WGS of intrauterine E. coli from cows with early postpartum uterine infection reveals a non-uterine specific genotype and virulence factors.

Escherichia coli has been attributed to playing a major role in a cascade of events that affect the prevalence and severity of uterine disease in cattle. The objectives of this project were to (i) define the association between the prevalence of specific antimicrobial resistance and virulence factor genes in E. coli with the clinical status related to uterine infection, (ii) identify the genetic relationship between E. coli isolates from cows with diarrhea, with mastitis, and with and without metritis, and (iii) determine the association between the phenotypic and genotypic antimicrobial resistance identified on the E. coli isolated from postpartum cattle. Bacterial isolates (n = 148) were obtained from a larger cross-sectional study. Cows were categorized into one of three clinical groups before enrollment: metritis, cows with purulent discharge, and control cows. For genomic comparison, public genomes (n = 130) from cows with diarrhea, mastitis, and metritis were included in a genome-wide association study, to evaluate differences between the drug classes or the virulence factor category among clinical groups. A distinct E. coli genotype associated with metritis could not be identified. Instead, a high genetic diversity among the isolates from uterine sources was present. A virulence factor previously associated with metritis (fimH) using PCR was not associated with metritis. There was moderate accuracy for whole-genome sequencing to predict phenotypic resistance, which varied depending on the antimicrobial tested. Findings from this study contradict the traditional pathotype classification and the unique intrauterine E. coli genotype associated with metritis in dairy cows.IMPORTANCEMetritis is a common infectious disease in dairy cattle and the second most common reason for treating a cow with antimicrobials. The pathophysiology of the disease is complex and is not completely understood. Specific endometrial pathogenic Escherichia coli have been reported to be adapted to the endometrium and sometimes lead to uterine disease. Unfortunately, the specific genomic details of the endometrial-adapted isolates have not been investigated using enough genomes to represent the genomic diversity of this organism to identify specific virulence genes that are consistently associated with disease development and severity. Results from this study provide key microbial ecological advances by elucidating and challenging accepted concepts for the role of Intrauterine E. coli in metritis in dairy cattle, especially contradicting the existence of a unique intrauterine E. coli genotype associated with metritis in dairy cows, which was not found in our study.

Agreement among deep nasopharyngeal sampling culture results for 3 different swab types in preweaning dairy calves.

Accurate isolation and identification of pathogens for an animal with bovine respiratory disease are of critical importance to direct appropriate decision-making related to the treatment of individual animals, as well as control and prevention options in a herd setting. The objective of this study was to compare nasopharyngeal sampling approaches to evaluate accuracy and agreement for the recovery of Mannheimia haemolytica (MH) and Pasteurella multocida (PM) from deep nasopharyngeal swabs (DNS) using 3 different swabs. Deep nasopharyngeal samples were collected from 45 dairy calves using 3 swabs: (1) double-guarded culture swab (DGS); (2) single-guarded culture swab (SGS); and (3) unguarded culture swab (UGS). To evaluate the degree of agreement between DGS, SGS, and UGS, culture results were compared for each calf sampled by using a kappa agreement test. Overall, findings from our study support that when using either SGS or DGS for DNS sampling of preweaning calves, a high agreement for recovery of PM is observed. A low recovery of MH was observed in the study, limiting the conclusion comparing the 3 DNS methods. Use of UGS is considered a potential alternative; however, a higher percentage of polymicrobial growth was found with UGS samples.

Antimicrobial resistance of Escherichia coli from dairy farms participating in an antimicrobial stewardship educational program for farm employees.

