Conhecimento e uso de métodos anticoncepcionais entre os calouDa Rosdo 1 semestre - U.F.S.C. em 1995.

Trabalho de Conclusão de Curso - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Departamento de Tocoginecologia, Curso de Medicina, Florianópolis, 199

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

BCG vaccination in patients with severe combined immunodeficiency: Complications, risks, and vaccination policies

BACKGROUND: Severe combined immunodeficiency (SCID) is a syndrome characterized by profound T-cell deficiency. BCG vaccine is contraindicated in patients with SCID. Because most countries encourage BCG vaccination at birth, a high percentage of patients with SCID are vaccinated before their immune defect is detected. OBJECTIVES: We sought to describe the complications and risks associated with BCG vaccination in patients with SCID. METHODS: An extensive standardized questionnaire evaluating complications, therapeutics, and outcomes regarding BCG vaccination in patients given a diagnosis of SCID was widely distributed. Summary statistics and association analysis was performed. RESULTS: Data on 349 BCG-vaccinated patients with SCID from 28 centers in 17 countries were analyzed. Fifty-one percent of the patients had BCG-associated complications, 34% disseminated and 17% localized (a 33,000- and 400-fold increase, respectively, over the general population). Patients receiving early vaccination (≤1 month) showed an increased prevalence of complications (P = .006) and death caused by BCG-associated complications (P < .0001). The odds of experiencing complications among patients with T-cell numbers of 250/μL or less at diagnosis was 2.1 times higher (95% CI, 1.4-3.4 times higher; P = .001) than among those with T-cell numbers of greater than 250/μL. BCG-associated complications were reported in 2 of 78 patients who received antimycobacterial therapy while asymptomatic, and no deaths caused by BCG-associated complications occurred in this group. In contrast, 46 BCG-associated deaths were reported among 160 patients treated with antimycobacterial therapy for a symptomatic BCG infection (P < .0001). CONCLUSIONS: BCG vaccine has a very high rate of complications in patients with SCID, which increase morbidity and mortality rates. Until safer and more efficient antituberculosis vaccines become available, delay in BCG vaccination should be considered to protect highly vulnerable populations from preventable complications.Fil: Gómez Raccio, Andrea C.. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños ; ArgentinaFil: Orellana, Julio Cesar. Provincia de Córdoba. Hospital de Niños de la Santísima Trinidad. División de Alergia e Inmunología Clínica; ArgentinaFil: Liberatore, Diana. Hospital Italiano; ArgentinaFil: Bezrodnik, Liliana. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños ; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Marciano, Beatriz E.. National Institutes of Health; Estados UnidosFil: Huang, Chiung Yu. National Institutes of Health; Estados UnidosFil: Joshi, Gyan. National Institutes of Health; Estados UnidosFil: Rezaei, Nima. Teheran University of Medical Sciences. Children's Medical Center Hospital. Pediatric Center of Excellence; IránFil: Costa Carvalho, Beatriz. Federal University of São Paulo; BrasilFil: Cunha, Luciana. Federal University of Minas Gerais; BrasilFil: Pinto, Jorge A.. Federal University of Minas Gerais; BrasilFil: Espinosa Padilla, Sara E.. Secretaría de Salud. Instituto Nacional de Pediatría; MéxicoFil: Hernandez Nieto, Leticia. Secretaría de Salud. Instituto Nacional de Pediatría; MéxicoFil: Elfeky, Reem A.. Ain Shams University; EgiptoFil: Ariga, Tadashi. Hokkaido University Graduate School of Medicine; JapónFil: Toshio, Heike. Kyoto University Hospital; JapónFil: Dogu, Figen. Ankara University Medical School; TurquíaFil: Cipe, Funda. Ankara University Medical School; TurquíaFil: Formankova, Renata. Charles University; República Checa. University Hospital Motol; República ChecaFil: Nuñez Nuñez, M. Enriqueta. Western National Medical Center; MéxicoFil: Gonçalo Marques, Jose. Santa María Hospital. Lisbon Academic Center; PortugalFil: Pereira, María I.. Provincia de Córdoba. Hospital de Niños de la Santísima Trinidad. División de Alergia e Inmunología Clínica; ArgentinaFil: Listello, Viviana. Provincia de Córdoba. Hospital de Niños de la Santísima Trinidad. División de Alergia e Inmunología Clínica; ArgentinaFil: Slatter, Mary A.. Great North Children's Hospital; Reino UnidoFil: Nademi, Zohreh. Great North Children's Hospital; Reino UnidoFil: Kowalczyk, Danuta. Children's University Hospital. Department of Clinical Immunology and Transplantology; PoloniaFil: Fleisher, Thomas A.. National Institutes of Health; Estados UnidosFil: Davies, Graham. Great Ormond Street Hospital for Children; Reino UnidoFil: Neven, Bénédicte. Necker Hospital. Immunology-Hematology and Rheumatology Service; FranciaFil: Rosenzweig, Sergio D.. National Institute of Health. National Institute of Allergy and Infectious. Laboratory of Host Defenses. Primary Immunodeficiency Clinic and Infectious Diseases Susceptibility Unit; Estados Unido

Reconstructing Three Decades of Land Use and Land Cover Changes in Brazilian Biomes with Landsat Archive and Earth Engine

