Considerações sobre a importância da turma no desempenho dos alunos em escolas municipais

O processo de distribuição dos alunos entre as turmas de uma mesma série, conhecido como enturmação, acarreta conseqüências para o desempenho dos alunos. Neste trabalho, oferecemos evidências do efeito turma sobre o desempenho, utilizando dados de uma amostra de escolas municipais de três municípios do Estado do Rio de Janeiro. Os dados referem-se ao teste de português, aplicado a 2254 alunos da 4ª série, distribuídos em 103 turmas de 53 escolas. O escopo do trabalho é o de contribuir para um melhor entendimento do efeito turma de três maneiras. Primeiro, para verificar a importância relativa da turma no desempenho dos alunos, são comparadas as variâncias explicadas pela turma e por três grupos de variáveis: alunos, professores, e diretores. Segundo, é visto como três fatores ligados à enturmação, (idade média da turma, rodízio de professores e tamanho da turma) afetam o desempenho médio das turmas. Finalmente, tendo a turma como unidade de análise, observa-se a relação entre a desigualdade do desempenho, medida pelo seu desvio padrão, e a eficiência, medida pela média desse desempenho

Atherogenic markers in predicting cardiovascular risk and targeting residual cardiovascular risk

Abstract Low-density lipoprotein (LDL) cholesterol (LDL-C) is the primary target in cardiovascular (CV) disease prevention and is commonly used in estimating CV risk; however, alternative markers may be needed when LDL-C is not an appropriate marker (e.g. in the presence of low LDL-C levels or elevated triglyceride [TG] levels). Non-high-density lipoprotein cholesterol (non-HDL-C) and apolipoprotein B (apoB) are markers of atherogenic lipoproteins with evidenced associations with CV risk and are, therefore, recommended as secondary targets, appropriate for use in the presence of elevated TG levels. The reported strength of the associations of non-HDL-C and apoB in comparison to LDL-C is conflicting between studies, potentially due to discordance of the markers which can alter their predictive pattern. Although LDL-C levels are commonly managed with statin treatment, a residual risk of CV events still remains, and an abnormal lipid profile can persist. Combination therapy to further reduce LDL-C levels can be beneficial; a statin therapy combined with other LDL-C-lowering therapy further reduced the number of CV events. In addition, targeting other markers, including non-HDL-C, apoB, total cholesterol and TGs may also be beneficial, specifically in patients with low HDL-C and elevated TG levels. More clinical evidence is required before definitive recommendations can be made; however, a statin–fenofibrate combination demonstrated favourable reductions in major CV events in these specific patients

Pharmaceutical strategies for reducing LDL-C and risk of cardiovascular disease

Abstract A key strategy in preventing cardiovascular (CV) disease is the reduction of low-density lipoprotein cholesterol (LDL-C). Statins are a crucial therapy for achieving LDL-C reductions, with the highest tolerated dose often prescribed, especially for patients who are at the greatest risk of CV disease. However, statin intolerance, heterogeneous responses to statins and non-adherence make alternative therapies necessary in some cases. Statins can be combined with a multitude of therapies with synergistic mechanisms of action to effectively manage lipid profiles, while improving safety and tolerability profiles. Addition of a cholesterol absorption inhibitor, bile acid sequestrant or fibrate to statin therapy leads to greater numbers of patients achieving and maintaining LDL-C goals. Furthermore, combination therapies can alter the plasma profiles of other molecules involved in hypercholesterolaemia, including triglycerides and high-density lipoprotein cholesterol. An additional strategy is proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibition therapy, for use in patients who are statin intolerant, patients with heterozygous or homozygous familial hypercholesterolaemia, and patients at very high CV risk, as a potential means for achieving large LDL-C reductions and maintaining LDL-C goals. Clinical trials have demonstrated that PCSK9 inhibition therapy is not only effective but can also be combined with statin therapy to ensure greater reductions in LDL-C. Current, ongoing studies are investigating the efficacy of novel therapies, including selective peroxisome proliferator-activated receptor (PPAR) alpha modulators, PCSK9-specific ribonucleic acid (RNA) interference and anti-inflammatory therapies

Identifying and Correcting Biases in Digital Image Correlation at Multiple Length Scales

Accurate strain measurement at grain and sub-grain levels is important to predict and understand crack initiation during fatigue of materials. During cyclic loading, low magnitude strain is accumulated in the material and any distortion in the images can lead to inaccurate strain measurements and false prediction of the material’s behavior. Digital Image Correlation (DIC) is a reliable tool used to measure strain localization by correlating images before, during, and after cyclic loading. DIC tracks the deformation of nano/micro-scale patterns placed on the surface of the specimens to determine strain fields. However, DIC software does not account for biases due to specimen misalignment, stress relaxation, light and contrast divergences, or image distortions when using Scanning Electron Microscopy (SEM). The work presented here establishes a protocol to collect and correct images that accounts for the biases induced during SEM capture. This protocol describes a procedure for image capture and a specific post-processing computational technique for distortion correction on SEM images. The combination of both methodologies allows for unbiased strain measurement and localization when using DIC software at different length scales

