Circadian rhythms and sleep—the metabolic connection

The circadian system coordinates mammalian physiology and behavior with the environmental light-dark cycle. It allocates sleep to the inactivity phase using various mechanisms involving neurotransmitters, nuclear receptors, and protein kinases. These pathways are related to metabolism, indicating that the circadian system and sleep are connected via metabolic parameters. This suggests that organs other than the brain may "sleep.” A hypothetic view on this aspect is presented providing a different perspective on sleep regulatio

Fundamentos da cidadania para professores fundamentais

O projeto “Fundamentos da Cidadania para Professores Fundamentais” é fruto do trabalho do Núcleo de Estudos da Tutela Penal e Educação em Direitos Humanos (NETPDH) da Universidade Estadual Paulista Júlio de Mesquita Filho (UNESP) – Campus de Franca?SP, em parceria com o Programa de Pós?Graduação em Direito (PPGD) da mesma faculdade, com a Diretoria Regional de Ensino de Franca?SP e com a Escola Estadual Lydia Rocha Alves, situada na periferia da cidade.O referido Núcleo foi formado em 2009, sob coordenação do Prof. Dr. Paulo Cesar Correa Borges, docente e coordenador do Programa de Pós?Graduação em Direito da UNESP. Atualmente conta com o envolvimento de discentes da graduação e da pós?graduação, bem como de docentes do próprio campus e de outras instituições de ensino superior. Suas atuais linhas de pesquisa são: a) Educação em Direitos Humanos; b) Formas de Violação dos Direitos Humanos com repercussão jurídico?penal; c) O Direito à Defesa dos Direitos Humanos; d) O Sistema Penitenciário como Violência Institucional. Além  disso, o NETPDH também é responsável por dois projetos de extensão no ano de 2012: o primeiro é realizado por discentes do curso de Direito junto a alunos do 6º ano do Ensino Fundamental, com o objetivo de se construir uma concepção pré?violatória dos Direitos Humanos no ambiente escolar e, consequentemente, na comunidade; e o segundo, já mencionado acima, que será objeto da presente análise

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