UTILIZAÇÃO DO TUBO-T E DA VENTILAÇÃO POR PRESSÃO DE SUPORTE NO DESMAME DA VENTILAÇÃO MECÂNICA: UMA REVISÃO

O objetivo deste estudo foi realizar uma revisão bibliográfica sobre a utilização do Tubo T e Pressão de Suporte Ventilatório no desmame da ventilação mecânica. Foi realizado um levantamento bibliográfico sobre o tema utilizando artigos das bases de dados Medline, Lilacs, Scielo e Cochrane publicados no período do ano de 2000 a abril de 2010. Para o acesso foram utilizados os seguintes descritores: desmame da ventilação mecânica, Tubo T e pressão de suporte. Foram incluídos artigos de revisões bibliográficas, revisões sistemáticas, ensaios clínicos randomizados, padronizações, relatos de casos, consensos de ventilação mecânica e dois artigos científicos dos anos de 1994 e 1995 que dão fundamentação ao tema proposto. Sendo excluídos artigos que dirigiam suas pesquisas para as áreas de pediatria e neonatologia. A revisão de literatura demonstrou que embora haja um avanço significativo na tentativa de padronizar os protocolos ainda não há consenso sobre o tema. Existem diversidades regionais na preferência pelos métodos de desmame e não há concordância quanto à superioridade entre as modalidades de interrupção da ventilação mecânica. Considera-se que há poucas pesquisas que comparam efetivamente os modos PSV e Tubo T ficando evidente a necessidade da realização de maior quantidade de pesquisas randomizadas sobre o tema para que seja possível a elaboração de um consenso sobre a eficácia e vantagem dos modos de desmame citados

TEP for incarcerated groin hernias: is it feasible for experienced surgeons?

Objective: To verify if endoscopic TEP surgery performed by an experienced surgeon is a feasible procedure to treat incarcerated groin hernia.Methods: This is a retrospective study in which we analyzed data from patients submitted to TEP endoscopic surgery for treatment of incarcerated and non-incarcerated groin hernias. The surgeries were all performed by a single surgeon. We obtained data on gender, age, ASA scores, BMI, hernia site and operating time. The two groups were descriptively analyzed and statistically compared in order to verify how similar the samples were. The operative times were also compared between the groups. The first 65 surgeries were excluded in order to evaluate the hability of an experienced surgeon.Results: 323 surgeries were performed. 32 (9.9%) were cases of incarcerated hernias. In 306 cases (96%), the surgical approach used was TEP, the other 13 cases (4%) were operated by TAPP. All incarcerated hernias were operated by the TEP method. No significant differences on gender, age, hernia site, BMI and ASA score were found between incarcerated and non-incarcerated hernia patients. The operative time was analyzed by site of hernias (left, right and bilateral) and no statistical differences were found between incarcerated and nonincarcerated hernias.Conclusions: 1) There was no significant differences on gender, age, ASA, BMI and site of hernias that could interfere in operative time in both groups. 2) The lack of significant statistical difference on operative time indicate that, for experienced surgeons, the technical difficulty is similar to operate incarcerated and non-incarcerated groin hernias by TEP.Keywords: Herniorraphy; Inguinal hernia; Endoscopy; Learning curve; Operative time

Comprehensive in silico analysis of the TDP-43 protein variants related to Amyotrophic Lateral Sclerosis and Frontotemporal Dementia: Abrangente na análise silicoanalítica das variantes proteicas TDP-43 relacionadas à Esclerose Lateral Amiotrófica e Demência Frontotempor

Amyotrophic lateral sclerosis (ALS) is a highly disabling neurodegenerative disorder characterized by the progressive loss of voluntary motor activity. ALS is currently the most frequent adult-onset motor neuron disorder, which is associated with a major economic burden. Two drugs have already been approved to treat ALS, but they confer a limited survival benefit. In turn, frontotemporal dementia (FTD) is an early-onset and fatal dementia characterized by deficits in behavior, language, and executive function. FTD is the most frequent cause of pre-senile dementia after Alzheimer's. Currently, FTD has no cure and the available treatments are merely symptomatic. Missense mutations in TDP-43, a nuclear RNA/DNA-binding protein, are among the main causes associated with ALS and FTD. Nonetheless, most of these mutations are not yet characterized. To date, no complete three-dimensional structure has already been determined for TDP-43. In this work, we characterized the impact of missense mutations in TDP-43 using prediction algorithms, evolutionary conservation analysis, and molecular dynamics simulations (MD). We also performed structural modeling and validation of the TDP-43 protein. Two hundred and seven TDP-43 mutations were compiled from the databases and literature. The predictive analysis pointed to a moderate rate of deleterious and destabilizing mutations. Furthermore, most mutations occur at evolutionarily variable positions. Combining the predictive analyses into a penalty system, our findings suggested that the uncharacterized mutations Y43C, D201Y, F211S, I222T, K224N, A260D, P262T, and A321D are considered the most-likely deleterious, thus being important targets for future investigation. This work also provided an accurate, complete, and unprecedented three-dimensional structure for TDP-43 that can be used to identify and optimize potential drug candidates. At last, our MD findings pointed to a noticeable flexibility increase in functional domains upon K263E, G335D, M337V, and Q343R variants, which may cause non-native interactions and impaired TDP-43 recognition, ultimately leading to protein aggregation

