Plastic surgeons as hand surgery specialists: determinant factors of public’s perceptions

INTRODUCTION: To assess the possible determinants that lead public to choose plastic surgeons as hand surgery specialists. METHODS: General public members (n = 701) were asked to choose one or two specialists that they perceived to be an expert in 11 hand surgery-related scenarios. Bivariate and multivariate analyses were applied to assess the possible determinants (socio-demographic data, source of reported information, and previous plastic surgery contact) of public choice of plastic surgeons as experts in the hand surgery-related scenarios. RESULTS: A significantly (all p < 0.05) poor understanding of the role of plastic surgeons was seen in infectious hand injury, hand tumor, hand fracture, hand tendon injury, carpal tunnel syndrome, rheumatoid arthritis deformity, and dupuytren contracture. Age was a significant (all p < 0.05) determinant of plastic surgeon as a response pattern. CONCLUSION: Participants' age was a determinant of public choose plastic surgeons as experts in hand surgery area

A rede de atenção à saúde mental a partir da Estratégia Saúde da Família

A Estratégia de Saúde da Família (ESF) é um importante aliado na rede de atenção à saúde mental, contribuindo para a integralidade e efetividade do cuidado. Este estudo teve como objetivo discutir a rede de atenção em saúde mental a partir do cotidiano de uma ESF. É um estudo avaliativo, com abordagem metodológica qualitativa. Foi desenvolvido em uma ESF de Porto Alegre, RS, Brasil. Os dados foram coletados entre julho e dezembro de 2010, por meio de entrevistas com 16 trabalhadores e dez familiares. Identificamos importantes recursos de cuidado na atenção básica, como a parceria com a academia. No entanto, a constituição desse cuidado ainda está embasada no especialismo, com a lógica do encaminhamento. Pretendemos com esse estudo contribuir para a operacionalização da rede de cuidados em saúde mental, consolidando a parceria com a ESF e desenvolvendo ações no espaço territorial, sensibilizando e desmistificando a atenção na área como unicamente especializada. Descritores: Saúde mental. Serviços de saúde. Atenção primária à saúde

Evaluation of access and welcoming at the center of psychosocial attention / Avaliação do acesso e acolhimento no Centro de Atenção Psicossocial

Objetivo: avaliar o acesso do usuário a partir do processo de acolhimento em um Centro de Atenção Psicossocial. Método: estudo qualitativo do tipo estudo de caso, baseado na Avaliação de Quarta Geração. A coleta de dados ocorreu em 2019, através dos métodos de análise documental, observação participante e entrevistas baseadas no Círculo Hermenêutico-Dialético. Participaram da pesquisa dez usuários, dez familiares e nove profissionais do serviço. Para a análise dos dados, foi utilizado o Método Comparativo Constante. Resultados: o serviço presta acolhimentos resolutivos e rápidos, podendo diminuir as internações psiquiátricas. Identificou a necessidade de rompimento de ações ambulatoriais no serviço, a revisão do processo de acolhimento e acesso dos usuários no CAPS e a implantação de espaços de educação permanente. Conclusão: as contribuições desta pesquisa podem subsidiar trabalhadores e gestores a diminuir as barreiras no acesso e a efetivar o cuidado em serviços especializados e estratégicos como o CAPS.

Redefining professional identity: the voice of a language teacher in a context of collaborative learning

Following a narrative and biographic approach, in this study, we present the case of an in-service language teacher and her professional learning trajectory in the context of the project ‘Languages and education: constructing and sharing train- ing’. This project aimed at the construction of a collaborative teacher education context for learning and transformation of experiences, views and practices in language education, and involved teachers, teacher educators and researchers. Based on a single case study, the analysis tries to disclose the teacher’s discur- sive displacements as hints of professional transformation while she reinterprets the learning taking place in the collaborative education process. The signs of change are visible in the way she constructs meanings regarding her professional identity, re-identifies her mission as a language teacher and reconsiders her pro- fessional identity. Finally, we reflect upon how collaborative teacher education scenarios may foster teachers’ personal professional learning and renewed self- images

