Dimensionamento de sumidouros: estudo de caso no município de Paragominas – PA: Sizing of sinks: a case study in the city of Paragominas – PA

A inexistência de alternativas coletivas de coleta e tratamento de esgoto em comunidades distantes dos centros urbanos faz com que seja primordial o estudo de alternativas descentralizadas mais adequadas e eficientes para cada região. Neste trabalho foi realizado estudo para determinar o per capta de consumo de água e esgoto nas penitenciárias do estado do Pará e ensaios de infiltração para subsidiar o dimensionamento de sumidouros que receberão os efluentes de uma Estação de Tratamento de Esgoto (ETE) compacta de um presídio localizado no município de Paragominas/Pa. Após a análise dos resultados, chegou-se a um per capita de água de aproximadamente 238 l/hab.dia e nos pontos estudados obteve-se uma média ponderada da taxa de percolação igual a 148,98 min/m, o que corresponde a um coeficiente de infiltração de 0,105m3/m2.dia. Assim, concluiu-se que o per capita de esgoto para o sistema prisional do Pará é de 190 l/hab.dia, 25,37% superior às demais unidades prisionais, e que seria necessária uma área de infiltração de 644,2 m², o que acarretaria uma grande área de implantação, tornando mais viável o projeto de reaproveitamento do efluente tratado

Global disparities in surgeons’ workloads, academic engagement and rest periods: the on-calL shIft fOr geNEral SurgeonS (LIONESS) study

: The workload of general surgeons is multifaceted, encompassing not only surgical procedures but also a myriad of other responsibilities. From April to May 2023, we conducted a CHERRIES-compliant internet-based survey analyzing clinical practice, academic engagement, and post-on-call rest. The questionnaire featured six sections with 35 questions. Statistical analysis used Chi-square tests, ANOVA, and logistic regression (SPSS® v. 28). The survey received a total of 1.046 responses (65.4%). Over 78.0% of responders came from Europe, 65.1% came from a general surgery unit; 92.8% of European and 87.5% of North American respondents were involved in research, compared to 71.7% in Africa. Europe led in publishing research studies (6.6 ± 8.6 yearly). Teaching involvement was high in North America (100%) and Africa (91.7%). Surgeons reported an average of 6.7 ± 4.9 on-call shifts per month, with European and North American surgeons experiencing 6.5 ± 4.9 and 7.8 ± 4.1 on-calls monthly, respectively. African surgeons had the highest on-call frequency (8.7 ± 6.1). Post-on-call, only 35.1% of respondents received a day off. Europeans were most likely (40%) to have a day off, while African surgeons were least likely (6.7%). On the adjusted multivariable analysis HDI (Human Development Index) (aOR 1.993) hospital capacity > 400 beds (aOR 2.423), working in a specialty surgery unit (aOR 2.087), and making the on-call in-house (aOR 5.446), significantly predicted the likelihood of having a day off after an on-call shift. Our study revealed critical insights into the disparities in workload, access to research, and professional opportunities for surgeons across different continents, underscored by the HDI

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

The Church and School in the perspective of musical practices in historical American schools professing the protestant faith (São Paulo: 1870 1920).

A pesquisa teve como objetivo estudar as escolas americanas de confissão protestante na província e depois estado se São Paulo, na perspectiva de conhecer como se deu a presença da música nestas escolas. O período que está sendo enfocado nesta pesquisa é de 1870 a 1920. A educação musical no período é um campo particularmente fértil, por não ter sido suficientemente estudada, seja no campo da História da Educação ou no campo da Educação Musical. Neste período, verifica-se uma nova conformação cultural que se deu na sociedade brasileira e, em particular na sociedade paulista, com a presença das denominações protestantes no Brasil e o desenvolvimento de uma rede de escolas americanas protestantes num cenário onde circulavam as tradicionais influências portuguesas, francesas e alemãs. Apoiada na bibliografia, esta pesquisa constatou que essas escolas se apresentavam enquanto a possibilidade de uma melhor formação, que a oferecida pelas escolas nacionais, sendo por isso, apoiadas pelos liberais e republicanos, os quais valorizavam o seu caráter democrático, os métodos atualizados e um particular interesse pela educação feminina. Foi retomado o estudo da inserção da música a partir da Reforma Protestante com o propósito de entender como foi utilizada a música na igreja e para verificar se esta teria influenciado o ensino da música nas escolas americanas dessa confissão. Em seguida foram estudadas três escolas protestantes em São Paulo ligadas a três Igrejas Históricas (Presbiteriana, Metodista e Batista), bem como o repertório musical nelas praticado, com o objetivo de comprovar se aquele movimento se verificou também nesse episódio histórico da educação paulista, trabalhando no campo interdisciplinar de pesquisa. Utilizamos como fontes primárias entre outros materiais inéditos, partituras e coletâneas musicais.The research aimed at studying American schools professing the protestant faith in the province and then the state of São Paulo, in the perspective of getting to know the ways in which music was present in these schools. The time period focused in this research ranges from 1870 to 1920. Musical education in this period is a particularly rich field as it has not been studied thoroughly enough whether in the field of the History of Education or in that of Musical Education. A new cultural framework is apparent as having taken place in the Brazilian society, markedly in the society of São Paulo, resulting from the presence of protestant denominations in Brazil and the development of a network of American protestant schools in a setting where traditional Portuguese, French and German influences were present. Supported by the bibliography, this research evidenced that these schools seemed to provide better quality of education than that of the national schools, being therefore supported by the liberals and republicans who valued their democratic nature, updated methodology and noteworthy interest in female education. The study of the insertion of music starting with the Protestant Reformation was resumed with the intent of understanding how music was used in the church and to verify if the later may have influenced the teaching of music in the American schools which professed such faith. Afterwards, working in the interdisciplinary field of research, three protestant schools located in São Paulo were studied, which are associated with three Historical churches (Presbyterian, Methodist and Baptist), as well as the musical repertoire practiced in them, with the intent of attesting if that movement was also present in this historical episode of education n São Paulo. Partitions and musical collections, among other unique material, were used as primary source

The Church and School in the perspective of musical practices in historical American schools professing the protestant faith (São Paulo: 1870 1920).

