Os meandros da memória em Tropical sol da liberdade: descortinando 1968 pelo olhar da mulher brasileira

We recognize the widespread assumption that the novel Tropical sol da liberdade establishes connections with its historical referent ”“ Brazilian military dictatorship ”“ placing itself by an aestheticbias, as a new look at this time: of trampled dreams, but also of struggle and transformation. In being so, this paper aims to observe which stylistic features are used in its formal constructionat the approach to the historical material and which perspective is produced by Ana Maria Machado’s novel relationship of literature/history/memory.Ao reconhecer a consideração já difundida de que Tropical sol da liberdade estabelece conexões com o referente histórico ”“ ditadura brasileira dos militares ”“ colocando-se dessa forma e pelo viés do estético, como um novo olhar sobre esse período: de sonhos pisoteados, mas também de luta e de transformação, o presente artigo se propõe a observar que recursos estilísticos são utilizados em sua construção formal na abordagem do material histórico e que perspectiva sobre a relação literatura/história/memória o romance de Ana Maria Machado produz

Atitudes para a colaboração interprofissional de equipes da Atenção Primária participantes do Programa Mais Médicos

Objetivos: comparar atitudes em relação à colaboração interprofissional de profissionais de saúde componentes de equipes da Estratégia Saúde da Família, participantes do Programa Mais Médicos, bem como identificar fatores associados a atitudes de colaboração interprofissional. Método: estudo descritivo, transversal e comparativo, desenvolvido com 63 profissionais de saúde que responderam à Escala Jefferson de Atitudes Relacionadas à Colaboração Interprofissional. Os dados foram analisados estatisticamente. Resultados: o somatório dos itens da escala variou de 88 a 139 pontos. A análise do conjunto das equipes de Saúde da Família indicou diferenças estatísticas significantes entre os escores da escala e a categoria profissional e entre os escores e a escolaridade, sugerindo que os enfermeiros e os profissionais com nível superior são mais inclinados para a prática colaborativa. A análise segundo o perfil do médico – brasileiro, intercambista ou cubano – não determinou diferenças estatísticas nos escores dos médicos, tampouco nos escores dos componentes das equipes de diferentes perfis. Conclusão: o perfil não sugeriu maior ou menor inclinação, com significância estatística, dos médicos ou das equipes para o trabalho interprofissional. Este estudo pode constituir subsídio para novas investigações que contribuam para análise sobre a colaboração interprofissional e o impacto do Programa Mais Médicos.Objectives: to compare the attitudes regarding interprofessional collaboration of health professionals that make up the Family Health Strategy teams participating in the ‘More Doctors’ (Mais Médicos) program; and to identify factors associated with attitudes of interprofessional collaboration. Method: a descriptive, transversal and comparative study developed with 63 health professionals who responded to the Jefferson Scale of Attitudes Toward Interprofessional Collaboration. The data were statistically analyzed. Results: the sum of the scale items ranged from 88 to 139 points. The analysis of all the Family Health teams indicated statistically significant differences between the scores of the scale and the professional category and between the scores and the education level, suggesting that nurses and professionals with higher education are more inclined towards collaborative practice. The analysis according to the profile of the doctor - Brazilian, Cuban or foreign exchange doctor - found no statistical differences regarding the physicians’ scores, nor in the scores of the components of teams with different profiles. Conclusion: the profile did not suggest a statistically significant greater or lesser inclination of the doctors or teams toward interprofessional work. This study can support new studies which will contribute to the analysis of inter-professional collaboration and the impact of the Mais Médicos program.Objetivos: comparar las actitudes en relación a la colaboración interprofesional de profesionales de la salud componentes de equipos de la Estrategia Salud de la Familia, participantes del Programa Más Médicos; e identificar los factores asociados a actitudes de colaboración interprofesional. Método: estudio descriptivo, transversal y comparativo, desarrollado con 63 profesionales de la salud que respondieron a la Escala Jefferson de Actitudes Relacionadas a la Colaboración Interprofesional. Los datos fueron analizados estadísticamente. Resultados: la suma de los ítems de la escala varió de 88 a 139 puntos. El análisis del conjunto de los equipos de la ESF indicó diferencias estadísticas significativas entre los puntajes de la escala y la categoría profesional y entre los puntajes y la escolaridad, sugiriendo que los enfermeros y los profesionales con nivel superior son más inclinados para la práctica colaborativa. El análisis según el perfil del médico - brasileño, participante de intercambio o cubano - no determinó diferencias estadísticas en los puntajes de los médicos ni en los puntajes de los componentes de los equipos de diferentes perfiles. Conclusión: el perfil no sugirió mayor o menor inclinación, con significación estadística, de los médicos o de los equipos para el trabajo interprofesional. Este estudio, inédito en Brasil, puede auxiliar nuevas investigaciones que contribuyan para realizar análisis más robustos sobre la colaboración interprofesional y el impacto del Más Médicos

Birthplace in New South Wales, Australia: An analysis of perinatal outcomes using routinely collected data

Background: The outcomes for women who give birth in hospital compared with at home are the subject of ongoing debate. We aimed to determine whether a retrospective linked data study using routinely collected data was a viable means to compare perinatal and maternal outcomes and interventions in labour by planned place of birth at the onset of labour in one Australian state.Methods: A population-based cohort study was undertaken using routinely collected linked data from the New South Wales Perinatal Data Collection, Admitted Patient Data Collection, Register of Congenital Conditions, Registry of Birth Deaths and Marriages and the Australian Bureau of Statistics. Eight years of data provided a sample size of 258,161 full-term women and their infants. The primary outcome was a composite outcome of neonatal mortality and morbidity as used in the Birthplace in England study.Results: Women who planned to give birth in a birth centre or at home were significantly more likely to have a normal labour and birth compared with women in the labour ward group. There were no statistically significant differences in stillbirth and early neonatal deaths between the three groups, although we had insufficient statistical power to test reliably for these differences.Conclusion: This study provides information to assist the development and evaluation of different places of birth across Australia. It is feasible to examine perinatal and maternal outcomes by planned place of birth using routinely collected linked data, although very large data sets will be required to measure rare outcomes associated with place of birth in a low risk population, especially in countries like Australia where homebirth rates are low. © 2014 Homer et al.; licensee BioMed Central Ltd

Life cycle assessment of biofuels from Jatropha curcas in West Africa: a field study

In recent years, liquid biofuels for transport have benefited from significant political support due to their potential role in curbing climate change and reducing our dependence on fossil fuels. They may also participate to rural development by providing new markets for agricultural production. However, the growth of energy crops has raised concerns due to their high consumption of conventional fuels, fertilizers and pesticides, their impacts on ecosystems and their competition for arable land with food crops. Lowinput species such as Jatropha curcas, a perennial, inedible crop well adapted to semiarid regions, has received much interest as a new alternative for biofuel production, minimizing adverse effects on the environment and food supply. Here, we used life-cycle assessment to quantify the benefits of J. curcas biofuel production inWest Africa in terms of greenhouse gas emissions and fossil energy use, compared with fossil diesel fuel and other biofuels. Biodiesel from J. curcas has a much higher performance than current biofuels, relative to oil-derived diesel fuels. Under West Africa conditions, J. curcas biodiesel allows a 72% saving in greenhouse gas emissions compared with conventional diesel fuel, and its energy yield (the ratio of biodiesel energy output to fossil energy input) is 4.7. J. curcas production studied is eco-compatible for the impacts under consideration and fits into the context of sustainable development

Variações no calibre das varizes esôfago-gástricas após tratamentos cirúrgicos de hipertensão portal

Um dos mais importantes fatores que levam à hemorragia digestiva por hipertensão portal é o calibre das varizes esôfago-gástricas. Visamos, no presente trabalho, avaliar endoscopicamente as variações de calibre antes e após diferentes cirurgias de hipertensão portal, realizadas em 73 pacientes com esquistossomose hépato-esplênica, no contexto de um estudo controlado e aleatorizado, sendo 24 deles submetidos a Anastomose Espleno-Renal (AER), 24 a Descompressão Portal Seletiva (DPS) e 25 a Desconexão Azigo-Portal com Esplenectomia (DAPE). As avaliações endoscópicas foram realizadas antes e até 10 anos após as cirurgias. O calibre das varizes foi classificado, segundo Palmer como de grau 1- até 3mm, grau 2 de 3 a 6 mm e grau 3 quando maiores do que 6mm de diâmetro, analizadas em quatro localizações anatômicas a saber: terços inferior, médio e superior do esôfago e estômago proximal. A somatória do número de pontos na gradação pré-operatória menos a somatória dos pontos na gradação evolutiva forneceu um número correspondente ao diferencial, que permitiu a comparação estatística entre os diferentes grupos cirúrgicos. Na avaliação qualitativa, bons resultados, correspondendo ao desaparecimento ou diminuição do calibre da varizes, foram encontrados mais freqüentemente após a AER do que DPS ou DAPE - respectivamente 95,8%, 83,3% e 72%. A análise estatística dos diferenciais de gradação demonstrou diferença estatisticamente significante favorecendo a AER em relação à DAPE, não havendo diferenças entre AER e DPS. Em conclusão, as cirurgias de anastomose ("shunt") foram mais eficientes do que a desvascularização, em termos de diminuir o calibre de varizes esôfago-gástricas.The size of gastroesophageal varices is one of the most important factors leading to hemorrhage related to portal hypertension. An endoscopic evaluation of the size of gastroesophageal varices before and after different operations for portal hypertension was performed in 73 patients with schistosomiasis, as part of a randomized trial: proximal splenorenal shunt (PSS n=24), distal splenorenal shunt (DSS n=24), and esophagogastric devascularization with splenectomy (EGDS n=25). The endoscopic evaluation was performed before and up to 10 years after the operations. Variceal size was graded according to Palmer's classification: grade 1 -- up to 3 mm, grade 2 -- from 3 to 6 mm, grade 3 -- greater than 6 mm, and were analyzed in four anatomical locations: inferior, middle or superior third of the esophagus, and proximal stomach. The total number of points in the pre-operative grading minus the number of points in the post-operative grading gave a differential grading, allowing statistical comparison among the surgical groups. Good results, in terms of disappearance or decrease of variceal size, were observed more frequently after PSS than after DSS or EGDS - 95.8%, 83.3%, and 72%, respectively. When differential grading was analyzed, a statistically significant difference was observed between PSS and EGDS, but not between proximal and distal splenorenal shunts. In conclusion, shunt surgeries were more efficient than devascularization in diminishing variceal size

Fisioterapia, Atenção Básica e Interprofissionalidade: reflexões a partir da implementação de um estágio curricular na Comunidade

