Ethical and methodological reflections on research exploring refugee family reunification in Brazil

Ethical discussions have become key to Refugee Studies. Ethical guidelines on refugee research provide indications on how to conduct ethical research including the principle of doing no-harm. However, it is important to understand how ethics happens in practice (Guillemin and Gillam, 2004) before going to the field, during and after. This paper discusses my experience of “ethics of care in practice” through the process of conducting phenomenological interviews with 20 refugees in the city of São Paulo, Brazil, in 2018. My research adopts the four pillars of care ethics (attentiveness, responsibility, responsiveness, and competence) (White and Tronto, 2004) as a practice that contributes to beyond “doing no-harm” (Mackenzie, McDowell & Pittaway, 2007) in refugee research. My reflection contributes to this literature on “ethics in practice” and refugee studies (Muller-Funk, 2021) and provides a practical reflection on the ethics of care on research involving South-South refugees in a Latin American country

Volume changes of grafted autogenous bone in sinus augmentation procedure

to evaluate associations between the osseous remodelling add 3-dimensional features of both the grafted bone and the recipient site as well as the density of the grafted bone,and to assess the relation between the degree of bone resorption and the type of autogenous bone.grafting procedure or the source(block or particulate bone from iliac crest or block bone from chin

NOVAS POPULAÇÕES DO MICO-lEÃO CAlÇARA, LEONTOPITHECUS CAISSARA (LORINI & PERSSON, 1990) NO SUDESTE DO BRASIL (PRIMATES - CALLITRICHIDAE)

o presente trabalho apresenta a distribuição de novas populações da espécie Leontopithecus caissara no litoral sul do Estado de São Paulo (PRIMATES - CALLlTRICHIDAE). A distribuição antes conhecida desta espécie restringia-se somente a sua localidade - tipo, IIhadeSuperaguí (25°18'S, 48°11 'W) no Paranáeáreas adjacentes ao continente deste estado. Nossas investigações ampliam em cerca de 130 km2 a áreade ocorrência desta espécie, apresentando pelo menos três populações distintas. São apresentadas também notas sobre a sua biologia

Partners in Crime in the Setting of Recurring Cardiac Arrest

No previous reports are available about the potential dramatic effects resulting from the combination of acquired long QT interval not associated to bradycardia and myocardial ischemia. We report the case of a man that during acute necrotic pancreatitis presented QT interval prolongation without bradycardia, TdP, and two episodes of cardiac arrest. A coronary angiogram revealed a subocclusive stenosis of left anterior descending coronary artery, treated with a percutaneous coronary intervention. After myocardial revascularization, even in presence of long QT interval, no arrhythmic events occurred suggesting the key role of myocardial ischemia in triggering TdP in acquired long QT even without bradycardia. ECG performed six months later, after complete recovery from pancreatitis, showed a normal QT interval

Defying genocide in Myanmar: everyday resistance narratives of Rohingyas

Rohingyas are the most persecuted minority in the world. They have been facing systematic discrimination and serious human rights violations since the 1970s when they stopped being recognized as citizens by the Burmese government. Acts committed against this predominantly Muslim minority in the Rakhine State can be classified as ethnic cleansing with the intent of genocide. Myanmar is also facing a case in the International Court of Justice (ICJ) due to violations of the Convention Against Genocide (1948). This paper employs the framework of everyday resistance to highlight Rohingyas’ acts and practices to resist genocidal acts in Myanmar. We analyzed 62, 56, and 145 micronarratives of forcibly displaced adult Rohingyas currently living in India, Malaysia, and Bangladesh, collected between March 2019 and April 2020. We conclude that the Rohingyas adopted various everyday resistance practices involving non-compliance, such as refusing to follow orders, giving money or going to forced labour; and avoiding staying at home and secrecy, including praying, using mobile phones, moving to other areas, studying, and marrying secretly. In addition, everyday resistance strategies connected to gender-focused protection against sexual violence were linked to staying at home, hiding girls and maintaining women pregnant. Finally, Rohingyas adopted resistance strategies to survive the 2017 attacks, including fleeing to Bangladesh in groups and supporting each other. This discussion dialogues with previous work on genocide studies that highlight the agency and resistance of Holocaust and other genocide survivors. It contributes to understanding the everyday resistance of a stateless minority, recognizing its agency against its genocidal state

Diagnosis of obstructive coronary artery disease using computed tomography angiography in patients with stable chest pain depending on clinical probability and in clinically important subgroups: meta-analysis of individual patient data

