Scaling up early language intervention in educational settings : First steps matter

Objective To report how improvements on a Brazilian language intervention for early childhood education settings (PROLIN) were made and evaluated. Study Design In the first phase, the programme layout and materials were improved. This involved redesigning the guidelines for the programme, adding videos (using a learning management system) and creating an observation checklist to monitor the fidelity of implementation. The second phase was a two-week pilot study (a seven-session intervention) involving two teachers and 22 students. Checklists and video footage were analysed to investigate implementation. Results Quality of implementation was generally good, but we identified additional areas for improvement. Teachers had some difficulties with aspects related to session dynamics, implementation of activities and use of techniques that reinforce learning. Conclusions The pilot study was instrumental in identifying obstacles for a scaled-up, high-quality implementation. The design of these materials took into consideration ways of guiding and supporting teachers to: (1) offer students adequate participation time; (2) help include children who are shy or have behaviour problems; (3) use teaching strategies properly; (4) bring sessions to a close; and (5) reach the objectives of each session. Further modification is still needed, especially in the manual, videos and supplementary materials

Caracterização de fitólitos de plantas e assembleias modernas de solo da caatinga como referência para reconstituições paleoambientais

A Caatinga, quarto domínio fitogeográfico brasileiro em número de espécies de angiospermas, é composta por um mosaico de florestas secas e vegetação arbustiva, com enclaves de florestas úmidas montanas e cerrados. Entretanto, é o segundo bioma brasileiro com menos áreas protegidas e com poucos estudos paleoambientais. Buscando contribuir para a discussão sobre a evolução deste bioma durante o Quaternário, foram escolhidos como indicadores os fitólitos. Por ser um trabalho pioneiro com esse tipo de proxy na região, foi necessário investigar primeiro se as plantas da Caatinga produzem bastante fitólitos e se os mesmos se preservam nos solos. Foram coletadas na Depressão Sertaneja Setentrional amostras de 33 plantas de 16 famílias e 5 amostras superficiais de solo (Assembleias Modernas) sob diferentes formações vegetais (AM1 Caatinga Arbustiva Aberta, AM 2 Floresta de Caatinga Média, AM3 Floresta de Caatinga Alta, AM4 Floresta Ciliar e AM5 Caatinga Arbustiva Densa), para servir de referência para futuros trabalhos com assembleias fósseis. Constatamos que as plantas da Caatinga produzem uma grande quantidade e variedade de fitólitos, predominando os traqueídeos, poliédricos, globular granulate e tricomas. Foi encontrado um bom grau de preservação dos fitólitos, variando nos tipos e na quantidade de acordo com a vegetação sobrejacente e a granulometria do solo. A assembleia com maior quantidade de fitólitos classificáveis foi AM3 e a com menor porcentagem foi a AM1. Os maiores estoques de fitólitos foram encontrados nas AM 3, 2 e 5, e os menores nas 1 e 4. Os morfotipos fitolíticos predominantes foram o globular granulate, globular echinate e elongate, o que é esperado nesse tipo de vegetação. Os índices fitolíticos D/P (0,6 a 15), Bi (50 a 78%), Iph (53 a 87%) e Pa/P (0,1 a 8,9) são compatíveis com os tipos de formação vegetal analisados. Os fitólitos se mostraram ferramentas promissoras para o melhor conhecimento da vegetação da região, bem como para estudos paleoambientais no bioma

Ampliação da sobrevida em crianças com AIDS no Brasil: resultados do segundo estudo nacional de 1999 a 2002

The objective of this study is to characterize survival in children with AIDS diagnosed in Brazil between 1999-2002, compared with the first national study (1983-1998). This national retrospective cohort study examined a representative sample of Brazilian children exposed to HIV from mother-to-child transmission and followed through 2007. The survival probability after 60 months was analyzed by sex, year of birth and death, clinical classification, use of antiretroviral therapy (ART) and prophylaxis for opportunistic diseases. 920 children were included. The survival probability increased: comparing cases diagnosed before 1988 with those diagnosed from 2001-2002 it increased by 3.5-fold (from 25% to 86.3%). Use of ART, initial clinical classification, and final classification were significant (p < 0.001) predictors of survival. Issues regarding quality of records and care were identified. The results point to the success of the Brazilian policy of providing ART. The improvement of clinical status contributes to quality of life, while indicating challenges, particularly practices to improve long-term care.Este estudo caracteriza a sobrevida em crianças com AIDS no Brasil entre 1999-2002, contextualizando com o primeiro estudo nacional (1983-1998). Trata-se de coorte histórica, com crianças expostas ao HIV por transmissão vertical e acompanhadas até 2007. A probabilidade de sobrevivência em 60 meses foi analisada segundo sexo, ano de nascimento e de óbito, classificação clínica, uso de terapia antirretroviral (TARV) e de profilaxia para doenças oportunistas. No total, 920 crianças foram incluídas. A probabilidade de sobrevivência foi ampliada 3,5 vezes nos dois períodos avaliados, passando de 25% antes de 1988 para 86,3% no período de 2001-2002. Uso de TARV, classificação clínica inicial e atual/final foram preditores que influíram significativamente (p < 0,001) para a ampliação da sobrevida. Os resultados deste estudo indicam o sucesso da política brasileira para a abordagem das crianças infectadas com HIV. A melhora do estado clínico contribuiu para melhora da qualidade de vida, mas sinaliza-se para a necessidade de incorporação de práticas pautadas na integralidade do cuidado

Technical performance of a lateral flow immunoassay for detection of anti-SARS-CoV-2 IgG in the outpatient follow-up of non-severe cases and at different times after vaccination: comparison with enzyme and chemiluminescent immunoassays

This study assessed the technical performance of a rapid lateral flow immunochromatographic assay (LFIA) for the detection of anti-SARS-CoV-2 IgG and compared LFIA results with chemiluminescent immunoassay (CLIA) results and an in-house enzyme immunoassay (EIA). To this end, a total of 216 whole blood or serum samples from three groups were analyzed: the first group was composed of 68 true negative cases corresponding to blood bank donors, healthy young volunteers, and eight pediatric patients diagnosed with other coronavirus infections. The serum samples from these participants were obtained and stored in a pre-COVID-19 period, thus they were not expected to have COVID-19. In the second group of true positive cases, we chose to replace natural cases of COVID-19 by 96 participants who were expected to have produced anti-SARS-CoV-2 IgG antibodies 30-60 days after the vaccine booster dose. The serum samples were collected on the same day that LFIA were tested either by EIA or CLIA. The third study group was composed of 52 participants (12 adults and 40 children) who did or did not have anti-SARS-CoV-2 IgG antibodies due to specific clinical scenarios. The 12 adults had been vaccinated more than seven months before LFIA testing, and the 40 children had non-severe COVID-19 diagnosed using RT-PCR during the acute phase of infection. They were referred for outpatient follow-up and during this period the serum samples were collected and tested by CLIA and LFIA. All tests were performed by the same healthcare operator and there was no variation of LFIA results when tests were performed on finger prick whole blood or serum samples, so that results were grouped for analysis. LFIA’s sensitivity in detecting anti-SARS-CoV-2 IgG antibodies was 90%, specificity 97.6%, efficiency 93%, PPV 98.3%, NPV 86.6%, and likelihood ratio for a positive or a negative result were 37.5 and 0.01 respectively. There was a good agreement (Kappa index of 0.677) between LFIA results and serological (EIA or CLIA) results. In conclusion, LFIA analyzed in this study showed a good technical performance and agreement with reference serological assays (EIA or CLIA), therefore it can be recommended for use in the outpatient follow-up of non-severe cases of COVID-19 and to assess anti-SARS-CoV-2 IgG antibody production induced by vaccination and the antibodies decrease over time. However, LFIAs should be confirmed by using reference serological assays whenever possible

