Olinda: memória e esquecimento

Este artigo discute as recentes práticas urbanísticas em sítios históricos, destacando aquelas exaltadas, por uns, como um novo e eficiente modo de pensar as cidades e criticadas, por outros, como “culturalismo de mercado”. A essas críticas acrescenta-se outro argumento: o de que tais práticas usam a história do lugar como valor cultural, mas intervêm esvanecendo a sua especificidade e singularidade. Adotando a reconstituição histórica da formação do sítio de Olinda, responde à seguinte indagação: que práticas dos urbanistas levam ao esquecimento ou à memória da história do lugar? Assim, estão relatados fatos do passado que parecem denotar destruição e perda. No decorrer do artigo relaciona-se essa discussão aos relatos de memorialistas e textos de historiadores que informam sobre a formação da então vila da Capitania de Pernambuco.

O Programa de Cidades Históricas : por uma política integrada de preservação do patrimônio cultural urbano

O Programa de Cidades Históricas (PCH), implementado a partir de 1973, foi o primeiro programa federal que investiu recursos para a recuperação do patrimônio cultural urbano. Implementado pelo Ministério do Planejamento, buscava o desenvolvimento econômico das cidades históricas e dialogava com outros assuntos em pauta naquele momento, como o desenvolvimento urbano e regional e o turismo cultural. Tinha em sua concepção uma mudança na maneira de abordar as cidades históricas: a partir do entendimento da cidade como produtora de capital, o patrimônio cultural geraria desenvolvimento econômico pelo seu consumo para a atividade turística. De 1973 a 1979, foram investidos 17,3 milhões de dólares, realizando-se 143 obras em monumentos (85% dos investimentos); 8 cursos de qualificação de mão de obra nos três níveis (superior, intermediário e operário); 7 planos urbanísticos; 6 obras em espaços públicos (urbanos); e 10 ações de tipos diversos. Nossa análise busca entender essa política a partir do seu processo de formulação e implementação, no período de 1972 a 1979. Pretende, nesse sentido: a) avaliar as relações de poder em jogo durante a construção e a implementação do programa; b) compreender o grau de sucesso que o programa obteve na construção de um Sistema Nacional de Patrimônio Cultural, analisando sua articulação junto aos estados e outros órgãos federais; e c) avaliar o papel do programa enquanto indutor de novas práticas institucionais no campo da preservação do patrimônio cultural, especialmente com relação ao Iphan e aos estados federativos brasileiros.The Historic Cities Program (PCH: 1973-1979) was the first federal program that has invested resources to the recovery of the urban cultural heritage. Implemented by the Ministry of Planning, sought economic development of historic towns and dialogued with other items on the agenda at the time, such as urban and regional development and cultural tourism. It brought a change in the way of approach the historic towns: from the understanding of the city as a producer of capital, heritage would generate economic development through its consume by the tourism. From 1973 to 1979 it was invested 17.3 million dollars, performing 143 works on monuments (85% of investments); 8 hand-to-work training courses in three levels (top, middle and working class); 7 urban plans; 6 works in public spaces (urban); and 10 shares of various types. Our analysis seeks to understand this policy from its formulation and implementation in the period from 1972 to 1979. The aim, in this sense, is: a) to assess the power relations at play during construction and implementation of the Program; b) to understand the degree of success that the program achieved in building a national system, analyzing its relationship with states and other federal agencies; and c) to evaluate the role of Program while inducing new institutional practices in the field of preservation of cultural heritage, especially with regard to Iphan

Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study

Background: Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation. Methods: WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with ClinicalTrials.gov, NCT03255109. Findings: Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0-4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 day), 457 (10·1%) had intermediate weaning (2-6 days), 433 (9·6%) required prolonged weaning (≥7 days), and 706 (15·6%) had weaning failure. Higher sedation scores were independently associated with delayed initiation of weaning. Delayed initiation of weaning and higher sedation scores were independently associated with weaning failure. 1742 (31·8%) of 5479 patients died in the intensive care unit and 2095 (38·3%) of 5465 patients died in hospital. Interpretation: In critically ill patients receiving at least 2 days of invasive mechanical ventilation, only 65% were weaned at 90 days. A better understanding of factors that delay the weaning process, such as delays in weaning initiation or excessive sedation levels, might improve weaning success rates. Funding: European Society of Intensive Care Medicine, European Respiratory Society

Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study

Background Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation. Methods WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with ClinicalTrials.gov, NCT03255109. Findings Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0–4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 day), 457 (10·1%) had intermediate weaning (2–6 days), 433 (9·6%) required prolonged weaning (≥7 days), and 706 (15·6%) had weaning failure. Higher sedation scores were independently associated with delayed initiation of weaning. Delayed initiation of weaning and higher sedation scores were independently associated with weaning failure. 1742 (31·8%) of 5479 patients died in the intensive care unit and 2095 (38·3%) of 5465 patients died in hospital. Interpretation In critically ill patients receiving at least 2 days of invasive mechanical ventilation, only 65% were weaned at 90 days. A better understanding of factors that delay the weaning process, such as delays in weaning initiation or excessive sedation levels, might improve weaning success rates