Effect of the alveolar recruitment manoeuvre on pulmonary complications in the immediate postoperative period of cardiac surgery: preliminary results of a randomised controlled trial

Introdução: dada a grande variabilidade nos protocolos de ventilação, manejo pós-operatório, características da manobra de recrutamento alveolar (MRA) (frequência, duração e intensidade) e tolerabilidade em pacientes submetidos à cirurgia cardíaca (CC), este estudo investiga se a MRA é benéfica nesta área, a fim de padronizar seu uso. Objetivo: investigou-se a eficácia da MRA contra complicações pulmonares (CPs) imediatamente após a CC. Metodologia: este ensaio clínico randomizado incluiu 134 pacientes com idade > 18 anos submetidos à cirurgia de revascularização do miocárdio ou cirurgia de substituição valvar em nossa instituição entre fevereiro e setembro de 2019. Os participantes foram alocados para receber fisioterapia padrão (grupo controle [GC], n=67) ou fisioterapia padrão com adição da MRA (grupo intervenção [GI], n=67). Resultados: não houve diferença estatisticamente significativa na incidência de CPs entre os grupos GC e GI (p=0,85). A MRA não melhorou as trocas gasosas ou reduziu o tempo total de ventilação mecânica, necessidade de reintubação na unidade de terapia intensiva e internação hospitalar. Conclusão: a MRA profilática não diminui a incidência de CPs no pós-operatório de CC, não melhora as trocas gasosas, nem reduziu o tempo de VM. A MRA foi associada a um risco aumentado de instabilidade hemodinâmica. Os pacientes devem ser avaliados antes de realizar MR

Fingerlings mass estimation: A comparison between deep and shallow learning algorithms

The paper presents some results regarding the automatic mass estimation of Pintado Real fingerlings, using machine learning techniques to support the fish production process. For this purpose, an image dataset called FISHCV1206FSEG, was created which is composed of 1206 images of fingerlings with their respective annotated masses. Through the fish contours, the area and perimeter were extracted, and submitted to the J48, SVM, and KNN classification algorithms and a linear regression algorithm. The images were also submitted to ResNet50, In- ceptionV3, Exception, VGG16, and VGG19 convolutional neural networks. As a result, the classification algorithm J48 reached an accuracy of 58.2% and a linear regression model capable of predicting the mass of a Pintado Real fingerling with a mean squared error of 1.5 g. The convolutional neural network ResNet50 obtained an accuracy of 67.08%. We can highlight the contributions of this work through the presentation of a methodology to classify the mass of fingerlings in a non-invasive way and by the analyses and comparing results of different machine learning algorithms for classification and regression

High anti-SARS-CoV-2 antibody seroconversion rates before the second wave in Manaus, Brazil, and the protective effect of social behaviour measures: results from the prospective DETECTCoV-19 cohort

