Avaliação das práticas diferenciais de amamentação: a questão da etnia

Breastfeeding practices in two Brazilian metropolitan areas (S. Paulo and Recife) are described, as part of a study carried out in 1987. In a random sample of healthy 0-8 month old infants, selected from all health care units, higher breastfeeding rates were found in S. Paulo (initiation, prevalence, median and average) than in Recife. The mean duration of breastfeeding, mixed and full, was of 127.5 and 66.6 days, respectively, for S. Paulo, and of 104.4 and 31.7 days for Recife. When data are analysed according to ethnic group, white S. Paulo women breastfeed more than white Recife women. Full breastfeeding rate is more prevalent among white and "mulato" S. Paulo women. However, when the data were analyzed for each city separately, it was found, remarkably, that the non-whites breastfeed more than the whites. In Recife, full breastfeeding is particularly low in whites (of 15.3 days median) and "mulatos" (of 16.7 days), but of 34.5 days in blacks. The study points out the need for greater in-depth investigation of the issue of ethnicity and infant feeding practices, still inadequately understood in world literature.Descreve-se a situação da prática de amamentar em duas áreas metropolitanas brasileiras: São Paulo e Recife, Brasil, em estudos conduzidos em 1987. Em amostras representativas da população de crianças saudáveis de 0-8 meses atendidas pelo sistema de saúde, nota-se que é maior em São Paulo a proporção das mães que iniciam a amamentação e a prevalência de amamentados. A duração média do aleitamento materno total (AM) e quase exclusivo (AE) é respectivamente de 127,5 e 66,6 dias em São Paulo. Em Recife, 104,4 e 31,7 dias, respectivamente, para AM e AE. Estudaram-se também os dados de amamentação conforme a cor da pele da mãe, concluindo que se amamenta mais em São Paulo do que em Recife, significativamente entre brancas. O aleitamento materno quase exclusivo é praticado mais em São Paulo do que em Recife, por brancas e pardas. Observando-se os grupos étnicos em cada uma das cidades, notou-se que são as mulheres não-brancas (pretas e pardas) aquelas que amamentam mais, sendo particularmente baixo o aleitamento quase exclusivo em Recife, maior entre as pretas (34,5 dias de mediana de AE) comparado a 15,3 dias entre brancas e 16,7 entre pardas. O estudo aponta para a necessidade de se elaborar desenhos de pesquisa que levem em conta a questão da etnia e a amamentação, questão não respondida pela literatura em nível mundial

Pulmonary Resection for Metastasis of Hepatocellular Carcinoma Recurring After Liver Transplant : An Italian Multicenter Experience

Background and aim: Liver transplantation (LT) is a validated treatment for hepatocellular carcinoma (HCC). HCC recurrence occurred between 8 and 20% of patients and lung is the most frequent site. Pulmonary metastases resection (PMR) prolongs survival, however in LT-setting the impact on survival is unclear. To give new lights on this issue, we report the experience of three Italian LT Centers. Methods: All consecutive HCC transplanted patients in three Italian LT Centers, who developed pulmonary metastasis from HCC (PM-HCC), as first metastasis, from 2008 to 2018, were included whenever treated with PMR. Results: Twenty-five patients were enrolled (median age 58 yrs, 84% male, 3% cirrhotics). HCC recurred after 34 months (9\u2013306) since LT and PMR was performed after 2.4 months (0\u201343.1). A total of 28 PMR (19 single resections; 9 multiple resections; 16 right; 2 left) have been performed on 24 patients while in one case percutaneous microwave ablation (MWA) was preferred. Four patients have been re-operated due to pulmonary HCC-recurrence after surgery. The majority of surgical resection type was wedge resection (26, 89%). Surgical access was: video-assisted thoracic surgery (VATS) in 17 cases (59%); thoracotomy in 11 (38%); MWA in 1 (3%). The 48% of nodule was in right lower lobe. Perioperative in-hospital mortality and 30 days mortality were nil; median surgical time 90 min (50\u2013365); median post-operative overall stay 5 days (2\u201311). Post-operative ICU treatment was necessary in 1 case (3%) for 3 days; blood transfusions in 2 cases (7%). Overall, 5 complications (2 bleeding; 1 AKI; 1 major cardiac; 1 wound dehiscence) occurred, with an overall complications rate of 23%. Eight (32%) patients died during a follow-up after HCC recurrence of 32 months (7\u2013213): 7 for HCC progression, 1 for severe liver failure due to chronic rejection. The 1 and 5 year cumulative probability of OS from recurrence were 100 and 43% (95%CI 12\u201374), respectively, with a median OS of 51 months (95%CI 24\u201378). Conclusion: Selected patients with isolated pulmonary HCC-recurrence after LT and with preserved hepatic function showed that a pulmonary metastasectomy could be efficacious in managing a PM-HCC and could give an opportunity for long-term survival

Schmidt-hammer exposure ages from periglacial patterned ground (sorted circles) in Jotunheimen, Norway, and their interpretative problems

© 2016 Swedish Society for Anthropology and Geography Periglacial patterned ground (sorted circles and polygons) along an altitudinal profile at Juvflya in central Jotunheimen, southern Norway, is investigated using Schmidt-hammer exposure-age dating (SHD). The patterned ground surfaces exhibit R-value distributions with platycurtic modes, broad plateaus, narrow tails, and a negative skew. Sample sites located between 1500 and 1925 m a.s.l. indicate a distinct altitudinal gradient of increasing mean R-values towards higher altitudes interpreted as a chronological function. An established regional SHD calibration curve for Jotunheimen yielded mean boulder exposure ages in the range 6910 ± 510 to 8240 ± 495 years ago. These SHD ages are indicative of the timing of patterned ground formation, representing minimum ages for active boulder upfreezing and maximum ages for the stabilization of boulders in the encircling gutters. Despite uncertainties associated with the calibration curve and the age distribution of the boulders, the early-Holocene age of the patterned ground surfaces, the apparent cessation of major activity during the Holocene Thermal Maximum (HTM) and continuing lack of late-Holocene activity clarify existing understanding of the process dynamics and palaeoclimatic significance of large-scale sorted patterned ground as an indicator of a permafrost environment. The interpretation of SHD ages from patterned ground surfaces remains challenging, however, owing to their diachronous nature, the potential for a complex history of formation, and the influence of local, non-climatic factors

Eclipses during the 2010 eruption of the recurrent nova U Scorpii

The eruption of the recurrent nova U Scorpii on 2010 January 28 is now the all-time best observed nova event. We report 36,776 magnitudes throughout its 67 day eruption, for an average of one measure every 2.6 minutes. This unique and unprecedented coverage is the first time that a nova has had any substantial amount of fast photometry. With this, two new phenomena have been discovered: the fast flares in the early light curve seen from days 9-15 (which have no proposed explanation) and the optical dips seen out of eclipse from days 41-61 (likely caused by raised rims of the accretion disk occulting the bright inner regions of the disk as seen over specific orbital phases). The expanding shell and wind cleared enough from days 12-15 so that the inner binary system became visible, resulting in the sudden onset of eclipses and the turn-on of the supersoft X-ray source. On day15, a strong asymmetry in the out-of-eclipse light points to the existence of the accretion stream. The normal optical flickering restarts on day 24.5. For days 15-26, eclipse mapping shows that the optical source is spherically symmetric with a radius of 4.1 R⊙. For days 26-41, the optical light is coming from a rim-bright disk of radius 3.4 R ⊙. For days 41-67, the optical source is a center-bright disk of radius 2.2 R⊙. Throughout the eruption, the colors remain essentially constant. We present 12 eclipse times during eruption plus five just after the eruption

Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK.

BACKGROUND: A safe and efficacious vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), if deployed with high coverage, could contribute to the control of the COVID-19 pandemic. We evaluated the safety and efficacy of the ChAdOx1 nCoV-19 vaccine in a pooled interim analysis of four trials. METHODS: This analysis includes data from four ongoing blinded, randomised, controlled trials done across the UK, Brazil, and South Africa. Participants aged 18 years and older were randomly assigned (1:1) to ChAdOx1 nCoV-19 vaccine or control (meningococcal group A, C, W, and Y conjugate vaccine or saline). Participants in the ChAdOx1 nCoV-19 group received two doses containing 5 × 1010 viral particles (standard dose; SD/SD cohort); a subset in the UK trial received a half dose as their first dose (low dose) and a standard dose as their second dose (LD/SD cohort). The primary efficacy analysis included symptomatic COVID-19 in seronegative participants with a nucleic acid amplification test-positive swab more than 14 days after a second dose of vaccine. Participants were analysed according to treatment received, with data cutoff on Nov 4, 2020. Vaccine efficacy was calculated as 1 - relative risk derived from a robust Poisson regression model adjusted for age. Studies are registered at ISRCTN89951424 and ClinicalTrials.gov, NCT04324606, NCT04400838, and NCT04444674. FINDINGS: Between April 23 and Nov 4, 2020, 23 848 participants were enrolled and 11 636 participants (7548 in the UK, 4088 in Brazil) were included in the interim primary efficacy analysis. In participants who received two standard doses, vaccine efficacy was 62·1% (95% CI 41·0-75·7; 27 [0·6%] of 4440 in the ChAdOx1 nCoV-19 group vs71 [1·6%] of 4455 in the control group) and in participants who received a low dose followed by a standard dose, efficacy was 90·0% (67·4-97·0; three [0·2%] of 1367 vs 30 [2·2%] of 1374; pinteraction=0·010). Overall vaccine efficacy across both groups was 70·4% (95·8% CI 54·8-80·6; 30 [0·5%] of 5807 vs 101 [1·7%] of 5829). From 21 days after the first dose, there were ten cases hospitalised for COVID-19, all in the control arm; two were classified as severe COVID-19, including one death. There were 74 341 person-months of safety follow-up (median 3·4 months, IQR 1·3-4·8): 175 severe adverse events occurred in 168 participants, 84 events in the ChAdOx1 nCoV-19 group and 91 in the control group. Three events were classified as possibly related to a vaccine: one in the ChAdOx1 nCoV-19 group, one in the control group, and one in a participant who remains masked to group allocation. INTERPRETATION: ChAdOx1 nCoV-19 has an acceptable safety profile and has been found to be efficacious against symptomatic COVID-19 in this interim analysis of ongoing clinical trials. FUNDING: UK Research and Innovation, National Institutes for Health Research (NIHR), Coalition for Epidemic Preparedness Innovations, Bill & Melinda Gates Foundation, Lemann Foundation, Rede D'Or, Brava and Telles Foundation, NIHR Oxford Biomedical Research Centre, Thames Valley and South Midland's NIHR Clinical Research Network, and AstraZeneca

Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK

Background A safe and efficacious vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), if deployed with high coverage, could contribute to the control of the COVID-19 pandemic. We evaluated the safety and efficacy of the ChAdOx1 nCoV-19 vaccine in a pooled interim analysis of four trials. Methods This analysis includes data from four ongoing blinded, randomised, controlled trials done across the UK, Brazil, and South Africa. Participants aged 18 years and older were randomly assigned (1:1) to ChAdOx1 nCoV-19 vaccine or control (meningococcal group A, C, W, and Y conjugate vaccine or saline). Participants in the ChAdOx1 nCoV-19 group received two doses containing 5 × 1010 viral particles (standard dose; SD/SD cohort); a subset in the UK trial received a half dose as their first dose (low dose) and a standard dose as their second dose (LD/SD cohort). The primary efficacy analysis included symptomatic COVID-19 in seronegative participants with a nucleic acid amplification test-positive swab more than 14 days after a second dose of vaccine. Participants were analysed according to treatment received, with data cutoff on Nov 4, 2020. Vaccine efficacy was calculated as 1 - relative risk derived from a robust Poisson regression model adjusted for age. Studies are registered at ISRCTN89951424 and ClinicalTrials.gov, NCT04324606, NCT04400838, and NCT04444674. Findings Between April 23 and Nov 4, 2020, 23 848 participants were enrolled and 11 636 participants (7548 in the UK, 4088 in Brazil) were included in the interim primary efficacy analysis. In participants who received two standard doses, vaccine efficacy was 62·1% (95% CI 41·0–75·7; 27 [0·6%] of 4440 in the ChAdOx1 nCoV-19 group vs71 [1·6%] of 4455 in the control group) and in participants who received a low dose followed by a standard dose, efficacy was 90·0% (67·4–97·0; three [0·2%] of 1367 vs 30 [2·2%] of 1374; pinteraction=0·010). Overall vaccine efficacy across both groups was 70·4% (95·8% CI 54·8–80·6; 30 [0·5%] of 5807 vs 101 [1·7%] of 5829). From 21 days after the first dose, there were ten cases hospitalised for COVID-19, all in the control arm; two were classified as severe COVID-19, including one death. There were 74 341 person-months of safety follow-up (median 3·4 months, IQR 1·3–4·8): 175 severe adverse events occurred in 168 participants, 84 events in the ChAdOx1 nCoV-19 group and 91 in the control group. Three events were classified as possibly related to a vaccine: one in the ChAdOx1 nCoV-19 group, one in the control group, and one in a participant who remains masked to group allocation. Interpretation ChAdOx1 nCoV-19 has an acceptable safety profile and has been found to be efficacious against symptomatic COVID-19 in this interim analysis of ongoing clinical trials

Highly-parallelized simulation of a pixelated LArTPC on a GPU

The rapid development of general-purpose computing on graphics processing units (GPGPU) is allowing the implementation of highly-parallelized Monte Carlo simulation chains for particle physics experiments. This technique is particularly suitable for the simulation of a pixelated charge readout for time projection chambers, given the large number of channels that this technology employs. Here we present the first implementation of a full microphysical simulator of a liquid argon time projection chamber (LArTPC) equipped with light readout and pixelated charge readout, developed for the DUNE Near Detector. The software is implemented with an end-to-end set of GPU-optimized algorithms. The algorithms have been written in Python and translated into CUDA kernels using Numba, a just-in-time compiler for a subset of Python and NumPy instructions. The GPU implementation achieves a speed up of four orders of magnitude compared with the equivalent CPU version. The simulation of the current induced on 10^3 pixels takes around 1 ms on the GPU, compared with approximately 10 s on the CPU. The results of the simulation are compared against data from a pixel-readout LArTPC prototype

Kangaroo Mother Care In Public Hospitals In The State Of São Paulo, Brazil: An Analysis Of The Implementation Process [o Método Mãe Canguru Em Hospitais Públicos Do Estado De São Paulo, Brasil: Uma Análise Do Processo De Implantaç ão]

This study analyzed the implementation of the Kangaroo Mother method in 28 different São Paulo State public hospitals. Teaching hospitals, Baby-Friendly Hospitals, hospitals with human milk banks, and those with more than 12 trained health professionals showed higher implementation scores. Because of staff resistance to family participation in neonatal care, the Kangaroo Mother method is basically applied in-hospital. Changes in the initial training, including manager awareness-raising and proper financial resource allocation, are necessary for implementation, follow-up, assessment, and feedback.223597607(2000) Boletim CIS/2000. N. 2. Mortalidade Infantil, , São Paulo: Secretaria de Estado da Saúde de São PauloLubchenko, L.O., Determinação do peso e idade gestacional (1984) Neonatologia, pp. 207-227. , Avery G, organizador. Rio de Janeiro: Médica e CientíficaLubchenko, L.O., Searls, D.T., Neonatal mortality rate: Relationship to birth weight and gestational age (1972) J Pediatr, (84), p. 4(1994) Manual de Assistência Ao Recém-nascido, , Brasília: Secretaria de Assistência à Saúde, Ministério da SaúdeCattaneo, A., Davanzo, R., Uxa, F., Tamburlini, G., Recommendations for the implementation of Kangaroo Mother Care for low birth weight infants (1998) Acta Paediatr, 87, pp. 440-445. , International Network on Kangaroo Mother Care(1994) Alimentação Infantil - Bases Fisiológicas, , São Paulo: Instituto de Saúde/IBFAN BrasilKennell, J.H., Klaus, M.H., Bonding: Recent observations that alter perinatal care (1998) Pediatr Rev, 9, pp. 4-12Lucas, A., Morley, R., Cole, T.J., Lister, G., Leeson-Payne, C., Breast milk and subsequent intelligence quotient in children born preterm (1992) Lancet, 339, pp. 261-264Bradley, R.H., Casey, P.H., Family environment and behavioral development of low-birth weight children (1992) Dev Med Child Neurol, 34, pp. 822-826Strathearn, L., Gray, P.H., O'Callaghan, M.J., Wood, D.O., Childhood neglect and cognitive