POEMS Syndrome: an Atypical Presentation with Chronic Diarrhoea and Asthenia

POEMS syndrome is a rare paraneoplastic condition associated with polyneuropathy, organomegaly, monoclonal gammopathy, endocrine and skin changes. We report a case of a man with Castleman disease and monoclonal gammopathy, with a history of chronic diarrhoea and asthenia. Gastrointestinal involvement in POEMS syndrome is not frequently referred to in the literature and its physiopathology is not fully understood. Diagnostic criteria were met during hospitalization but considering the patient’s overall health condition, therapeutic options were limited. Current treatment for POEMS syndrome depends on the management of the underlying plasma cell disorder. This report outlines the importance of a thorough review of systems and a physical examination to allow an attempted diagnosis and appropriate treatment

Yellow Nail Syndrome: Report of Two Cases and a Brief Review of the Current Literature

Yellow Nail Syndrome (YNS) is a rare, and probably misdiagnosed, condition. It must be considered in middle-aged patients with unexplained chronic respiratory manifestations, lymphedema and nail abnormalities. We present two cases of undiagnosed YNS until the current admissions, despite several years of investigation. The authors wish to draw attention to this syndrome, of which diagnosis is clinical and of exclusion

Francisco de Oliveira : questões, diálogos, depoimentos

Depois de um ano e alguns meses de ausência de Francisco de Oliveira, nosso Chico, o Centro de Estudos dos Direitos da Cidadania (Cenedic), que foi fundado e alimentado intelectualmente por ele, prestou-lhe uma homenagem, rememorando sua produção e os momentos de convívio e diálogo que marcaram nossos encontros, seminários, projetos e livros. Rememorar e reler as obras de Francisco de Oliveira, que ocupa um lugar de destaque no pensamento e na produção das Ciências Sociais nacionais, acaba sendo uma recuperação – nem sempre fácil – da história social e política do país. Uma biografia não autorizada do Brasil – aliás, título de sua última obra – pode ser encontrada nos vários momentos e temas de sua produção. No seminário que realizamos em sua homenagem, de encerramento emocionado e sensível, rememoramos em conjunto o sentimento que então nos tornava, de certo modo, partes de uma mesma família: “somos filhos fundadores”, “somos todos filhos de Francisco”. Filiações, vínculos, saudade, certo, mas também um conjunto de ideias, proposições, provocações, idas e vindas que foram sendo identificadas pelos depoimentos e textos no decorrer do evento de novembro de 2020. Essa variedade de leituras, essa identificação de diálogos com outros pensadores e cientistas sociais, esse novelo de heranças e de lembranças parece conter um tesouro que agora partilhamos numa forma escrita. Esse tesouro reside na crítica sem ponto de repouso, em uma inquietação intelectual permanente, em um inconformismo com o que está dado, em uma escolha das leituras a contrapelo que vão da Crítica à razão dualista, de 1972, até os últimos textos sobre a tragédia brasileira

Large Morgagni Hernia in an Adult Patient

A 70-year-old woman presented to the emergency department with symptoms of a lower respiratory infection. A chest x-ray showed enlargement of the mediastinal space. The patient was admitted with a respiratory tract infection and started on antibiotic treatment. A computed tomography (CT) scan of the thorax revealed a large diaphragmatic hernia with stomach, large intestine and caudal pancreas lodged in the thoracic cavity. After the antibiotic treatment, the patient became asymptomatic and surgery repair was declined. Morgagni hernia is an uncommon type of congenital diaphragmatic hernia, which may be asymptomatic until late in life or may be present acutely with life threatening conditions