Background: The city of Manaus, Brazil, has seen two collapses of the health system due to the COVID-19 pandemic. We report anti-SARS-CoV-2 nucleocapsid IgG antibody seroconversion rates and associated risk factors in Manaus residents before the second wave of the epidemic in Brazil. Methods: A convenience sample of adult (aged ≥18 years) residents of Manaus was recruited through online and university website advertising into the DETECTCoV-19 study cohort. The current analysis of seroconversion included a subgroup of DETECTCoV-19 participants who had at least two serum sample collections separated by at least 4 weeks between Aug 19 and Oct 2, 2020 (visit 1), and Oct 19 and Nov 27, 2020 (visit 2). Those who reported (or had no data on) having a COVID-19 diagnosis before visit 1, and who were positive for anti-SARS-CoV-2 nucleocapsid IgG antibodies at visit 1 were excluded. Using an in-house ELISA, the reactivity index (RI; calculated as the optical density ratio of the sample to the negative control) for serum anti-SARS-CoV-2 nucleocapsid IgG antibodies was measured at both visits. We calculated the incidence of seroconversion (defined as RI values ≤1·5 at visit 1 and ≥1·5 at visit 2, and a ratio >2 between the visit 2 and visit 1 RI values) during the study period, as well as incidence rate ratios (IRRs) through cluster-corrected and adjusted Poisson regression models to analyse associations between seroconversion and variables related to sociodemographic characteristics, health access, comorbidities, COVID-19 exposure, protective behaviours, and symptoms. Findings: 2496 DETECTCoV-19 cohort participants returned for a follow-up visit between Oct 19 and Nov 27, 2020, of whom 204 reported having COVID-19 before the first visit and 24 had no data regarding previous disease status. 559 participants were seropositive for anti-SARS-CoV-2 nucleocapsid IgG antibodies at baseline. Of the remaining 1709 participants who were seronegative at baseline, 71 did not meet the criteria for seroconversion and were excluded from the analyses. Among the remaining 1638 participants who were seronegative at baseline, 214 showed seroconversion at visit 2. The seroconversion incidence was 13·06% (95% CI 11·52–14·79) overall and 6·78% (5·61–8·10) for symptomatic seroconversion, over a median follow-up period of 57 days (IQR 54–61). 48·1% of seroconversion events were estimated to be asymptomatic. The sample had higher proportions of affluent and higher-educated people than those reported for the Manaus city population. In the fully adjusted and corrected model, risk factors for seroconversion before visit 2 were having a COVID-19 case in the household (IRR 1·49 [95% CI 1·21–1·83]), not wearing a mask during contact with a person with COVID-19 (1·25 [1·09–1·45]), relaxation of physical distancing (1·31 [1·05–1·64]), and having flu-like symptoms (1·79 [1·23–2·59]) or a COVID-19 diagnosis (3·57 [2·27–5·63]) between the first and second visits, whereas working remotely was associated with lower incidence (0·74 [0·56–0·97]). Interpretation: An intense infection transmission period preceded the second wave of COVID-19 in Manaus. Several modifiable behaviours increased the risk of seroconversion, including non-compliance with non-pharmaceutical interventions measures such as not wearing a mask during contact, relaxation of protective measures, and non-remote working. Increased testing in high-transmission areas is needed to provide timely information about ongoing transmission and aid appropriate implementation of transmission mitigation measures. Funding: Ministry of Education, Brazil; Fundação de Amparo à Pesquisa do Estado do Amazonas; Pan American Health Organization (PAHO)/WHO.World Health OrganizationRevisión por pare

A voz dos bandos: colectivos de justiça e ritos da palavra portuguesa em Timor Leste colonial

Este artigo examina as relações entre o discurso da justiça e a prática do ritual nos bandos do governo colonial português em Timor Leste, entre a segunda metade do século XIX e as primeiras décadas do século XX. Os bandos consistiam em ordens e instruções de comando emanadas pelo governador português em Díli, e comunicadas de forma cerimonial por oficiais às populações dos diversos reinos timorenses dispersos pelo país. Bandos eram um instrumento por excelência de governação colonial dos assuntos indígenas, servindo para arbitrar conflitos, punir transgressões e, em geral, instituir realidades no mundo timorense. Contudo, esta instituição assumiu igualmente uma singular expressão nos usos timorenses, servindo bandos para comunicar também as ordens de autoridades tradicionais, os liurais. O artigo acompanha as variações coloniais e indígenas que os bandos adquiriram em Timor Leste, conceptualizando-os enquanto colectivos de justiça. Ao considerar assim os bandos como colectivos – formações heterogéneas em que elementos linguísticos e não linguísticos se combinam na produção de efeitos de poder sobre as populações – o artigo propõe uma via conceptual alternativa às perspectivas linguísticas e literárias de análise do discurso colonial

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

Patologias atuais: a compulsão e a sociedade dos excessos: Current pathologies: compulsion and the society of excesses

O artigo em tela tem por objetivo analisar os aspectos biopsicossociais da conduta compulsiva de consumo. Propõe-se a apresentar os elementos psicológicos contidos nesse comportamento, além de verificar quais são os resultados decorrentes dessa compulsão. O consumo compulsivo, também chamado de oniomania, é um transtorno causado pela ansiedade despertada pela necessidade de comprar e saciada, somente, quando é materializada a aquisição daquilo que se deseja comprar. O estudo em questão pode ser classificado como sendo de cunho bibliográfico, a partir da análise de documentos publicados em forma de artigos científicos e livros em formato digital

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

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

Epidemiological profile, routes of referral and accuracy of acute cholangitis diagnosis in individuals with obstructive jaundice admitted at a tertiary university hospital : development of an institutional guideline

