Maintenance of Gains, Morbidity, and Mortality at 1 Year Following Cardiac Rehabilitation in a Middle‐Income Country: A Wait‐List Control Crossover Trial

Background-—Despite the epidemic of cardiovascular diseases in middle-income countries, few trials are testing the benefits of cardiac rehabilitation (CR). This trial assessed (1) maintenance of functional capacity, risk factor control, knowledge, and hearthealth behaviors and (2) mortality and morbidity at 6 months following CR in a middle-income country. Methods and Results-—Eligible Brazilian coronary patients were initially randomized (1:1:1 concealed) to 1 of 3 parallel arms (comprehensive CR [exercise plus education], exercise-only CR, or wait-list control). The CR programs were 6 months in duration, at which point follow-up assessments were performed. Mortality and morbidity were ascertained from chart and patient or family report (blinded). Controls were then offered CR (crossover). Outcomes were again assessed 6 months later (blinded). ANCOVA was performed for each outcome at 12 months. Overall, 115 (88.5%) patients were randomized, and 62 (53.9%) were retained at 1 year. At 6 months, 23 (58.9%) of those 39 initially randomized to the wait-list control elected to attend CR. Functional capacity, risk factors, knowledge, and heart-health behaviors were maintained from 6 to 12 months in participants from both CR arms (all P>0.05). At 1 year, knowledge was significantly greater with comprehensive CR at either time point (P<0.001). There were 2 deaths. Hospitalizations (P=0.03), nonfatal myocardial infarctions (P=0.04), and percutaneous coronary interventions (P=0.03) were significantly fewer with CR than control at 6 months. Conclusions-—CR participation is associated with lower morbidity, long-term maintenance of functional capacity, risk factors, and heart-health behaviors, as well as with greater cardiovascular knowledge compared with no CR. Clinical Trial Registration-—URL: http://www.clinicaltrials.gov. Unique identifier: NCT02575976. (J Am Heart Assoc. 2019;8: e011228. DOI: 10.1161/JAHA.118.011228.) Key Words: cardiac rehabilitation • coronary disease • morbidity/mortality • rehabilitation • risk factorYork University Librarie

Barriers to cardiac rehabilitation delivery in a low-resource setting from the perspective of healthcare administrators, rehabilitation providers, and cardiac patients

Background: Despite clinical practice guideline recommendations that cardiovascular disease patients participate, cardiac rehabilitation (CR) programs are highly unavailable and underutilized. This is particularly true in low-resource settings, where the epidemic is at its’ worst. The reasons are complex, and include health system, program and patient-level barriers. This is the first study to assess barriers at all these levels concurrently, and to do so in a lowresource setting. Methods: In this cross-sectional study, data from three cohorts (healthcare administrators, CR coordinators and patients) were triangulated. Healthcare administrators from all institutions offering cardiac services, and providers from all CR programs in public and private institutions of Minas Gerais state, Brazil were invited to complete a questionnaire. Patients from a random subsample of 12 outpatient cardiac clinics and 11 CR programs in these institutions completed the CR Barriers Scale. Results: Thirty-two (35.2%) healthcare administrators, 16 (28.6%) CR providers and 805 cardiac patients (305 [37.9%] attending CR) consented to participate. Administrators recognized the importance of CR, but also the lack of resources to deliver it; CR providers noted referral is lacking. Patients who were not enrolled in CR reported significantly greater barriers related to comorbidities/functional status, perceived need, personal/family issues and access than enrollees, and enrollees reported travel/work conflicts as greater barriers than non-enrollees (all p < 0.01). Conclusions: The inter-relationship among barriers at each level is evident; without resources to offer more programs, there are no programs to which physicians can refer (and hence inform and encourage patients to attend), and patients will continue to have barriers related to distance, cost and transport. Advocacy for services is needed. Keywords: Health care services, Cardiac rehabilitation, Cardiac care facilities, Attitude of health personnelYork University Librarie

