Relações entre avaliatividade e ethos no prólogo da Compilação de todas as obras de Gil Vicente

The Portuguese playwright Gil Vicente wrote his plays between 1502 and 1536, possible year of his death. During his life, he served the king without having his liberty as an artist compromised by any formality. However, from 1536 on, Tribunal do Santo Ofício, whose function, among others, was censoring books, is established in Portugal. This paper aims to discuss the transmission of Gil Vicente’s works, through a discourse-semantic analysis of the prologue to the first edition of Compilação de todas as obras de Gil Vicente, written by the author himself. For this purpose, the analysis will draw upon the Appraisal system, developed by Martin & White (2005), and also upon the text’s rhetorical structure, to highlight the composition of the author’s ethos and to understand why the aforementioned text was censored by the Inquisition in its second edition.O dramaturgo português Gil Vicente escreveu suas peças entre 1502 e 1536, possível ano de sua morte. Durante a vida, esteve a serviço do rei sem ter sua liberdade como artista comprometida por qualquer formalidade, porém, a partir do ano de 1536 estabelece-se em Portugal o Tribunal do Santo Ofício que teve como uma de suas funções a censura de livros. Desta forma, este artigo se propõe a fazer uma reflexão acerca da transmissão da obra vicentina, por meio de uma análise do prólogo escrito por Gil Vicente na primeira edição da Compilação de todas as obras de Gil Vicente, em que buscou-se utilizar a teoria da avaliatividade de Martin & White (2005) e estrutura retórica do texto para ilustrar a composição do ethos do autor e tentar entender por que este texto foi censurado pela Inquisição na segunda edição da mesma obra

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

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

Anoftalmia congênita clínica - alterações oculares e sistêmicas associadas

Purpose: To describe alterations observed in patients with congenital clinical anophthalmia and the occurrence of association with other ocular and extra ocular abnormalities. Methods: An observational retrospective study was conducted evaluating 12 patients with congenital clinical anophthalmia at Faculdade de Medicina de Botucatu-UNESP, between 1992 and 2005. In those patients it was observed the ocular abnormalities, severity, laterality, follow-up and to systemic abnormalities associated. The congenital clinical anophthalmia have been associated to major severity abnormalities extra-oculars, mainly when the anophthalmia was bilateral, such agenesis of corpus callosum, others craniofacial anomalies and cardiac defects. In the cases unilateral, the alteration associated more frequently was the facial asymmetry, showing the direct correlation between anophthalmos and development of orbit and face. Conclusion: There was relation between congenital clinical anophthalmia and ocular abnormally and extra-ocular abnormally. Patients with bilateral anophthalmos disease have more severe alterations. anophthalmia congenital attends a course with abnormalities of development of the face

Environmental education and clandestine extraction of the heart of palm euterpe edulis: the case "Carlos Botelho" state park.

Neste trabalho investigou-se planos e ações de educação ambiental do Parque Estadual "Carlos Botelho" (PECB) buscando possíveis relações com os distúrbios antrópicos em seu interior causados pela extração clandestina de palmito (Euterpe edulis). Esta área é considerada uma Unidade de Conservação de Proteção Integral e abrange 37.644,36 ha localizados na região sul do Estado de São Paulo. Sua porção que pertence ao Vale do Ribeira, em conjunto com outras unidades de conservação (Parque Estadual Turístico do Alto Ribeira e Parque Estadual Intervales), compõem um importante continuum ecológico do estado de São Paulo. Entre 1988 a 1994, apesar do poder público não destinar recursos institucionais para a formalização de atividades educacionais no PECB, iniciam-se as atividades de educação ambiental nessa área com o apoio financeiro do World Wildlife Fund (WWF) e da Fundação O Boticário de Proteção à Natureza. A partir da coleta e analise dos processos técnico-administrativos, dos relatórios de projetos e das atas de reunião do Parque, referentes ao período de 1988 a 2000, obteve-se os elementos necessários para compreender o histórico do Programa e sua fundamentação pedagógica. A metodologia adotada foi a de estudo de caso. Foram compilados também dados secundários sobre a extração de palmito na polícia ambiental e delegacia da região e realizadas entrevistas com indivíduos que, de algum modo, estão ligados à rede de extração de palmito e à população do entorno. Foi elaborado um diário de campo, com registros fotográficos e registros de reuniões entre setembro de 1999 a novembro de 2000, onde se registrou as atividades do Programa de Educação Ambiental e Uso Público do Parque. Neste contexto, procurou-se identificar a forma com que os distúrbios antrópicos, mais especificamente a extração clandestina de palmito, são trabalhados na gestão do Parque e mais especificamente no Programa de Uso Público, no subprograma de educação ambiental. Constata-se a carência de um tratamento mais aprofundado do conflito como estratégia privilegiada para se fazer educação ambiental.The main objective of this work was to investigate plans and actions of environmental education developed by "Carlos Botelho" State Park (CBSP) related to riots caused by the clandestine extraction of the heart of palm Euterpe edulis. This area (37,644.36 ha) is located in the south of the state of São Paulo and it is considering Integral Unit of Conservation and Protection. The Ribeira Valley, which composes an important ecological continuum area, is formed by other two units of conservation (Alto do Ribeira Tourist State Park and Intervales State Park). From 1988 to 1994 the brazilian government did not give any support to promote environmental educational activities at CBSP, but it was possible to start the environmental education program, which was supported by the following no governmental organizations: World Wildlife Fund (WWF) and Boticário Foundation to Nature Protection. Based on the collected and analyzed administrative technical processes, project reports and acts of meeting occurred at CBSP during the period of 1988 to 2000, it was possible to obtain the necessary elements to understand the environmental program historic and how it was base on. The methodology adopted was the case study. It was compiled a secondary data about the heart of palm extraction, which were given by the policy and people from the neighborhood of the park and individuals who had been in contact with the environmental program or other activities developed by the park as well as the extraction of the heart of palm Euterpe edulis were interviewed. From September 1999 to November 2000 a field daily was elaborated and photos, meetings and activities of the environmental education program and public use developed by the park were registered. In this context and considering the environmental education subprogram, it was identified how the riots, specifically the clandestine extraction of the heart of palm Euterpe edulis, has been incorporated in the management of the park. It was found that the clandestine extraction of the heart of palm Euterpe edulis is not treated as it should be to guarantee the environmental education program efficiency

Retinopatia de Purtscher-like e pancreatite aguda Purtscher-like retinopathy and acute pancreatitis

Retinopatia de Purtscher-like é uma baixa súbita da visão associada à imagem de múltiplas áreas branco-amareladas (manchas algodonosas) e hemorragias no pólo posterior de ambos os olhos. O exato mecanismo da injúria ainda não é claro, mas provavelmente seria de natureza embólica.Tem sido descrita em uma variedade de condições, incluindo pancreatite aguda, síndrome de embolia gordurosa, insuficiência renal, nascimento (parto e pós-parto), desordens do tecido conectivo, entre outras. Serão relatados três casos de pancreatite aguda confirmada pelos exames laboratoriais e história clínica, associadas a alterações no exame do fundo de olho, compatíveis com esta retinopatia.<br>Purtscher-like retinopathy is acute loss of vision associated image of the multiple areas of retinal whitening and hemorrhage in the posterior pole of both eyes. The exact mechanism of injury remains unclear, current evidence suggests that it is embolic in nature. In a variety of conditions are been described including acute pancreatitis, fat embolism syndrome, renal failure, childbirth, and connective tissue disorders. Will are related three cases of the acute pancreatitis which was confirmed by complementary laboratory studies and clinical history, associated from exam of the fundus of the eye, similar is this retinopathy