Importância da triagem pré-natal no manejo da sífilis gestacional e impactos para o concepto: uma revisão integrativa

A gestante diagnosticada com sífilis que não é tratada ou que é tratada de forma inadequada, pode transmitir essa infecção ao concepto, causando a sífilis congênita, um problema global de saúde pública, principalmente, em países em desenvolvimento, como o Brasil. Dentre os fatores que estão associados aos elevados números de sífilis congênita, pode-se destacar a falta ou uma assistência pré-natal deficiente. A presente revisão integrativa objetivou discutir a importância da assistência pré-natal de qualidade no manejo de grávidas com sífilis e seu impacto para a saúde concepto. Entre agosto e outubro de 2023, foi realizado o levantamento bibliográfico utilizando os descritores “sífilis” (syphilis), “cuidado pré-natal” (prenatal care) e “parto” (parturition) e seguindo os seguintes critérios de inclusão: artigos publicados nos últimos cinco anos, escritos em português ou inglês, publicados em periódicos com classificação Qualis CAPES mínimo B2 e com texto completo eletronicamente disponível. Após a busca bibliográfica, foram identificados um total de 111 artigos, sendo 90 na BVS e 11 na PubMed. Destes, 9 atenderam a todos os critérios e foram incluídos na presente revisão. Percebe-se que a falta de acesso ou o manejo deficiente da gestante com sífilis (diagnóstico tardio ou tratamento inadequado) durante a assistência pré-natal é responsável pelos números elevados de casos de sífilis congênita. Assim, faz-se necessário o desenvolvimento de estratégias que busquem fortalecer e qualificar a assistência pré-natal às gestantes com sífilis para reduzir ou eliminar os casos de sífilis congênita

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Les représentations sociales de l'évaluation des apprentissages chez des finissants d'un baccalauréat en éducation préscolaire et en enseignement primaire (BEPEP)

Dans un contexte où le domaine de l’éducation s’inspire des cadres de référence de différents paradigmes de l’apprentissage, cette recherche aborde les représentations sociales de l’évaluation des apprentissages chez des finissants d’un baccalauréat en éducation préscolaire et en enseignement primaire au Québec. Ce choix découle de la confusion existant dans les pratiques évaluatives des enseignants et dans le sentiment d’incompétence des futurs enseignants face à l’évaluation. La théorie des représentations sociales postule qu’elles se forment en fonction des expériences vécues tout au long d’une vie et qu’elles sont à la base de toute action. Les futurs enseignants ont vécu un type d’évaluation influencé par les principes du paradigme du néobéhaviorisme, mais ont reçu une formation axée sur les principes issus des paradigmes du constructivisme, du socioconstructivisme et du cognitivisme. À partir de ces présupposés, la question se pose à savoir quelles sont les représentations sociales de l’évaluation des apprentissages chez les finissants en éducation au préscolaire et en enseignement primaire ? Les représentations sociales sont formées de connaissances, d’opinions, de croyances et d’attitudes qui guident les conduites. Pour l’analyse, cette recherche s’appuie sur les théories du noyau central, des processus d’objectivation et d’ancrage et des principes organisateurs. L’évaluation des apprentissages y est également définie au regard des paradigmes principaux de l’apprentissage à savoir, le néobéhaviorisme, le constructivisme, le socioconstructivisme, le cognitivisme et l’humanisme. L’étude des représentations sociales demande d’analyser le discours des finissants, mais également les actions et les raisons sous-jacentes aux actions. L’approche par méthodes mixtes intègre, à la fois, une analyse de type quantitatif d’un questionnaire distribué à tous les finissants et une analyse de type qualitatif d’observations en classe et d’entretiens d’autoconfrontation menés auprès de quatre stagiaires. Les résultats du questionnaire mettent en évidence que les finissants définissent l’évaluation des apprentissages en évoquant des termes qui rejoignent les principes sous-jacents aux différents paradigmes de l’apprentissage avec une tendance pour les paradigmes du constructivisme et du néobéhaviorisme. Lorsque les finissants doivent se positionner à partir d’énoncés, ils sont toutefois favorables aux principes du paradigme du cognitivisme. Les observations indiquent une tendance chez les stagiaires à opter pour l’enseignement dirigé et collectif. Lors des entretiens d’autoconfrontation, les stagiaires valident leurs actions en exprimant des opinions rejoignant les différents paradigmes étudiés dans cette recherche. La discussion met en perspective trois interprétations de l’évaluation des apprentissages données par les stagiaires : l’évaluation en cours d’apprentissage axée sur le produit, l’évaluation en cours d’apprentissage axée sur le processus, l’évaluation de fin d’étape. La discussion met en évidence les différentes influences que subissent les stagiaires dans la construction de leurs représentations sociales, mais également leur façon d’interpréter les concepts intégrés durant leur formation initiale. L’auteure poursuit en questionnant les difficultés à intégrer la fonction de l’évaluation comme aide à l’apprentissage. Un retour sur les résultats significatifs de cette recherche, sur sa contribution scientifique ainsi que sur les perspectives de recherche au regard de l’évaluation comme aide à l’apprentissage clôt la thèse

The Effectiveness of Topical Dimethicone Together with a One Health Approach for the Control of Tungiasis in the Sanumás Communities, Yanomami Territory, Amazon Rainforest: A Real-World Study

Background: The success of tungiasis treatment is highly dependent on adequate environmental control. Methods: This is a real-world observational cohort study designed to monitor the effectiveness of topical dimethicone together with a One Health approach for the control of tungiasis in the Sanumás communities, Amazon rainforest, Brazil. We followed up on 562 indigenous people and 81 domestic dogs for 1.5 years in a 3-month interval. A new molecular method for large-scale soil evaluation was also tested. The control of tungiasis was independently conducted by the Brazilian Ministry of Health and comprised topical dimethicone application (NYDA®) for humans, single-dose oral afoxolaner for dogs, and in-house soil fumigation with fipronil. The main outcome was the occurrence of tungiasis after the use of topical dimethicone together with the One Health approach. Results: A total of 49 of the 562 indigenous people had active tungiasis at enrollment (8.72%). Only three cases of tungiasis resulted in active lesions after the use of topical dimethicone together with the One Health approach, with two cases of recurrence. From the 6-month follow-up and after, soil infestation was not detected. Conclusions: We conclude that the use of NYDA® together with animal and environmental interventions are effective measures for the control of tungiasis

Tungiasis in the Sanumás Amerindians in the Amazon Rainforest, Brazil: Prevalence, Intensity and Morbidity

Background: Tungiasis is a disease associated with extreme poverty. We aimed to evaluate the prevalence of tungiasis in six different settlements of the Sanumás indigenous community in a remote area in the Auaris region, Yanomami territory, Brazil. Methods: We conducted an observational study to detect clinical and epidemiological factors associated with tungiasis using a cross-sectional strategy and multivariate logistic regression. Soil analysis was performed by visual and microscopic methods. Results: We examined 555 persons, 45 of whom had active tungiasis; 18 cases were classified as mild, 16 as moderate and 11 as severe. The disease was significantly more prevalent in children than in adults (odds ratio (OR) 15.77; 95% confidence interval (CI) = 5.34–67.91; p < 0.001). Soil infestation was significantly related to the occurrence of human tungiasis (OR = 12.29; 95% CI = 3.75–45.88). The sex and GPS location of the houses were not related to the occurrence of tungiasis. Conclusions: We conclude that tungiasis is an important problem in the Sanumás community, especially for children. We suggest that interruption of the off-host transmission cycle, together with regular treatment [human and animal interventions], must be prioritized to achieve control of tungiasis in indigenous populations

Care arrangements for people with dementia in developing countries.

