Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Uma experiência de uso do método de casos em formação continuada de professores

The use of the case methods in continuing teacher education is especially relevant in that it can enable teachers to evoke and narrate real work situations, share their narrative with other colleagues in training and with trainers, collectively reflect on each case and about the set of cases under analysis. This article aims to describe an experience of continuing education of teachers (two for each school or group of schools) invested with the mission of becoming the training and monitoring section of a given inter-school training center. Within the training strategy that was outlined, the use of the case method took place in the initial phase of the project, which should be concluded by the production, by the participants, of teacher training plans, properly contextualized, to be integrated in the educational project of each school. The developed project was inspired by personalist and inquiry-oriented teacher education models, as defined by Zeichner (1983) and rooted in the accumulated scientific knowledge about the use of the case method in teacher education. In addition to the productive value that the use of the case method had, we observed its formative value for the constitution and dynamics of a group of trainees who did not know each other previously and among whom it mattered to develop trust, collaboration, peer training capacity and reflexivity.O uso do método de casos na formação continuada de professores é especialmente relevante na medida em que lhes pode permitir evocar e narrar situações reais de trabalho, partilhar a sua narrativa com os restantes colegas em formação e com os formadores, refletir coletivamente sobre cada caso e sobre o conjunto de casos em análise. Visa-se com este artigo descrever uma experiência de formação continuada de professores (dois por cada escola ou agrupamento de escolas) investidos da missão de passarem a constituir a secção de formação e monitorização de um dado centro de formação inter-escolas. Dentro da estratégia de formação que foi delineada, o uso do método de casos teve lugar na fase inicial do projeto que deveria concluir-se pela produção, pelos participantes, de planos de formação docente, devidamente contextualizados, a integrar no projeto educativo de cada escola. O projeto desenvolvido inspirou-se nos modelos de formação personalista e orientado para a pesquisa, tal como Zeichner (1983) os define e radicou no conhecimento científico acumulado acerca do uso do método dos casos na formação de professores. Para além do valor produtivo que o uso do método de casos teve, será posto em evidência o seu valor formativo para a constituição e a dinâmica de um grupo de formandos que não se conheciam à partida e entre os importava que se desenvolvesse a confiança, a colaboração, a capacidade de formação interpares e a reflexividade.L'utilisation de la méthode des cas dans la formation continue des enseignants est particulièrement pertinente en ce qu'elle peut leur permettre d'évoquer et de raconter des situations de travail réelles, de partager leurs récits avec d'autres collègues en formation et avec des formateurs, de réfléchir collectivement sur chaque cas et sur l'ensemble des cas analysés. Cet article vise à décrire une expérience de formation continue des enseignants (deux pour chaque école ou groupe d'écoles) investis de la mission de devenir la section de formation et de suivi d'un centre de formation interscolaire donné. Dans le cadre de la stratégie de formation que nous avons esquissée, l'utilisation de la méthode des cas a eu lieu dans la phase initiale du projet, qui devrait se conclure par la production, par les participants, de plans de formation des enseignants, dûment contextualisés, à intégrer dans le projet pédagogique de chaque école. Le projet développé a été inspiré par des modèles de formation personnalistes et axés sur la recherche, tels que définis par Zeichner (1983) et enraciné dans les connaissances scientifiques accumulées sur l'utilisation de la méthode des cas dans la formation des enseignants. Outre la valeur productive que l'utilisation de la méthode des cas a présenté, nous avons constaté sa valeur formatrice pour la constitution et la dynamique d'un groupe de professionnels qui ne se connaissaient pas au départ et parmi lesquels il fallait que la confiance, la collaboration, la capacité de formation entre pairs et la réflexivité se dévellopent

A formação docente, inicial e contínua, para o trabalho com adultos em Portugal: o olhar dos professores

Este trabalho objetivou investigar as políticas públicas de formação contínua de professores, especificamente os que atuam com a educação da pessoa adulta em Portugal e no Brasil. No recorte dado a esta comunicação, selecionaram- -se os dados referentes a Portugal. Buscou-se traçar a história de vida dos educadores investigados, dez no total, sua inserção no campo da Educação de Adultos e seu processo formativo para a atuação nesse campo, via entrevistas semiestruturadas. Esta investigação se assentou numa perspectiva qualitativa, interpretativa e descritiva. Os professores narraram suas experiências, percepções e reflexões sobre o próprio processo formativo. A análise evidenciou um grupo de docentes comprometidos e satisfeitos com a educação e formação da pessoa adulta, que reconhecem a necessidade de uma formação específica para este trabalho, além do excesso de discursos e da pobreza na oferta de práticas formativas para essa área por parte dos poderes públicos

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved