Desempenho de rede de abastecimento de água a partir da simulação computacional utilizando o EPANET 2.0 / Performance indicators of water supply network from the computational simulation using the EPANET 2.0

A região Nordeste sofre com escassez prolongada de água e necessita de uma gestão eficiente dos sistemas de abastecimento de água. Para tanto, foi realizada a análise do Índice de Hashimoto para a pressão ao longo de bairros, situados na Zona de pressão B na cidade de Campina Grande-PB. O estudo objetivou simular a variação dos indicadores, traçando a rede de distribuição no software EPANET e determinando os indicadores de confiabilidade, resiliência e vulnerabilidade. A partir desta, observou-se que os bairros Prata e São José possuem comportamento semelhantes com pressões satisfatórias ao longo dos pontos selecionados, entretanto o bairro Centro possui pontos em não conformidade devido sua grande extensão e topografia irregular. A partir desses resultados pode-se concluir que o uso de modelos de simulação da qualidade da água pode contribuir significativamente para a melhoria da qualidade do serviço de abastecimento de água, apoiando as atividades de operação e manutenção do sistema

Cuidados paliativos em oncologia: conhecimento dos acadêmicos de fisioterapia / Palliative care in oncology: knowledge of physiotherapy academics

Devido ao alto índice de pacientes acometidos pelo câncer, sendo esta uma condição progressiva que ameaça a vida, a necessidade de cuidados paliativos é essencial. Essa abordagem vem ganhando cada vez mais espaço, porém observa-se uma carência na qualificação profissional. Nesta perspectiva, o presente estudo teve como objetivo avaliar o conhecimento dos acadêmicos de fisioterapia nos cuidados paliativos em oncologia. Para compreender esta realidade, foi realizado um estudo transversal, descritivo com abordagem quantitativa, numa instituição privada de ensino superior, no período de agosto a setembro de 2019, com a participação de 100 acadêmicos de fisioterapia cursando o último ano de graduação. Foi utilizado um questionário semiestruturado com perguntas relacionadas ao tema, seguindo as normas e aspectos éticos da resolução 466/12 do Conselho Nacional de Saúde e aprovado pelo Comitê de Ética em Pesquisa. Os dados foram organizados em uma planilha eletrônica utilizando o software Excel, versão 2010 e analisados através da estatística descritiva simples. Com relação aos resultados houve predomínio do sexo feminino com 85% (n=85) e média de idade de 25,11±5,08. Diante dos questionamentos, 100% (n=100) relataram conhecer os cuidados paliativos, 53% (n=53) afirmaram ter interesse em atuar nesta área e 92% (n=92) afirmaram saber sobre a atuação da fisioterapia nessa abordagem de cuidado; entretanto, 75% (n=75) não se sentem preparados para tal função e 83% (n=83) alegaram que esta temática não é bem abordada em sala de aula. Pode-se concluir que os acadêmicos de fisioterapia possuem conhecimento acerca dos cuidados paliativos em oncologia, porém observa-se uma percepção restrita sobre o seu conceito, mostrando a necessidade da capacitação profissional dos acadêmicos para esta vertente de cuidado

Síndrome de Sheehan, um relato de caso

A síndrome de Sheehan refere-se ao hipopituitarismo secundário a necrose hipofisária devido a hipotensão grave precipitada por hemorragia pós parto. Sua apresentação pode ser de forma aguda ou crônica, sendo esta última de caráter insidioso, com sintomas inespecíficos, levando, frequentemente, a um diagnóstico tardio. Sua investigação requer uma história obstétrica compatível com hemorragia pós parto, evoluindo com agalactia e amenorréia, associada a evidência de insuficiência dos hormônios hipofisários de grau variável e exame de imagem evidenciando a sela turca total ou parcialmente vazia. O tratamento consiste na reposição hormonal, importante para melhora da qualidade de vida e redução da morbimortalidade das pacientes.  Dessa forma, este trabalho tem como objetivo relatar um caso de síndrome de Sheehan e informar sobre esta condição médica que ainda é subdiagnosticada

Linfangioleiomiomatose diagnosticada a partir de um pneumotórax espontâneo, um relato de caso

A Linfagioleiomiomatose (LAM) é uma doença multissistêmica rara, caracterizada sobretudo por manifestações pulmonares. Sua apresentação inicial pode-se dar pelo desenvolvimento de Pneumotórax espontâneo, o qual ocorre em dois terços dos pacientes. A investigação diagnóstica deve ser realizada através de testes de função pulmonar, exames de imagem, bem como com a exclusão de doenças reumatológicas que participam do diagnóstico diferencial. O tratamento é a imunossupressão, sendo o Sirolimo considerado o padrão-ouro. Assim, o presente estudo tem como objetivos relatar um caso de Linfagioleiomiomatose diagnosticada partir do surgimento de um Pneumotórax espontâneo e revisar a literatura a respeito desta condição clínica

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

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

La renovación de la palabra en el bicentenario de la Argentina : los colores de la mirada lingüística

El libro reúne trabajos en los que se exponen resultados de investigaciones presentadas por investigadores de Argentina, Chile, Brasil, España, Italia y Alemania en el XII Congreso de la Sociedad Argentina de Lingüística (SAL), Bicentenario: la renovación de la palabra, realizado en Mendoza, Argentina, entre el 6 y el 9 de abril de 2010. Las temáticas abordadas en los 167 capítulos muestran las grandes líneas de investigación que se desarrollan fundamentalmente en nuestro país, pero también en los otros países mencionados arriba, y señalan además las áreas que recién se inician, con poca tradición en nuestro país y que deberían fomentarse. Los trabajos aquí publicados se enmarcan dentro de las siguientes disciplinas y/o campos de investigación: Fonología, Sintaxis, Semántica y Pragmática, Lingüística Cognitiva, Análisis del Discurso, Psicolingüística, Adquisición de la Lengua, Sociolingüística y Dialectología, Didáctica de la lengua, Lingüística Aplicada, Lingüística Computacional, Historia de la Lengua y la Lingüística, Lenguas Aborígenes, Filosofía del Lenguaje, Lexicología y Terminología

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