ORIENTA + COVID" CALL CENTER SERVICE IN THE XINGU-PA REGION

Em todo o mundo, foram desenvolvidas diretrizes que indicam a adoção de medidas que possam orientar e auxiliar a população em tempos de pandemia. Nesse sentido, diversos municípios têm incorporado a prática de centrais de atendimento em saúde com especialistas qualificados para prestar informações corretas sobre a doença, criando canais remotos para realização de ligações como telefones, videochamadas e aplicativos que não exigem aglomeração de pessoas nas unidades de saúde. O objetivo do trabalho foi descrever a experiência do serviço de teleatendimento “Orienta+COVID”, instalado na região do Xingu-PA, Brasil. O estudo foi realizado na região do Xingu, Pará, Brasil. Foram coletados os relatos dos atendentes participantes do projeto, bem como analisado o relatório de registro dos atendimentos, ocorridos no período de 25 de maio a 30 de junho de 2020. Foram realizados 1210 atendimentos no período analisado, por meio de 60 atendentes que se revezavam em plantões. Durante a teleorientação, os profissionais de saúde coletaram os dados dos pacientes, suas queixas e dúvidas para determinar, através da classificação dos sintomas, quais seriam as orientações a serem passadas. O teleatendimento realizado pelos profissionais de saúde durante o projeto foi essencial para sanar as dúvidas dos pacientes, no sentido de orientá-los sobre como proceder em casos suspeitos ou confirmados da COVID-19 e assim contribuir para a redução da procura por serviços de urgência e emergência.En todo el mundo se han desarrollado lineamientos que indican la adopción de medidas que puedan orientar y asistir a la población en tiempos de pandemia. En este sentido, varios municipios han incorporado la práctica de centros de salud con especialistas calificados para brindar información correcta sobre la enfermedad, creando canales remotos para realizar llamadas como teléfonos, videollamadas y aplicaciones que no requieran aglomeración de personas en unidades de salud. El objetivo de este estudio fue describir la experiencia del teleservicio "Orienta+COVID", instalado en la región xingu-pa, Brasil. El estudio se realizó en la región de Xingu de Pará, Brasil. Recogimos los informes de los asistentes participantes en el proyecto, así como analizamos el informe de registro de las visitas, que se produjeron del 25 de mayo al 30 de junio de 2020. Se realizaron un total de 1.210 visitas en el periodo analizado, a través de 60 asistentes que estuvieron en turnos. Durante la teleorientación, los profesionales sanitarios recogieron datos de pacientes, quejas y dudas para determinar, a través de la clasificación de los síntomas, qué pautas se aprobarían. El teleservicio prestado por los profesionales sanitarios durante el proyecto fue fundamental para atender las dudas de los pacientes, con el fin de orientarlos sobre cómo proceder en casos sospechosos o confirmados de COVID-19 y contribuir así a la reducción de la demanda de servicios de emergencia y emergencia.Worldwide, guidelines have been developed that indicate the adoption of measures, which can guide and assist the population in times of pandemic. In this sense, several cities have incorporated the practice of health call centers with qualified specialists to provide correct information about the disease, creating remote channels to make calls such as telephones, video calls and applications that do not require the crowding of people at health units. The objective of the work was to describe the “Orienta+COVID” call center service installed in the Xingu-PA region, Brazil. The study was carried out in the Xingu region, Pará, Brazil. The reports of the attendants participating in the project were collected and the attendance registration report, which took place from May 25th to June 30th, 2020, was analyzed. A total of 1210 visits were made in the period analyzed through 60 attendants who took turns on duty. During tele orientation, health professionals collected patient data, their complaints and doubts to determine, through the classification of symptoms, what would be the guidelines to be passed. The call center performed by health professionals during the project was essential to answer patients' doubts as well as being able to better guide them on how to proceed in suspected or confirmed cases of the new coronavirus and thus contribute to reducing the demand for urgent and emergency services

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Núcleos de Ensino da Unesp: artigos 2008

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq

Bioenergia: desenvolvimento, pesquisa e inovação

Com 27 trabalhos produzidos por pesquisadores do Instituto de Pesquisa em Bioenergia (Bioen), da Unesp, este livro oferece uma ampla visão sobre as áreas que compõem o segmento. Seu principal objetivo é contribuir para melhorar a compreensão dos vários aspectos da bioenergia, em especial no Brasil, que figura entre os países com maior nível de desenvolvimento tecnológico no setor. Os artigos abordam uma série abrangente de questões relacionadas à bioenergia, como a construção genética das plantas de cana-de-açúcar visando ao aumento de produtividade, a disseminação de sementes para estimular a propagação de espécies com potencial energético, etapas de produção de bioenergia, usos do combustível e seus efeitos nos diversos tipos de motores. Agrupados por assunto, os textos estão distribuídos em cinco partes: Biomassa para bioenergia; Produção de biocombustíveis; Utilização de bioenergia; Biorrefinaria, alcoolquímica e oleoquímica e Sustentabilidade dos biocombustíveis