Assisted Reproductive Techniques on South American Wild Mammals

For South American wild mammals, assisted reproductive techniques (ARTs) have been established in accordance with the procedures used for domestic mammals. However, often, it is not possible to infer the experimental conditions from one species to another. In general, the use of these ARTs aims the conservation of the animal genetic material, using gamete manipulation, embryo technology by in vivo or in vitro methods, and cloning. In all animals, the previous knowledge of reproductive physiology becomes the starting point for the use of ARTs in the expansion of all species of interest. In this sense, the purpose of this chapter is to develop an approach of theoretical, technical, and applied aspects of the ARTs in South American wild mammals, with emphasis on the state-of-the-art and its progress and perspectives

Not just the river: Genes, shapes, and sounds reveal population-structured diversification in the Amazonian frog Allobates tapajos (Dendrobatoidea)

In the Amazon basin, the distribution of many vertebrate species is delimited by large rivers, which are frequently considered as biogeographical barriers strongly related to the origin and maintenance of the elevated biodiversity found in the region. In this study, we conducted a phylogeographical investigation of the effect of the Tapajós River on multiple classes of genotypic and phenotypic characters in a species of frog, Allobates tapajos. We sampled populations throughout the known distributional range of the species on both margins of the middle and lower sections of the river. We obtained fragments of mitochondrial (16S) and nuclear (RAG1) genes, as well as external morphometric measurements and advertisement call acoustic parameters of 48 individuals from six localities (populations). While the nuclear marker was monomorphic across the geographic distribution of A. tapajos, the mitochondrial fragment revealed low genetic distances accompanied by high spatial structuring, with restricted and absent haplotype sharing between populations and opposite river margins, respectively. Cladogenetic events were concentrated in the Pleistocene epoch, the time period corresponding to the establishment of the Tapajós River drainage. Acoustic parameters diverged between river margins, a pattern not observed in relation to the morphological markers analysed. There was no correlation in the variability pattern of the different classes of characters between them or in relation to linear geographic distance among populations. In addition, discriminant function analyses correctly assigned most of the individuals to their populations based on phenotypic characters. Our results show that the distribution of the variability within A. tapajos is affected not only by the transposition of a historical riverine barrier but also mostly by an elevated genotypic and phenotypic structure at the population level. © 2017 The Linnean Society of London

Cardiac Rehabilitation Models around the Globe.

Alternative models of cardiac rehabilitation (CR) delivery, such as home or community-based programs, have been developed to overcome underutilization. However, their availability and characteristics have never been assessed globally. In this cross-sectional study, a piloted survey was administered online to CR programs globally. CR was available in 111/203 (54.7%) countries globally; data were collected in 93 (83.8% country response rate). 1082 surveys (32.1% program response rate) were initiated. Globally, 85 (76.6%) countries with CR offered supervised programs, and 51 (45.9%; or 25.1% of all countries) offered some alternative model. Thirty-eight (34.2%) countries with CR offered home-based programs, with 106 (63.9%) programs offering some form of electronic CR (eCR). Twenty-five (22.5%) countries with CR offered community-based programs. Where available, programs served a mean of 21.4% ± 22.8% of their patients in home-based programs. The median dose for home-based CR was 3 sessions (Q25-Q75 = 1.0⁻4.0) and for community-based programs was 20 (Q25⁻Q75 = 9.6⁻36.0). Seventy-eight (47.0%) respondents did not perceive they had sufficient capacity to meet demand in their home-based program, for reasons including funding and insufficient staff. Where alternative CR models are offered, capacity is insufficient half the time. Home-based CR dose is insufficient to achieve health benefits. Allocation to program model should be evidence-based

Curriculum, evaluation and the constitution of the teaching subject.

