Mismatch between midline shift and hematoma thickness as a prognostic factor of mortality in patients sustaining acute subdural hematoma.

BACKGROUND: Acute subdural hematoma (ASDH) is a traumatic lesion commonly found secondary to traumatic brain injury. Radiological findings on CT, such as hematoma thickness (HT) and structures midline shift (MLS), have an important prognostic role in this disease. The relationship between HT and MLS has been rarely studied in the literature. Thus, this study aimed to assess the prognostic accuracy of the difference between MLS and HT for acute outcomes in patients with ASDH in a low-income to middle-income country. METHODS: This was a post-hoc analysis of a prospective cohort study conducted in a university-associated tertiary-level hospital in Brazil. The TRIPOD (Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis) statement guidelines were followed. The difference values between MLS and HT (Zumkeller index, ZI) were divided into three categories (3). Logistic regression analyses were performed to reveal the OR of categorized ZI in predicting primary outcome measures. A Cox regression was also performed and the results were presented through HR. The discriminative ability of three multivariate models including clinical and radiological variables (ZI, Rotterdam score, and Helsinki score) was demonstrated. RESULTS: A total of 114 patients were included. Logistic regression demonstrated an OR value equal to 8.12 for the ZI >3 category (OR 8.12, 95% CI 1.16 to 40.01; p=0.01), which proved to be an independent predictor of mortality in the adjusted model for surgical intervention, age, and Glasgow Coma Scale (GCS) score. Cox regression analysis demonstrated that this category was associated with 14-day survival (HR 2.92, 95% CI 1.38 to 6.16; p=0.005). A multivariate analysis performed for three models including age and GCS with categorized ZI or Helsinki or Rotterdam score demonstrated area under the receiver operating characteristic curve values of 0.745, 0.767, and 0.808, respectively. CONCLUSIONS: The present study highlights the potential usefulness of the difference between MLS and HT as a prognostic variable in patients with ASDH. LEVEL OF EVIDENCE: Level III, epidemiological study

Evaluation of massive education in prison health: a perspective of health care for the person deprived of freedom in Brazil

Education, with an emphasis on prison health, has acted as a policy inducing changes in work processes, which the Brazilian National Health System (SUS) has used, and which is present in permanent health education, which promotes health care for people deprived of liberty. This article aims to present an analysis of the impacts of the strategy of massive education on prison health in Brazil from the perspective of health professionals and other actors operating in the Brazilian prison system. The data used in the study come from a questionnaire consisting of 37 questions applied nationwide between March and June 2022. Responses were collected from students who completed the course “Health Care for People Deprived of Freedom” of the learning pathway “Prison System”, available in the Virtual Learning Environment of the Brazilian Health System (AVASUS). This course was offered nationally, whose adhesion (enrollment) occurred spontaneously, i.e., the course was not a mandatory. The data collected allowed us to analyze the impacts of massive education on prison health. The study also shows that the search for the course is made by several areas of knowledge, with a higher incidence in the health area, but also in other areas, such as humanities, which also work directly with the guarantee of the rights of people deprived of liberty, which are professionals in the areas of social work, psychology, and education. The analysis based on the data suggests that the massive education mediated by technology through the courses of the learning pathway, besides disseminating knowledge–following the action plan of the 2030 Agenda of the United Nations Educational, Scientific and Cultural Organization (UNESCO)–, are an effective tool to promote resilience in response to prison health and care demands of people deprived of liberty

Comparação estatística de competitividade de campeonatos nacionais de Futebol

Introduction: Soccer championships are played in almost every country in the world and draw attention to the title challenge in each of them. Soccer is the most popular sport in the world and a lot of money is bustling around it, yet it is not equally competitive in all countries. Objectives: In this paper, the competitiveness of national championships in 12 countries is analyzed in order to find similarities/differences between them. Sample: The analysis is based on 60 championships held 12 countries selected according to performance criteria. It is considered, for each country and year, the champion and the runner-up. Methods: Indicators are defined for the comparison, the indicators are selected and using the clustering technique are groups of similarities. Results: It is observed that there are three groups of championships, with respect to competitiveness. In one of them, the less competitive, presents great concentration of titles obtained by only two clubs. Conclusions: Group analysis can show the group formation, in which the results are similar to the Top5 analysis.Introdução: Os Campeonatos de Futebol são disputados em quase todos os países do mundo e chamam a atenção pela disputa de títulos em cada um deles. O Futebol é o esporte mais popular do mundo e muito dinheiro é movimentado em torno dele, contudo não é igualmente competitivo em todos os países. Objetivos: Neste artigo, aborda-se a competitividade de campeonatos nacionais de 12 países visando encontrar similaridades/diferenças entre eles. Amostra: A análise é feita com base em 60 campeonatos realizados 12 países selecionados segundo critério de desempenho. Considera-se, para cada país e ano, o campeão e o vice-campeão. Métodos: Define-se indicadores para a comparação, seleciona-se os indicadores e utilizando a técnica de clustering encontra-se grupos de similaridades. Resultados: Observa-se que existem três grupos de campeonatos, com respeito a competitividade. Em um deles, o menos competitivo, apresenta grande concentração de títulos obtidos por apenas dois clubes. Conclusões: Através da análise de agrupamentos pode-se apresentar a formação dos grupos, na qual os resultados são similares a análise com o Top5

