A produção escrita de alunos com e sem síndrome de Down: uma análise da coerência textual

Neste trabalho, analisa-se a coerência textual a partir da reescrita do conto de Rapunzel. Baseia-se em uma abordagem psicogenética da língua escrita. Participaram desse estudo nove alunos, sendo seis com síndrome de Down (Grupo I) e os outros três sem deficiência (Grupo II). Eles cursavam entre o 2º e 8º anos do Ensino Fundamental em escolas regulares. O procedimento de produção textual consistiu em um encontro individual, cuja solicitação de produção escrita era precedida pela leitura do conto pela pesquisadora. Os dados indicaram a presença da coerência textual nos dois grupos, embora mais frequente nas produções do grupo II, que demonstrava maior competência com os elementos de coerência textual. O grupo II apresentou estratégias poderosas para mobilizar os recursos cognitivos que permitiram articular conhecimentos anteriores e focalizá-los na produção e articulação de suas ideias no texto. O grupo I, na sua maioria, experimentava dificuldades em elaborar um desfecho em estreita relação com as partes que compunham o texto. Não apresentaram, porém, dificuldades em definir e manter a personagem principal ao longo de toda a história escrita, mesmo quando a história era incoerente se considerarmos outros indicadores. Qualitativamente, os textos dos alunos com síndrome de Down se diferenciaram daqueles produzidos pelo grupo II. Não identificamos, porém, características que podem representar especificidades na produção escrita dos alunos com essa síndrome, visto que alguns alunos com síndrome de Down produziram textos apresentando coerência

Organizational factors associated with adherence to low tidal volume ventilation: a secondary analysis of the CHECKLIST-ICU database

Background: Survival benefit from low tidal volume (VT) ventilation (LTVV) has been demonstrated for patients with acute respiratory distress syndrome (ARDS), and patients not having ARDS could also benefit from this strategy. Organizational factors may play a role on adherence to LTVV. The present study aimed to identify organizational factors with an independent association with adherence to LTVV. Methods: Secondary analysis of the database of a multicenter two-phase study (prospective cohort followed by a cluster-randomized trial) performed in 118 Brazilian intensive care units. Patients under mechanical ventilation at day 2 were included. LTVV was defined as a VT ≤ 8 ml/kg PBW on the second day of ventilation. Data on the type and number of beds of the hospital, teaching status, nursing, respiratory therapists and physician staffing, use of structured checklist, and presence of protocols were tested. A multivariable mixed-effect model was used to assess the association between organizational factors and adherence to LTVV. Results: The study included 5719 patients; 3340 (58%) patients received LTVV. A greater number of hospital beds (absolute difference 7.43% [95% confidence interval 0.61–14.24%]; p = 0.038), use of structured checklist during multidisciplinary rounds (5.10% [0.55–9.81%]; p = 0.030), and presence of at least one nurse per 10 patients during all shifts (17.24% [0.85–33.60%]; p = 0.045) were the only three factors that had an independent association with adherence to LTVV. Conclusions: Number of hospital beds, use of a structured checklist during multidisciplinary rounds, and nurse staffing are organizational factors associated with adherence to LTVV. These findings shed light on organizational factors that may improve ventilation in critically ill patients

Worldwide Disparities in Recovery of Cardiac Testing 1 Year Into COVID-19

BACKGROUND The extent to which health care systems have adapted to the COVID-19 pandemic to provide necessary cardiac diagnostic services is unknown.OBJECTIVES The aim of this study was to determine the impact of the pandemic on cardiac testing practices, volumes and types of diagnostic services, and perceived psychological stress to health care providers worldwide.METHODS The International Atomic Energy Agency conducted a worldwide survey assessing alterations from baseline in cardiovascular diagnostic care at the pandemic's onset and 1 year later. Multivariable regression was used to determine factors associated with procedure volume recovery.RESULTS Surveys were submitted from 669 centers in 107 countries. Worldwide reduction in cardiac procedure volumes of 64% from March 2019 to April 2020 recovered by April 2021 in high- and upper middle-income countries (recovery rates of 108% and 99%) but remained depressed in lower middle- and low-income countries (46% and 30% recovery). Although stress testing was used 12% less frequently in 2021 than in 2019, coronary computed tomographic angiography was used 14% more, a trend also seen for other advanced cardiac imaging modalities (positron emission tomography and magnetic resonance; 22%-25% increases). Pandemic-related psychological stress was estimated to have affected nearly 40% of staff, impacting patient care at 78% of sites. In multivariable regression, only lower-income status and physicians' psychological stress were significant in predicting recovery of cardiac testing.CONCLUSIONS Cardiac diagnostic testing has yet to recover to prepandemic levels in lower-income countries. Worldwide, the decrease in standard stress testing is offset by greater use of advanced cardiac imaging modalities. Pandemic-related psychological stress among providers is widespread and associated with poor recovery of cardiac testing. (C) 2022 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation