Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

A representação social do aluno com deficiência na Educação Inclusiva: o olhar das crianças

Historically excluded, handicapped people have been socially included through new standards guided by egalitarian principles. The Social Representation Theory, which studies how the common sense builds �theories� about relevant objects, was used to answer how this situation affects children socially and psychologically in inclusive schools. We use a multimethodological approach with free associations, drawings and focus groups to study the social representations of 39 third and fourth-grade students about their handicapped colleagues, all the children being from a state school in Recife, Pernambuco. The data were submitted to content analysis and analysis using the EVOC software, and the results indicate that handicapped children are seen as people limited by a temporary or permanent shortage or disability; they learn differently from others and disrupt classes; they require constant care and protection; they are allowed to join the group, but not to be part of it. The group seems to be outlining the contours of otherness, which shows a representation under construction.Historicamente excluídas, as pessoas com deficiência vêm sendo socialmente inseridas por meio de novas normas orientadas por princípios igualitários. A Teoria das Representações Sociais, que estuda como o senso comum constrói �teorias� sobre objetos relevantes, foi utilizada para responder como essa conjuntura afeta social e psicologicamente as crianças nas escolas inclusivas. Utilizamos uma abordagem plurimetodológica com associações livres, desenhos e grupos focais para estudar as representações sociais sobre o colega com deficiência compartilhadas por 39 crianças de turmas de terceiro e quarto ano do Ensino Fundamental de uma escola estadual do Recife. Os dados foram submetidos à análise de conteúdo e do software EVOC e os resultados evidenciam que as crianças com deficiência são vistas como pessoas limitadas por uma falta ou incapacidade permanente ou passageira; aprendem de forma diferente das demais e atrapalham as aulas; necessitam de cuidado e proteção; são autorizadas a participar do grupo, sem constituir parte dele. O grupo parece estar delineando os contornos da alteridade, evidenciando uma representação em construção

When is Peer Aggression 'Bullying?' An Analysis of Elementary and Middle School Student Discourse on Bullying at School

Algunas formas de agresión entre iguales son llamadas de “acoso escolar” por estudiantes, familias y adultos, y esto puede ser una fuente de confusión en las instituciones educativas. El principal propósito de este estudio es explorar las circunstancias en las cuales los estudiantes caracterizan la agresión entre iguales como casos de acoso escolar. Una meta secundaria es examinar los sentimientos que los estudiantes tienen sobre la eficacia de denunciar la agresión entre iguales a los adultos. Ambos objetivos intentan revelar información que permita mejorar la comunicación entre adultos y estudiantes sobre la agresión entre iguales y el acoso escolar. Se realizaron seis grupos de discusión con 54 estudiantes entre los cursos de tercero a octavo en el sistema educativo de Estados Unidos de América. Los grupos fueron organizados basados en el patrón del nivel del curso, el género, y el método cualitativo usado para el análisis. Los hallazgos muestran que aunque los estudiantes definen el acoso escolar con criterios similares a la literatura científica, ellos lo describen con un vocabulario diferente. Los estudiantes jóvenes también expresan mayor fe en la habilidad de los adultos para responder efectivamente a las situaciones de acoso escolar. Los estudiantes mayores prefieren confrontar al abusón con la fuerza de los iguales o razonando para que el acosador detenga la agresión.Many forms of peer aggression are referred to as "bullying" by students, parents and adults, and this can be a source of confusion in schools. The main purpose of this study is to explore the circumstances under which students characterize peer aggression as “bullying” incidents. A secondary goal is to examine the feelings students have about the effectiveness of reporting peer aggression to adults. Both objectives are intended to reveal information that will enhance communication about peer aggression and bullying between students and adults. Six focus groups with 54 students in grades three through eight were conducted. The groups were organized in patterns based on grade level and gender, and qualitative methods were used to analyze the results. The findings showed that although the students defined bullying in ways that are similar to the criteria in the literature, they chose different words to describe them. Younger students also expressed greater faith in the ability of adults to respond effectively to bullying situations. Older students preferred to confront a bully with equal force or to reason with a bully to stop the aggression

Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42·4% vs 44·2%; absolute difference -1·69 [-9·58 to 6·11] p=0·67; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5-8] vs 6 [5-8] cm H2O; p=0·0011). ICU mortality was higher in MICs than in HICs (30·5% vs 19·9%; p=0·0004; adjusted effect 16·41% [95% CI 9·52-23·52]; p<0·0001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0·80 [95% CI 0·75-0·86]; p<0·0001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status