One of the fields of action of health professionals is Primary Health Care (PHC). The presence of different professional formations within PHC and the articulation between these professionals is fundamental for the integrality of the assistance provided to the population. Collaborative practices and comprehensive care are essential skills that are common to all professionals working in PHC and in the Family Health Strategy. For the World Health Organization (WHO), Interprofessional Health Learning occurs when students and/or professionals from two or more areas learn from each other, about the work of the other, and from each other, aiming to bring benefits to patients. Thus, this experience report aims to report the experience arising from teaching activities carried out in the academic internship of students from the 7th and 8th terms of the Physiotherapy course at Universidade de Ribeirão Preto (UNAERP). The activities were developed in partnership with the Family Health Team of Unit Dr. Vinício Plastino, in the city of Ribeirão Preto, from February 2018 to December 2019. Such activities result from the implementation of an internship that focuses on the professional's performance of physiotherapy at PHC. Within this unit, students from the Medicine, Pharmacy and Physiotherapy courses worked together. After recognizing the territory and the dynamics of the local Family Health Team, the group of interns started a health education work with actions planned in an interprofessional and collaborative way. Based on the perception of the population's health needs, those actions that the team performs in the territory were aligned to the discipline practices - individual and family registration, territorialization, home visits and health education groups; added by those of health promotion specific to physical therapy. The experience in the territory allowed: expanding the students’ experience in the FHS, enabling observation and reflection on teamwork in this context; and sensitize academics to the health needs of the population and discuss these needs through health education. Through experience, physiotherapy students, along with the team and students from other courses in the health area, it was able to resize the importance and complexity of interprofessional work in PHC and, together, develop or improve skills essential to their profession.  Um dos campos de atuação dos profissionais de saúde é a Atenção Básica (AB). A presença de diferentes formações profissionais dentro da AB e a articulação entre esses profissionais é fundamental para a integralidade da assistência prestada à população. As práticas colaborativas e a integralidade do cuidado são habilidades essenciais e comuns a todos os profissionais que atuam na AB e na Estratégia de Saúde da Família. Para a Organização Mundial de Saúde a Educação Interprofissional em Saúde ocorre quando estudantes e/ou profissionais de duas ou mais áreas aprendem com o outro, sobre o trabalho do outro, e entre si, visando trazer benefícios aos pacientes. Dessa forma, este relato de experiência tem como objetivo refletir sobre as atividades realizadas no estágio acadêmico intitulado “Fisioterapia na Saúde Coletiva” dos alunos do 7º e 8º período do curso de Fisioterapia de uma Universidade do interior do Estado de São Paulo. As atividades foram desenvolvidas em parceria com a Equipe de Saúde da Família da Unidade XXX, na cidade de XXX, no período de fevereiro de 2018 a dezembro de 2019. Dentro dessa unidade atuaram conjuntamente estudantes dos cursos de Medicina, Farmácia e Fisioterapia. Após o reconhecimento do território e da dinâmica da Equipe de Saúde da Família local, o grupo de estagiários iniciou um trabalho de educação em saúde com ações planejadas de forma interprofissional e colaborativa. A partir da percepção das necessidades de saúde da população foram alinhadas às práticas da disciplina aquelas ações que a equipe realiza no território - cadastramento individual e familiar, territorialização, visita domiciliar e grupos de educação em saúde; acrescidas por aquelas de promoção da saúde específicas da fisioterapia. e atividades de cadastramento individual e familiar da população, territorialização, visita domiciliar e grupos de educação em saúde. Foram realizadas também atividades de promoção de saúde específicas da fisioterapia. A experiência no território permitiu: ampliar a vivência dos discentes na ESF, possibilitando a observação e a reflexão sobre o trabalho em equipe nesse contexto; e sensibilizar os acadêmicos para as necessidades em saúde da população e discutir essas necessidades a partir da educação em saúde. Através da vivência, os estudantes da fisioterapia, juntamente com a equipe e alunos de outros cursos da área da saúde, puderam redimensionar a importância e a complexidade do trabalho interprofissional na APS e, juntos, desenvolver ou aprimorar habilidades essenciais à sua profissão. &nbsp

Optimising fusion detection through sequential DNA and RNA molecular profiling of non-small cell lung cancer

OBJECTIVES: There is an increasing number of driver fusions in NSCLC which are amenable to targeted therapy. Panel testing for fusions is increasingly appropriate but can be costly and requires adequate good quality biopsy material. In light of the typical mutual exclusivity of driver events in NSCLC, the objective of this study was to trial a novel testing pathway, supported by industrial collaboration, in which only patients negative for driver mutations on DNA-NGS were submitted for fusion panel analysis. MATERIALS AND METHODS: Over 18 months, all patients from a single centre with non-squamous NSCLC were submitted for DNA-NGS, plus ALK and ROS1 immunohistochemistry +/− FISH. Those which were negative for a driver mutation were then recalled for RNA panel testing. RESULTS: 307 samples were referred for DNA-NGS mutation analysis, of which, 10% of cases were unsuitable for or failed DNA-NGS analysis. Driver mutations were detected in 61% (167/275) of all those successfully tested. Of those without a driver mutation and with some remaining tissue available, 28% had insufficient tissue/extracted RNA or failed RNA-NGS. Of those successfully tested, 24% (17/72) had a fusion gene detected involving either ALK, ROS, MET, RET, FGFR or EGFR. Overall, 66% (184/277) of patients had a driver event detected through the combination of DNA and RNA panels. CONCLUSION: Sequential DNA and RNA based molecular profiling increased the efficacy of detecting fusion driven NSCLCs. Continued optimisation of tissue procurement, handling and the diagnostic pathways for gene fusion analysis is necessary to reduce analysis failure rates and improve detection rate for treatment with the next generation of small molecule inhibitors