OBJECTIVE: To determine whether coronary computed tomography angiography (CTA) should be performed in patients with any clinical probability of coronary artery disease (CAD), and whether the diagnostic performance differs between subgroups of patients. DESIGN: Prospectively designed meta-analysis of individual patient data from prospective diagnostic accuracy studies. DATA SOURCES: Medline, Embase, and Web of Science for published studies. Unpublished studies were identified via direct contact with participating investigators. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Prospective diagnostic accuracy studies that compared coronary CTA with coronary angiography as the reference standard, using at least a 50% diameter reduction as a cutoff value for obstructive CAD. All patients needed to have a clinical indication for coronary angiography due to suspected CAD, and both tests had to be performed in all patients. Results had to be provided using 2×2 or 3×2 cross tabulations for the comparison of CTA with coronary angiography. Primary outcomes were the positive and negative predictive values of CTA as a function of clinical pretest probability of obstructive CAD, analysed by a generalised linear mixed model; calculations were performed including and excluding non-diagnostic CTA results. The no-treat/treat threshold model was used to determine the range of appropriate pretest probabilities for CTA. The threshold model was based on obtained post-test probabilities of less than 15% in case of negative CTA and above 50% in case of positive CTA. Sex, angina pectoris type, age, and number of computed tomography detector rows were used as clinical variables to analyse the diagnostic performance in relevant subgroups. RESULTS: Individual patient data from 5332 patients from 65 prospective diagnostic accuracy studies were retrieved. For a pretest probability range of 7-67%, the treat threshold of more than 50% and the no-treat threshold of less than 15% post-test probability were obtained using CTA. At a pretest probability of 7%, the positive predictive value of CTA was 50.9% (95% confidence interval 43.3% to 57.7%) and the negative predictive value of CTA was 97.8% (96.4% to 98.7%); corresponding values at a pretest probability of 67% were 82.7% (78.3% to 86.2%) and 85.0% (80.2% to 88.9%), respectively. The overall sensitivity of CTA was 95.2% (92.6% to 96.9%) and the specificity was 79.2% (74.9% to 82.9%). CTA using more than 64 detector rows was associated with a higher empirical sensitivity than CTA using up to 64 rows (93.4% v 86.5%, P=0.002) and specificity (84.4% v 72.6%, P<0.001). The area under the receiver-operating-characteristic curve for CTA was 0.897 (0.889 to 0.906), and the diagnostic performance of CTA was slightly lower in women than in with men (area under the curve 0.874 (0.858 to 0.890) v 0.907 (0.897 to 0.916), P<0.001). The diagnostic performance of CTA was slightly lower in patients older than 75 (0.864 (0.834 to 0.894), P=0.018 v all other age groups) and was not significantly influenced by angina pectoris type (typical angina 0.895 (0.873 to 0.917), atypical angina 0.898 (0.884 to 0.913), non-anginal chest pain 0.884 (0.870 to 0.899), other chest discomfort 0.915 (0.897 to 0.934)). CONCLUSIONS: In a no-treat/treat threshold model, the diagnosis of obstructive CAD using coronary CTA in patients with stable chest pain was most accurate when the clinical pretest probability was between 7% and 67%. Performance of CTA was not influenced by the angina pectoris type and was slightly higher in men and lower in older patients. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42012002780

Patient Acceptance of Noninvasive and Invasive Coronary Angiography

BACKGROUND: Noninvasive angiography using multislice computed tomography (MSCT) is superior to magnetic resonance imaging (MRI) for detection of coronary stenoses. We compared patient acceptance of these two noninvasive diagnostic tests and invasive conventional coronary angiography (Angio). METHODS AND FINDINGS: A total of 111 consecutive patients with suspected coronary artery disease underwent MSCT, MRI, and Angio. Subsequently, patient acceptance of the three tests was evaluated with questionnaires in all patients. The main acceptance variables were preparation and information prior to the test, degree of concern, comfort, degree of helplessness, pain (on visual analog scales), willingness to undergo the test again, and overall satisfaction. Preparation for each test was not rated significantly differently, whereas patients were significantly more concerned about Angio than the two noninvasive tests (p<0.001). No pain during MSCT, MRI, and Angio as assessed on visual analog scales (0 to 100) was reported by 99, 93, and 31 patients, respectively. Among the 82 patients who felt pain during at least one procedure, both CT (0.9±4.5) and MRI (5.2±16.6) were significantly less painful than Angio (24.6±23.4, both p<0.001). MSCT was considered significantly more comfortable (1.49±0.64) than MRI (1.75±0.81, p<0.001). In both the no-revascularization (55 patients) and the revascularization group (56 patients), the majority of the patients (73 and 71%) would prefer MSCT to MRI and Angio for future imaging of the coronary arteries. None of the patients indicated to be unwilling to undergo MSCT again. The major advantages patients attributed to MSCT were its fast, uncomplicated, noninvasive, and painless nature. CONCLUSIONS: Noninvasive coronary angiography with MSCT is considered more comfortable than MRI and both MSCT and MRI are less painful than Angio. Patient preference for MSCT might tip the scales in favor of this test provided that the diagnostic accuracy of MSCT can be shown to be high enough for clinical application