionals, especially the nursing staff, is evident in this pandemic scenario. It is important, therefore, to have a more sensitive look at workers, so that they can express the feelings they experience, and thus mitigate the suffering in the face of physical and emotional exhaustion in dealing with the pandemic.Objetivou-se identificar os sentimentos reprimidos por profissionais de saúde, frente à pandemia do COVID-19. Relato de experiência realizado por internas de Enfermagem em um centro municipal de saúde no município do Rio de Janeiro. A realização dessa prática viabilizou a oportunidade de escuta dos profissionais de saúde de diferentes áreas de atuação, em que foi possível identificar os sentimentos reprimidos por estes durante a pandemia do COVID-19. Narrou-se a vivência de seis estudantes do penúltimo período da graduação de enfermagem que, ao cumprir o tempo de estágio obrigatório em um centro municipal de saúde, se depararam com profissionais sobrecarregados, com uma alta demanda de serviços devido às consequências da pandemia do COVID-19. É evidente a sobrecarga física e mental dos profissionais de saúde, sobretudo, da equipe de enfermagem diante desse cenário de pandemia. Torna-se importante, portanto, um olhar mais sensível para os trabalhadores, para que possam expressar os sentimentos vivenciados, e assim mitigar o sofrimento frente ao desgaste físico e emocional no enfrentamento da pandemia

Extracellular Vesicles Enriched in Connexin 43 Promote a Senescent Phenotype in Bone and Synovial Cells Contributing to Osteoarthritis Progression

[Abstract] The accumulation of senescent cells is a key characteristic of aging, leading to the progression of age-related diseases such as osteoarthritis (OA). Previous data from our laboratory has demonstrated that high levels of the transmembrane protein connexin 43 (Cx43) are associated with a senescent phenotype in chondrocytes from osteoarthritic cartilage. OA has been reclassified as a musculoskeletal disease characterized by the breakdown of the articular cartilage affecting the whole joint, subchondral bone, synovium, ligaments, tendons and muscles. However, the mechanisms that contribute to the spread of pathogenic factors throughout the joint tissues are still unknown. Here, we show for the first time that small extracellular vesicles (sEVs) released by human OA-derived chondrocytes contain high levels of Cx43 and induce a senescent phenotype in targeted chondrocytes, synovial and bone cells contributing to the formation of an inflammatory and degenerative joint environment by the secretion of senescence-associated secretory associated phenotype (SASP) molecules, including IL-1ß and IL-6 and MMPs. The enrichment of Cx43 changes the protein profile and activity of the secreted sEVs. Our results indicate a dual role for sEVs containing Cx43 inducing senescence and activating cellular plasticity in target cells mediated by NF-kß and the extracellular signal-regulated kinase 1/2 (ERK1/2), inducing epithelial-to-mesenchymal transition (EMT) signalling programme and contributing to the loss of the fully differentiated phenotype. Our results demonstrated that Cx43-sEVs released by OA-derived chondrocytes spread senescence, inflammation and reprogramming factors involved in wound healing failure to neighbouring tissues, contributing to the progression of the disease among cartilage, synovium, and bone and probably from one joint to another. These results highlight the importance for future studies to consider sEVs positive for Cx43 as a new biomarker of disease progression and new target to treat OA.This work was supported in part through funding from Health Institute ‘Carlos III’ (ISCIII, Spain), the European Regional Development Fund, ‘A way of making Europe’ from the European Union (to MDM): grant PI19/00145; a grant from the Joint Transnational Call for Proposals for “European Innovative Research & Technological Development Projects in Nanomedicine” EURONANOMED III (AC21_2/00026) (to MDM); a grant from Xunta de Galicia (IN607B2020/12) (to MDM) and from H2020, Future and Emerging Technologies (grant 858014 “PANACHE”) to MDM. MV-E was funded with a predoctoral (ED481A-2015/188) and post-doctoral fellowship (IN606B-2019/004) from Xunta de Galicia. AG-C was funded with a predoctoral fellowship (FIS20/00310) from ISCIII. PC-F was funded with a post-doctoral fellowship and a grant from Xunta de Galicia (INB606B 2017/014 and IN606C 2021/006). We thank members of the CellCOM group for helpful technical suggestion, María Dolores Álvarez Alvariño (CHUS) for generously collecting tissue samples in the operating room after surgery and Arantxa Tabernero (INCYL, University of Salamanca) for kindly providing the human Cx43 plasmid used in this studyXunta de Galicia; IN607B2020/12Xunta de Galicia; ED481A-2015/188Xunta de Galicia; IN606B-2019/004Xunta de Galicia; INB606B 2017/014Xunta de Galicia; IN606C 2021/00

