Ilha encantada: plano de marketing digital turístico para o município de Itamaracá - PE

This Course Completion Paper proposes a Digital Marketing Plan for the Island of Itamaracá seeking to promote and enhance tourism in the city, which is currently stagnant, as shown by the results of our field research. In the theoretical construction, we anchored on classic authors from the tourist field, such as De La Torre, Ruschamann, Beni and Panosso Neto, as well as on the Marketing segment, such as Kotler, Swarbrooke and Horner. Digital marketing strategies provide opportunities for growth and visibility, and can contribute to the objective of leveraging tourist activity in the city. In order to better understand the object of study, in the methodological field, we carried out a literature review, data analysis and application of field research in a virtual way. With the results of the study, we raised the tourist attractions, identified the desires of tourists and visitors in relation to the Island, and the digital opportunities for boosting tourism in the place.O presente Trabalho de Conclusão de Curso propõe um Plano de Marketing Digital para a Ilha de Itamaracá buscando divulgar e potencializar o turismo no município, que atualmente se encontra estagnado, conforme demonstram os resultados de nossa pesquisa de campo. Na construção teórica, nos ancoramos em autores clássicos, do campo turístico, tais como De La Torre, Ruschamann, Beni e Panosso Neto, assim como no segmento de Marketing a exemplo de Kotler, Swarbrooke e Horner. As estratégias de marketing digital proporcionam oportunidade de crescimento e de visibilidade, e podem contribuir com o objetivo de alavancar a atividade turística na cidade. De maneira a entender melhor o objeto de estudo, no campo metodológico, realizamos revisão bibliográfica, análise de dados e aplicação de pesquisa de campo de forma virtual. Com os resultados do estudo, levantamos os atrativos turísticos, identificamos os desejos dos turistas e visitantes em relação à Ilha, e as oportunidades digitais para o impulsionamento do Turismo no local

Evaluation of Venous Congestion by Point-of-Care Ultrasound: State of the Art

The assessment of venous congestion is one of the grea-test medical challenges of this century: from more invasive procedures to the arising of ultrasound evaluation, there has been a constant quest for reliable and non-invasive bedside tools to determine and monitor hemodynamic status. Venous hypertension is an important pathophysiological mechanism of organ congestion, leading to its injury in various clinical settings. A practical bedside assessment of venous congestion is often challenging due to the limitations of tradi-tional methods.Point-of-care ultrasonography (POCUS) provides a real time picture of the patients' anatomy and physiology (inclu-ding analysis of dynamic flows), allowing a diagnosis and mo-nitoring of venous congestion with a higher sensitivity than standard physical examination.In this brief summary, the authors summarize the physio-logy of venous congestion and the most recent tools for con-gestion assessment by POCUS.info:eu-repo/semantics/publishedVersio

Working Conditions and Organization of Teachers of Public Schools

This paper aims at analysing working conditions and organization of public basic school teachers in João Pessoa (PB). To do so we departed from a multidiciplinary approach: activity ergonomy and psycho-dynamics of working under a gender social relations viewpoint. Alongside this research we made use of activity observation and formed communities expanded search. In regard to the research participants, a group of forty professionals from three different schools collaborated with the investigation. When it comes to the analysis of the produced data, we observed that the main reason why theses professionals chose the educational workfield is deeply rooted in gender social relations and socio-economic conditions. We also verified certain discrepancies between the job description and the work actually done by theses professionals. However, it was noticed that despite the difficulties encountered in work situations, the teachers through the use of their sensitivity and creativity, develop various forms of regulation of the activity, giving new ways to work and inventing different ways to link to it

Implicações das políticas educacionais nas vivências subjetivas de professoras de escolas públicas

The educational policies implemented in Brazil since the 1990s have been producing significant effects on the restructuring of the teaching job. The carried out study aimed to analyze the implications of these educational policies in the subjective experiences of teachers from public schools in the municipality of João Pessoa. For that, we have used observations of the activities and of the constitution of amplified communities researched. The analysis of the materials produced was carried out following the dialogic perspective of the discourse. We have verified that the educational programs, in general, are seen by the teachers as immediate and palliative measures, which do not effectively solve education and teaching quality problems. They report that these programs, instead of favoring their job, have generated overload, making it difficult the accomplishment of their activity, and also causing implications to their health. We have observed, however, that, despite the difficulties found in the work situations, the teachers, through their creative mobilization, carry out several ways of activity regulation, giving new shapes to the work and developing different ways of articulating themselves to it.As políticas educacionais implementadas no Brasil desde a década de 1990 têm produzido efeitos significativos na reestruturação do trabalho docente. O estudo realizado teve como objetivo analisar as implicações dessas políticas nas vivências subjetivas de professoras de escolas públicas do município de João Pessoa. Para tanto, fizemos uso de observações da atividade e da constituição de comunidades ampliadas de pesquisa. A análise dos materiais produzidos foi realizada seguindo a perspectiva dialógica do discurso. Constatamos que, em geral, os programas educacionais são vistos pelas professoras como medidas imediatas e paliativas, que não resolvem efetivamente os problemas da educação e da qualidade do ensino. As professoras relatam que esses programas, ao invés de favorecer seu trabalho, têm gerado sobrecarga, dificultando a realização de sua atividade, e, inclusive, acarretando implicações na sua saúde. Entretanto, observamos que, apesar das dificuldades encontradas pelas professoras nas situações de trabalho, elas realizam, por intermédio de sua mobilização criativa, diversos modos de regulação da atividade, dando novas formas ao trabalho e desenvolvendo diferentes maneiras de articular-se em relação a ele

Effects of dapagliflozin and gliclazide on the cardiorenal axis in people with type 2 diabetes

OBJECTIVES: There is a bidirectional relationship between cardiovascular and renal disease. The drug-class of SGLT2 inhibitors improves outcomes at both ends of this so called cardiorenal axis. We assessed the effects of SGLT2 inhibition and sulfonylurea treatment on systemic hemodynamic function and investigated whether SGLT2 inhibitor-induced changes in systemic hemodynamics correlate with changes in renal hemodynamics. METHODS: Forty-four people with type 2 diabetes were randomized to 12 weeks of dapagliflozin 10 mg/day or gliclazide 30 mg/day treatment. Systemic hemodynamic function, autonomic nervous system activity, and vascular stiffness were measured noninvasively, whereas renal hemodynamics, glomerular filtration rate (GFR) and effective renal plasma flow, were assessed with gold-standard urinary clearances of inulin or iohexol and para-aminohippuric acid, respectively. Correlation analyses were performed to assess relationships between dapagliflozin-induced changes in cardiovascular and renal variables. RESULTS: Dapagliflozin reduced stroke volume by 4%, cardiac output by 5%, vascular stiffness by 11%, and mean arterial pressure by 5% from baseline, without increasing heart rate or sympathetic activity, while simultaneously lowering glomerular filtration rate by 8%. Despite similar improvements in glycemic control by dapagliflozin and gliclazide (-0.5 ± 0.5 versus-0.7 ± 0.5%; P = 0.12), gliclazide did not affect any of these measurements. There was no clear association between the dapagliflozin-induced changes in cardiovascular and renal physiology. CONCLUSION: Dapagliflozin seemingly influences systemic and renal hemodynamics independently and beyond glucose lowering in people with type 2 diabetes.This clinical trial was registered at https://clinicalTrials.gov (ID: NCT02682563)

An AI-powered patient triage platform for future viral outbreaks using COVID-19 as a disease model

Over the last century, outbreaks and pandemics have occurred with disturbing regularity, necessitating advance preparation and large-scale, coordinated response. Here, we developed a machine learning predictive model of disease severity and length of hospitalization for COVID-19, which can be utilized as a platform for future unknown viral outbreaks. We combined untargeted metabolomics on plasma data obtained from COVID-19 patients (n = 111) during hospitalization and healthy controls (n = 342), clinical and comorbidity data (n = 508) to build this patient triage platform, which consists of three parts: (i) the clinical decision tree, which amongst other biomarkers showed that patients with increased eosinophils have worse disease prognosis and can serve as a new potential biomarker with high accuracy (AUC = 0.974), (ii) the estimation of patient hospitalization length with ± 5 days error (R2 = 0.9765) and (iii) the prediction of the disease severity and the need of patient transfer to the intensive care unit. We report a significant decrease in serotonin levels in patients who needed positive airway pressure oxygen and/or were intubated. Furthermore, 5-hydroxy tryptophan, allantoin, and glucuronic acid metabolites were increased in COVID-19 patients and collectively they can serve as biomarkers to predict disease progression. The ability to quickly identify which patients will develop life-threatening illness would allow the efficient allocation of medical resources and implementation of the most effective medical interventions. We would advocate that the same approach could be utilized in future viral outbreaks to help hospitals triage patients more effectively and improve patient outcomes while optimizing healthcare resources

A violência obstétrica sob a óptica dos sentimentos da parturiente: uma revisão de literatura / Obstetric violence from the perspective of the feelings of the parturient woman: a literature review

