The genetic architecture of the human cerebral cortex

The cerebral cortex underlies our complex cognitive capabilities, yet little is known about the specific genetic loci that influence human cortical structure. To identify genetic variants that affect cortical structure, we conducted a genome-wide association meta-analysis of brain magnetic resonance imaging data from 51,665 individuals. We analyzed the surface area and average thickness of the whole cortex and 34 regions with known functional specializations. We identified 199 significant loci and found significant enrichment for loci influencing total surface area within regulatory elements that are active during prenatal cortical development, supporting the radial unit hypothesis. Loci that affect regional surface area cluster near genes in Wnt signaling pathways, which influence progenitor expansion and areal identity. Variation in cortical structure is genetically correlated with cognitive function, Parkinson's disease, insomnia, depression, neuroticism, and attention deficit hyperactivity disorder

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Benefit of medication reviews by renal pharmacists in the setting of a computerized physician order entry system with clinical decision support

What Is Known and Objective A 'renal pharmacist consultant service' (RPCS) reviewing patients' charts with renal impairment (RI) for drug-related problems (DRP) can foster patient safety. However, the benefit of this service in the new setting of a computerized physician order entry (CPOE)-system with a clinical decision support (CDS)-system is unknown. The aim of our study was to evaluate the general need for an RPCS on wards with a CPOE-CDS-system already in use and its effectiveness on prescription changes to ensure in-hospital patient safety. Methods Over a period of 3 months (02-04/2021), elective orthopaedic and trauma patients with eGFR(absolute)/CrCl <60 ml/min at a German University Hospital received a medication review by a renal pharmacist for all medication entered into the CPOE-system (Meona (R)) by the treating physicians. Written consultations explaining identified DRP and recommending interventions to solve them, for example, dose or drug adaptation, were shared with the physicians directly in the drug chart tab of Meona (R). In complex cases, DRP were additionally discussed via phone. The prescription changes were evaluated retrospectively. Results and Discussion During 53 working days, 712 (30.5%) of 2331 screened patients were included with an eGFR(non-indexed)/CrCl <60 ml/min and a pharmacist-led medication review was performed for all medication presented in the CPOE-system (Meona (R)). In 79 of 712 (11.1%) patients, one or more DRP were detected (median 1 DRP (1-3) per patient) and written recommendations concerning 106 of 1090 (9.7%) drugs were shared via Meona (R). In total, 104 DRP were identified, mostly caused by 'dosage too high' (n = 55, 52.9%), 'dosage regime wrong' (n = 13, 12.5%), and 'contraindication' (n = 9, 8.7%). Acceptance rate of recommendations was 74.0% (n = 77/104). In nine cases (8.7%), despite of specific recommendations, no adjustment of drugs was made because of lack of alternatives. In 11 (10.6%) cases, prescription remained unchanged for unknown reasons and in seven (6.7%) cases, the result was unknown due to discharge. What Is New and Conclusion In the setting of prescribing in a CPOE-CDS-system, that provides physicians with advice for drug or dose adaption, the pharmacist-led medication reviews still identified DRP in orthopaedic and trauma patients with RI. A RPCS forwarding recommendations to solve DRP via the electronic medical record increased appropriate prescribing by physicians and, thus, may further improve patient safety

Ambientação à escola: atuação junto a um grupo de crianças iniciando o ciclo básico

Este é um estudo exploratório que descreve: um programa desenvolvido junto a crianças iniciantes no ciclo básico e algumas características comportamentais destas crianças nesta fase de transição ecológica. O programa envolveu uma atuação sobre o contexto ambiental visando a facilitação da ambientação das crianças à escola. Os resultados mostram dados favoráveis à proposta apresentada e novos estudos são sugeridos para maiores considerações

O papel da educação no hospital: uma reflexão com base nos estudos de Wallon e Vigotski

A educação no hospital ainda é um tema novo para a academia e possui poucos estudos nesta área. Com o objetivo de contribuir para o debate, o texto apresenta, através da análise de cenas de um atendimento pedagógico em hospital, possibilidades de interlocução entre a educação e a saúde. Com base nos estudos de Wallon e Vigotski, o artigo discute cenas de interação entre quatro crianças, os diferentes papéis que a educação pode desempenhar no contexto hospitalar. A aprendizagem como elemento propulsor do desenvolvimento ganha novos contornos numa enfermaria pediátrica. Além de resgatar a auto-estima da criança, o ato de aprender gera conhecimentos que contribuem para refletir sobre sua doença e compreender as causas que lhe trazem desconforto emocional, diminuindo a tensão de uma hospitalização. Assim, ao proporcionar momentos de construção, expressão e reelaboração de pensamentos, a educação tem um importante papel a desempenhar no resgate da saúde da criança hospitalizada

Apropriação de práticas de numeramento na EJA: valores e discursos em disputa

Este artigo contempla questões da apropriação de práticas de numeramento no contexto escolar por estudantes jovens e adultos da educação básica. Consideramos essas práticas sociais que envolvem ideias, critérios e representações matemáticas como práticas de letramento, constituídas por modos de uso da língua escrita e informadas pelas relações que estabelecem com valores e conhecimentos relativos à cultura letrada. No âmbito do estudo aqui apresentado, analisamos as posições discursivas assumidas pelos sujeitos em interações em sala de aula ocorridas durante a correção de uma atividade de matemática em que se solicitava que os alunos indicassem a ordem de grandeza de alguns objetos e a expressão das medidas aproximadas no sistema métrico decimal. Enquanto a proposta escolar requeria a produção de estimativas em detrimento da referência em situações específicas, os estudantes produziram respostas que se apoiam em situações contextuais e buscam a precisão. A análise sugere que os processos de apropriação das práticas de numeramento escolares não se restringem a uma dimensão técnica, estando relacionados às maneiras de os sujeitos se apropriarem dos valores a elas vinculados. No jogo discursivo escolar, alunos e alunas assumem posições diversas, que ora se solidarizam com os modos de conhecer escolares, ora os questionam, colocando-se como sujeitos de aprendizagem, nos diversos modos de conhecer e se relacionar com o mundo

Results of a Global Phase 3, Randomized, Double-Blind, Placebo-Controlled Trial Evaluating the Efficacy and Safety of Sebelipase Alfa as an Enzyme Replacement Therapy in Children and Adults with Lysosomal Acid Lipase Deficiency

WOS: 00034551700000