Antimicrobial use in food-producing animals is under increasing scrutiny due to the potential effect on the selection of antimicrobial-resistant bacteria that may be transmitted to humans by direct contact, with the food chain, or the environment. Novel data monitoring commensal Escherichia coli from dairy farms is essential for understanding antimicrobial resistance (AMR) patterns and their association with herd health management practices. The objectives of this study were to: (1) compare the prevalence of antimicrobial resistance in the E. coli isolates from the hospital, fresh, and mid-lactation pens from 18 conventional dairy farms participating in an educational training program in antimicrobial stewardship practices in California and Ohio, and (2) to characterize the prevalence of antimicrobial resistance of commensal E. coli isolated from pooled fecal pat samples before and 3 mo after participating in the educational training program. Pooled fecal pat samples were collected from the hospital pen, the fresh pen (1 to 5 DIM), and the mid-lactation pens (90 to 150 DIM) on conventional dairies in CA (n = 9) and OH (n = 9). Fecal samples were collected as part of a larger study using a quasi-experimental design that assigned farms to the training intervention group (TG; 6 per state) or the control group (CG; 3 per state). For the TG, farm worker(s) identified as having the task of diagnosis and treatment of adult cows on the farm participated in a training program on antimicrobial stewardship practices. Pooled fecal samples (n = 7) were collected at enrollment and 3 mo after completing the intervention on each of the participating farms (n = 18), followed by culture for E. coli isolation and antimicrobial sensitivity testing using the broth microdilution methodology. Logistic regression models were used to evaluate the association between E. coli antimicrobial resistance patterns with the training intervention and farm-level factors. No effect was observed in the prevalence of resistant isolates between the control and intervention farms after the training was delivered. Isolates from the hospital pens were 2.48 (95% CI: 1.06-6.22, P = 0.03) and 5.61 (95% CI: 1.94-16.91, P < 0.001) times, more likely to be resistant to streptomycin and chloramphenicol, respectively, than isolates from the mid-lactation pens. Our findings indicate there was a higher prevalence of AMR in E. coli associated with the hospital pen within the farm, while the training program for 3 mo did not affect the prevalence of AMR in E. coli on the farms participating in the program. Further research efforts should be conducted to identify factors driving AMR at the pen level, as well as approaches that could be used to reduce the risk of disseminating AMR from sick pens to animals being housed and to other pens on the farm.

Inserção do homem na enfermagem universitária piauiense / Inserting man in nursing academic level in the State of Piauí, Brazil / Inserción de hombres en la enfermería universitaria en el Estado de Piauí, Brasil

Objetivo: analisar a inserção do homem, por meio do registro profissional, na enfermagem piauiense. Método: estudo de natureza sócio-histórica fundamentado por pressupostos de Aróstegui, conduzido a partir do número de inscrições no Conselho Regional de Enfermagem do Piauí do período de 1975 a 2021. Os dados foram organizados por ordem cronológica e de acordo com o gênero do inscrito, com análise pautada nos conceitos de Edward Palmer Thompson. Resultados: apesar da primeira inscrição masculina ocorrer apenas em 1979, percebe-se que, desde então, ocorreu um aumento progressivo de homens na enfermagem. Tal progressão é justificada pela reforma universitária, que deu origem a Universidade Federal do Piauí; além da criação do Sistema COFEN/COREN. Considerações finais: a inserção do homem na enfermagem piauiense ocorreu de forma lenta e desigual, quando comparada ao sexo feminino. Fatores sócio-políticos, econômicos e sociais foram essenciais para justificar o crescimento(AU)

Objective: analyze the insertion of men, through professional registration, in nursing in Piauí, Brazil. Method: socio-historical study based on Aróstegui's assumptions, conducted from the number of registrations in the Regional Council of Nursing of Piauí from 1975 to 2021. The data were organized in chronological order and according to the gender of the participant, with analysis based on the concepts of Edward Palmer Thompson. Results: despite the fact that the first male enrollment occurred only in 1979, it is clear that, since then, there has been a progressive increase in the number of men in nursing. Such progression is justified by the university reform, which gave rise to the Federal University of Piauí; in addition to the creation of the COFEN/COREN System. Final considerations: the insertion of men in nursing in Piauí occurred slowly and unevenly, when compared to women. Socio-political, economic and social factors were essential to justify the growth(AU)

Objetivo: analizar la inserción de los hombres, a través del registro profesional, en la enfermería en Piauí, Brasil. Método: estudio de naturaleza sociohistórica basado en los supuestos de Aróstegui, realizado a partir del número de registros en el Consejo Regional de Enfermería de Piauí de 1975 a 2021. Los datos fueron organizados en orden cronológico y según el género del participante, con análisis basado en los conceptos de Edward Palmer Thompson. Resultados: a pesar de que la primera incorporación masculina se produjo recién en 1979, es evidente que, desde entonces, se ha producido un aumento progresivo del número de hombres en enfermería. Tal progresión está justificada por la reforma universitaria, que dio origen a la Universidad Federal de Piauí; además de la creación del Sistema COFEN/COREN. Consideraciones finales: la inserción de los hombres en la enfermería de Piauí ocurrió de manera lenta y desigual, en comparación con la de las mujeres. Los factores sociopolíticos, económicos y sociales fueron esenciales para justificar el crecimiento(AU)

Unveiling the microbiome during post-partum uterine infection: a deep shotgun sequencing approach to characterize the dairy cow uterine microbiome.

BACKGROUND: The goal of this study was to assess the microbial ecology and diversity present in the uterus of post-partum dairy cows with and without metritis from 24 commercial California dairy farms using shotgun metagenomics. A set subset of 95 intrauterine swab samples, taken from a larger selection of 307 individual cow samples previously collected, were examined for α and ß diversity and differential abundance associated with metritis. Cows within 21 days post-partum were categorized into one of three clinical groups during sample collection: control (CT, n = 32), defined as cows with either no vaginal discharge or a clear, non-purulent mucus vaginal discharge; metritis (MET, n = 33), defined as a cow with watery, red or brown colored, and fetid vaginal discharge; and purulent discharge cows (PUS, n = 31), defined as a non-fetid purulent or mucopurulent vaginal discharge. RESULTS: All three clinical groups (CT, MET, and PUS) were highly diverse, with the top 12 most abundant genera accounting for 10.3%, 8.8%, and 10.1% of mean relative abundance, respectively. The α diversity indices revealed a lower diversity from samples collected from MET and PUS when compared to CT cows. PERMANOVA statistical testing revealed a significant difference (P adjusted < 0.01) in the diversity of genera between CT and MET samples (R2 = 0.112, P = 0.003) and a non-significant difference between MET and PUS samples (R2 = 0.036, P = 0.046). ANCOM-BC analysis revealed that from the top 12 most abundant genera, seven genera were increased in the natural log fold change (LFC) of abundance in MET when compared to CT samples: Bacteroides, Clostridium, Fusobacterium, Phocaeicola, Porphyromonas, Prevotella, and Streptococcus. Two genera, Dietzia and Microbacterium, were decreased in natural LFC of abundance when comparing MET (regardless of treatment) and CT, while no changes in natural LFC of abundance were observed for Escherichia, Histophilus, and Trueperella. CONCLUSIONS: The results presented here, are the current deepest shotgun metagenomic analyses conducted on the bovine uterine microbiome to date (mean of 256,425 genus-level reads per sample). Our findings support that uterine samples from cows without metritis (CT) had increased α-diversity but decreased ß-diversity when compared to metritis or PUS cows, characteristic of dysbiosis. In summary, our findings highlight that MET cows have an increased abundance of Bacteroides, Porphyromonas, and Fusobacterium when compared to CT and PUS, and support the need for further studies to better understand their potential causal role in metritis pathogenesis.

In vitro evaluation of the effect of transport medium, temperature, and time on the recovery of Mannheimia haemolytica and Pasteurella multocida.

Appropriate sample collection, storage conditions, and time for transport to the laboratory are important for an accurate diagnostic result. We evaluated the effects of transport storage medium type, time of storage, and storage temperatures on Mannheimia haemolytica (MH) and Pasteurella multocida (PM) recovery using an in vitro model simulation. A quantitative culture method, using colony-forming units per milliliter, was used to recover MH or PM by an in vitro model with cotton swabs. Three independent trials were conducted, in which cotton swabs were inoculated with MH or PM and placed in either (1) a sterile 15-mL polypropylene tube without transport medium (dry), (2) Amies culture medium with charcoal (ACM), or (3) Cary-Blair transport agar (CBA). Swabs were evaluated for recovery of MH or PM when stored at 3 temperatures (4°C, 23°C, or 36°C) and after storage for 8 h, 24 h, or 48 h. From all study group combinations, a total of 162 individual independent swabs were evaluated. The nonparametric Dunn all-pairs approach was used to compare the proportion of culturable bacteria, between the various storage media, temperature, and time point combinations. The proportion of MH in samples stored at 4°C was significantly higher for ACM and CBA than dry storage at 24 and 48 h. The MH samples stored at 36°C had a significantly higher proportion for ACM and CBA than dry storage at 24 h. The proportion of PM in samples stored at 4°C was significantly lower for ACM compared with dry at 8 h but significantly higher at 48 h. The PM samples stored at 23°C in ACM had a significantly higher proportion than dry samples at 24 h, and, at 48 h, ACM and CBA had a significantly higher proportion than the dry group. All swabs stored at 36°C for 48 h had a proportion close to zero, indicating decreasing diagnostic efficacy. These results support the use of transport media such as ACM and CBA for increasing the detection of PM and MH from samples, especially when samples are exposed to high temperatures. The combination of longer periods from collection of samples to diagnostic evaluation (>24 h) and higher storage temperatures (>23°C) were shown to significantly impair diagnostic accuracy.

