A ética do silêncio racial no contexto urbano: políticas públicas e desigualdade social no Recife, 1900-1940

Mais de meio século após o preconceito racial ter se tornado o principal alvo dos movimentos urbanos pelos direitos civis nos Estados Unidos e na África do Sul, e décadas depois do surgimento dos movimentos negros contemporâneos no Brasil, o conjunto de ferramentas legislativas criado no Brasil para promover o direito à cidade ainda adere à longa tradição brasileira de silêncio acerca da questão racial. Este artigo propõe iniciar uma exploração das raízes históricas desse fenômeno, remontando ao surgimento do silêncio sobre a questão racial na política urbana do Recife, Brasil, durante a primeira metade do século XX. O Recife foi eé um exemplo paradigmático do processo pelo qual uma cidade amplamente marcada por traços negros e africanos chegou a ser definida política e legalmente como um espaço pobre, subdesenvolvido e racialmente neutro, onde as desigualdades sociais originaram na exclusão capitalista, e não na escravidão e nas ideologias do racismo científico. Neste sentido, Recife lança luzes sobre a política urbana que se gerou sob a sombra do silêncio racial.More than half a century after racial prejudice became central to urban civil rights movements in the United States and South Africa, and decades after the emergence of Brazil’s contemporary Black movements, Brazil's internationally recognized body of rights-to-the-city legislation still adheres to the country's long historical tradition of racial silence. This article explores the historical roots of this phenomenon by focusing on the emergence of racial silence in Recife, Brazil during the first half of the 20th Century. Recife was and remains a paradigmatic example of the process through which a city marked by its Black and African roots came to be legally and politically defined as a poor, underdeveloped and racially neutral space, where social inequalities derived from capitalist exclusion rather than from slavery and scientific racism. As such, Recife'sexperience sheds light on the urban policies that were generated in the shadow of racial silence

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

Testing a global standard for quantifying species recovery and assessing conservation impact.

Recognizing the imperative to evaluate species recovery and conservation impact, in 2012 the International Union for Conservation of Nature (IUCN) called for development of a "Green List of Species" (now the IUCN Green Status of Species). A draft Green Status framework for assessing species' progress toward recovery, published in 2018, proposed 2 separate but interlinked components: a standardized method (i.e., measurement against benchmarks of species' viability, functionality, and preimpact distribution) to determine current species recovery status (herein species recovery score) and application of that method to estimate past and potential future impacts of conservation based on 4 metrics (conservation legacy, conservation dependence, conservation gain, and recovery potential). We tested the framework with 181 species representing diverse taxa, life histories, biomes, and IUCN Red List categories (extinction risk). Based on the observed distribution of species' recovery scores, we propose the following species recovery categories: fully recovered, slightly depleted, moderately depleted, largely depleted, critically depleted, extinct in the wild, and indeterminate. Fifty-nine percent of tested species were considered largely or critically depleted. Although there was a negative relationship between extinction risk and species recovery score, variation was considerable. Some species in lower risk categories were assessed as farther from recovery than those at higher risk. This emphasizes that species recovery is conceptually different from extinction risk and reinforces the utility of the IUCN Green Status of Species to more fully understand species conservation status. Although extinction risk did not predict conservation legacy, conservation dependence, or conservation gain, it was positively correlated with recovery potential. Only 1.7% of tested species were categorized as zero across all 4 of these conservation impact metrics, indicating that conservation has, or will, play a role in improving or maintaining species status for the vast majority of these species. Based on our results, we devised an updated assessment framework that introduces the option of using a dynamic baseline to assess future impacts of conservation over the short term to avoid misleading results which were generated in a small number of cases, and redefines short term as 10 years to better align with conservation planning. These changes are reflected in the IUCN Green Status of Species Standard

Prevalence of thyroid dysfunction in neonates receiving parenteral nutrition in the intensive care unit

Objective: The use of parenteral nutrition (PN) formulations that do not contain iodine can contribute to the deficiency of this mineral, potentially leading to hypothyroidism and, ultimately, neurocognitive impairments. This study aimed to evaluate TSH alterations in newborns receiving PN. Methods: Retrospective study of neonatal intensive care unit patients receiving PN for > 15 days. Nutritional, anthropometric, and biochemical variables (TSH, T4, CRP) were analyzed. Hypothyroidism was defined by TSH > 10 mU/L. Results: Two hundred newborns were evaluated [156 (78%) preterm, 31±5 weeks of gestational age, 112 (56%) with very or extremely low birth weight]. The median (IQR) hospital stay was 68 (42-110) days, PN duration was 31 (21-47) days, and 188 (94%) patients also received enteral nutrition. Overall, 143 (71.5%) newborns underwent at least one TSH measurement. The prevalence of hypothyroidism was 10.5%. The Median PN duration in this group was 51 (34-109) days. Among those with hypothyroidism, 10 received Lugol's solution and six levothyroxine. Thirteen patients received prophylactic Lugol's solution with a median PN duration of 63 (48-197) days. TSH levels correlated positively with PN duration (r = 0.19, p = .02). Conclusions: The present data suggest that changes in TSH and T4 levels are present in neonates receiving PN for > 15 days, suggesting this population may be at risk for developing hypothyroidism. Therefore, the authors suggest that TSH and T4 measurements should be included as routine in neonatal patients receiving PN for > 15 days if PN formulations are not supplemented with iodine, and that iodine supplementation be provided as necessary