A aterosclerose nos cuidados de saúde primários: estudo da vida real

Introduction and Objectives: To characterize patients with atherosclerosis, a disease with a high socioeconomic impact, in the Lisbon and Tagus Valley Health Region. Methods: A cross-sectional observational study was carried out through the Lisbon and Tagus Valley Regional Health Administration primary health care database, extracting data on the clinical and demographic characteristics and resource use of adult primary health care users with atherosclerosis during 2016. Different criteria were used to define atherosclerosis (presence of clinical manifestations, atherothrombotic risk factors and/or consumption of drugs related to atherosclerosis). Comparisons between different subpopulations were performed using parametric tests. Results: A total of 318 692 users were identified, most of whom (n=224 845 users; 71%) had no recorded clinical manifestations. The subpopulation with clinical manifestations were older (72.0±11.5 vs. 71.3±11.0 years), with a higher proportion of men (58.0% vs. 45.9%), recorded hypertension (78.3% vs. 73.5%) and dyslipidemia (55.8% vs. 53.5%), and a lower proportion of recorded obesity (18.2% vs. 20.8%), compared to those without clinical manifestations (p<0.001). Mean blood pressure, LDL-C and glycated hemoglobin values were lower in the subpopulation with manifestations (142/74 vs. 146/76 mmHg, 101 vs. 108 mg/dl, and 6.80 vs. 6.84%, respectively; p<0.001). Each user with atherosclerosis attended 4.1±2.9 face-to-face medical consultations and underwent 8.6±10.0 laboratory test panels, with differences in subpopulations with and without clinical manifestations (4.4±3.2 vs. 4.0±2.8 and 8.3±10.3 vs. 8.7±9.8, respectively; p<0.001). Conclusions: About one in three adult primary health care users with atherosclerosis have clinical manifestations. The results suggest that control of cardiovascular risk factors is suboptimal in patients with atherosclerosis.Introdução e objetivos: caracterizar os doentes com aterosclerose, uma doença com elevado impacto socioeconómico, na Região de Saúde de Lisboa e Vale do Tejo. Métodos: Estudo observacional transversal, recorrendo ao Sistema de Informação desta Administração Regional de Saúde, com extração de dados clínico-demográficos e de consumo de recursos dos utilizadores adultos com aterosclerose em 2016. A aterosclerose foi definida pela presença de manifestações clínicas, fatores de risco aterotrombóticos e/ou consumo de medicamentos marcadores de aterosclerose. Foram comparados os resultados para a população com e sem manifestações clínicas (testes paramétricos). Resultados: Identificámos 318 692 utilizadores, a maioria (n=224 845 doentes; 71%) sem registo de manifestações clínicas. A subpopulação com manifestações clínicas era mais idosa (72,0±11,5 versus 71,3±11,0 anos), com maior proporção de homens (58,0% versus 45,9%), registo de hipertensão arterial (78,3% versus 73,5%), dislipidemia (55,8% versus 53,5%) e menor proporção de registo de obesidade (18,2% versus 20,8%), em comparação com a população sem manifestações clínicas (p<0,001). Os valores médios de pressão arterial sistólica/diastólica, C-C-LDL e hemoglobina glicada foram inferiores na subpopulação com manifestações (142/74 versus 146/76 mmHg, 101 versus 108 mg/dL, 6,80 versus 6,84%, respetivamente; p<0,001). Cada utilizador com aterosclerose realizou 4,1±2,9 consultas médicas presenciais e 8,6±10,0 painéis de análises clínicas, com diferenças nas subpopulações com e sem manifestações clínicas (4,4 ± 3,2 versus 4,0 ± 2,8 e 8,3 ± 10,3 versus 8,7±9,8, respetivamente; p<0,001). Conclusões: Cerca de um em cada três utilizadores adultos de cuidados de saúde primários com aterosclerose têm manifestações clínicas. Os resultados sugerem que o controlo dos factores de risco cardiovascular é sub-óptimo em doentes com aterosclerose.info:eu-repo/semantics/acceptedVersio

The burden of atherosclerosis in Portugal

© The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please [email protected]: This paper sought to estimate the burden of disease attributable to atherosclerosis in mainland Portugal in 2016. Methods and results: The burden of atherosclerosis was measured in disability-adjusted life years (DALY) following the latest 2010 Global Burden of Disease (GBD) methodology. DALYs were estimated as the sum of years of life lost (YLL) with years lived with disability (YLD). The following clinical manifestations of atherosclerosis were included: ischemic heart disease (IHD) (including acute myocardial infarction (AMI), stable angina, and ischemic heart failure (IHF)), ischemic cerebrovascular disease (ICVD) and peripheral arterial disease (PAD). YLL were estimated based on all-cause mortality data for the Portuguese population and mortality due to IHD, ICVD and PAD for the year 2016 sourced from national statistics. Standard life expectancy was sourced from the GBD study. YLD corresponded to the product of the number of prevalent cases by an average disability weight (DW) for all possible combinations of disease. Prevalence data for the different clinical manifestations of atherosclerosis were sourced from epidemiological studies. DW were sourced from the published literature. In 2016, 15,123 deaths were attributable to atherosclerosis, which corresponded to 14.3% of overall mortality in mainland Portugal. DALYs totaled 260,943, 75% due to premature death (196,438 YLL) and 25% due to disability (64,505 YLD). Conclusion: Atherosclerosis entails a high disease burden to society. A large part of this burden would be avoidable if evidence-based effective and cost-effective interventions targeting known risk factors, from prevention to treatment, were implemented.This study was funded by Bayer Portugal, Lda. Funding was independent of the study outcomes.info:eu-repo/semantics/publishedVersio