Cartografia local e o ensino de história

Esse trabalho dissertativo ao modo interdisciplinar percorre o caminho da abordagem cartográfica, na intenção de demonstrar sua importância no auxílio do ensino de História, contribuindo para a dinâmica do ambiente escolar na reconstituição da história local em suas diferentes escalas. O objetivo é provocar reflexões sobre a concepção de espaço-tempo em sala de aula, através da constituição de um observatório de abordagem cartográfica sobre o espaço habitado no tempo presente. Constituem-se as cartografias, representações culturais e metodológicas em sua funcionalidade imagética de condução a essa tarefa dissertativa corográfica, antecipando-se a todo o aparato bibliográfico e ao próprio ato de escrever. Dessa forma, bibliografias e escrita enredadas pelas cartografias tornam-se textos contextualizados. Na conjuntura escolar, as cartografias devem se fazer presentes no processo de ensinoaprendizagem pelo letramento cartográfico, mas também como fonte de investigação, reflexão e releitura das representações produzidas.This dissertative work, in an interdisciplinary way, follows the path of cartographic approach in order to demonstrate its importance in helping History teaching, contributing to school dynamicsin the reconstruction of local history in its different scales. The objective is to provoke reflections on space-time concepts in the classroom, through the constitution of an observatory with a cartographic approach of the space inhabited in the present time. Constituting cartographies, cultural and methodological representations in their imagery functionality lead to this chorographic essay task, anticipating the entire bibliographic apparatus and the act of writing itself. In this way, bibliographies and writing entangled by cartographies become contextualized texts. In the school context, cartographies must be present in teaching-learning process through cartographic literacy, but also as a source of investigation, reflection and rereading the representations produced

Estimating the global conservation status of more than 15,000 Amazonian tree species

Estimates of extinction risk for Amazonian plant and animal species are rare and not often incorporated into land-use policy and conservation planning. We overlay spatial distribution models with historical and projected deforestation to show that at least 36% and up to 57% of all Amazonian tree species are likely to qualify as globally threatened under International Union for Conservation of Nature (IUCN) Red List criteria. If confirmed, these results would increase the number of threatened plant species on Earth by 22%. We show that the trends observed in Amazonia apply to trees throughout the tropics, and we predict thatmost of the world’s >40,000 tropical tree species now qualify as globally threatened. A gap analysis suggests that existing Amazonian protected areas and indigenous territories will protect viable populations of most threatened species if these areas suffer no further degradation, highlighting the key roles that protected areas, indigenous peoples, and improved governance can play in preventing large-scale extinctions in the tropics in this century

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to <90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

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

Por uma concepção dionisíaca de educação

A partir da obra nietzschiana, A Origem da Tragédia, aparece-nos uma proposta de visão de mundo, completamente avessa às categorias filosóficas tradicionais de análise da realidade. Nietzsche apresenta de forma surreal a experiência vivida pelo homem grego através da intensidade mitológica. Como propósito investigativo, no campo da crise referencial no contexto da educação contemporânea, nossa proposta é instigada pela busca de um caminho hermenêutico interpretativo. Caminho esse que, devido aos rumos da obra nietzschiana, se aplica como possibilidade de uma concepção de educação dionisíaca, na perspectiva de experiências vivenciadas e aplicadas neste sentido. Isto, sem deixar de lado o ponto de vista de diferentes autores e comentadores que, por sua vez, apontam para essa proposta de educação. Desta forma, a educação como tragédia apresenta-se como um paradigma para pensar, sentir e intuir, mas também como uma problemática

Multi-parameter approach to evaluate the timing of memory status after 17DD-YF primary vaccination

