Avaliação da mobilidade em espaços urbanos com deficiências para pessoas com dificuldade de locomoção

Esta pesquisa pretende avaliar as condições de mobilidade oferecidas ao pedestre (incluindo Pessoas com Dificuldade de Locomoção) considerando o nível de acessibilidade dos espaços urbanos, através de avaliação multicritério em ambiente SIG. É apresentado um estudo piloto em um campus universitário para os seguintes grupos de usuários: 1) sem deficiência aparente, 2) com deficiência física, 3) com deficiência sensorial/visual e 4) com restrição de locomoção. Os resultados identificaram locais com piores níveis de acessibilidade para cada tipo de usuário, evidenciando que a disposição das edificações do setor pedagógico em blocos independentes e dispersos gera bolsões de acessibilidade mais elevada. Contudo, esses bolsões nem sempre comunicam entre si por zonas de fácil acessibilidade o que compromete a mobilidade global no campus, sobretudo para os cadeirantes. As conclusões sugerem que o método é adequado e promissor para identificar espaços urbanos com deficientes soluções para a mobilidade de grupos específicos da população usuária

A qualitative study of cardiovascular disease risk communication in NHS Health Check using different risk calculators: protocol for the RIsk COmmunication in NHS Health Check (RICO) study. BMC family practice, 20(1), 11.

Background NHS Health Check is a national cardiovascular disease (CVD) risk assessment programme for 40–74 year olds in England, in which practitioners should assess and communicate CVD risk, supported by appropriate risk-management advice and goal-setting. This requires effective communication, to equip patients with knowledge and intention to act. Currently, the QRISK®2 10-year CVD risk score is most common way in which CVD risk is estimated. Newer tools, such as JBS3, allow manipulation of risk factors and can demonstrate the impact of positive actions. However, the use, and relative value, of these tools within CVD risk communication is unknown. We will explore practitioner and patient CVD risk perceptions when using QRISK®2 or JBS3, the associated advice or treatment offered by the practitioner, and patients’ responses. Methods RIsk COmmunication in NHS Health Check (RICO) is a qualitative study with quantitative process evaluation. Twelve general practices in the West Midlands of England will be randomised to one of two groups: usual practice, in which practitioners use QRISK®2 to assess and communicate CVD risk; intervention, in which practitioners use JBS3. Twenty Health Checks per practice will be video-recorded (n = 240, 120 per group), with patients stratified by age, gender and ethnicity. Post-Health Check, video-stimulated recall (VSR) interviews will be conducted with 48 patients (n = 24 per group) and all practitioners (n = 12–18), using video excerpts to enhance participant recall/reflection. Patient medical record reviews will detect health-protective actions in the first 12-weeks following a Health Check (e.g., lifestyle referrals, statin prescription). Risk communication, patient response and intentions for health-protective behaviours in each group will be explored through thematic analysis of video-recorded Health Checks (using Protection Motivation Theory as a framework) and VSR interviews. Process evaluation will include between-group comparisons of quantitatively coded Health Check content and post-Health Check patient outcomes. Finally, 10 patients with the most positive intentions or behaviours will be selected for case study analysis (using all data sources). Discussion This study will produce novel insights about the utility of QRISK®2 and JBS3 to promote patient and practitioner understanding and perception of CVD risk and associated implications for patient intentions with respect to health-protective behaviours (and underlying mechanisms). Recommendations for practice will be developed

Photography-based taxonomy is inadequate, unnecessary, and potentially harmful for biological sciences

The question whether taxonomic descriptions naming new animal species without type specimen(s) deposited in collections should be accepted for publication by scientific journals and allowed by the Code has already been discussed in Zootaxa (Dubois & Nemésio 2007; Donegan 2008, 2009; Nemésio 2009a–b; Dubois 2009; Gentile & Snell 2009; Minelli 2009; Cianferoni & Bartolozzi 2016; Amorim et al. 2016). This question was again raised in a letter supported by 35 signatories published in the journal Nature (Pape et al. 2016) on 15 September 2016. On 25 September 2016, the following rebuttal (strictly limited to 300 words as per the editorial rules of Nature) was submitted to Nature, which on 18 October 2016 refused to publish it. As we think this problem is a very important one for zoological taxonomy, this text is published here exactly as submitted to Nature, followed by the list of the 493 taxonomists and collection-based researchers who signed it in the short time span from 20 September to 6 October 2016

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

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

Germinação e maturidade fisiológica de sementes de Piptadenia Viridiflora (Kunth.) Benth relacionadas a estádios de frutificação e conservação pós-colheita Germination and physiological maturity in seeds of Piptadenia Viridiflora (Kunth.) Benth related to fruiting times and forms of post-harvest conservation

O objetivo deste trabalho foi verificar o efeito dos estádios de frutificação e formas de conservação na germinação e qualidade fisiológica de sementes de surucucu. Em 25 árvores na região de Vitória da Conquista, BA, foram realizadas coletas de frutos no período de 17/05 a 9/07 de 2007, em intervalos de sete dias a partir do início da frutificação, caracterizando oito estádios de desenvolvimento das vagens. Cada período de coleta foi definido por lotes diferenciados de sementes, sendo realizadas avaliações de massas fresca e seca de 100 sementes e teor de água. As sementes de cada uma das oito coletas foram mantidas em condições ambientais de laboratório, sendo subdivididas em dois lotes: em um lote, as sementes permaneceram no interior das vagens e, no outro, as vagens foram eliminadas. Após o período de 49 dias a partir do início da frutificação, massas fresca e seca de 100 sementes e teor de água foram determinados. Posteriormente, as sementes foram submetidas a testes de germinação em câmara tipo BOD, com temperatura de 25 ºC, em regime de fotoperíodo de 8 h de luz. Depois de cinco dias foi realizada a primeira contagem de germinação e aos 10 dias, avaliadas as seguintes características: porcentagem de germinação, plântulas anormais e classificação do vigor das plântulas (vigor alto, médio e baixo). A presença das vagens durante o período de conservação das sementes foi fator determinante para a qualidade fisiológica das sementes. A germinação e o acúmulo de matéria seca determinados por ocasião do teste de germinação aumentaram com o período de frutificação, atingindo o máximo aos 37 dias.<br>The objective of this study was to investigate the effect of different fruiting stages and conservation techniques on the germination and physiological quality of surucucu seeds. Fruits were collected on eight occasions from 25 trees in the region of Vitória da Conquista - BA, in the period from 05/17 to 07/09 2007, at sevenday intervals from the beginning of the fruiting stage. Each collection period was characterized by distinct seed lots. Evaluations were made for green and dry weight of 100 seeds and water content. The seeds in each of the eight collections were maintained under room conditions in the laboratory, and were subdivided into two lots: in the first, the seeds remained inside their pods, while in the other the pods were eliminated. After a 49-day period from the beginning of fruiting, determinations were made for green and dry weight of 100 seeds and water content. The seeds were then submitted to germination tests in a BOD incubator adjusted to 25ºC, with an 8:16 hr (light:dark) photoperiod. The first germination count was made after five days. At ten days, evaluations were made for germination percentage and abnormal seedlings, and plantlets were classified as to their vigor (high, medium, and low). Germination increased as the fruiting period progressed, and was directly related to dry matter accumulation in the seeds, as determined during the germination test