Antimicrobial stewardship on the dairy: Evaluating an on-farm framework for training farmworkers.

Dairy farmworkers are commonly responsible for disease diagnosis and routine treatment decisions for cattle. This highlights the importance of farmworkers' knowledge and skills to successfully implement judicious use of antimicrobials in livestock production systems. The main objectives of this project were to develop and evaluate an on-farm educational program for farmworkers in antimicrobial stewardship in adult dairy cattle. A longitudinal quasi-experimental study design was used, by enrolling 12 conventional dairy farms in the United States (6 in California and 6 in Ohio). Farmworkers responsible for treatment decisions on the farm (n = 25) participated in a didactic and hands-on 12-wk antimicrobial stewardship training program led by the investigators. All antimicrobial stewardship training materials were available in Spanish and English. Interactive short videos with audio were developed to cover the learning objectives for each of the 6 teaching modules: antimicrobial resistance, treatment protocols, visual identification of sick animals, clinical mastitis, puerperal metritis, and lameness. Pre- and post-training assessments were administered using an online training assessment tool to evaluate changes in knowledge and attitudes about antimicrobial stewardship practices. Cluster analysis and multiple correspondence analyses were conducted to evaluate the association among categorical variables for participants' level of change in knowledge and its association with language, farm size, and state. A 32% average increase in knowledge was observed through an assessment conducted after completing the antimicrobial stewardship training, compared with the pre-training assessment. A significant improvement in 7 of 13 attitude questions related to antimicrobial stewardship practices on the farm was observed. Knowledge and attitude scores of participants on antimicrobial stewardship and identification of sick animals significantly improved after completing the antimicrobial stewardship training. The results observed in this study support the relevance of antimicrobial stewardship training programs targeting farmworkers to improve antimicrobial drug use knowledge and skills.

Evaluation of antimicrobial resistance and risk factors for recovery of intrauterine Escherichia coli from cows with metritis on California commercial dairy farms.

The goals of this study were to evaluate factors affecting recovery and antimicrobial resistance (AMR) in intrauterine E. coli in post-partum dairy cows with and without metritis from commercial California dairy farms. Using a cross-sectional study design, a total of 307 cows were sampled from 25 farms throughout California, from which a total of 162 intrauterine E. coli isolates were recovered. During farm visits, cows within 21 days post-partum were categorized in one of three clinical presentation groups before enrollment: metritis (MET, n = 86), defined as a cow with watery, red or brown colored, and fetid vaginal discharge; cows with purulent discharge (PUS, n = 106), defined as a non-fetid purulent or mucopurulent vaginal discharge; and control cows, (CTL, n = 115) defined as cows with either no vaginal discharge or a clear, non-purulent mucus vaginal discharge. Cows diagnosed as MET had significantly higher odds for recovery of E. coli compared to cows diagnosed as CTL (OR = 2.16, 95% CI: 1.17-3.96), with no significant difference observed between PUS and CTL, and PUS and MET. An increase in days in milk (DIM) at the time of sampling was significantly associated with a decrease in the odds ratio for E. coli recovery from intrauterine swabs (OR = 0.94, 95% CI: 0.89-0.98). All intrauterine E. coli were resistant to ampicillin (AMP), with an AMR prevalence of 30.2% and 33.9% observed for chlortetracycline and oxytetracycline, respectively. Only 8.6% of isolates were resistant to ceftiofur (CEFT), one of the most common drugs used to treat cows on farms sampled. No significant difference in the prevalence of AMR was observed among clinical groups at the individual cow level. At the farm level, a significantly higher odds for isolating intrauterine E. coli resistant to chlortetracycline (OR: 2.6; 95% CI: 3.7-58.0) or oxytetracycline (OR: 1.9; 95% CI: 1.4-33.8) was observed at farms that used an intrauterine infusion of oxytetracycline as a treatment for metritis when compared to those farms that did not use this practice. Findings from this study indicate the need for further research supporting a broader understanding of farm practices driving AMR in cows with metritis, as well as data to increase the accuracy of breakpoints for AMR classification of intrauterine E. coli from cattle.

Defining clinical diagnosis and treatment of puerperal metritis in dairy cows: A scoping review.

