Análise crítica da construção de uma escola em Guiné-Bissau : vantagens e desvantagens no regime de ajuda mútua

A falta de moradias atinge milhões de pessoas por todo o mundo, apesar de ser um direito básico fundamental a todos os indivíduos. Uma alternativa possível a este problema é a ajuda mútua, na qual uma comunidade une-se em prol da construção de edificações. Em Guiné-Bissau, em 2011, o autor participou da construção de uma escola no regime de ajuda mútua. Este trabalho elenca as vantagens e desvantagens encontradas na experiência africana, possibilitando uma análise crítica desta forma construtiva pouco abordada na literatura, através de uma comparação do que temos na bibliografia e apresentando dificuldades não exploradas até então.The lack of housing strikes millions of people all over the world, despite of being a basic and fundamental right to all people. A possible alternative to this problem is the mutual-aid, in which a community gathers to build edifications. In Guinea-Bissau, in 2011, the author took part in the construction of a school through mutual-aid. This paper brings the advantages and disadvantages found in this African experience and analyses it by comparing data available in literature and showing difficulties unexplored until now

Nanoparticles exhibiting self-regulating temperature as innovative agents for Magnetic Fluid Hyperthermia

During the last few years, for therapeutic purposes in oncology, considerable attention has been focused on a method called magnetic fluid hyperthermia (MFH) based on local heating of tumor cells. In this paper, an innovative, promising nanomaterial, M48 composed of iron oxide-based phases has been tested. M48 shows self-regulating temperature due to the observable second order magnetic phase transition from ferromagnetic to paramagnetic state. A specific hydrophilic coating based on both citrate ions and glucose molecules allows high biocompatibility of the nanomaterial in biological matrices and its use in vivo. MFH mediator efficiency is demonstrated in vitro and in vivo in breast cancer cells and tumors, confirming excellent features for biomedical application. The temperature increase, up to the Curie temperature, gives rise to a phase transition from ferromagnetic to paramagnetic state, promoting a shortage of the r2 transversal relaxivity that allows a switch in the contrast in Magnetic Resonance Imaging (MRI). Combining this feature with a competitive high transversal (spin-spin) relaxivity, M48 paves the way for a new class of temperature sensitive T2 relaxing contrast agents. Overall, the results obtained in this study prepare for a more affordable and tunable heating mechanism preventing the damages of the surrounding healthy tissues and, at the same time, allowing monitoring of the temperature reached

Seismic markers of the Messinian salinity crisis in the deep Ionian Basin

We conduct the seismic signal analysis on vintage and recently collected multichannel seismic reflection profiles from the Ionian Basin to characterize the deep basin Messinian evaporites. These evaporites were deposited in deep and marginal Mediterranean sedimentary basins as a consequence of the “salinity crisis” between 5.97 and 5.33 Ma, a basin‐wide oceanographic and ecological crisis whose origin remains poorly understood. The seismic markers of the Messinian evaporites in the deep Mediterranean basins can be divided in two end‐members, one of which is the typical “trilogy” of gypsum and clastics (Lower Unit – LU), halite (Mobile Unit – MU) and upper anhydrite and marl layers (Upper Unit – UU) traced in the Western Mediterranean Basins. The other end‐member is a single MU unit subdivided in seven sub‐units by clastic interlayers located in the Levant Basin. The causes of these different seismic expressions of the Messinian salinity crisis (MSC) appear to be related to a morphological separation between the two basins by the structural regional sill of the Sicily Channel. With the aid of velocity analyses and seismic imaging via prestack migration in time and depth domains, we define for the first time the seismic signature of the Messinian evaporites in the deep Ionian Basin, which differs from the known end‐members. In addition, we identify different evaporitic depositional settings suggesting a laterally discontinuous deposition. With the information gathered we quantify the volume of evaporitic deposits in the deep Ionian Basin as 500,000 km3 ± 10%. This figure allows us to speculate that the total volume of salts in the Mediterranean basin is larger than commonly assumed. Different depositional units in the Ionian Basin suggest that during the MSC it was separated from the Western Mediterranean by physical thresholds, from the Po Plain/Northern Adriatic Basin, and the Levant Basin, likely reflecting different hydrological and climatic conditions. Finally, the evidence of erosional surfaces and V‐shaped valleys at the top of the MSC unit, together with sharp evaporites pinch out on evaporite‐free pre‐Messinian structural highs, suggest an extreme Messinian Stage 3 base level draw down in the Ionian Basin. Such evidence should be carefully evaluated in the light of Messinian and post‐Messinian vertical crustal movements in the area. The results of this study demonstrates the importance of extracting from seismic data the Messinian paleotopography, the paleomorphology and the detailed stratal architecture in the in order to advance in the understanding of the deep basins Messinian depositional environments. Highlights First description of a new type of deepwater Messinian salt giant in the Ionian Sea. First quantification of the Messinian salt volume in the Ionian Sea. New seismic evidence of erosional surfces and Lago Mare deposits in the deep Ionian Basin. Further evidence of sea level lowering during the Messinian Salinity Crisis. Evidence for a different, physically separated deepwater Messinian salt basins in the Mediterranean