Apicultura e empoderamento: ressignificação do espaço de atuação da mulher na sociedade do alto oeste potiguar / Beekeeping and empowerment: ressignification of women's space in the west potiguar society

O projeto de pesquisa trata de uma análise sociológica sobre a percepção das mulheres do projeto de extensão Abelha Operaria Empoderada. O objetivo dessa pesquisa é explicar o processo de empoderamento dessas mulheres. Para tanto, realizamos uma revisão bibliográfica sobre as seguintes temáticas: cidadania, gênero e empoderamento. Em seguida foi realizada a análise do questionário inicial submetido para inscrição dessas mulheres no projeto de extensão e, posteriormente, fizemos a aplicação de entrevistas com as mesmas, avaliando a percepção do projeto sobre suas vidas. Após a análise dos dados coletados antes e depois do projeto de extensão, foi possível perceber que o curso proporcionou a estas mulheres mais autonomia, independência e valorização da autoestima sugerindo o empoderamento destas. Além disso, ampliaram os seus conhecimentos através de oficinas que tinham o viés de trabalhar a subjetividade e o empreendedorismo. Portanto, o projeto de extensão contribuiu para que essas mulheres fortalecessem a autoconfiança, mostrando que elas são capazes de alcançar seus objetivos.

Tide assessment for the continental shelf situated in the southwestern Atlantic between the latitudes 19.8ºS and 21.2ºS

Abstract The astronomical tide was numerically simulated by the MOHID model for the South-Central Region of Espírito Santo State (Brazil), between latitudes 19.8ºS and 21.2ºS. The grid nesting technique was used to transpose the boundary conditions from the larger domain to a more refined local domain (spatial resolution around 450 m), with tidal harmonics provided by the TPXO tide inverse model as boundary conditions for the larger domain. Results from the numerical model were compared with both the pre-existing tide harmonics and the harmonics calculated from measured data. From the maps of phase, amplitude, tidal ellipses and residual currents the main tidal kinematic characteristics in the study area were described. On the continental shelf, the results showed that the physiography and bathymetry of the region play an important role in the distribution of tidal co-phases, co-amplitudes, ellipses and residual currents. The MOHID model was able to reproduce satisfactorily the astronomical tide and thus can be used to study the behaviour of the tidal propagation in continental shelf areas

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Evaluation of the structural behavior of composite slim floor beams with openings in the web

Os sistemas de piso mistos convencionais sao formados por Vigas de aço e lajes de diferentes tipos, posicionadas sobre o perfil de aço. Nestes sistemas, o comportamento misto entre aço e concreto é “ativado” por meio de conectores mecanicos tipo pino com cabeça, que são colocados sobre a mesa superior do perfil de aço. Os sistemas slim floor são formados por Vigas de aço e lajes de diferentes tipos, integradas dentro do piso, proporcionando uma redução na altura total do sistema de piso. Contudo, ao reduzir a altura do sistema de piso a utilização dos conectores tipo pino com cabega sobre o perfil de aço torna-se inviável, uma vez que a capa de concreto sobre o perfil de aço não possui espessura suficiente para que esses conectores desempenhem de forma adequada sua função. Assim, ao longo dos útimos anos, foram realizadas diversas pesquisas com o objetivo de desenvolver mecanismos capazes de “ativar” o comportamento misto entre aço e concreto em Vigas de slim floor. Uma destas pesquisas resultou nas Vigas de slim floor com aberturas na alma que compõem o sistema Composite Slim-floor Beam (CoSFB). Neste trabalho, avaliou-se o comportamento estrutural a flexão de Vigas mistas de slim floor com aberturas na alma a partir de modelos de elementos finitos, criados com o auxilio do software ABAQUS e da metodologia proposta por Paes (2003). A fim de validar esta metodologia realizaram-se estudos de comparação entre os resultados obtidos a partir dos modelos numéricos com os resultados experimentais de Vigas mistas de slim floor obtidos por Lawson et a]. (1997), Leskel'a e Hopia (2000) e Braun et al. (2014), por meio dos quais verificou-se que os modelos numéricos desenvolvidos são capazes de representar os diversos fenomenos que ocorrem nas Vigas mistas de slim floor a medida que estas são carregadas. A partir dos modelos numéricos validados, foram feitos estudos de variação de parâmetros de projeto, os quais permitiram avaliar a influência de algumas caracteristicas geométricas e mecânicas sobre o comportamento estrutural à flexão das Vigas mistas de slim floor com aberturas na alma que compéem o sistema COSFB. Por meio destes estudos, pode-se verificar que, em função dos meios de conexão utilizados (pinos de concrete, barras passantes através das aberturas e aderência), as Vigas mistas de slim floor com aberturas na alma conseguem atingir diversos graus de interação, podendo atingir a condição de interação completa.The conventional composite floor systems are formed by steel beams and slabs of different types placed over the steel profile. In these systems, the composite behavior between steel and concrete is “activated” through headed stud shear connectors welded onto the steel section’s top flange. The slim-floor system consists of steel beams and slabs of different types, integrated within the floor, allowing the reduction of the floor system’s total height. However, this reduction will render the utilization of headed stud shear connectors unviable, since the concrete layer above the steel profile will no longer be thick enough for these connectors to work adequately. Because of this, over the past few years, several studies envisioning the development of mechanisms capable of “activating” the composite behavior between steel and concrete in slim-floor beams were performed. One of these studies resulted in slim-floor beams with web openings, which form the Composite Slim-Floor Beam system (CoSFB). This paper evaluates the structural behavior of composite slim-floor beams with web openings subjected to bending, through finite elements models, created with the aid of the ABAQUS software and of the methodology proposed by Paes (2003). In order to validate this methodology, studies comparing results obtained through numerical models and through experiments with composite slim-floor beams obtained by Lawson et al. (1997), Leskel'a and Hopia (2000) and Braun et al. (2014) were conducted. Through these studies, it was possible to verify that the numeric models developed are capable of representing the various phenomena that occur in composite slim-floor beams during loading. Through the validated numeric models, studies of project parameter variations were conducted, which enabled the evaluation of the influence of some geometric and mechanical characteristics over the structural behavior of composite slim-floor beams with web openings that compose the CoSFB system when subjected to bending. Through these studies, it was possible to verify that composite slim-floor beams with web openings can reach several degrees of interaction in function of the type of connection employed (concrete studs, bars passing through the openings and adherence), with the possibility of reaching a condition of full interaction.Coordenação de Aperfeiçoamento de Pessoal de Nível Superio