Brazil has a monitoring system to track annual forest conversion in the Amazon and most recently to monitor the Cerrado biome. However, there is still a gap of annual land use and land cover (LULC) information in all Brazilian biomes in the country. Existing countrywide efforts to map land use and land cover lack regularly updates and high spatial resolution time-series data to better understand historical land use and land cover dynamics, and the subsequent impacts in the country biomes. In this study, we described a novel approach and the results achieved by a multi-disciplinary network called MapBiomas to reconstruct annual land use and land cover information between 1985 and 2017 for Brazil, based on random forest applied to Landsat archive using Google Earth Engine. We mapped five major classes: forest, non-forest natural formation, farming, non-vegetated areas, and water. These classes were broken into two sub-classification levels leading to the most comprehensive and detailed mapping for the country at a 30 m pixel resolution. The average overall accuracy of the land use and land cover time-series, based on a stratified random sample of 75,000 pixel locations, was 89% ranging from 73 to 95% in the biomes. The 33 years of LULC change data series revealed that Brazil lost 71 Mha of natural vegetation, mostly to cattle ranching and agriculture activities. Pasture expanded by 46% from 1985 to 2017, and agriculture by 172%, mostly replacing old pasture fields. We also identified that 86 Mha of the converted native vegetation was undergoing some level of regrowth. Several applications of the MapBiomas dataset are underway, suggesting that reconstructing historical land use and land cover change maps is useful for advancing the science and to guide social, economic and environmental policy decision-making processes in Brazil

Indirect effects of habitat loss via habitat fragmentation: A cross-taxa analysis of forest-dependent species

Recent studies suggest that habitat amount is the main determinant of species richness, whereas habitat fragmentation has weak and mostly positive effects. Here, we challenge these ideas using a multi-taxa database including 2230 estimates of forest-dependent species richness from 1097 sampling sites across the Brazilian Atlantic Forest biodiversity hotspot. We used a structural equation modeling approach, accounting not only for direct effects of habitat loss, but also for its indirect effects (via habitat fragmentation), on the richness of forest-dependent species. We reveal that in addition to the effects of habitat loss, habitat fragmentation has negative impacts on animal species richness at intermediate (30–60%) levels of habitat amount, and on richness of plants at high (>60%) levels of habitat amount, both of which are mediated by edge effects. Based on these results, we argue that dismissing habitat fragmentation as a powerful force driving species extinction in tropical forest landscapes is premature and unsafe

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.13Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

The DUNE Far Detector Vertical Drift Technology, Technical Design Report

International audienceDUNE is an international experiment dedicated to addressing some of the questions at the forefront of particle physics and astrophysics, including the mystifying preponderance of matter over antimatter in the early universe. The dual-site experiment will employ an intense neutrino beam focused on a near and a far detector as it aims to determine the neutrino mass hierarchy and to make high-precision measurements of the PMNS matrix parameters, including the CP-violating phase. It will also stand ready to observe supernova neutrino bursts, and seeks to observe nucleon decay as a signature of a grand unified theory underlying the standard model. The DUNE far detector implements liquid argon time-projection chamber (LArTPC) technology, and combines the many tens-of-kiloton fiducial mass necessary for rare event searches with the sub-centimeter spatial resolution required to image those events with high precision. The addition of a photon detection system enhances physics capabilities for all DUNE physics drivers and opens prospects for further physics explorations. Given its size, the far detector will be implemented as a set of modules, with LArTPC designs that differ from one another as newer technologies arise. In the vertical drift LArTPC design, a horizontal cathode bisects the detector, creating two stacked drift volumes in which ionization charges drift towards anodes at either the top or bottom. The anodes are composed of perforated PCB layers with conductive strips, enabling reconstruction in 3D. Light-trap-style photon detection modules are placed both on the cryostat's side walls and on the central cathode where they are optically powered. This Technical Design Report describes in detail the technical implementations of each subsystem of this LArTPC that, together with the other far detector modules and the near detector, will enable DUNE to achieve its physics goals

The DUNE Far Detector Vertical Drift Technology, Technical Design Report

International audienceDUNE is an international experiment dedicated to addressing some of the questions at the forefront of particle physics and astrophysics, including the mystifying preponderance of matter over antimatter in the early universe. The dual-site experiment will employ an intense neutrino beam focused on a near and a far detector as it aims to determine the neutrino mass hierarchy and to make high-precision measurements of the PMNS matrix parameters, including the CP-violating phase. It will also stand ready to observe supernova neutrino bursts, and seeks to observe nucleon decay as a signature of a grand unified theory underlying the standard model. The DUNE far detector implements liquid argon time-projection chamber (LArTPC) technology, and combines the many tens-of-kiloton fiducial mass necessary for rare event searches with the sub-centimeter spatial resolution required to image those events with high precision. The addition of a photon detection system enhances physics capabilities for all DUNE physics drivers and opens prospects for further physics explorations. Given its size, the far detector will be implemented as a set of modules, with LArTPC designs that differ from one another as newer technologies arise. In the vertical drift LArTPC design, a horizontal cathode bisects the detector, creating two stacked drift volumes in which ionization charges drift towards anodes at either the top or bottom. The anodes are composed of perforated PCB layers with conductive strips, enabling reconstruction in 3D. Light-trap-style photon detection modules are placed both on the cryostat's side walls and on the central cathode where they are optically powered. This Technical Design Report describes in detail the technical implementations of each subsystem of this LArTPC that, together with the other far detector modules and the near detector, will enable DUNE to achieve its physics goals