Evaluación de componentes de la red para atención de los usuarios de crack

Objetivo: Avaliar componentes da Rede de Atenção Psicossocial (RAPS) no cuidado ao usuário de crack em um município do Rio Grande do Sul. Método: Estudo qualitativo, baseado na Avaliação de Quarta Geração. A coleta de dados ocorreu em 2014, através de observação participante e entrevistas, com base no Círculo Hermenêutico-Dialético. Participaram dez usuários, onze familiares, sete gestores e oito trabalhadores de um Centro de Atenção Psicossocial. O Método Comparativo Constante foi adotado para a análise dos dados. Resultados: Foram identificadas dificuldades na articulação em rede com o hospital geral devido ao preconceito e falta de estrutura da equipe. A dependência do SAMU na Brigada Militar para realizar atendimentos aponta uma fragilidade da rede. Há consenso sobre a necessidade de repensar o modo como as fazendas terapêuticas operam na rede. Conclusão: A RAPS está em implementação e sua efetivação depende do envolvimento dos profissionais e gestores, e do controle social de usuários e familiares.Objective: Assess components of the Psychosocial Attention Network (RAPS) in crack user care in a Rio Grande do Sul municipality. Method: Qualitative study based on Fourth Generation Evaluation. Data collection occurred in 2014, through participating observation and interviews based on the Hermeneutic-Dialectic Circle. Ten uses, eleven family members, seven managers and eight workers at a Psychosocial Attention Center participated. The Constant Comparative Method was used for data analysis. Results: Difficulties were observed in the network articulation with the general hospital, due to prejudice and the lack of structure of the team. SAMU’s (Mobile Emergency Care Service) dependence on the Military Brigade for the service indicates a frailty of the network. The need to re-think the way therapeutic farms operate in the network is a consensus. Conclusion: RAPS is being implemented and its concretization depends on the involvement of professionals, managers and social control of users and family membersObjetivo: Evaluar los componentes de la Red de Atención Psicosocial (RAPS) en la atención de los usuarios de crack en una ciudad de Rio Grande do Sul. Método: Investigación cualitativa basada en la evaluación de cuarta generación. La recolección de datos se produjo en 2014, a través de la observación participante y entrevistas, basadas en el Círculo Hermenéutico-Dialéctico. Participaron diez usuarios, once familiares, siete gerentes y ocho trabajadores de un Centro de Atención Psicosocial. El Método Comparativo Constante fue adoptado para el análisis de datos. Resultados: Se identificaron dificultades en la articulación de la red con el hospital general debido a los prejuicios y la falta de estructura del equipo. La dependencia del Servicio Móvil de Atención de Emergencia (SAMU) en la Brigada Militar para proporcionar servicio demuestra una debilidad de la red. Existe consenso sobre la necesidad de repensar la forma en que operan las granjas terapéuticas en la red. Conclusión: La Red de Atención Psicosocial se está implementando y su implementación depende de la participación de profesionales y gerentes, y del control social de los usuarios y sus familia

Mapping and assessment of forest ecosystems and their services - Applications and guidance for decision making in the framework of MAES

The aim of this report is to illustrate by means of a series of case studies the implementation of mapping and assessment of forest ecosystem services in different contexts and geographical levels. Methodological aspects, data issues, approaches, limitations, gaps and further steps for improvement are analysed for providing good practices and decision making guidance. The EU initiative on Mapping and Assessment of the state of Ecosystems and their Services (MAES), with the support of all Member States, contributes to improve the knowledge on ecosystem services. MAES is one of the building-block initiatives supporting the EU Biodiversity Strategy to 2020.JRC.H.3-Forest Resources and Climat

Stakeholders' perspectives on the operationalisation of the ecosystem service concept : Results from 27 case studies

The ecosystem service (ES) concept is becoming mainstream in policy and planning, but operational influence on practice is seldom reported. Here, we report the practitioners' perspectives on the practical implementation of the ES concept in 27 case studies. A standardised anonymous survey (n = 246), was used, focusing on the science-practice interaction process, perceived impact and expected use of the case study assessments. Operationalisation of the concept was shown to achieve a gradual change in practices: 13% of the case studies reported a change in action (e.g. management or policy change), and a further 40% anticipated that a change would result from the work. To a large extent the impact was attributed to a well conducted science-practice interaction process (>70%). The main reported advantages of the concept included: increased concept awareness and communication; enhanced participation and collaboration; production of comprehensive science-based knowledge; and production of spatially referenced knowledge for input to planning (91% indicated they had acquired new knowledge). The limitations were mostly case-specific and centred on methodology, data, and challenges with result implementation. The survey highlighted the crucial role of communication, participation and collaboration across different stakeholders, to implement the ES concept and enhance the democratisation of nature and landscape planning. (C) 2017 Published by Elsevier B.V.Peer reviewe

Global and national Burden of diseases and injuries among children and adolescents between 1990 and 2013