BACKGROUND: Rapid demographic ageing will soon lead to large increases in the numbers of persons with dementia in developing countries. This study is the first comprehensive assessment of care arrangements for people with dementia in those regions. METHODS: A descriptive and comparative study of dementia care; caregiver characteristics, the nature of care provided, and the practical, psychological (Zarit Burden Interview, General Health Questionnaire) and economic impact upon the caregiver in 24 centres in India, China and South East Asia, Latin America and the Caribbean and Africa. RESULTS: We interviewed 706 persons with dementia, and their caregivers. Most caregivers were women, living with the person with dementia in extended family households. One-quarter to one-half of households included a child. Larger households were associated with lower caregiver strain, where the caregiver was co-resident. However, despite the traditional apparatus of family care, levels of caregiver strain were at least as high as in the developed world. Many had cutback on work to care and faced the additional expense of paid carers and health services. Families from the poorest countries were particularly likely to have used expensive private medical services, and to be spending more than 10% of the per capita GNP on health care. CONCLUSIONS: Older people in developing countries are indivisible from their younger family members. The high levels of family strain identified in this study feed into the cycle of disadvantage and should thus be a concern for policymakers in the developing world

Seminário de Dissertação (2024)

Página da disciplina de Seminário de Dissertação (MPPP, UFPE, 2022) Lista de participantes == https://docs.google.com/spreadsheets/d/1mrULe1y04yPxHUBaF50jhaM1OY8QYJ3zva4N4yvm198/edit#gid=

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.13Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Separation of track- and shower-like energy deposits in ProtoDUNE-SP using a convolutional neural network

International audienceLiquid argon time projection chamber detector technology provides high spatial and calorimetric resolutions on the charged particles traversing liquid argon. As a result, the technology has been used in a number of recent neutrino experiments, and is the technology of choice for the Deep Underground Neutrino Experiment (DUNE). In order to perform high precision measurements of neutrinos in the detector, final state particles need to be effectively identified, and their energy accurately reconstructed. This article proposes an algorithm based on a convolutional neural network to perform the classification of energy deposits and reconstructed particles as track-like or arising from electromagnetic cascades. Results from testing the algorithm on experimental data from ProtoDUNE-SP, a prototype of the DUNE far detector, are presented. The network identifies track- and shower-like particles, as well as Michel electrons, with high efficiency. The performance of the algorithm is consistent between experimental data and simulation

Scintillation light detection in the 6-m drift-length ProtoDUNE Dual Phase liquid argon TPC

DUNE is a dual-site experiment for long-baseline neutrino oscillation studies, neutrino astrophysics and nucleon decay searches. ProtoDUNE Dual Phase (DP) is a 6 $\times$ 6 $\times$ 6 m$^3$ liquid argon time-projection-chamber (LArTPC) that recorded cosmic-muon data at the CERN Neutrino Platform in 2019–2020 as a prototype of the DUNE Far Detector. Charged particles propagating through the LArTPC produce ionization and scintillation light. The scintillation light signal in these detectors can provide the trigger for non-beam events. In addition, it adds precise timing capabilities and improves the calorimetry measurements. In ProtoDUNE-DP, scintillation and electroluminescence light produced by cosmic muons in the LArTPC is collected by photomultiplier tubes placed up to 7 m away from the ionizing track. In this paper, the ProtoDUNE-DP photon detection system performance is evaluated with a particular focus on the different wavelength shifters, such as PEN and TPB, and the use of Xe-doped LAr, considering its future use in giant LArTPCs. The scintillation light production and propagation processes are analyzed and a comparison of simulation to data is performed, improving understanding of the liquid argon properties.DUNE is a dual-site experiment for long-baseline neutrino oscillation studies, neutrino astrophysics and nucleon decay searches. ProtoDUNE Dual Phase (DP) is a 6x6x6m3 liquid argon time-projection-chamber (LArTPC) that recorded cosmic-muon data at the CERN Neutrino Platform in 2019-2020 as a prototype of the DUNE Far Detector. Charged particles propagating through the LArTPC produce ionization and scintillation light. The scintillation light signal in these detectors can provide the trigger for non-beam events. In addition, it adds precise timing capabilities and improves the calorimetry measurements. In ProtoDUNE-DP, scintillation and electroluminescence light produced by cosmic muons in the LArTPC is collected by photomultiplier tubes placed up to 7 m away from the ionizing track. In this paper, the ProtoDUNE-DP photon detection system performance is evaluated with a particular focus on the different wavelength shifters, such as PEN and TPB, and the use of Xe-doped LAr, considering its future use in giant LArTPCs. The scintillation light production and propagation processes are analyzed and a comparison of simulation to data is performed, improving understanding of the liquid argon properties