Caminhos e vertentes: os sentimentos reprimidos pelos profissionais de saúde da linha de frente da pandemia pela COVID-19

The aim was to identify the feelings repressed by health professionals in the face of the COVID-19 pandemic. Experience report carried out by nursing interns at a municipal health center in the city of Rio de Janeiro. The performance of this practice enabled the opportunity to listen to health professionals from different areas of expertise, in which it was possible to identify the feelings repressed by them during the COVID-19 pandemic. The experience of six students from the penultimate period of the nursing graduation was narrated who, while fulfilling the mandatory internship time at a municipal health center, came across overworked professionals, with a high demand for services due to the consequences of the COVID pandemic -19. The physical and mental burden of health professionals, especially the nursing staff, is evident in this pandemic scenario. It is important, therefore, to have a more sensitive look at workers, so that they can express the feelings they experience, and thus mitigate the suffering in the face of physical and emotional exhaustion in dealing with the pandemic.Objetivou-se identificar os sentimentos reprimidos por profissionais de saúde, frente à pandemia do COVID-19. Relato de experiência realizado por internas de Enfermagem em um centro municipal de saúde no município do Rio de Janeiro. A realização dessa prática viabilizou a oportunidade de escuta dos profissionais de saúde de diferentes áreas de atuação, em que foi possível identificar os sentimentos reprimidos por estes durante a pandemia do COVID-19. Narrou-se a vivência de seis estudantes do penúltimo período da graduação de enfermagem que, ao cumprir o tempo de estágio obrigatório em um centro municipal de saúde, se depararam com profissionais sobrecarregados, com uma alta demanda de serviços devido às consequências da pandemia do COVID-19. É evidente a sobrecarga física e mental dos profissionais de saúde, sobretudo, da equipe de enfermagem diante desse cenário de pandemia. Torna-se importante, portanto, um olhar mais sensível para os trabalhadores, para que possam expressar os sentimentos vivenciados, e assim mitigar o sofrimento frente ao desgaste físico e emocional no enfrentamento da pandemia

Left atrial geometry and outcome of atrial fibrillation ablation: results from the multicentre LAGO-AF study

Aims: Left atrial (LA) remodelling is a key determinant of atrial fibrillation (AF) ablation outcome. Optimal methods to assess this process are scarce. LA sphericity is a shape-based parameter shown to be independently associated to procedural success. In a multicentre study, we aimed to test the feasibility of assessing LA sphericity and evaluate its capability to predict procedural outcomes. Methods and results: This study included consecutive patients undergoing first AF ablation during 2013. A 3D model of the LA chamber, excluding pulmonary veins and LA appendage, was used to quantify LA volume (LAV) and LA sphericity (≥82.1% was considered spherical LA). In total, 243 patients were included across 9 centres (71% men, aged 56 ± 10 years, 44% with hypertension and 76% CHA2DS2-VASc ≤ 1). Most patients had paroxysmal AF (66%) and underwent radiofrequency ablation (60%). Mean LA diameter (LAD), LAV, and LA sphericity were 42 ± 6 mm, 100 ± 33 mL, and 82.6 ± 3.5%, respectively. Adjusted Cox models identified paroxysmal AF [hazard ratio (HR 0.54, P = 0.032)] and LA sphericity (HR 1.87, P = 0.035) as independent predictors for AF recurrence. A combined clinical-imaging score [Left Atrial Geometry and Outcome (LAGO)] including five items (AF phenotype, structural heart disease, CHA2DS2-VASc ≤ 1, LAD, and LA sphericity) classified patients at low (≤2 points) and high risk (≥3 points) of procedural failure (35% vs. 82% recurrence at 3-year follow-up, respectively; HR 3.10, P < 0.001). Conclusion: In this multicentre, real-life cohort, LA sphericity and AF phenotype were the strongest predictors of AF ablation outcome after adjustment for covariates. The LAGO score was easy to implement, identified high risk of procedural failure, and could help select optimal candidates. Clinical Trial Registration Information: NCT02373982 (http://clinicaltrials.gov/ct2/show/NCT02373982)