Submitted by Priscila Nascimento ([email protected]) on 2018-06-20T18:10:46Z No. of bitstreams: 1 Multi-parameter_approach_to_evaluate_the_timing_of.pdf: 8388797 bytes, checksum: 234fb0f5fbecbf0d6e239427b5c7095d (MD5)Approved for entry into archive by Priscila Nascimento ([email protected]) on 2018-06-20T18:52:14Z (GMT) No. of bitstreams: 1 Multi-parameter_approach_to_evaluate_the_timing_of.pdf: 8388797 bytes, checksum: 234fb0f5fbecbf0d6e239427b5c7095d (MD5)Made available in DSpace on 2018-06-20T18:52:14Z (GMT). No. of bitstreams: 1 Multi-parameter_approach_to_evaluate_the_timing_of.pdf: 8388797 bytes, checksum: 234fb0f5fbecbf0d6e239427b5c7095d (MD5) Previous issue date: 2018Fundação Oswaldo Cruz. Centro de Pesquisas René Rachou.Belo Horizonte, Minas Gerais, Brasil.Governo do Estado de Minas Gerais. Secretaria de Estado de Saúde. Belo Horizonte, Minas Gerais, Brasil.Universidade Federal de Alfenas. Alfenas, Minas Gerais, Brasil.Universidade Federal de Uberlândia. Laboratório de Bioinformática e Análises Moleculares. Uberlândia, Minas Gerais, Brasil.Food and Drug Administration. Center for Biologics Evaluation and Research. Silver Spring, Maryland, United States of America.Instituto de Biologia do Exército. Rio de Janeiro, Rio de Janeiro, Brasil.Fundação Oswaldo Cruz. Instituto de Tecnologia em Imunobiológicos. Rio de Janeiro, RJ, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Brasília, DF, Brasil.Universidade de Brasília. Brasília, DF, Brasil.Instituto Evandro Chagas. Ananindeua, Pará, Brasil.Fundação Oswaldo Cruz. Diretoria Regional de Brasília. Brasília, DF, Brasil.Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública. Rio de Janeiro, RJ, Brasil.Nesta investigação, as técnicas melhoradas por máquina foram aplicadas para trazer insights científicos para identificar um conjunto mínimo de biomarcadores relacionados à memória fenotípica / funcional para o acompanhamento pós-vacinação da vacinação contra a febre amarela (FA). Para este propósito, o estado de memória das células T circulantes (Naïve / efetor-precoce / Memória-Central / Memória Efetiva) e células B (Naïve / memória não clássica / memória clássica) juntamente com o perfil de citocinas (IFN / TNF / IL-5 / IL-10) foram monitorizados antes do NV (dia 0) e em pontos de tempo distintos após a vacinação primária com 17DD-YF - VP (dia30-45); PV (ano1-9) e PV (ano10-11). Um conjunto de biomarcadores (eEfCD4; EMCD4; CMCD19; EMCD8; IFNCD4; IL-5CD8; TNFCD4; IFNCD8; TNFCD8; IL-5CD19; IL-5CD4) foi observado em PV (dia30-45), mas não em NV (dia0) , com a maioria deles ainda observada em VP (ano1-9). Deficiências de biomarcadores fenotípicos / funcionais foram observadas em NV (dia 0), enquanto a falta total de atributos relacionados à memória foi observada na PV (ano10-11), independentemente da idade na vacinação primária. Análise de diagrama de Venn pré-selecionada 10 atributos (eEfCD4, EMCD4, CMCD19, EMCD8, IFNCD4, IL-5CD8, TNFCD4, IFNCD8, TNFCD8 e IL-5CD4), dos quais a média geral apresentou moderada precisão para discriminar PV (dia30-45) e PV (year1-9) de NV (day0) e PV (year10-11). Abordagens multi-parâmetro e algoritmos de árvore de decisão definiram os atributos EMCD8 e IL-5CD4 como os dois principais preditores com desempenho moderado. Juntamente com os títulos PRNT, os dois principais biomarcadores levaram a um status de memória resultante observado em 80% e 51% dos voluntários em PV (dia30-45) e PV (ano1-9), contrastando com 0% e 29% encontrados em NV ( day0) e PV (year10-11), respectivamente. A deficiência de atributos relacionados à memória observada na PV (year10-11) ressalta a diminuição conspícua dependente do tempo da memória resultante após a vacinação primária com 17DD-YF, que pode ser útil para monitorar potenciais correlatos de proteção em áreas sob risco de transmissão da FA.In this investigation, machine-enhanced techniques were applied to bring about scientific insights to identify a minimum set of phenotypic/functional memory-related biomarkers for post-vaccination follow-up upon yellow fever (YF) vaccination. For this purpose, memory status of circulating T-cells (Naïve/early-effector/Central-Memory/Effector-Memory) and Bcells (Naïve/non-Classical-Memory/Classical-Memory) along with the cytokine profile (IFN/ TNF/IL-5/IL-10) were monitored before-NV(day0) and at distinct time-points after 17DD-YF primary vaccinationÐPV(day30-45); PV(year1-9) and PV(year10-11). A set of biomarkers (eEfCD4; EMCD4; CMCD19; EMCD8; IFNCD4; IL-5CD8; TNFCD4; IFNCD8; TNFCD8; IL-5CD19; IL-5CD4) were observed in PV(day30-45), but not in NV(day0), with most of them still observed in PV(year1-9). Deficiencies of phenotypic/functional biomarkers were observed in NV(day0), while total lack of memory-related attributes was observed in PV (year10-11), regardless of the age at primary vaccination. Venn-diagram analysis preselected 10 attributes (eEfCD4, EMCD4, CMCD19, EMCD8, IFNCD4, IL-5CD8, TNFCD4, IFNCD8, TNFCD8 and IL-5CD4), of which the overall mean presented moderate accuracy to discriminate PV(day30-45)&PV(year1-9) from NV(day0)&PV(year10-11). Multi-parameter approaches and decision-tree algorithms defined the EMCD8 and IL-5CD4 attributes as the top-two predictors with moderated performance. Together with the PRNT titers, the toptwo biomarkers led to a resultant memory status observed in 80% and 51% of volunteers in PV(day30-45) and PV(year1-9), contrasting with 0% and 29% found in NV(day0) and PV (year10-11), respectively. The deficiency of memory-related attributes observed at PV (year10-11) underscores the conspicuous time-dependent decrease of resultant memory following17DD-YF primary vaccination that could be useful to monitor potential correlates of protection in areas under risk of YF transmission