Importance The literature focuses on mortality among children younger than 5 years. Comparable information on nonfatal health outcomes among these children and the fatal and nonfatal burden of diseases and injuries among older children and adolescents is scarce. Objective To determine levels and trends in the fatal and nonfatal burden of diseases and injuries among younger children (aged <5 years), older children (aged 5-9 years), and adolescents (aged 10-19 years) between 1990 and 2013 in 188 countries from the Global Burden of Disease (GBD) 2013 study. Evidence Review Data from vital registration, verbal autopsy studies, maternal and child death surveillance, and other sources covering 14 244 site-years (ie, years of cause of death data by geography) from 1980 through 2013 were used to estimate cause-specific mortality. Data from 35 620 epidemiological sources were used to estimate the prevalence of the diseases and sequelae in the GBD 2013 study. Cause-specific mortality for most causes was estimated using the Cause of Death Ensemble Model strategy. For some infectious diseases (eg, HIV infection/AIDS, measles, hepatitis B) where the disease process is complex or the cause of death data were insufficient or unavailable, we used natural history models. For most nonfatal health outcomes, DisMod-MR 2.0, a Bayesian metaregression tool, was used to meta-analyze the epidemiological data to generate prevalence estimates. Findings Of the 7.7 (95% uncertainty interval [UI], 7.4-8.1) million deaths among children and adolescents globally in 2013, 6.28 million occurred among younger children, 0.48 million among older children, and 0.97 million among adolescents. In 2013, the leading causes of death were lower respiratory tract infections among younger children (905 059 deaths; 95% UI, 810 304-998 125), diarrheal diseases among older children (38 325 deaths; 95% UI, 30 365-47 678), and road injuries among adolescents (115 186 deaths; 95% UI, 105 185-124 870). Iron deficiency anemia was the leading cause of years lived with disability among children and adolescents, affecting 619 (95% UI, 618-621) million in 2013. Large between-country variations exist in mortality from leading causes among children and adolescents. Countries with rapid declines in all-cause mortality between 1990 and 2013 also experienced large declines in most leading causes of death, whereas countries with the slowest declines had stagnant or increasing trends in the leading causes of death. In 2013, Nigeria had a 12% global share of deaths from lower respiratory tract infections and a 38% global share of deaths from malaria. India had 33% of the world’s deaths from neonatal encephalopathy. Half of the world’s diarrheal deaths among children and adolescents occurred in just 5 countries: India, Democratic Republic of the Congo, Pakistan, Nigeria, and Ethiopia. Conclusions and Relevance Understanding the levels and trends of the leading causes of death and disability among children and adolescents is critical to guide investment and inform policies. Monitoring these trends over time is also key to understanding where interventions are having an impact. Proven interventions exist to prevent or treat the leading causes of unnecessary death and disability among children and adolescents. The findings presented here show that these are underused and give guidance to policy makers in countries where more attention is needed

Identification of unique neoantigen qualities in long-term survivors of pancreatic cancer

Pancreatic ductal adenocarcinoma is a lethal cancer with fewer than 7% of patients surviving past 5 years. T-cell immunity has been linked to the exceptional outcome of the few long-term survivors1,2, yet the relevant antigens remain unknown. Here we use genetic, immunohistochemical and transcriptional immunoprofiling, computational biophysics, and functional assays to identify T-cell antigens in long-term survivors of pancreatic cancer. Using whole-exome sequencing and in silico neoantigen prediction, we found that tumours with both the highest neoantigen number and the most abundant CD8+ T-cell infiltrates, but neither alone, stratified patients with the longest survival. Investigating the specific neoantigen qualities promoting T-cell activation in long-term survivors, we discovered that these individuals were enriched in neoantigen qualities defined by a fitness model, and neoantigens in the tumour antigen MUC16 (also known as CA125). A neoantigen quality fitness model conferring greater immunogenicity to neoantigens with differential presentation and homology to infectious disease-derived peptides identified long-term survivors in two independent datasets, whereas a neoantigen quantity model ascribing greater immunogenicity to increasing neoantigen number alone did not. We detected intratumoural and lasting circulating T-cell reactivity to both high-quality and MUC16 neoantigens in long-term survivors of pancreatic cancer, including clones with specificity to both high-quality neoantigens and predicted cross-reactive microbial epitopes, consistent with neoantigen molecular mimicry. Notably, we observed selective loss of high-quality and MUC16 neoantigenic clones on metastatic progression, suggesting neoantigen immunoediting. Our results identify neoantigens with unique qualities as T-cell targets in pancreatic ductal adenocarcinoma. More broadly, we identify neoantigen quality as a biomarker for immunogenic tumours that may guide the application of immunotherapies