Algumas observaçoes sobre a estimulaçao cardíaca no Brasil entre 2000 e 2014: 25 anos do RBM - Registro Brasileiro de Marcapassos, Desfibriladores e Ressincronizadores Cardíacos

INTRODUÇAO: Desde que foi iniciado, há 25 anos, o Registro Brasileiro de Marcapassos, Desfibriladores e Ressincronizadores Cardíacos (RBM) cadastrou 306.886 cirurgias até 31 de dezembro de 2014, das quais 216.537 foram primeiro implante (190.747 marcapassos, 13.725 cardiodesfibriladores, 6.683 ressincronizadores, 4.052 cardiodesfibriladores com ressincronizadores e 1.330 sem informaçoes) e 90.349, trocas de dispositivos. MÉTODO: Analisamos o número de cirurgias e suas variedades entre 2000 e 2014 (dados de 31 de dezembro de 2015) e comparamos com alguns países, com a média europeia e com informaçoes populacionais do Instituto Brasileiro de Geografia e Estatística. RESULTADOS: O número do RBM referente às cirurgias realizadas no Brasil (129/1.000.000) foi comparado com a média europeia (960/1.000.000), verificando-se valores 7,4 vezes menores (mesmo estimando-se proporcionalmente, os valores sao 4,5 vezes menores). A modificaçao na etiologia da primeira cirurgia entre 2009 e 2014 revelou aumento da incidência de fibrose do sistema de conduçao (de 32,58% para 38,05%) e reduçao da doença de Chagas (de 18% para 11,70%), sem grandes modificaçoes nas outras causas. Considerando-se o número total de cirurgias, nota-se pequeno aumento em todas as regioes, exceto a Norte, com discreto aumento das cirurgias de cardiodesfibrilador implantável e cardiodesfibrilador implantável multissítio em todo o País. Houve pequeno aumento dos hospitais que realizaram cirurgias com a utilizaçao desses dispositivos. O número total de médicos que fazem implantes de dispositivos aumentou discretamente, especialmente nas regioes Sul e Sudeste, com queda discreta nas outras. O grupo que realizou até 10 cirurgias por ano cresceu 19,28% e o de 11-50 cirurgias por ano, 12,84%. CONCLUSAO: Houve discreto aumento do número de cirurgias, com prevalência insatisfatória, e pequeno e insuficiente aumento dos procedimentos mais complexos e modernos. Quanto à etiologia que motivou as cirurgias, ocorreu aumento da incidência de fibrose do sistema de conduçao e reduçao da doença de Chagas. Observou-se aumento do número de hospitais que realizaram até 50 cirurgias por ano, além de concentraçao de profissionais nas regioes com maior densidade populacional, com pequeno aumento do número de médicos que realizaram os procedimentos, especialmente daqueles que realizaram até 10 cirurgias por ano. Nao houve modificaçao significativa na proporçao médica por regiao, à exceçao de queda na regiao Norte

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

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

Geologia, contexto Geotectônico e Potencial Metalogenético para depósitos de Ni-Cu- (EGP) do Complexo máfico-ultramáfico de Brejo Seco, Faixa Riacho do Pontal, Sudeste do Piauí

Exportado OPUSMade available in DSpace on 2019-08-10T21:08:09Z (GMT). No. of bitstreams: 1 mestrado_silas_salgado.pdf: 4717937 bytes, checksum: f56e09f4dd2bd695393ed15462e35f11 (MD5) Previous issue date: 30O Complexo máfico-ultramáfico de Brejo Seco ocorre no extremo oeste da Faixa neoproterozóica Riacho do Pontal, limite norte do Cráton do São Francisco, sudeste do Estado do Piauí, Brasil. Neste trabalho, dados cartográficos, petrográficos, geoquímicos e isotópicos possibilitaram um novo modelo para a sua gênese e uma avaliação de seu potencial metalogenético. O Complexo de Brejo Seco (CBS) consiste em um corpo ígneo acamadado, invertido tectonicamente, que mergulha em média 70° para norte. Foi aqui considerado como de origem intracontinental, em contraste a uma origem ofiolítica previamente proposta. Sua estratigrafia é formada por quatro zonas principais: Zona Máfica Inferior (ZMI), Zona Ultramáfica (ZU), Zona Máfica Transicional (ZMT) e Zona Máfica Superior (ZMS). Dados isotópicos Sm-Nd indicam que o CBS intrudiu a crosta continental há aproximadamente 900 Ma. A sequência de cristalização magmática (Ol+Chr >> Pl+Ol+Chr >> Pl+Cpx+Ol >> Pl+Cpx+Ilm+Mag+Apt) definida para o CBS, em conjunto ao fracionamento geoquímico e a química da olivina, sugerem uma afinidade Mg-toleítica para o magma parental. Os valores de åNd(T=900) obtidos ao longo da estratigrafia do CBS (-0.2 a +3.3), evidenciam a interação do magma parental com a crosta siálica e, em conjunto a sequência de cristalização e a química mineral, registram pelo menos quatro estágios principais de preenchimento da câmara magmática. Destaca-se o Estágio III, que representa a mineralização sulfetada localizada nos contatos entre a ZU e ZMT e formada pela interação entre um magma parental primitivo (Fo87-89) e contaminado (åNd > Pl+Ol+Chr >> Pl+Cpx+Ol >> Pl+Cpx+Ilm+Mag+Apt) defined for the BSC, together with geochemical fractionation and olivine chemistry, suggest an affinity for Mg-tholeiitic parental magma. Nd(T=900) values obtained along of Brejo Seco stratigraphy (-0.2 a +3.3), show the interaction of parental magma with sialic crust and together with crystallization sequence and mineral chemistry, record at least four major phases of magmatic chamber filling. The phase three has a special interest as it represents the sulphide mineralization, located in the contact between the UZ and the MTZ, and formed by the interaction between a primitive parental magma (Fo87-89) and contaminated (Nd < 0) and moderately a primitive magma (Fo82). The evaluation of the metallogenic potential of the BSC to host Ni-Cu-(EGP) sulphide deposits revealed no potential target specifically, but can be used as a guide for future exploration works. Chemical analyzes performed on mineralized zone indicated low levels of Ni-Cu-(EGP). The Tonian age (~ 900 Ma) obtained for the CBS allows to interpret it as a record of early rifting stages of the Riacho do Pontal fold belt, as well as correlate it to Monte Orebe basalts (~820 Ma), which represent the oceanic crust developed during the rifting evolution. The BSC can also be correlated to the Tonian extensional magmatic event responsible for fragmentation of the supercontinent Rodinia. Evidence of this magmatism are present in several fold belts as well as the São Francisco and Congo Cratons

