Intra-and interobserver reproducibility in the cobb angle in scoliosis patients

o objetivo deste estudo é analisar a variabilidade intra e interobservador do método de Cobb em indivíduos escolióticos. Foram avaliadas trinta e quatro radiografias de sujeitos com escoliose para mensuração do ângulo de Cobb. A avaliação intraobservador foi realizada por um avaliador, enquanto a avaliação interobservador foi realizada por três avaliadores. Foram controlados possíveis erros intrínsecos e extrínsecos de mensuração, mas não houve a pré-seleção das vértebras que caracterizam a escoliose. A concordância intra e interobservador foi avaliada pelo coeficiente de correlação de Pearson (p < 0,05). Não houve diferenças significativas de julgamento na condição intra e interobservadores. A magnitude dos coeficientes de correlação oscilou de bom até excelente nos níveis torácico e tóraco-lombar. Na coluna lombar não houve correlação em ambas as condições.the aim of this study is to assess intra and interobserver variability of the Cobb method in subjects who have scoliosis. Thirty four scoliosis radiographs were evaluated for measure of the angle of Cobb. The intra-observer assessment was carried out by an observer, while the inter-observer evaluation was carried out by three observers. It was controlled intrinsic and extrinsic errors of measurement, but there was no pre-selection of the vertebrae that characterized the scoliosis. Both intraobserver and interobserver reliabilities were assessed by calculating the Pearson correlation coefficient (p d"0.05). No significant differences were observed between intra-and interobservers. The magnitude of correlation coefficients ranged from very high to unreasonable in chest and thoracolumbar level. Lumbar spine did not correlate in both conditions

A EQUOTERAPIA NO EQUILÍBRIO POSTURAL DE PESSOAS COM ESCLEROSE MÚLTIPLA

Multiple sclerosis (MS) is a chronic and progressive disease induced by autoimmune inflammatory responses that attack myelin of the nerve tissue, with changes in postural balance being common manifestations in MS. Objective: Verify if the hippotherapy, inserted as a complementary activity, influences the postural balance of MS patients. Method: A total of six cases were evaluated. The performance of postural balance was assessed by the Berg Balance Scale (BBS) before and after 30 sessions of hippotherapy, performed twice a week, over a period of four months. Results: After the intervention, there was an increase in scores on BBS in four individuals and two of them maintained their scores. Conclusions: The stimulation of hippotherapy as a complementary activity proved to be able to improve the results of performance in functional tasks that require static and dynamic balance, assessed by BBS.http://dx.doi.org/10.5902/2236583414470 A Esclerose Múltipla (EM) é uma doença crônica e progressiva decorrente de respostas inflamatórias auto-imunes que acometem à mielina do tecido nervoso, sendo comuns na EM as alterações no equilíbrio postural. Objetivo: verificar se a Equoterapia, inserida como atividade complementar, influencia o equilíbrio postural de pessoas com EM. Método: Foram avaliados seis casos. O desempenho do equilíbrio postural foi avaliado pela Escala de Equilíbrio de Berg (EEB) antes e após 30 sessões de Equoterapia, realizadas duas vezes por semana, em um período de quatro meses. Resultados: Após a intervenção observou-se aumento dos escores na EEB em quatro casos e manutenção em dois. Conclusões: A estimulação da Equoterapia, como atividade terapêutica complementar, mostrou-se capaz de melhorar ou manter os resultados no desempenho das tarefas funcionais que envolvem o equilíbrio estático e dinâmico de pessoas com EM avaliadas pela EEB

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Attenuated total reflectance with fourier transform infrared spectroscopy (ATR/FTIR) and different PLS algorithms for simultaneous determination of clavulanic acid and amoxicillin in powder pharmaceutical formulation

Um método para determinação simultânea de ácido clavulânico (CA) e amoxicilina (AMO) foi desenvolvido utilizando a técnica de espectroscopia no infravermelho médio com transformada de Fourier acoplada ao acessório de reflexão total atenuada (ATR/FTIR). Utilizaram-se 27 e 8 amostras para os conjuntos de calibração e previsão, respectivamente. Os modelos de calibração foram desenvolvidos utilizando os algoritmos por mínimos quadrados parciais (PLS), PLS por intervalo (iPLS), PLS por sinergismo (siPLS) e PLS por exclusão (biPLS). Os melhores modelos foram aqueles que utilizaram o algoritmo biPLS. Obtiveram-se erro padrão relativo de previsão (RSEP) de 3,8 e 5,1% para CA e AMO, respectivamente. Os resultados obtidos pela metodologia proposta foram comparados com os obtidos por cromatografia líquida de alta eficiência (HPLC) e nenhuma diferença significativa foi observada. O método proposto utilizando ATR/FTIR associado a métodos de análise multivariados foi satisfatório para determinação de CA e AMO em produtos farmacêuticos.A method for simultaneous determination of clavulanic acid (CA) and amoxicillin (AMO) was developed using Fourier transform mid infrared technique coupled with attenuated total reflectance (ATR/FTIR) accessory. 27 samples were used as calibration set and 8 samples were used for prediction set. Calibration models were developed using partial least squares (PLS), interval PLS (iPLS), synergy PLS (siPLS) and backward PLS (biPLS). Multiplicative scatter correction and the mean centering were used and produced the best models. Relative standard error of prediction (RSEP) of 3.8% for CA and 5.1% for AMO were obtained using biPLS algorithm for ATR/FTIR data. Results obtained by the proposed methodology were compared with those using high performance liquid chromatography (HPLC) and no significant differences were obtained. The proposed method using ATR/FTIR combined to multivariate analysis methods was suitable for the simultaneous determination of CA and AMO in commercial pharmaceutical products

Características biomecânicas dos pés no período gravídico-puerperal: estudo de caso = Biomechanical characteristics of feet during pregnancy and puerperium: a case study

Objetivos: A valiar as variações antropométricas e a distribuição de pressão plantar dos pés durante o ciclo gravídico - puerperal de uma paciente. Descrição do caso: Este estudo descritivo - exploratório analisou uma gestante por meio de oito avaliações, seis durante a gestação (na 26 ª, 28 ª, 30 ª, 32 ª, 34 ª e 36 ª semana da gestação) e duas no puerpério (10 º e 50 º dia a pós o parto). Foram avaliadas seis variáveis antropomé tricas dos pés e tornozelos. Por meio do escaneamento dos pés, obteve - se indiretamente o ângulo da impressão plantar. O Sistema Pedar - Mobile (Novel GmbH), avaliou o índice do arco plantar e o pico de pressão máxima plantar tan to estátic o como din â mico. Durante o período gestacional o comprimento e o perímetro do mediopé direito apresentaram - se maiores do que o esquerdo. Ocorreu diminuição do ângulo plantar com a evolução da gestação. A variação do índice do arco plantar na tarefa estática mostrou variaçã o mínima em todo o período avaliado, enquanto na dinâmica demonstrou diminuição progressiva dos valores durante a gestação e aumento no período puerperal. As médias dos picos de pressão plantar na tarefa dinâmica foram mais elevadas durante o período gesta cional em comparaç ão ao puerpério. Conclusões: Estes dados mostram alterações nas características biomecânicas dos pés no ciclo gravídico - puerperal, ressaltando aumento na perimetria e diminuição do arco planta