Eficàcia i seguretat d’un tractament oral a base de mucopolisacàrids, col·lagen tipus I i vitamina C en pacients amb tendinopaties

Introducció i objectius La tendinopatia és una lesió freqüent durant la pràctica esportiva que es manifesta amb una alteració estructural del tendó. L’objectiu d’aquest estudi fou avaluar l’eficàcia i la seguretat d’un complement alimentari a base de mucopolisacàrids, col·lagen tipus i i vitamina C (Tendoactive®) sobre l’evolució clínica i estructural de les tendinopaties del tendó d’Aquil·les, del rotular i de l’epicòndil lateral del colze. Material i mètodes Es realitzà un estudi multicèntric prospectiu, de tipus exploratori en fase iv, obert i no comparatiu. S’inclogueren un total de 98 pacients amb tendinopaties (32 d’Aquil·les, 32 de rotular i 34 de l’epicòndil lateral) que reberen una dosi diària de 435 mg de mucopolisacàrids, 75 mg de col·lagen tipus i i 60 mg de vitamina C (equivalent a 3 càpsules al dia de Tendoactive®) durant 90 dies consecutius. Mensualment s’avaluà el dolor en repòs i en activitat mitjançant una escala visual analògica (EVA), la funció articular mitjançant els qüestionaris VISA-A, VISA-P i PRTEE, i el tendó afectat es caracteritzà ecogràficament. Resultats En els 3 tipus de tendinopatia es registrà una reducció significativa del dolor, tant en repòs com en activitat, des de la primera visita de control (dia 30) fins al final de l’estudi (dia 90). Així mateix, el dia 90 es detectà una millora del 38% en VISA-A, del 46% en VISA-P i del 77% en PRTEE (p < 0,001). Simultàniament es registrà una reducció del 12% en el gruix del tendó d’Aquil·les, del 10% en el rotular i del 20% en el tendó de l’epicòndil lateral (p < 0,05). Conclusions Els resultats de l’estudi indiquen que l’administració de Tendoactive® és segura i eficaç per millorar els símptomes clínics i l’evolució estructural de les tendinopaties del tendó d’Aquil·les, del tendó rotular i del tendó de l’epicòndil lateral

The efficacy and safety of oral mucopolysaccharide, type I collagen and vitamin C treatment in tendinopathy patients

Introduction and objectives Tendinopathy, which is accompanied by structural changes to the tendon, is a common sporting injury. The aim of this study was to evaluate the efficacy and safety of a nutritional supplement containing mucopolysaccharides, type I collagen and vitamin C (TendoactiveTM) on the clinical and structural evolution of tendinopathies of the Achilles tendon, patellar tendon and lateral epicondyle tendon in the elbow. Materials and methods A multicenter, open-label, non-comparative, prospective, exploratory phase iv study was performed. A total of 98 tendinopathy patients (32 Achilles, 32 patellar and 34 lateral epicondylar), who received a daily dose of 435 mg mucopolysaccharides, 75 mg type i collagen and 60 mg vitamin C (equivalent to three capsules of TendoactiveTM per day) for 90 consecutive days, were included. Every month, pain at rest and when active was assessed using a visual analogue scale (VAS), joint function was assessed using the VISA-A, VISA-P and PRTEE questionnaires, and the tendon affected was characterized by ultrasound. Results A significant reduction in pain both at rest and when active was observed between the first control visit (day 30) and the end of the study (day 90) for all three types of tendinopathy. Thus, a 38% improvement in VISA-A, 46% in VISA-P and 77% in PRTEE was observed on day 90 (P < .001). Similarly, a 12% decrease in the thickness of the Achilles tendon, a 10% decrease in the patellar tendon and a 20% decrease in the lateral epicondyle tendon was observed (P < .05). Conclusions The results of this study show that the administration of TendoactiveTM is safe and effective for improving the clinical symptoms and structural evolution of tendinopathies of the Achilles, patella and lateral epicondyle tendons