Stratigraphy, petrography and tectonics of the manganese-bearing Buritirama Formation, Northern Carajás Domain, Amazon Craton

Abstract The Buritirama Formation (BF) occurs at the extreme north of the Carajás Province, close to the contact with the Bacajá domain, in the southeastern portion of the Amazon Craton (Brazil). The BF consists of a 40 km long, ca. 3 km wide NW-SE trending structure arranged in four imbricated thrusts that individualize three main stratigraphic units. The lower unit is composed of orthoquartzite followed by carbonate-silicate rocks. The intermediate unit hosts a supergene manganese ore deposit formed by weathering of kutnohorite-rich marble. Quartzite/mica-quartz schist followed by carbonate-silicate rocks make up the upper unit. The local basement is constituted by orthogneiss-migmatite (Xingu Complex) and the Buritirama metagranite. Mineral chemistry data and metamorphic textures record high consumption of carbonate and quartz to produce clinopyroxenes. The structural assemblage of the BF records mass transport from NE to SW and the following deformational phases: D1 (compressional ductile), D2 (compressional brittle) and D3 (extensional brittle). The BF is interpreted as part of a platformal depositional system positioned at the border of the Carajás domain, which was probably inverted, deformed and metamorphosed during the Transamazonian event (ca. 2.1 Ga), in a deformation belt related to the amalgamation between the Carajás and Bacajá domains

Provenance of the Buritirama Formation reveals the Paleoproterozoic assembly of the Bacaj? and Caraj?s blocks (Amazon Craton) and the chronocorrelation of Mn-deposits in the Transamazonian/Birimian system of northern Brazil/West Africa.

The Mn-bearing Buritirama Formation along the homonymous ridge consists of a 40?km long by ca. 3?km wide NW-SE trending unit that limits the northern border of the Archean Caraj?s domain with the Paleoproterozoic Bacaj? domain in the southeastern Amazon Craton. The Buritirama Formation type section is arranged in four imbricated thrusts that individualize three main stratigraphic units: Lower Unit, Intermediate Unit and Upper Unit. Detrital U-Pb zircons ages from the Lower Unit and Upper Unit record the prevalence of Neoarchean populations, suggesting the Caraj?s block as the main sedimentary source for the Buritirama basin. However, minor Paleoproterozoic populations attributed to the Bacaj? block are also recognized, defining a maximum depositional age at ca. 2186 Ma. The anorogenic Buritirama metagranite occurs at the local basement, represents a probable precursor stage of the Buritirama rift and yielded a Concordia age of 2549???5.9?Ma (U-Pb). Supported by these new geochronological data, a framework model for the evolution of the Buritirama basin is proposed. Contrary to previous interpretations, the basin was active until at least the Rhyacian, representing a platformal setting fringing the northern margin of the Caraj?s block. A regional metamorphic event (ca. 2.06?Ga) records the closure of the basin during the Transamazonian Orogeny and the amalgamation of the Bacaj? and Caraj?s blocks. The depositional age bracketed in between 2.3 and 2.1?Ga links the Buritirama Mn deposit (southeastern Amazon Craton) with those of Serra do Navio (Amap? Block, northeastern Amazon Craton) and Nsuta (West African Craton), suggesting: (i) widespread chronocorrelation of Mn-bearing sequences in the continental-scale Rhyacian Transamazonian/Birimian orogenic system, and (ii) formation of the primary carbonate ores under the influence of a major global manganese deposition episode

Conhecimento da população sobre o aborto legal e a descriminalização da prática em caso de anencefalia fetal

O número de casos clandestinos de aborto provocado tem aumentado ao longo dos anos no Brasil. Regulamentada pelo Código Penal Brasileiro, a lei sobre aborto sofreu alterações pelo Supremo Tribunal Federal em 2012, ocasião em que o aborto de fetos anencéfalos se tornou legal. Por isso discutir o assunto é importante, visto que é um grande problema de saúde pública e traz graves prejuízos à vida da mulher. O objetivo do presente trabalho foi captar a percepção e o conhecimento da população a respeito desta prática e da decisão do Supremo Tribunal Federal. Como método foi utilizado um estudo transversal, quantitativo, realizado através de entrevista com homens e mulheres da cidade de Juiz de Fora - Minas Gerais, Brasil. Constatou-se que o nível de conhecimento sobre as indicações de aborto legal no Brasil é baixo, principalmente após a mudança da lei. Embora haja desconhecimento sobre o tema, a maioria dos entrevistados apoiaria o uso deste atributo diante de um dos três casos de indicação de aborto legal (em caso de estupro, feto anencéfalo e risco de vida da gestante). Por fim, também foi observado que níveis maiores de estudo e renda são determinantes para praticar ou apoiar o aborto ilegal, assim como crenças religiosas atuam como inibidoras desta prática na amostra geral

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P &lt; 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)