Cultural adaptation and validation of the "Pregnancy Physical Activity Questionnaire" for the Portuguese population.

BackgroundThe lack of instruments to assess the level of physical activity in pregnant women, led to the development of the PPAQ (Pregnancy Physical Activity Questionnaire), a self-administered questionnaire, which has already been translated in several countries and has already been used in several studies.Aim(s)Translate and adapt the PPAQ into Portuguese and test its reliability and validity.MethodsAn analytical observational study was carried out. Linguistic and semantic equivalence was performed through translation and back-translation and content validity was tested by a panel of experts. To test reliability, a test-retest was performed on a sample of 184 pregnant women, with an interval of 7 days and the ICC was used. To test the criterion validity, Pearson's correlation coefficient (r) was used between the PPAQ and the accelerometer, in a sample of 226 pregnant women.FindingsThe questionnaire was considered comprehensive. The ICC values of Reliability were: total score (0.77); sedentary activities (0.87); light-intensity activities (0.76); moderate-intensity activities (0.76); vigorous-intensity activities (0.70). For criterion validity was obtained a coefficient correlation of r = -0.030, considered weak and negative, for total activity.DiscussionThis study describes the translation and validation process of the PPAQ questionnaire from English to Portuguese. The final version of the PPAQ was considered as a valid instrument in terms of content to measure physical activity and was referred to as being simple to apply and easy to understand.ConclusionThe PPAQ has content validity, excellent reliability and weak criterion validity, as in the original version

Cultural adaptation and validation of the “Pregnancy Physical Activity Questionnaire” for the Portuguese population

Background The lack of instruments to assess the level of physical activity in pregnant women, led to the development of the PPAQ (Pregnancy Physical Activity Questionnaire), a self-administered questionnaire, which has already been translated in several countries and has already been used in several studies. Aim(s) Translate and adapt the PPAQ into Portuguese and test its reliability and validity. Methods An analytical observational study was carried out. Linguistic and semantic equivalence was performed through translation and back-translation and content validity was tested by a panel of experts. To test reliability, a test-retest was performed on a sample of 184 pregnant women, with an interval of 7 days and the ICC was used. To test the criterion validity, Pearson’s correlation coefficient (r) was used between the PPAQ and the accelerometer, in a sample of 226 pregnant women. Findings The questionnaire was considered comprehensive. The ICC values of Reliability were: total score (0.77); sedentary activities (0.87); light-intensity activities (0.76); moderate-intensity activities (0.76); vigorous-intensity activities (0.70). For criterion validity was obtained a coefficient correlation of r = -0.030, considered weak and negative, for total activity. Discussion This study describes the translation and validation process of the PPAQ questionnaire from English to Portuguese. The final version of the PPAQ was considered as a valid instrument in terms of content to measure physical activity and was referred to as being simple to apply and easy to understand. Conclusion The PPAQ has content validity, excellent reliability and weak criterion validity, as in the original version