Comparación de modelos no lineales para describir curvas de crecimiento del portainjerto limón rugoso (Citrus jambhiri Lush.) bajo condiciones de vivero

This work aimed to find the statistical model that best describes the growth pattern of  Lemon 'Rugoso' rootstock (Citrus jambhir Lusch.) in the nursery up to grafting diameter. Thus, the sowing was carried out in seedlings. 45 days after emerging, the seedlings were transplanted to 5 L pots with a substrate consisting of rice husks (40%), soil (40%), and commercial substrate (20%). Growth variables were evaluated every 30 days. For aerial growth, the following were quantified: neck diameter (DC), number of leaves (CH), stem length (LT), fresh mass of the stem (MFTa), fresh mass of leaves (MFH), dry mass of the stem (MSTa), dry mass of leaves (MSH). Also, root growth through root length (LR), fresh (MFR) and dry root mass (MSR), and total variables: total fresh mass (MFTotal), total dry mass (MSTotal), and full length (LT). To model growth curves, Logistic, Gompertz, and Monomolecular models were tested. The Gompertz model best fitted the rootstock growth over time for the aerial growth variables (except the number of leaves) and for the total variables (except the total length), while the Logistic model was the one that best adjusted the growth of the rootstock based on the time for the root growth variables. It was also suitable for the variables number of leaves and total length due to it presented a lower residual mean square of the error compared to the Logistic, Richards, and Monomolecular models. El objetivo fue encontrar el modelo estadístico que mejor describa el patrón de crecimiento del portainjerto Limón 'Rugoso' (Citrus jambhiri Lusch.) en vivero hasta diámetro de injertación. Para ello se sembró en almácigos y a los 45 días de la emergencia los plantines se trasplantaron a macetas de 5 L con sustrato constituido por cascarilla de arroz (40 %), suelo (40 %), y sustrato comercial (20 %). Se evaluaron variables de crecimiento cada 30 días. Para el crecimiento aéreo se cuantificó: diámetro de cuello (DC); cantidad de hojas (CH), largo del tallo (LT); masa fresca del tallo (MFTa), masa fresca de hojas (MFH), masa seca del tallo (MSTa); masa seca de hojas (MSH).  También el crecimiento de raíz mediante: largo de raíz (LR), masa fresca (MFR) y seca de raíz (MSR), y variables totales: masa fresca total (MFTotal); masa seca total (MSTotal) y largo total (LT). Para modelar las curvas de crecimiento se probaron los modelos Logístico, Gompertz y Monomolecular. El modelo Gompertz fue el que mejor ajustó al crecimiento del portainjerto en el tiempo para las variables de crecimiento aéreo (a excepción del número de hojas) y para las variables totales (a excepción del largo total), mientras que el modelo Logístico fue el que mejor ajustó al crecimiento del portainjerto en función del tiempo para las variables de crecimiento radicular.  También, obtuvo buen ajuste para las variables número de hojas y largo total, debido a que presentó menor cuadrado medio residual del error comparado con los modelos Logístico, Richards y Monomolecular

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Análise crítica da construção de uma escola em Guiné-Bissau : vantagens e desvantagens no regime de ajuda mútua

A falta de moradias atinge milhões de pessoas por todo o mundo, apesar de ser um direito básico fundamental a todos os indivíduos. Uma alternativa possível a este problema é a ajuda mútua, na qual uma comunidade une-se em prol da construção de edificações. Em Guiné-Bissau, em 2011, o autor participou da construção de uma escola no regime de ajuda mútua. Este trabalho elenca as vantagens e desvantagens encontradas na experiência africana, possibilitando uma análise crítica desta forma construtiva pouco abordada na literatura, através de uma comparação do que temos na bibliografia e apresentando dificuldades não exploradas até então.The lack of housing strikes millions of people all over the world, despite of being a basic and fundamental right to all people. A possible alternative to this problem is the mutual-aid, in which a community gathers to build edifications. In Guinea-Bissau, in 2011, the author took part in the construction of a school through mutual-aid. This paper brings the advantages and disadvantages found in this African experience and analyses it by comparing data available in literature and showing difficulties unexplored until now