A pesquisa teve como objetivo estudar as escolas americanas de confissão protestante na província e depois estado se São Paulo, na perspectiva de conhecer como se deu a presença da música nestas escolas. O período que está sendo enfocado nesta pesquisa é de 1870 a 1920. A educação musical no período é um campo particularmente fértil, por não ter sido suficientemente estudada, seja no campo da História da Educação ou no campo da Educação Musical. Neste período, verifica-se uma nova conformação cultural que se deu na sociedade brasileira e, em particular na sociedade paulista, com a presença das denominações protestantes no Brasil e o desenvolvimento de uma rede de escolas americanas protestantes num cenário onde circulavam as tradicionais influências portuguesas, francesas e alemãs. Apoiada na bibliografia, esta pesquisa constatou que essas escolas se apresentavam enquanto a possibilidade de uma melhor formação, que a oferecida pelas escolas nacionais, sendo por isso, apoiadas pelos liberais e republicanos, os quais valorizavam o seu caráter democrático, os métodos atualizados e um particular interesse pela educação feminina. Foi retomado o estudo da inserção da música a partir da Reforma Protestante com o propósito de entender como foi utilizada a música na igreja e para verificar se esta teria influenciado o ensino da música nas escolas americanas dessa confissão. Em seguida foram estudadas três escolas protestantes em São Paulo ligadas a três Igrejas Históricas (Presbiteriana, Metodista e Batista), bem como o repertório musical nelas praticado, com o objetivo de comprovar se aquele movimento se verificou também nesse episódio histórico da educação paulista, trabalhando no campo interdisciplinar de pesquisa. Utilizamos como fontes primárias entre outros materiais inéditos, partituras e coletâneas musicais.The research aimed at studying American schools professing the protestant faith in the province and then the state of São Paulo, in the perspective of getting to know the ways in which music was present in these schools. The time period focused in this research ranges from 1870 to 1920. Musical education in this period is a particularly rich field as it has not been studied thoroughly enough whether in the field of the History of Education or in that of Musical Education. A new cultural framework is apparent as having taken place in the Brazilian society, markedly in the society of São Paulo, resulting from the presence of protestant denominations in Brazil and the development of a network of American protestant schools in a setting where traditional Portuguese, French and German influences were present. Supported by the bibliography, this research evidenced that these schools seemed to provide better quality of education than that of the national schools, being therefore supported by the liberals and republicans who valued their democratic nature, updated methodology and noteworthy interest in female education. The study of the insertion of music starting with the Protestant Reformation was resumed with the intent of understanding how music was used in the church and to verify if the later may have influenced the teaching of music in the American schools which professed such faith. Afterwards, working in the interdisciplinary field of research, three protestant schools located in São Paulo were studied, which are associated with three Historical churches (Presbyterian, Methodist and Baptist), as well as the musical repertoire practiced in them, with the intent of attesting if that movement was also present in this historical episode of education n São Paulo. Partitions and musical collections, among other unique material, were used as primary source

Equipamentos de Proteção Individual Impressos em 3D por Instituições de Ensino Federais para o Enfrentamento da COVID-19

A coronavirus pandemic (SARS-CoV-2), associated with a shortage of Personal Protective Equipment (PPEs) presents itself as a threat to global health. The objective of the study was to identify a production of PPE printed in 3D, in Federal Education Institutions in the confrontation of COVID-19. The research source of the Ministry of Education's Monitoring database in the Teaching Institutions. To date, 89 institutions were producing three different 3D PPE models. The models found were “Face Shield” face protectors, models of masks similar to N-95 and a dome in a semi-cylindrical shape. Federal Education Institutions are making technology and science available to Brazilian society in the fight against COVID-19, seeking to respond to the global crisis with 3D printing, safely, with innovation, low cost and rapid production. A pandemia causada pelo coronavírus (SARS-CoV-2), associada à escassez dos Equipamentos de Proteção Individuais (EPIs), apresenta-se como uma ameaça à saúde global. O objetivo do estudo foi identificar a produção de EPIs impressos em 3D nas Instituições de Ensino Federais para o enfrentamento da COVID-19. A fonte de pesquisa foi o banco de dados do Portal do Ministério da Educação de Monitoramento nas Instituições de Ensino. Até o momento, 89 instituições estavam produzindo três modelos diferentes de EPIs em 3D. Os modelos encontrados foram os Protetores Faciais tipo “Face Shield”, as máscaras similares ao modelo N-95 e a máscara com uma cúpula em formato semicilíndrico. As Instituições de Ensino Federais estão colocando a tecnologia e a ciência à disposição da sociedade brasileira no combate à COVID-19, buscando responder à crise global com a impressão 3D, de forma segura, com inovação, baixo custo e com rápida produção