development in extremely low birth weight infants: A prospective study (2001) Pediatrics, 108, pp. 142-151Symington, A., Pinelli, J., Developmental care for promoting development and preventing morbidity in preterm infants (2004) The Cochrane Library, (1). , Oxford: Update SoftwareFurman, L., Kennell, J., Breast milk and skin-to-skin kangaroo care for premature infants. Avoiding bonding failure (2000) Acta Paediatr, 89, pp. 1280-1283Charpak, N., Figueroa, Z., Hamel, A., (1999) O Método Mãe Canguru: Pais e Familiares Dos Bebês Prematuros Podem Substituir As Incubadoras, , Rio de Janeiro: McGraw-HillAnderson, G.C., Marks, E.A., Wahlberg, V., Kangaroo care for premature infants (1986) Am J Nurs, 86, pp. 807-809Colonna, F., Uxa, F., Da Graca, A.M., De Vonderweld, U., The "kangaroo-mother" method: Evaluation of an alternative model for the care of low birth weight newborns in developing countries (1990) Int J Gynaecol Obstet, 31, pp. 355-359Ludington-Hoe, S.M., Anderson, G.C., Simpson, S., Hollingsead, A., Argote, L.A., Rey, H., Birth-related fatigue in 34-36 week preterm neonates: Rapid recovery with very early kangaroo (skin-to-skin) care (1999) J Obstet Gynecol Neonatal Nurs, 28, pp. 94-103Ludington-Hoe, S.M., Nguyen, N., Swinth, J.Y., Satyshur, R.D., Kangaroo care compared to incubators in maintaining body warmth in preterm infants (2000) Biol Res Nurs, 2, pp. 60-73Carvalho, M.R., Prochnik, M., Método Mãe-Canguru de Atenção Ao Prematuro, , http://federativo.bndes.gov.br/bf_bancos/experiencias/x0001959.pdfPortaria GM N. 693 - Norma de orientação para a implantação do método canguru Diário Oficial da União 2000, , 5 julNormas de atenção humanizada ao recém-nascido de baixo peso (método canguru) no Estado de São Paulo Diário Oficial do Estado 2001, , 6 jun(1993) Manejo e Promoção Do Aleitamento Materno: Curso de 18 Horas para Equipes de Maternidades, , Brasília: Fundo das Nações Unidas para a InfânciaLevin, A., Humane neonatal care initiative (1999) Acta Paediatr, 88, pp. 353-355(2002) Saúde No Estado de São Paulo: Compromisso Com O Cidadão, , São Paulo: Secretaria de Estado da Saúde de São PauloKirsten, G.F., Bergman, N.J., Hann, F.M., Kangaroo mother care in the nursery (2001) Pediatr Clin North Am, 48, pp. 443-452Toma, T.S., Método Mãe Canguru: O papel dos serviços de saúde e das redes familiares no sucesso do programa (2003) Cad Saúde Pública, 19 (2 SUPPL.), pp. S233-42Lima, G., Quintero-Romero, S., Cattaneo, A., Feasibility, acceptability and cost of kangaroo mother care in Recife, Brazil (2000) Ann Trop Paediatr, 20, pp. 22-26Lincetto, O., Nazir, A.I., Cattaneo, A., Kangaroo mother care with limited resources (2000) J Trop Pediatr, 46, pp. 293-295Cecchetto, S., Mãe canguru: Tecnologia perinatal humana. Parte I: Uma abordagem pela bioética (2002) Amamentação: Bases Científicas para a Prática Profissional, pp. 132-136. , Carvalho MR, Tamez RN, organizadores. Rio de Janeiro: Guanabara KooganNogueira-Martins, M.C.F., (2001) Humanização Das Relações Assistenciais: A Formação Do Profissional de Saúde, , São Paulo: Casa do PsicólogoDenis, J.-L., Champagne, F., Análise da implantação (2000) Avaliação Em Saúde: Dos Modelos Conceituais à Prática Na Análise de Implantação de Programas, pp. 49-88. , Hartz ZMA, organizadora. Rio de Janeiro: Editora FiocruzFurlan, C.E.F.B., Scochi, C.G.S., Furtado, M.C.C., Percepção dos pais sobre a vivência no método mãecanguru (2003) Rev Lat Am Enfermagem, 11, pp. 444-45