Considerações sobre a disponibilidade dos tópicos de Astronomia em livros didáticos de Física do PNLD 2018

This work presents the results of the analysis of High School Physics textbooks, approved and offered by the “Programa Nacional do LivroDidático” (PNLD), for the triennium 2018-2020, about the way they approach and present knowledge about Astronomy. The bibliographic research also consulted the PCN + of Natural Sciences for Secondary Education, which has as one of its themes the "Universe, Earth and Life", for the diagnosis of the relationship between the contents and themes addressed in that and those contemplated within structure of the textbooks analyzed. The research is considered of a qualitative nature, based on a bibliographical review of works that deal with both Physics and Astronomy teaching, as well as presenting official references and guidelines on the curricular proposals for the pedagogical work of the natural sciences in High School, the last stage of Basic Education. In the analysis of the data collected in each work, as well as in the comparison between the collections that were objects of study of this research, it is verified that the works made available by the PNLD 2018 are not consonant in relation to the amount of astronomical subjects approached, according to the specific guidelines of the PCN + of Natural Sciences for High School.O presente trabalho relata as análises realizadas nos livros didáticos de Física do Ensino Médio, aprovados e ofertados pelo Programa Nacional do Livro Didático (PNLD), para o triênio2018-2020, acerca da abordagem dos conhecimentos sobre Astronomia. A pesquisa bibliográfica também consultou o PCN + de Ciências Naturais para o Ensino Médio, que possui como um dos seus temas estruturadores o “Universo, Terra e Vida”, para o diagnóstico da relação entre os conteúdos e temas abordados nesse com os contemplados dentro da estrutura dos livros didáticos analisados. A pesquisa é considerada de natureza quantitativa, embasada em revisão bibliográfica de obras que versam tanto sobre o Ensino de Física quanto da Astronomia, além de apresentar referências e orientações oficiais sobre as propostas curriculares para o trabalho pedagógico das ciências naturais no Ensino Médio, última etapa da Educação Básica. Na análise das informações coletados em cada obra, como também na comparação entre as coleções que foram objetos de estudo deste trabalho de pesquisa, constata-se que as obras disponibilizadas pelo PNLD 2018 não são consonantes em relação à quantidade de assuntos astronômicos abordados, considerando como referencia as orientações específicas do PCN + de Ciências Naturais para o Ensino Médio

“Holographic” pyramid: conceptual errors and didactic potential

<p></p><p>Allusion to holograms is identified in different contexts to refer to different devices and shows, like the images displayed by the pyramids “holographic”. However, as we pointed out in this article, the images displayed by these pyramids, besides not being holograms in fact, are just two-dimensional images. We identified, however, a rich didactic potential in “holographic” pyramids for the teaching of Physics, especially when we consider the transition from the student's naive curiosity to epistemological curiosity and the teaching of certain concepts of optics and mathematics. Therefore, we built a quadrangular pyramid using acrylic plates and we made discussions about their operation. Through this article, we hope, among other things, to promote the critical awareness of teachers and students in the face of technological artifacts in constant changes around them, especially those considered as holograms.</p><p></p

Mismatch between midline shift and hematoma thickness as a prognostic factor of mortality in patients sustaining acute subdural hematoma