O presente artigo analisa de modo articulado: a. o dispositivo curricular do Estado de Minas Gerais ? Conte?dos B?sicos Comuns (CBC) ? e b. o dispositivo avaliativo a ele atrelado ? Sistema Mineiro de Avalia??o da Educa??o P?blica (SIMAVE) a partir da compreens?o de que as pr?ticas neoliberais presentes no Estado e na sociedade enquadram o curr?culo e a avalia??o sob a ?tica da economia. O vi?s de an?lise toma o neoliberalismo como uma forma de governo no sentido foucaultiano, ou seja, que produz processos de subjetiva??o sobre as popula??es docentes da rede p?blica estadual de Minas Gerais. Desse modo, o neoliberalismo usa a educa??o de forma interessada na produ??o do sujeito para o mercado, como um importante mecanismo do Capital Humano. Seguindo essa trilha te?ricometodol?gica, investigamos empiricamente as mudan?as em curso expressas em documentos oficiais da Secretaria de Estado de Educa??o de Minas Gerais (especialmente relacionados ao CBC e ao SIMAVE). Os resultados apontam o CBC como uma proposta sintonizada com o Choque de Gest?o do governo de estado de 2003 a 2014 que coloca a educa??o do estado de Minas Gerais sob mecanismos de regula??o gerencial e de resultados, ambos a favor da economia. Conclu?mos que a partir da articula??o entre o CBC e o SIMAVE atuam pr?ticas de mercado gerenciais e perform?ticas por meio de uma s?rie de poderes e saberes que a ela est?o associados, tornando as propostas curriculares supostamente indissoci?veis dessas pr?ticas e dos processos de subjetiva??o dos docentes.This paper analyzes in an articulated manner: a. the Minas Gerais State curriculum ? Common Basic Content (CBC, Brazilian Portuguese abbreviation) ? and b. the evaluation guidelines linked to it ? Public Education Evaluation System of Minas Gerais (SIMAVE, Brazilian Portuguese abbreviation) from the understanding that neoliberal practices frame the curriculum and the evaluation within the economy perspective. The analysis approach takes neoliberalism as a government system in the Foucauldian sense, that is, one which produces processes of subjectivation on the teaching population in the State education system in Minas Gerais. Therefore, neoliberalism uses education aiming at preparing the individuals to the market, as an important mechanism of the Human Capital. Following this theoretical-methodological route, we investigated empirically the ongoing changes expressed in the official documents issued by the Minas Gerais State Education Secretariat (mainly those related to the CBC and SIMAVE). The results show the CBC as a proposal which is in tune with the Management Chock of the State Government from 2003 to 2014 which places the education in the State of Minas Gerais under regulating mechanisms of management and results, both in favor of the economy. The conclusion points to the articulation between CBC and SIMAVE acting as managerial and performing market practices through a number of powers and knowledges associated to it, making the curriculum proposal supposedly inseparable from such practices

Communication tools used by distributed teams in a BIM learning project

The constant changes in the world market demand flexible and fluid organizational structures, such as rotating and engaging human effort, to provide high performance. Therefore, organizations make use of distributed multicultural teams, meetings, and online lead projects. However, these social categorization processes can become a disadvantage if trigger potential conflicts during task performance. Distributed teams can also be difficult to manage, and their members can face extra adversities in communication. Architecture, Engineering and Construction Industry (AEC), is a context where the use of distributed teams is growing significantly, particularly through the enabling features of Building Information Modelling (BIM) methodologies. This paper was aimed at the diagnosis of communication behaviour in distributed teams in the context of a PBL methodology that requested students to work in distributed teams on two distinct locations. For that, the authors managed a workshop on Lean Project Management and Collaborative Tools in the European Master in Building Information Modelling (BIM A+) using a Lego for Scrum activity, adapted to a team of students distributed in Portugal and Slovenia. After that, nine distributed teams of students had to design exposition pavilions in BIM platform and using collaborative tools. At the end, each team had to present the project for the entire body of students and faculty, located in Guimaraes (Portugal) and Ljubljana (Slovenia).- (undefined

Curriculum, evaluation and the constitution of the teaching subject.