Introdução: A Violência Obstétrica, bastante presente nos cotidianos das maternidades, é um grande impasse que gera sentimentos de medo e ansiedade, dificultando o processo de vínculo das puérperas nos ambientes de saúde. Esse tipo de violência se manifesta, principalmente, nos momentos de parto, quando se nega o direito da mulher ter o seu acompanhante. As relações de poder, que ditam o comportamento social, fomentam algumas ações violentas dos profissionais de saúde. Essas, dessa forma, podem acarretar em danos no que se refere ao estado físico e mental das mulheres.  Objetivo: Analisar os impactos provocados pela violência obstétrica. Método: Resultados/discussão: Diante do conjunto de estudos elegidos, há consonância quanto à repercussão negativa que a violência obstétrica provoca no âmbito da saúde. Algumas das evidências apontam para o comprometimento na vida reprodutiva da mulher e também para a ruptura no curso natural do parto. Atrelado a isso, está bem consolidada a relação entre violência obstétrica e aumento no número de cesáreas e complicações no trabalho de parto. Os impactos psicossociais também se fortalecem a partir da literatura analisada, sendo especialmente mencionada a depressão pós-parto. Somado a isso, alguns estudos destacam a violência obstétrica como deletéria à saúde dos recém-nascidos e ao nível de satisfação dos profissionais da saúde. Conclusão: Os resultados evidenciados neste artigo sobre violência obstétrica sob a óptica das parturientes ressaltaram os impactos negativos decorrentes dessa violência na saúde física e mental das parturientes, ferindo a dignidade humana delas. Dentre as repercussões descritas, destacam-se problemas na sexualidade, na autoestima e na saúde mental e física das mulheres após sofrerem violência. Ademais, a perda de privacidade e a privação de direitos, como o direito a acompanhante, também foram ressaltadas como problemas decorrentes da violência obstétrica.  Junto a isso, essa violência sofrida também teve repercussões negativas na saúde dos recém-nascidos e na relação materno-infantil

Effect of sitagliptin on cardiovascular outcomes in type 2 diabetes

BACKGROUND: Data are lacking on the long-term effect on cardiovascular events of adding sitagliptin, a dipeptidyl peptidase 4 inhibitor, to usual care in patients with type 2 diabetes and cardiovascular disease. METHODS: In this randomized, double-blind study, we assigned 14,671 patients to add either sitagliptin or placebo to their existing therapy. Open-label use of antihyperglycemic therapy was encouraged as required, aimed at reaching individually appropriate glycemic targets in all patients. To determine whether sitagliptin was noninferior to placebo, we used a relative risk of 1.3 as the marginal upper boundary. The primary cardiovascular outcome was a composite of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for unstable angina. RESULTS: During a median follow-up of 3.0 years, there was a small difference in glycated hemoglobin levels (least-squares mean difference for sitagliptin vs. placebo, -0.29 percentage points; 95% confidence interval [CI], -0.32 to -0.27). Overall, the primary outcome occurred in 839 patients in the sitagliptin group (11.4%; 4.06 per 100 person-years) and 851 patients in the placebo group (11.6%; 4.17 per 100 person-years). Sitagliptin was noninferior to placebo for the primary composite cardiovascular outcome (hazard ratio, 0.98; 95% CI, 0.88 to 1.09; P<0.001). Rates of hospitalization for heart failure did not differ between the two groups (hazard ratio, 1.00; 95% CI, 0.83 to 1.20; P = 0.98). There were no significant between-group differences in rates of acute pancreatitis (P = 0.07) or pancreatic cancer (P = 0.32). CONCLUSIONS: Among patients with type 2 diabetes and established cardiovascular disease, adding sitagliptin to usual care did not appear to increase the risk of major adverse cardiovascular events, hospitalization for heart failure, or other adverse events

Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049

Neuropeptides, Trophic Factors, and Other Substances Providing Morphofunctional and Metabolic Protection in Experimental Models of Diabetic Retinopathy

Vision is the most important sensory modality for many species, including humans. Damage to the retina results in vision loss or even blindness. One of the most serious complications of diabetes, a disease that has seen a worldwide increase in prevalence, is diabetic retinopathy. This condition stems from consequences of pathological metabolism and develops in 75% of patients with type 1 and 50% with type 2 diabetes. The development of novel protective drugs is essential. In this review we provide a description of the disease and conclude that type 1 diabetes and type 2 diabetes lead to the same retinopathy. We evaluate existing experimental models and recent developments in finding effective compounds against this disorder. In our opinion, the best models are the long-term streptozotocin-induced diabetes and Otsuka Long-Evans Tokushima Fatty and spontaneously diabetic Torii rats, while the most promising substances are topically administered somatostatin and pigment epithelium-derived factor analogs, antivasculogenic substances, and systemic antioxidants. Future drug development should focus on these