Gestão de Gravidez de Alto Risco: Estratégias Clínicas e Resultados Materno-Infantis

Objective: The article analyzes the management of high-risk pregnancies, addressing clinical strategies, medical innovations, ethical challenges, and socioeconomic impact. It aims to provide a comprehensive understanding of the topic by integrating technological, cultural, and ethical aspects to inform healthcare professionals and researchers about advances in obstetrics. Methodology: The article employed a comprehensive review methodology, analyzing studies on the management of high-risk pregnancies, covering clinical aspects, medical innovations, ethical challenges, and socioeconomic impact. The integration of technological, cultural, and ethical data aimed to offer a complete view of the subject for healthcare professionals and researchers. Results: The results highlight clinical approaches, medical innovations, and ethical challenges in managing high-risk pregnancies. Socioeconomic impact is considered, and future perspectives include the pursuit of equity in healthcare access. The article aims to inform professionals and researchers about the complexities and advancements in obstetrics. Conclusion: Managing high-risk pregnancies requires a balance between medical innovations, ethics, and equitable healthcare access. Emphasizing education and prevention empowers women, while the future emphasizes a patient-centered approach to mitigate risks and ensure positive experiences for families.Objetivo: O artigo analisa a gestão de gravidezes de alto risco, abordando estratégias clínicas, inovações médicas, desafios éticos e o impacto socioeconômico. Busca oferecer uma compreensão abrangente do tema, integrando aspectos tecnológicos, culturais e éticos para informar profissionais de saúde e pesquisadores sobre avanços na obstetrícia. Metodologia: O artigo adotou uma metodologia de revisão abrangente, analisando estudos sobre a gestão de gravidezes de alto risco, abordando aspectos clínicos, inovações médicas, desafios éticos e impacto socioeconômico. A integração de dados tecnológicos, culturais e éticos visou proporcionar uma visão completa do tema para profissionais de saúde e pesquisadores. Resultados: Os resultados destacam abordagens clínicas, inovações médicas e desafios éticos na gestão de gravidezes de alto risco. O impacto socioeconômico é considerado, e perspectivas futuras incluem a busca por equidade no acesso à saúde. O artigo visa informar profissionais e pesquisadores sobre complexidades e avanços nesse campo obstétrico. Conclusão: A gestão de gravidezes de alto risco exige equilíbrio entre inovações médicas, ética e acesso equitativo à saúde. A ênfase na educação e prevenção capacita as mulheres, enquanto o futuro destaca uma abordagem centrada na paciente para mitigar riscos e garantir experiências positivas para as famílias

Low prevalence of renal, cardiac, pulmonary, and neurological extra-articular clinical manifestations in spondyloarthritis: analysis of the Brazilian Registry of Spondyloarthritis

OBJECTIVE: To describe the extra-articular manifestations (cardiac, renal, pulmonary, and neurological), usually not related to spondyloarthritis (SpA), in a large cohort of Brazilian patients. MATERIALS AND METHODS: This retrospective study analyzed 1,472 patients diagnosed with SpA and cared for at 29 health care centers distributed in the five major geographic regions in the country, participating in the Brazilian Registry of Spondyloarthritis (BRS). All patients were assessed for the prevalence of major extra-articular manifestations (cardiac, renal, pulmonary, and neurological), classified according to the diagnosis [ankylosing spondylitis (AS), psoriatic arthritis (PsA), reactive arthritis (ReA), arthritis associated with inflammatory bowel disease (IBD), undifferentiated spondyloarthritis (uSpA), and juvenile SpA], and according to the clinical presentation (axial, peripheral, mixed, and enthesitis). RESULTS: Of the patients with SpA assessed, 963 had AS, 271 PsA, 49 ReA, 48 arthritis associated with IBD, 98 uSpA, and 43 juvenile SpA. Cardiac involvement was reported in 44 patients (3.0%), pulmonary involvement in 19 (1.3%), renal involvement in 17 (1.2%), and neurological involvement in 13 patients (0.9%). Most patients with visceral involvement had AS or PsA, and the mixed (axial + peripheral) and/or predominantly axial clinical form. CONCLUSION: Cardiac, renal, pulmonary, and neurological extra-articular manifestations are quite infrequent in SpA, ranging from 0.9% to 3% in this large Brazilian cohort, and affected predominantly patients with AS and PsA.OBJETIVO: Descrever as manifestações extra-articulares (cardíacas, renais, pulmonares e neurológicas) geralmente não relacionadas às espondiloartrites (EpA) em uma grande coorte de pacientes brasileiros. MÉTODOS: Este estudo retrospectivo analisou 1.472 pacientes com o diagnóstico de EpA atendidos em 29 centros distribuídos pelas cinco principais regiões geográficas do Brasil, integrantes do Registro Brasileiro de Espondiloartrites. Todos os pacientes foram avaliados para a prevalência das principais manifestações extra-articulares (cardíacas, renais, pulmonares e neurológicas), divididas por diagnóstico [espondilite anquilosante (EA), artrite psoriásica (AP), artrite reativa (ARe), artrite associada a doença inflamatória intestinal (DII), EpA indiferenciada (EI) e EpA juvenil] e por forma clínica (axial, periférica, mista e entesítica). RESULTADOS: Dentre os pacientes avaliados com EpA, 963 apresentavam EA, 271 AP, 49 ARe, 48 artrite associada a DII, 98 EI e 43 EpA juvenil. Acometimento cardíaco foi observado em 44 pacientes (3,0%), seguido por acometimento pulmonar em 19 (1,3%), renal em 17 (1,2%) e neurológico em 13 pacientes (0,9%). A maioria dos casos de acometimento visceral ocorreu nos pacientes com EA ou AP e naqueles com forma clínica mista (axial e periférica) e/ou predominantemente axial. CONCLUSÃO: As manifestações extra-articulares cardíacas, renais, pulmonares e neurológicas são muito pouco frequentes nas EpA, variando de 0,9%-3% nesta grande coorte brasileira, estando mais associadas a EA e AP.37938

Measurement of the cosmic ray spectrum above 4×10184{\times}10^{18} eV using inclined events detected with the Pierre Auger Observatory

A measurement of the cosmic-ray spectrum for energies exceeding $4{\times}10^{18}$ eV is presented, which is based on the analysis of showers with zenith angles greater than $60^{\circ}$ detected with the Pierre Auger Observatory between 1 January 2004 and 31 December 2013. The measured spectrum confirms a flux suppression at the highest energies. Above $5.3{\times}10^{18}$ eV, the "ankle", the flux can be described by a power law $E^{-\gamma}$ with index $\gamma=2.70 \pm 0.02 \,\text{(stat)} \pm 0.1\,\text{(sys)}$ followed by a smooth suppression region. For the energy ($E_\text{s}$) at which the spectral flux has fallen to one-half of its extrapolated value in the absence of suppression, we find $E_\text{s}=(5.12\pm0.25\,\text{(stat)}^{+1.0}_{-1.2}\,\text{(sys)}){\times}10^{19}$ eV.Comment: Replaced with published version. Added journal reference and DO

Energy Estimation of Cosmic Rays with the Engineering Radio Array of the Pierre Auger Observatory

The Auger Engineering Radio Array (AERA) is part of the Pierre Auger Observatory and is used to detect the radio emission of cosmic-ray air showers. These observations are compared to the data of the surface detector stations of the Observatory, which provide well-calibrated information on the cosmic-ray energies and arrival directions. The response of the radio stations in the 30 to 80 MHz regime has been thoroughly calibrated to enable the reconstruction of the incoming electric field. For the latter, the energy deposit per area is determined from the radio pulses at each observer position and is interpolated using a two-dimensional function that takes into account signal asymmetries due to interference between the geomagnetic and charge-excess emission components. The spatial integral over the signal distribution gives a direct measurement of the energy transferred from the primary cosmic ray into radio emission in the AERA frequency range. We measure 15.8 MeV of radiation energy for a 1 EeV air shower arriving perpendicularly to the geomagnetic field. This radiation energy -- corrected for geometrical effects -- is used as a cosmic-ray energy estimator. Performing an absolute energy calibration against the surface-detector information, we observe that this radio-energy estimator scales quadratically with the cosmic-ray energy as expected for coherent emission. We find an energy resolution of the radio reconstruction of 22% for the data set and 17% for a high-quality subset containing only events with at least five radio stations with signal.Comment: Replaced with published version. Added journal reference and DO

Measurement of the Radiation Energy in the Radio Signal of Extensive Air Showers as a Universal Estimator of Cosmic-Ray Energy

We measure the energy emitted by extensive air showers in the form of radio emission in the frequency range from 30 to 80 MHz. Exploiting the accurate energy scale of the Pierre Auger Observatory, we obtain a radiation energy of 15.8 \pm 0.7 (stat) \pm 6.7 (sys) MeV for cosmic rays with an energy of 1 EeV arriving perpendicularly to a geomagnetic field of 0.24 G, scaling quadratically with the cosmic-ray energy. A comparison with predictions from state-of-the-art first-principle calculations shows agreement with our measurement. The radiation energy provides direct access to the calorimetric energy in the electromagnetic cascade of extensive air showers. Comparison with our result thus allows the direct calibration of any cosmic-ray radio detector against the well-established energy scale of the Pierre Auger Observatory.Comment: Replaced with published version. Added journal reference and DOI. Supplemental material in the ancillary file

CIRURGIA MINIMAMENTE INVASIVA VERSUS PROCEDIMENTOS CONVENCIONAIS: UMA ANÁLISE COMPARATIVA

Objective: This article aims to explore the dichotomy between minimally invasive surgery (MIS) and conventional procedures (PC), analyzing the technological advances and clinical challenges inherent to both approaches. Results: CMI, with its reduced access and innovative technologies, has transformed surgical practice, challenging conventional procedures, which often involve more extensive incisions and prolonged recovery. The evolution of refined instrumentation such as endoscopes and surgical robotics has improved the accuracy of CMI, although challenges such as the learning curve and cost considerations persist. Methodology: The search included several academic databases such as PubMed, Scopus, Scielo, VHL and Web of Science, using specific terms such as "Minimally Invasive Surgery", "Conventional Procedures" and other related terms. Boolean operators were used to optimize the search. The inclusion criteria ensured relevance, covering studies that directly compared clinical results between Minimally Invasive Surgery and conventional procedures. We excluded studies with heterogeneous samples or without pertinent information. Conclusion: The search for a comprehensive understanding of the advantages and limitations of both approaches is constant, encouraging critical reflection on the future of surgery in search of better results for patients.Objetivo: Este artigo tem como objetivo explorar a dicotomia entre cirurgia minimamente invasiva (CMI) e procedimentos convencionais (PC), analisando os avanços tecnológicos e desafios clínicos inerentes a ambas as abordagens. Resultados: A CMI, com seu acesso reduzido e tecnologias inovadoras, transformou a prática cirúrgica, desafiando os procedimentos convencionais, que frequentemente envolve incisões mais extensas e recuperação prolongada. A evolução de instrumentações refinadas, como endoscópios e robótica cirúrgica, aprimorou a precisão da CMI, embora desafios como a curva de aprendizado e considerações de custo persistam. Metodologia: A busca incluiu diversas bases acadêmicas como PubMed, Scopus, Scielo, BVS e Web of Science, usando termos específicos como "Cirurgia Minimamente Invasiva", "Procedimentos Convencionais" e outros relacionados. Operadores booleanos foram empregados para otimizar a busca. Os critérios de inclusão garantiram relevância, abrangendo estudos que compararam diretamente resultados clínicos entre Cirurgia Minimamente Invasiva e procedimentos convencionais. Excluímos estudos com amostras heterogêneas ou sem informações pertinentes. Conclusão: A busca por uma compreensão abrangente das vantagens e limitações de ambas as abordagens é constante, incentivando uma reflexão crítica sobre o futuro da cirurgia em busca de melhores resultados para os pacientes

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Performance of the CMS Cathode Strip Chambers with Cosmic Rays

The Cathode Strip Chambers (CSCs) constitute the primary muon tracking device in the CMS endcaps. Their performance has been evaluated using data taken during a cosmic ray run in fall 2008. Measured noise levels are low, with the number of noisy channels well below 1%. Coordinate resolution was measured for all types of chambers, and fall in the range 47 microns to 243 microns. The efficiencies for local charged track triggers, for hit and for segments reconstruction were measured, and are above 99%. The timing resolution per layer is approximately 5 ns