Alunos hiperativos x professor: construindo um elo harmonioso

Atualmente, ouve-se falar muito na questão da inclusão. Percebe-se que os professores sentem-se despreparados diante do problema. Apesar dos cursos oferecidos na área do Ensino Especial, os professores ainda se sentem incapazes de lidar com alunos hiperativos. Este trabalho objetivou colher informações pertinentes sobre hiperatividade no intuito de colaborar com pais e professores que vivenciam e compartilham com essas crianças suas inseguranças, a exclusão social e sua agitação diária e permanente. A pesquisa foi em uma abordagem qualitativa onde teve como participantes especialistas em educação e professores do Ensino Fundamental das séries iniciais. Todos da rede pública do Distrito Federal que trabalham com crianças acometidas pelo TDAH. O instrumento de coleta de dados utilizado neste trabalho, foi o questionário. As categorias selecionadas para professores foram: características de aluno hiperativo; dificuldades pedagógicas com aluno hiperativo; fatores positivos e negativos que influenciam na aprendizagem de aluno hiperativo; possíveis suportes oferecidos pelo sistema de ensino para o aperfeiçoamento do professor; a afetividade e auto-estima de aluno hiperativo; procedimentos utilizados no trabalho com aluno hiperativo. Para os especialistas, as categorias foram: diferença entre hiperatividade e falta de limites; conseqüências da falta do tratamento em uma criança hiperativa; faixa etária para um diagnóstico seguro; administração e / ou auto-superação de uma criança hiperativa sem o tratamento apropriado; identificação da hiperatividade pelos professores na escola; postura de professores e familiares diante de uma criança hiperativa; profissionais que podem diagnosticar e tratar o TDAH. Após a coleta, análise e discussão dos dados concluiu-se que as características da hiperatividade envolvem principalmente a inquietação e desatenção, e, conseqüentemente, a dificuldade de aprendizagem. Os professores despreparados sentem-se angustiados por não saberem lidar com o aluno acometido de tal distúrbio, e sugerem que se deve manter sempre um diálogo como também uma valorização para com o aluno. A hiperatividade pode decorrer de situações traumáticas, distúrbios psicológicos etc. O diagnóstico e o tratamento devem sempre ser feitos o mais cedo possível, mas, caso estes forem realizados aos sete anos de idade e mediante relatórios de professores e psicopedadgogos, terão maiores sucessos. Um ambiente com poucas atrações visuais e trabalhos com atividades dinâmicas, favorecem uma maior concentração do aluno hiperativo. O diagnóstico do TDAH deve ser feito por neuropediatras e psicólogos complementados pelos relatórios dos psicopedagogos, professores e pais. Ao final deste trabalho, pode-se concluir que, apesar deste ser um assunto recente, os profissionais de educação estão buscando informações sobre o mesmo. Este distúrbio precisa ser orientado por órgãos competentes no intuito de se levar o conhecimento aos professores e, assim, melhorar o relacionamento com essas crianças

Using a perception matrix to elicit farmers‘ perceptions towards stakeholders in the context of biodiversity-friendly farming

Farmers' pro-environmental action is substantially influenced by various stakeholders from their business and social environment. Recent studies recommend actively involving influential stakeholders in agri-environmental initiatives, information or media campaigns. While it has been argued that farmers' perceptions towards these stakeholders can help inform effective involvement, comprehensive assessments of these perceptions remain scarce, particularly in the context of biodiversity-friendly farming. To understand and compare farmers’ perceptions of these stakeholder quantitatively, we developed and applied a perception matrix. In an exploratory survey with 49 farmers across ten European countries, farmers rated twelve groups of stakeholders (e.g. government bodies, farm advisors and input suppliers) against eight perception constructs (e.g. trustworthiness, interest in protecting biodiversity). We found that perceptions differed significantly both between groups of stakeholders and between constructs. Whereas several stakeholders were, on average, perceived positively regarding their general characteristics, such as trustworthiness, reliability, understanding and support for farming, perceptions regarding their biodiversity-related behavior were significantly more negative. Our findings indicate potential to improve policy development and implementation of agri-environmental initiatives through the involvement of multiple, non-governmental, agricultural and non-agricultural stakeholders in biodiversity-friendly farming initiatives across the entire agri-food value chain. Such multi-stakeholder initiatives could help to not only reinforce biodiversity conservation action among the farming community, but across society as a whole as emphasized by the Convention on Biological Diversity. Further research is needed to confirm the observed trends on a larger, representative sample, for which the presented perception matrix is well suited