O presente artigo analisa de modo articulado: a. o dispositivo curricular do Estado de Minas Gerais ? Conte?dos B?sicos Comuns (CBC) ? e b. o dispositivo avaliativo a ele atrelado ? Sistema Mineiro de Avalia??o da Educa??o P?blica (SIMAVE) a partir da compreens?o de que as pr?ticas neoliberais presentes no Estado e na sociedade enquadram o curr?culo e a avalia??o sob a ?tica da economia. O vi?s de an?lise toma o neoliberalismo como uma forma de governo no sentido foucaultiano, ou seja, que produz processos de subjetiva??o sobre as popula??es docentes da rede p?blica estadual de Minas Gerais. Desse modo, o neoliberalismo usa a educa??o de forma interessada na produ??o do sujeito para o mercado, como um importante mecanismo do Capital Humano. Seguindo essa trilha te?ricometodol?gica, investigamos empiricamente as mudan?as em curso expressas em documentos oficiais da Secretaria de Estado de Educa??o de Minas Gerais (especialmente relacionados ao CBC e ao SIMAVE). Os resultados apontam o CBC como uma proposta sintonizada com o Choque de Gest?o do governo de estado de 2003 a 2014 que coloca a educa??o do estado de Minas Gerais sob mecanismos de regula??o gerencial e de resultados, ambos a favor da economia. Conclu?mos que a partir da articula??o entre o CBC e o SIMAVE atuam pr?ticas de mercado gerenciais e perform?ticas por meio de uma s?rie de poderes e saberes que a ela est?o associados, tornando as propostas curriculares supostamente indissoci?veis dessas pr?ticas e dos processos de subjetiva??o dos docentes.This paper analyzes in an articulated manner: a. the Minas Gerais State curriculum ? Common Basic Content (CBC, Brazilian Portuguese abbreviation) ? and b. the evaluation guidelines linked to it ? Public Education Evaluation System of Minas Gerais (SIMAVE, Brazilian Portuguese abbreviation) from the understanding that neoliberal practices frame the curriculum and the evaluation within the economy perspective. The analysis approach takes neoliberalism as a government system in the Foucauldian sense, that is, one which produces processes of subjectivation on the teaching population in the State education system in Minas Gerais. Therefore, neoliberalism uses education aiming at preparing the individuals to the market, as an important mechanism of the Human Capital. Following this theoretical-methodological route, we investigated empirically the ongoing changes expressed in the official documents issued by the Minas Gerais State Education Secretariat (mainly those related to the CBC and SIMAVE). The results show the CBC as a proposal which is in tune with the Management Chock of the State Government from 2003 to 2014 which places the education in the State of Minas Gerais under regulating mechanisms of management and results, both in favor of the economy. The conclusion points to the articulation between CBC and SIMAVE acting as managerial and performing market practices through a number of powers and knowledges associated to it, making the curriculum proposal supposedly inseparable from such practices

The lizards along the road BR-319 in the Purus-Madeira interfluve, Brazilian Amazonia (Squamata, Lacertilia)

Here we present data on the identity and geographic distribution of lizard taxa in the Purus-Madeira interfluve, along the road BR-319 in Brazilian Amazonia. We sampled 10 modules located at least 40 kilometres from each other. Data collection was performed through active search on vegetation and leaf-litter along 250 m-long transects, and by occasional encounters. Twenty-five taxa from 16 genera and eight families were recorded. The present assessment reinforces the importance of this area to the conservation of Amazonian lizards and should be considered as basis for studies of ecology and environmental impact regarding lizard communities in this threatened region. © 2019, Societas Europaea Herpetologica. All rights reserved

Objective assessment of the cryoprotective effects of dimethylformamide for freezing goat semen

AbstractThe aim of this work was to assess the cryoprotective effects of dimethylformamide (DMF) for freezing goat semen, using an objective analysis by computer-assisted sperm analysis (CASA). Twenty-one ejaculates (seven per animal) were collected from three stud bucks with the aid of an artificial vagina and immediately evaluated for gross and microscopic characteristics. The semen was diluted in two steps with a Tris–egg yolk extender containing 6% glycerol or 6% DMF, frozen in 0.50-mL straws, and stored in liquid nitrogen. Samples were accessed for sperm morphology, sperm membrane structural and functional integrity, and by CASA, immediately after thawing. There were differences (P<0.05) between glycerol and DMF with regard to subjective progressive motility (23.9±2.2% vs. 16.6±2.0%), objective progressive motility (3.5±0.4% vs. 1.8±0.3%), linearity (53.9±1.6% vs. 48.1±1.4%) and amplitude of lateral head (2.3±0.1 vs. 2.9±0.1mm), which confirmed the efficiency of glycerol. In conclusion, dimethylformamide could be used as an alternative cryoprotectant for goat semen freezing. However it was showed that no benefits were derived by using dimethylformamide to replace glycerol at an equal 6% concentration