Hydrogen bond network topology in liquid water and methanol: a graph theory approach

Networks are increasingly recognized as important building blocks of various systems in nature and society. Water is known to possess an extended hydrogen bond network, in which the individual bonds are broken in the sub-picosecond range and still the network structure remains intact. We investigated and compared the topological properties of liquid water and methanol at various temperatures using concepts derived within the framework of graph and network theory (neighbour number and cycle size distribution, the distribution of local cyclic and local bonding coefficients, Laplacian spectra of the network, inverse participation ratio distribution of the eigenvalues and average localization distribution of a node) and compared them to small world and Erdős–Rényi random networks. Various characteristic properties (e.g. the local cyclic and bonding coefficients) of the network in liquid water could be reproduced by small world and/or Erdős–Rényi networks, but the ring size distribution of water is unique and none of the studied graph models could describe it. Using the inverse participation ratio of the Laplacian eigenvectors we characterized the network inhomogeneities found in water and showed that similar phenomena can be observed in Erdős–Rényi and small world graphs. We demonstrated that the topological properties of the hydrogen bond network found in liquid water systematically change with the temperature and that increasing temperature leads to a broader ring size distribution. We applied the studied topological indices to the network of water molecules with four hydrogen bonds, and showed that at low temperature (250 K) these molecules form a percolated or nearly-percolated network, while at ambient or high temperatures only small clusters of four-hydrogen bonded water molecules exist

Maternal and perinatal outcomes by planned place of birth in Australia 2000 - 2012: A linked population data study

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. Objective To compare perinatal and maternal outcomes for Australian women with uncomplicated pregnancies according to planned place of birth, that is, in hospital labour wards, birth centres or at home. Design A population-based retrospective design, linking and analysing routinely collected electronic data. Analysis comprised χ 2 tests and binary logistic regression for categorical data, yielding adjusted ORs. Continuous data were analysed using analysis of variance. Setting All eight Australian states and territories. Participants Women with uncomplicated pregnancies who gave birth between 2000 and 2012 to a singleton baby in cephalic presentation at between 37 and 41 completed weeks' gestation. Of the 1 251 420 births, 1 171 703 (93.6%) were planned in hospital labour wards, 71 505 (5.7%) in birth centres and 8212 (0.7%) at home. Main outcome measures Mode of birth, normal labour and birth, interventions and procedures during labour and birth, maternal complications, admission to special care/high dependency or intensive care units (mother or infant) and perinatal mortality (intrapartum stillbirth and neonatal death). Results Compared with planned hospital births, the odds of normal labour and birth were over twice as high in planned birth centre births (adjusted OR (AOR) 2.72; 99% CI 2.63 to 2.81) and nearly six times as high in planned home births (AOR 5.91; 99% CI 5.15 to 6.78). There were no statistically significant differences in the proportion of intrapartum stillbirths, early or late neonatal deaths between the three planned places of birth. Conclusions This is the first Australia-wide study to examine outcomes by planned place of birth. For healthy women in Australia having an uncomplicated pregnancy, planned births in birth centres or at home are associated with positive maternal outcomes although the number of homebirths was small overall. There were no significant differences in the perinatal mortality rate, although the absolute numbers of deaths were very small and therefore firm conclusions cannot be drawn about perinatal mortality outcomes

Safety and efficacy of antenatal milk expressing for women with diabetes in pregnancy: protocol for a randomised controlled trial

Many maternity providers recommend that women with diabetes in pregnancy express and store breast milk in late pregnancy so breast milk is available after birth, given (1) infants of these women are at increased risk of hypoglycaemia in the first 24 h of life; and (2) the delay in lactogenesis II compared with women without diabetes that increases their infant\u27s risk of receiving infant formula. The Diabetes and Antenatal Milk Expressing (DAME) trial will establish whether advising women with diabetes in pregnancy (pre-existing or gestational) to express breast milk from 36 weeks gestation increases the proportion of infants who require admission to special or neonatal intensive care units (SCN/NICU) compared with infants of women receiving standard care. Secondary outcomes include birth gestation, breastfeeding outcomes and economic impact