Orientador: Everton CazzoDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências MédicasResumo: Introdução: O sinal clínico de icterícia apresenta um amplo espectro de etiologias, bem como de gravidade, sendo um grupo heterogêneo de pacientes, incluindo desde assintomáticos sem necessidade de intervenção até outros com risco de morte iminente. Objetivo: Analisar criticamente os encaminhamentos de pacientes com icterícia obstrutiva tratados por colangiopancreatografia retrógrada endoscópica (CPRE) ou cirurgia no Hospital de Clínicas da Unicamp. Criar Manual de Condutas para condução destes casos. Metodologia: Estudo transversal, retrospectivo e descritivo, avaliando os pacientes com icterícia obstrutiva atendidos no Hospital de Clínicas ¿ Unicamp tratados posteriormente por CPRE ou cirurgias de ressecção e/ou derivações biliares entre os períodos de setembro de 2017 a julho de 2018. Produção de Manual de condutas com revisão não sistemática da literatura e baseado em protocolo institucional vigente. Resultados: A presente casuística, 91 pacientes, apresentou predominância de pacientes do sexo feminino (58%), com idade a partir da quinta década (média de 56 anos ± 16,3 anos), sendo as etiologias benignas discretamente mais prevalentes (52% dos casos). O nível de bilirrubina média dos pacientes encaminhados foi de 15,8 mg/dL. Houve o registro em prontuário de 9,9% de colangite nos casos de icterícia obstrutiva, contudo a revisão dos casos com aplicação dos critérios de Tóquio 2018 mostrou uma prevalência de, aproximadamente, 43%. A acurácia global do diagnóstico clínico de colangite à admissão foi estimada em 67%, com sensibilidade de 23% e especificidade de 100%. Quanto às vias de encaminhamento dos pacientes com icterícia obstrutiva, a principal via foi o contato direto (31,8%) e a UER (29,7%). O encaminhamento via regulação CROSS/DRS representou 17,6% dos casos e o encaminhamento interno de outras especialidades, 20%. A via de encaminhamento extraoficial por contato direto foi a mais importante para os casos de etiologia neoplásica (p<0,01) e a mais rápida (p<0,01), contudo não houve diferença estatística nos níveis de bilirrubina entre as vias de encaminhamento. O Manual de condutas firma definições e cria algoritmos para condução e priorização de paciente com icterícia obstrutiva em atendimentos pré-hospitalar, Pronto Atendimento e em ambulatório da especialidade. Conclusões: Há uma deficiência nas vias oficiais de encaminhamento de pacientes com icterícia obstrutiva, uma vez que apenas 17% dos pacientes chegam através do sistema de regulação. Essa deficiência não impacta significativamente sobre o tempo e os níveis de bilirrubina dos pacientes devido à existência de vias alternativas e atendimentos de urgência. A frequência de encaminhamento por causas neoplásicas e não-neoplásicas é similar. A acurácia do diagnóstico clínico de Colangite Aguda é precária e a maior difusão dos critérios do Protocolo de Tóquio é essencial. A elaboração de um manual institucional de condutas foi efetivada baseada nos achados do presente estudoAbstract: Background: The clinical sign of jaundice presents a broad spectrum of etiologies, as well as severity, being a heterogeneous group of patients, ranging from asymptomatic ones without intervention to others even imminent death risk. Objective: To critically analyze the referrals of patients with obstructive jaundice treated by endoscopic retrograde cholangiopancreatography (ERCP) or surgery at Unicamp Hospital de Clínicas. Methods: Cross-sectional, retrospective and descriptive study evaluating patients with obstructive jaundice treated at Hospital de Clínicas - Unicamp, who were treated by ERCP or resection and/or surgical biliary drainage from September 2017 through July 2018. Results: There was 91 patients, a predominance of female patients (58%), with an average age of 56 ± 16,3 years; benign etiologies were slightly more prevalent (52% of cases). The mean bilirubin level of patients referred was 15.8 mg/dL. Acute cholangitis was detected in 9.9% of the individuals, but the review of the cases with the application of the Tokyo criteria showed a real prevalence of approximately 43%. Regarding the routes of referral of patients with obstructive jaundice, the main route was direct contact (31.8%) and urgency (29.7%). Routing via the official regulation represented 17.6% of the cases and internal referral from other specialties, 20%. The direct route of unofficial referral was the most important for cases of neoplastic etiology (p <0.01) and the fastest route (p <0.01); however, there was no statistical difference in bilirubin levels between the routing. Conclusions: There is a deficiency in the official routes of referral of patients with obstructive jaundice, since only 17% of patients arrive through the regulation system. This deficiency does not significantly impact the time and bilirubin levels of patients due to the existence of alternative routes and emergency care. The frequency of referral for neoplastic and non-neoplastic causes is close. The accuracy of the clinical diagnosis of Acute Cholangitis is precarious and a greater diffusion of the criteria of the Tokyo protocol is essential. An institutional guideline was created based on the findings of the current studyMestradoQualificação dos Processos AssistenciaisMestre em Ciência