Background Acute subdural hematoma (ASDH) is a traumatic lesion commonly found secondary to traumatic brain injury. Radiological findings on CT, such as hematoma thickness (HT) and structures midline shift (MLS), have an important prognostic role in this disease. The relationship between HT and MLS has been rarely studied in the literature. Thus, this study aimed to assess the prognostic accuracy of the difference between MLS and HT for acute outcomes in patients with ASDH in a low-income to middle-income country.Methods This was a post-hoc analysis of a prospective cohort study conducted in a university-associated tertiary-level hospital in Brazil. The TRIPOD (Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis) statement guidelines were followed. The difference values between MLS and HT (Zumkeller index, ZI) were divided into three categories (&lt;0.00, 0.01–3, and &gt;3). Logistic regression analyses were performed to reveal the OR of categorized ZI in predicting primary outcome measures. A Cox regression was also performed and the results were presented through HR. The discriminative ability of three multivariate models including clinical and radiological variables (ZI, Rotterdam score, and Helsinki score) was demonstrated.Results A total of 114 patients were included. Logistic regression demonstrated an OR value equal to 8.12 for the ZI &gt;3 category (OR 8.12, 95% CI 1.16 to 40.01; p=0.01), which proved to be an independent predictor of mortality in the adjusted model for surgical intervention, age, and Glasgow Coma Scale (GCS) score. Cox regression analysis demonstrated that this category was associated with 14-day survival (HR 2.92, 95% CI 1.38 to 6.16; p=0.005). A multivariate analysis performed for three models including age and GCS with categorized ZI or Helsinki or Rotterdam score demonstrated area under the receiver operating characteristic curve values of 0.745, 0.767, and 0.808, respectively.Conclusions The present study highlights the potential usefulness of the difference between MLS and HT as a prognostic variable in patients with ASDH.Level of evidence Level III, epidemiological study

External validation of the Glasgow coma scale-pupils in low- to middle-income country patients with traumatic brain injury: Could "motor score-pupil" have higher prognostic value?

BACKGROUND: The objective of this study is to validate the admission Glasgow coma scale (GCS) associated with pupil response (GCS-P) to predict traumatic brain injury (TBI) patient's outcomes in a low- to middle-income country and to compare its performance with that of a simplified model combining the better motor response of the GCS and the pupilar response (MS-P). METHODS: This is a prospective cohort of patients with TBI in a tertiary trauma reference center in Brazil. Predictive values of the GCS, GCS-P, and MS-P were evaluated and compared for 14 day and in-hospital mortality outcomes and length of hospital stay (LHS). RESULTS: The study enrolled 447 patients. MS-P demonstrated better discriminative ability than GCS to predict mortality (AUC 0.736 × 0.658; P < 0.001) and higher AUC than GCS-P (0.736 × 0.704, respectively; P = 0.073). For hospital mortality, MS-P demonstrated better discrimination than GCS (AUC, 0.750 × 0.682; P < 0.001) and higher AUC than GCS-P (0.750 × 0.714; P = 0.027). Both scores were good predictors of LHS (r2 = 0.084 [GCS-P] × 0.079 [GCS] × 0.072 [MS-P]). CONCLUSION: The predictive value of the GCS, GCS-P, and MS-P scales was demonstrated, thus contributing to its external validation in low- to middle-income country

Importance of duration of acute kidney injury after severe trauma: a cohort study

Background Acute kidney injury (AKI) is common after severe trauma. AKI incidence and AKI stage have previously been shown to be associated with poor outcomes after trauma. However, AKI duration may also be important for outcomes after trauma, given that it is associated with long-term morbidity and mortality in general intensive care unit (ICU) and hospitalized patients. We hypothesized that duration of AKI is independently associated with poor outcomes after trauma.Methods A cohort study was conducted at a single, level 1 trauma center. Patients admitted to the ICU between 2009 and 2018 were included. Data were extracted from the trauma registry and electronic medical records. AKI within 7 days from presentation was defined according to the Kidney Disease Improving Global Outcomes guidelines. Multivariable analyses were performed to assess the association between AKI incidence, AKI stage, and AKI duration with outcomes including prolonged ICU and hospital length of stay, discharge to home, and mortality.Results Of 7049 patients included, 72% were male, the median age was 41 years (IQR 27–58), and 10% died. The AKI incidence was 45%, with 69% of these patients presenting with AKI on arrival. The majority (73%) of patients who suffered AKI recovered within 2 days. After adjustment in separate models, AKI incidence, AKI stage and AKI duration were each associated with prolonged hospitalization, an unfavorable discharge disposition, and mortality. AKI stage and duration were not used in the same model due to collinearity.Conclusions Post-traumatic AKI was common on arrival and frequently short lasting. Duration correlated with highest AKI stage, and both were separately associated with prolonged hospitalization, discharge destination other than home, and mortality on adjusted analyses. Given the high incidence of AKI on arrival, stage or duration may be better targets for future interventions and quality improvement initiatives to improve outcomes after post-traumatic AKI.Level of evidence III. Prognostic