Effect of Lung Recruitment and Titrated Positive End-Expiratory Pressure (PEEP) vs Low PEEP on Mortality in Patients With Acute Respiratory Distress Syndrome : a Randomized Clinical Trial

IMPORTANCE The effects of recruitment maneuvers and positive end-expiratory pressure (PEEP) titration on clinical outcomes in patients with acute respiratory distress syndrome (ARDS) remain uncertain. OBJECTIVE To determine if lung recruitment associated with PEEP titration according to the best respiratory-system compliance decreases 28-day mortality of patients with moderate to severe ARDS compared with a conventional low-PEEP strategy. DESIGN, SETTING, AND PARTICIPANTS Multicenter, randomized trial conducted at 120 intensive care units (ICUs) from 9 countries from November 17, 2011, through April 25, 2017, enrolling adults with moderate to severe ARDS. INTERVENTIONS An experimental strategy with a lung recruitment maneuver and PEEP titration according to the best respiratory-system compliance (n = 501experimental group) or a control strategy of low PEEP (n = 509). All patients received volume-assist control mode until weaning. MAIN OUTCOMES AND MEASURES The primary outcomewas all-cause mortality until 28 days. Secondary outcomes were length of ICU and hospital stayventilator-free days through day 28pneumothorax requiring drainage within 7 daysbarotrauma within 7 daysand ICU, in-hospital, and 6-month mortality. RESULTS A total of 1010 patients (37.5% femalemean [SD] age, 50.9 [17.4] years) were enrolled and followed up. At 28 days, 277 of 501 patients (55.3%) in the experimental group and 251 of 509 patients (49.3%) in the control group had died (hazard ratio [HR], 1.2095% CI, 1.01 to 1.42P =.041). Compared with the control group, the experimental group strategy increased 6-month mortality (65.3% vs 59.9%HR, 1.1895% CI, 1.01 to 1.38P =.04), decreased the number of mean ventilator-free days (5.3 vs 6.4difference, -1.195% CI, -2.1 to -0.1P =.03), increased the risk of pneumothorax requiring drainage (3.2% vs 1.2%difference, 2.0%95% CI, 0.0% to 4.0%P =.03), and the risk of barotrauma (5.6% vs 1.6%difference, 4.0%95% CI, 1.5% to 6.5%P =.001). There were no significant differences in the length of ICU stay, length of hospital stay, ICU mortality, and in-hospital mortality. CONCLUSIONS AND RELEVANCE In patients with moderate to severe ARDS, a strategy with lung recruitment and titrated PEEP compared with low PEEP increased 28-day all-cause mortality. These findings do not support the routine use of lung recruitment maneuver and PEEP titration in these patients. (C) 2017 American Medical Association. All rights reserved.Brazilian Ministry of HealthBrazilian Ministry of HealthHCor Res Inst, Sao Paulo, BrazilUniv Sao Paulo, Cardiopulmonary Dept, Div Pulm, Heart Inst Incor, Sao Paulo, BrazilHosp Moinhos de Vento, Porto Alegre, RS, BrazilIrmandade Santa Casa Misericordia Porto Alegre, Porto Alegre, RS, BrazilFed Univ Sao Paulo UNIFESP, Anesthesiol Pain & Intens Care Dept, Sao Paulo, BrazilUniv Sao Paulo, Dept Epidemiol, Sch Publ Hlth, Sao Paulo, BrazilHosp Maternidade Sao Vicente Paulo, Barbalha, BrazilHosp Nereu Ramos, Florianopolis, SC, BrazilHosp Unimed Vitoria, Vitoria, BrazilHosp & Prontosocorro 28 Agosto, Manaus, Amazonas, BrazilUniv Sao Paulo, Unidade Emergencia Hosp Clin FMRP, Ribeirao Preto, BrazilHosp Estadual Dr Jayme Santos Neves, Serra, BrazilFundacao Univ Fed Grande Dourados, Univ Hosp, Dourados, BrazilUniv ICESI, Fdn Valle Lili, Dept Intens Care Med, Cali, ColombiaHosp Univ Oeste Parana, Cascavel, BrazilHosp Pablo Tobon Uribe, Medellin, ColombiaHosp Clin Porto Alegre, Porto Alegre, RS, BrazilHosp Reg Hans Dieter Schmidt, Joinville, BrazilUniv Malaya, Med Ctr, Kuala Lumpur, MalaysiaJagiellonian Univ, Med Coll, Dept Intens Care & Perioperat Med, Krakow, PolandHosp Nacl Alejandro Posadas, Moron, ArgentinaFed Univ Sao Paulo UNIFESP, Anesthesiol Pain & Intens Care Dept, Sao Paulo, BrazilWeb of Scienc