TRIAGEM NEONATAL DE IMUNODEFICIÊNCIAS GRAVES COMBINADAS POR MEIO DE TRECS E KRECS: SEGUNDO ESTUDO PILOTO NO BRASIL

RESUMO Objetivo: Validar a quantificação de T-cell receptor excision circles (TRECs) e kappa-deleting recombination circles (KRECs) por reação em cadeia de polimerase (polymerase chain reaction, PCR) em tempo real (qRT-PCR), para triagem neonatal de imunodeficiências primárias que cursam com defeitos nas células T e/ou B no Brasil. Métodos: Amostras de sangue de recém-nascidos (RN) e controles foram coletadas em papel-filtro. O DNA foi extraído e os TRECs e KRECs foram quantificados por reação duplex de qRT-PCR. O valor de corte foi determinado pela análise de Receiver Operating Characteristics Curve, utilizando-se o programa Statistical Package for the Social Sciences (SSPS) (IBM®, Armonk, NY, EUA). Resultados: 6.881 amostras de RN foram analisadas quanto à concentração de TRECs e KRECs. Os valores de TRECs variaram entre 1 e 1.006 TRECs/µL, com média e mediana de 160 e 139 TRECs/µL, respectivamente. Três amostras de pacientes diagnosticados com imunodeficiência grave combinada (severe combined immunodeficiency, SCID) apresentaram valores de TRECs abaixo de 4/µL e um paciente com Síndrome de DiGeorge apresentou TRECs indetectáveis. Os valores de KRECs encontraram-se entre 10 e 1.097 KRECs/µL, com média e mediana de 130 e 108 KRECs/µL, e quatro pacientes com diagnóstico de agamaglobulinemia tiveram resultados abaixo de 4 KRECs/µL. Os valores de corte encontrados foram 15 TRECs/µL e 14 KRECs/µL, e foram estabelecidos de acordo com a análise da Receiver Operating Characteristics Curve, com sensibilidade de 100% para detecção de SCID e agamaglobulinemia, respectivamente. Conclusões: A quantificação de TRECs e KRECs foi capaz de diagnosticar crianças com linfopenias T e/ou B em nosso estudo, validando a técnica e dando o primeiro passo para a implementação da triagem neonatal em grande escala no Brasil

The NANOGrav 15-year Data Set: Evidence for a Gravitational-Wave Background

We report multiple lines of evidence for a stochastic signal that is correlated among 67 pulsars from the 15-year pulsar-timing data set collected by the North American Nanohertz Observatory for Gravitational Waves. The correlations follow the Hellings-Downs pattern expected for a stochastic gravitational-wave background. The presence of such a gravitational-wave background with a power-law-spectrum is favored over a model with only independent pulsar noises with a Bayes factor in excess of $10^{14}$, and this same model is favored over an uncorrelated common power-law-spectrum model with Bayes factors of 200-1000, depending on spectral modeling choices. We have built a statistical background distribution for these latter Bayes factors using a method that removes inter-pulsar correlations from our data set, finding $p = 10^{-3}$ (approx. $3\sigma$) for the observed Bayes factors in the null no-correlation scenario. A frequentist test statistic built directly as a weighted sum of inter-pulsar correlations yields $p = 5 \times 10^{-5} - 1.9 \times 10^{-4}$ (approx. $3.5 - 4\sigma$). Assuming a fiducial $f^{-2/3}$ characteristic-strain spectrum, as appropriate for an ensemble of binary supermassive black-hole inspirals, the strain amplitude is $2.4^{+0.7}_{-0.6} \times 10^{-15}$ (median + 90% credible interval) at a reference frequency of 1/(1 yr). The inferred gravitational-wave background amplitude and spectrum are consistent with astrophysical expectations for a signal from a population of supermassive black-hole binaries, although more exotic cosmological and astrophysical sources cannot be excluded. The observation of Hellings-Downs correlations points to the gravitational-wave origin of this signal.Comment: 30 pages, 18 figures. Published in Astrophysical Journal Letters as part of Focus on NANOGrav's 15-year Data Set and the Gravitational Wave Background. For questions or comments, please email [email protected]

Reinfection rate in a cohort of healthcare workers over 2 years of the COVID-19 pandemic

Abstract In this large cohort of healthcare workers, we aimed to estimate the rate of reinfections by SARS-CoV-2 over 2 years of the COVID-19 pandemic. We investigated the proportion of reinfections among all the cases of SARS-CoV-2 infection from March 10, 2020 until March 10, 2022. Reinfection was defined as the appearance of new symptoms that on medical evaluation were suggestive of COVID-19 and confirmed by a positive RT-PCR. Symptoms had to occur more than 90 days after the previous infection. These 2 years were divided into time periods based on the different variants of concern (VOC) in the city of São Paulo. There were 37,729 medical consultations due to COVID-19 at the hospital’s Health Workers Services; and 25,750 RT-PCR assays were performed, of which 23% (n = 5865) were positive. Reinfection by SARS-CoV-2 was identified in 5% (n = 284) of symptomatic cases. Most cases of reinfection occurred during the Omicron period (n = 251; 88%), representing a significant increase on the SARS-CoV-2 reinfection rate before and during the Omicron variant period (0.8% vs. 4.3%; p < 0.001). The mean interval between SARS-CoV-2 infections was 429 days (ranged from 122 to 674). The Omicron variant spread faster than Gamma and Delta variant. All SARS-CoV-2 reinfections were mild cases