Vaginal axis after abdominal sacrocolpopexy versus vaginal sacrospinous fixation-a randomized trial

Aims To compare postoperative vaginal axis (VA) following vaginal sacrospinous fixation (VSF) or abdominal sacrocolpopexy (ASC) using magnetic resonance imaging (MRI) at postoperative period, in a randomized sample. Methods Seventy-one patients randomized to VSF with an anterior mesh or ASC were recruited with a mean 27-month follow-up for pelvic MRI; 40 patients underwent the examination. VA was calculated in relation to the pelvic inclination correction line. All patients were submitted to physical examination according to the pelvic organ prolapse quantification system, subjective impression questionnaires and quality of life (QoL) questionnaires (International Consultation on Incontinence Questionnaire, ICIQ). Objective failure was defined as points Ba, Bp, or C > 0. Subjective cure was defined as questions 5a and 6a from the ICIQ-VS questionnaire equal to zero. Results VA exhibited two portions (inferior and medium). Mean medium axis was equally more obtuse in VSF (85.9 degrees +/- 9.9 degrees; P < 0.001) and ASC (87.1 degrees +/- 14.7 degrees; P < 0.001) groups, with no difference between them. Mean inferior axis was more acute for both groups (VSF, 72.5 degrees +/- 19.1 degrees, P < 0.001; ASC, 75.7 degrees +/- 15.5 degrees, P < 0.001). All women had normal medium axes and 47.5% had inferior axis values above the 95th or below the fifth percentile, without differences regarding type of surgery performed. Women with abnormal vs normal VA did not present any difference regarding pre or postoperative physical examination, demographic characteristics, objective or subjective cure, patient satisfaction, QoL scores, or sexuality. Conclusions Both VSF and ASC deviate the physiological VA, both in its medium and inferior portions, where values fall outside normality percentiles. However, this alteration was not associated with worse objective, subjective, QoL, or sexual outcomes38411421151FAPESP – Fundação de Amparo à Pesquisa Do Estado De São Paulo2016-24065-

Avaliação da saturação tecidual de oxigênio durante o sintoma claudicante em pacientes com doença arterial periférica

Resumo Contexto O relato de sintoma claudicante em pacientes com doença arterial periférica é utilizado como modulador da intensidade de exercício físico para o tratamento clínico, entretanto os valores de oxigenação tecidual nesse momento são desconhecidos. Objetivo Descrever o suprimento tecidual de oxigênio por meio da espectroscopia de luz próxima ao infravermelho ou Near-Infrared Spectroscopy (NIRS) nos momentos em que o paciente relata sintoma claudicante inicial e máximo em testes de exercício. Métodos Nove pacientes, oito homens com 65,63 ± 6,02 anos de idade, previamente diagnosticados com doença arterial periférica, realizaram teste de exercício de carga constante e de carga incremental com monitorização do nível de oxigenação tecidual através da NIRS. As saturações de oxigênio obtidas no momento em que o paciente relata sintoma claudicante inicial e no momento em que relata sintoma claudicante máximo foram comparadas com os valores de saturação da manobra de oclusão arterial por meio do intervalo de confiança de 95% da diferença. Resultados Verificou-se que os valores de saturação nos momentos de sintoma claudicante inicial e máximo são estatisticamente distintos quando comparados àqueles obtidos na manobra de oclusão arterial, entretanto, através da análise percentual do quão distante esses valores encontram-se é possível observar que, do ponto de vista clínico, eles estão próximos. Conclusões A saturação no momento em que o paciente relata sintomas claudicantes inicial e máximo é bastante próxima do valor de saturação no momento de oclusão e do ponto de vista clínico o relato subjetivo de sintoma do paciente é adequado como parâmetro para a prescrição do exercício físico

Composition and structure of the fig wasp community in Amazonia

An understanding of the complex ecological interaction between fig wasps and their host plants in Amazonia requires previous knowledge of their distribution and diversity. The objective of this study was to describe the composition and structure of the wasp community associated with four species of Ficus in the municipal area of Manaus, Amazonas, Brazil. A total of 600 syconia from four species were collected. The study species were: Ficus obtusifolia Kunth; Ficus citrifolia Mill; F. americana subspecies guianensis Desv. form mathewsii; and F. americana subspecies guianensis Desv. form parkeriana. Statistical analyses were used to examine the relationship between fig wasp diversity and syconium diameter, and the effect of non-pollinating wasps on numbers of pollinators and seeds. Forty three species of fig wasp were identified, distributed across seven genera (Pegoscapus, Idarnes, Aepocerus, Physothorax, Anidarnes, Heterandrium , Eurytoma). Idarnes (carme group) was the wasps genus non-pollinator with greatest number of individuals with the greatest number of infested syconia (7409 wasps in 376 syconia). Analysing non-pollinating wasp diversity in relation to fig diameter, a significant difference was observed between the four fig species. Ficus citrifolia and F. americana subspecies guianensis form mathewsii had the smallest diameter but the greatest diversity of fig wasp. Ficus obtusifolia was the only species in which the non-pollinating wasps had a significant negative effect on the number of Pegoscapus sp. and on seed production