RECONSTITUIÇÃO PALEOAMBIENTAL DE DUNAS VEGETADAS NA CAATINGA EM ARACATI, CEARÁ, ATRAVÉS DE BIOMINERALIZAÇÕES DE SÍLICA

Ce travail fait partie d'un projet qui étudie les sols et les plantes de Caatinga, en les reliant à la géomorphologie, au climat et au type de couverture végétale de l'écorégion de Dépression Sertaneja Setentrionelle. L'objectif est d'étudier les modifications de la végétation liées aux variations climatiques du Quaternaire par le biais de biominéralisations de silice, d'analyses pédologiques, d'isotopes de carbone et de relevés floristiques. Des échantillons ont été prélevés dans un profil de sol et de 8 familles de plantes à Aracati, Ceará. Toutes les plantes étudiées produisent des phytolithes sauf Poincianella bracteosa. L'analyse δ13C indique la présence de plantes C3. Des mégascleres de spicules marines ont été trouvées. Il existe une prédominance des grains grossiers mais les fractions fines augmentent avec la profondeur. Les phytolithes sont bien conservés, avec une prédominance de types bulliform, acicular et globular. La densité des arbres augmente entre environ 2300 et 700 ans cal. AP, indiquant des moments où l’environnement et le climat était relativement plus humides qu’au présent.Este trabalho faz parte de um projeto que estuda solos e plantas da Caatinga, relacionando-os com a geomorfologia, clima e tipo de cobertura vegetal na Ecorregião da Depressão Sertaneja Setentrional. O objetivo é estudar mudanças na vegetação ligadas a variações climáticas do Quaternário, através de biomineralizações de sílica, análises pedológicas, isótopos de carbono e levantamento florístico. Foram coletadas amostras em um perfil de solo e amostras de 8 famílias de plantas em Aracati, CE. Todas as plantas estudadas produzem fitólitos, exceto Poincianella bracteosa. O δ13C indica presença de plantas C3. Foram encontradas megascleras de espículas marinhas. Há predominância de granulometria grossa, porém aumentam as frações finas com a profundidade. Os fitólitos estão bem preservados, com predominância dos tipos bulliform, acicular e globular. A densidade arbórea aumenta nos períodos de cerca de 2300 e 700 anos cal AP, indicando momentos de ambiente e clima relativamente mais úmido que o atual

A Brazilian university hospital position regarding transplantation criteria for HIV-positive patients according to the current literature

Human immunodeficiency virus (HIV) infection was considered a contraindication for solid organ transplantation (SOT) in the past. However, HIV management has improved since highly active antiretroviral therapy (HAART) became available in 1996, and the long-term survival of patients living with HIV has led many transplant programs to reevaluate their policies regarding the exclusion of patients with HIV infection. Based on the available data in the medical literature and the cumulative experience of transplantation in HIVpositive patients at our hospital, the aim of the present article is to outline the criteria for transplantation in HIVpositive patients as recommended by the Immunocompromised Host Committee of the Hospital das Clı´nicas of the University of Sa˜o Paulo

Differences in children and adolescents with SARS-CoV-2 infection: a cohort study in a Brazilian tertiary referral hospital

OBJECTIVES: To compare demographic/clinical/laboratory/treatments and outcomes among children and adolescents with laboratory-confirmed coronavirus disease 2019 (COVID-19). METHODS: This was a cross-sectional study that included patients diagnosed with pediatric COVID-19 (aged &lt;18 years) between April 11, 2020 and April 22, 2021. During this period, 102/5,951 (1.7%) of all admissions occurred in neonates, children, and adolescents. Furthermore, 3,962 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) detection samples were processed in patients aged &lt;18 years, and laboratory-confirmed COVID-19 occurred in 155 (4%) inpatients and outpatients. Six/155 pediatric patients were excluded from the study. Therefore, the final group included 149 children and adolescents (n=97 inpatients and 52 outpatients) with positive SARS-CoV-2 results. RESULTS: The frequencies of sore throat, anosmia, dysgeusia, headache, myalgia, nausea, lymphopenia, pre-existing chronic conditions, immunosuppressive conditions, and autoimmune diseases were significantly reduced in children and adolescents (p&lt;0.05). Likewise, the frequencies of enoxaparin use (p=0.037), current immunosuppressant use (p=0.008), vasoactive agents (p=0.045), arterial hypotension (p&lt;0.001), and shock (p=0.024) were significantly lower in children than in adolescents. Logistic regression analysis showed that adolescents with laboratory-confirmed COVID-19 had increased odds ratios (ORs) for sore throat (OR 13.054; 95% confidence interval [CI] 2.750-61.977;&nbsp;p=0.001), nausea (OR 8.875; 95% CI 1.660-47.446;&nbsp;p=0.011), and lymphopenia (OR 3.575; 95% CI 1.355-9.430;&nbsp;p=0.010), but also had less hospitalizations (OR 0.355; 95% CI 0.138-0.916;&nbsp;p=0.032). The additional logistic regression analysis on patients with preexisting chronic conditions (n=108) showed that death as an outcome was significantly associated with pediatric severe acute respiratory syndrome (SARS) (OR 22.300; 95% CI 2.341-212.421;&nbsp;p=0.007) and multisystem inflammatory syndrome in children (MIS-C) (OR 11.261; 95% CI 1.189-106. 581;&nbsp;p=0.035). CONCLUSIONS: Half of the laboratory-confirmed COVID-19 cases occurred in adolescents. Individuals belonging to this age group had an acute systemic involvement of SARS-CoV-2 infection. Pediatric SARS and MIS-C were the most important factors associated with the mortality rate in pediatric chronic conditions with COVID-19