Neonatal screening: 9% of children with filter paper thyroid‐stimulating hormone levels between 5 and 10 μIU/mL have congenital hypothyroidism

Objectives: To determine the prevalence of congenital hypothyroidism in children with filter paper TSH levels (f‐TSH) between 5 and 10 μUI/mL in the neonatal screening. Methods: This was a retrospective study including children screened from 2003 to 2010, with f‐TSH between 5 and 10 μIU/mL, who were followed‐up during the first two years of life when there was no serum TSH normalization. The diagnosis of congenital hypothyroidism was defined as serum TSH ≥10 μIU/mL and start of levothyroxine treatment up to 2 years of age. Results: Of the 380,741 live births, 3,713 (1.04%) had f‐TSH between 5 and 10 μIU /mL and, of these, 339 (9.13%) had congenital hypothyroidism. Of these, 76.11% of the cases were diagnosed in the first three months of life and 7.96% between 1 and 2 years of age. Conclusion: The study showed that 9.13% of the children with f‐TSH between 5 and 10 μIU/mL developed hypothyroidism and that in approximately one‐quarter of them, the diagnosis was confirmed only after the third month of life. Based on these findings, the authors suggest the use of a 5 μIU/mL cutoff for f‐TSH and long‐term follow‐up of infants whose serum TSH has not normalized to rule out congenital hypothyroidism

TELE-critical Care verSus usual Care On ICU PErformance (TELESCOPE): protocol for a cluster-randomised clinical trial on adult general ICUs in Brazil

Introduction Daily multidisciplinary rounds (DMRs) consist of systematic patient-centred discussions aiming to establish joint therapeutic goals for the next 24 hours of intensive care unit (ICU) care. The aim of the present study protocol is to evaluate whether an intervention consisting of guided DMRs, supported by a remote specialist and audit/feedback on care performance will reduce ICU length of stay compared with a control group.Methods and analysis A multicentre, controlled, cluster-randomised superiority trial including 30 ICUs in Brazil (15 intervention and 15 control), from August 2019 to June 2021. In a parallel assignment, ICUs are randomised to a complex-intervention composed by daily rounds carried out through Tele-ICU by a remote ICU physician; development of local quality indicators dashboards coupled with monthly meetings with local leadership; and dissemination of evidence-based clinical protocols versus usual care. Primary outcome is ICU length of stay. Secondary outcomes include classification of the unit according to the profiles defined by the standardised resource use and the standardised mortality rate, hospital mortality, incidence of healthcare-associated infections, ventilator-free days at 28 days, patient-days receiving oral or enteral feeding, patient-days under light sedation or alert and calm, rate of patients under normoxaemia. All adult patients admitted after the beginning of the study in each participant ICU will be enrolled. Inclusion criteria (clusters): public Brazilian ICUs with a minimum of 8 ICU beds interested/committed to participating in the study. Exclusion criteria (clusters): units with fully established DMRs by an intensivist, specialised or step-down units.Ethics and dissemination The study protocol was approved by the institutional review board (IRB) of the coordinator centre, and by IRBs of each enrolled hospital/ICU. Statistical analysis protocol is being prepared for submission before the end of patient’s enrolment. Results will be disseminated through conferences, peer-reviewed journals and to each participating unit.Trial registration number NCT03920501; Pre-results

Neonatal screening: 9% of children with filter paper thyroid-stimulating hormone levels between 5 and 10 µIU/mL have congenital hypothyroidism

Abstract Objectives: To determine the prevalence of congenital hypothyroidism in children with filter-paper blood-spot TSH (b-TSH) between 5 and 10 µIU/mL in the neonatal screening. Methods: This was a retrospective study including children screened from 2003 to 2010, with b-TSH levels between 5 and 10 µIU/mL, who were followed-up during the first two years of life when there was no serum TSH normalization. The diagnosis of congenital hypothyroidism was defined as serum TSH ≥10 µIU/mL and start of levothyroxine treatment up to 2 years of age. Results: Of the 380,741 live births, 3713 (1.04%) had filter paper TSH levels between 5 and 10 µIU/mL and, of these, 339 (9.13%) had congenital hypothyroidism. Of these, 76.11% of the cases were diagnosed in the first three months of life and 7.96% between 1 and 2 years of age. Conclusion: The study showed that 9.13% of the children with b-TSH levels between 5 and 10 µIU/mL developed hypothyroidism and that in approximately one-quarter of them, the diagnosis was confirmed only after the third month of life. Based on these findings, the authors suggest the use of a 5 µIU/mL cutoff for b-TSH levels and long-term follow-up of infants whose serum TSH has not normalized to rule out congenital hypothyroidism