Although puerperal metritis (PM) is a common infectious disease in dairy cattle, there are currently discrepancies between clinical case definitions within and between available peer-reviewed literature and on-farms practices. The inconsistent use of PM criteria across studies and on-farms practices can result in disparities related to recommendations for treating cows, affecting judicious use of antimicrobials. The objective of this study was to systematically review the peer-reviewed literature for clinical signs used for case definition of PM. The criteria used included local (e.g., vaginal discharge) and systemic clinical signs of infection (e.g., fever, drop in milk). The Preferred Reporting Items for Systematic Review and Meta-Analysis extension for scoping reviews protocols were used to screen commonly used databases. Following this protocol, one reviewer screened title and abstract for eligibility (n = 2,096), followed by full-text screening of selected articles (n = 396) by 2 reviewers to confirm eligible articles (n = 174). The most frequently cited reference article (37.5%) for the definition of PM was published in 2006, followed by articles published between 1998 and 2009 (13%). In 40.2% of articles, no reference was provided for definition of PM; vaginal discharge was described in terms of color, odor, and viscosity when related to the PM definition. Terms used for description of vaginal discharge color were red-brown (61.4%), red (5.1%), brown (8.6%), chocolate (4%), white (1.7%), yellow (0.5%), pink (5.7%), or gray (0.5%); vaginal discharge color was not reported in 24.1% articles. The vaginal discharge odor was described as fetid (75.8%), putrid (5.1%), foul (10.3%), or other (5.7%; e.g., abnormal, malodorous, odoriferous); odor was not mentioned in 7.4% of articles. The vaginal discharge viscosity was described as watery (74.1%), purulent (27%), mucopurulent (8.6%), thin (4%), serous (2.8%), or abnormal (2.3%) and was not mentioned in 11.5% of articles. Fever was included in 59.7% of articles as a criterion for PM diagnosis. The most used rectal temperature threshold was ≥39.5°C (56.8%), followed by ≥39.2°C (2.8%). Approaches used for vaginal discharge evaluation included rectal palpation (37.3%), intravaginal exploration with a gloved hand (18.4%), Metricheck (9.8%), or speculum (5.7%); and in 28.7% of articles, diagnostic tools used were not mentioned. Many of the color and odor vaginal discharge descriptions observed in the literature, used synonymous words to describe the same vaginal discharge sample, highlighting a lack of terminology consensus that could result in disagreements, especially due to the subjective character of these clinical evaluations of vaginal discharge color and odor. Although select consensus articles are available, it is common for studies to disregard a reference when defining PM cases. Furthermore, our findings highlight the need for a robust and clear consensus on criteria and terminology used to diagnose PM.

Silenciamento da sexualidade do adolescente no contexto rural / Silencing adolescent sexuality in rural settings / Silenciamiento de la sexualidad del adolescente en el contexto rural

A educação para a sexualidade é um pilar fundamental da saúde sexual e reprodutiva. Contudo, há um distanciamento dessa discussão para adolescentes rurais. O objetivo deste artigo é analisar o discurso sobre a sexualidade do adolescente no contexto rural e as perspectivas para romper com a ordens do discurso. Adota como metodologia a pesquisa-ação desenvolvida em duas escolas rurais: uma no Brasil e outra na Colômbia. Para análise dos dados foi aplicada a Análise Crítica do Discurso. A sexualidade do adolescente no contexto da escola rural é atravessada por dispositivos que produzem o silenciamento. A construção da sexualidade é marcada pelos modelos biomédico, biológico e sexista que se exacerbam no contexto rural. É preciso reeducar o conceito de sexualidade como dimensão humanizadora e avançar na discussão sobre como a tecnologia e a mídia interferem nos modos de vida e na sexualidade dos adolescentes no contexto rural. (AU)

Education for sexuality is a central pillar of sexual and reproductive health. However, adolescents living in rural areas are distanced from this discussion. The aim of this article is to analyze the discourse on the sexuality of adolescents living in rural settings and the prospects for breaking with the orders of discourse. It adopts as methodology the action research study in two rural schools in Brazil and Colombia. The data were analyzed using critical discourse analysis. Adolescent sexuality in the context of rural schools is permeated by devices that create silence. The construction of sexuality is characterized by biomedical, biological and sexist models, which are exacerbated in rural settings. It is necessary to reteach the concept of sexuality as a humanizing dimension and make strides in the discussion of how technology and the media interfere in the ways of life and sexuality of adolescents living in rural areas. (AU)

La educación para la sexualidad es un pilar fundamental de la salud sexual y reproductiva. No obstante, hay un distanciamiento de esa discusión para adolescentes rurales. El objetivo de este artículo es analizar el discurso sobre la sexualidad del adolescente en el contexto rural y las perspectivas para romper el orden del discurso. Adopta como metodología la investigación-acción desarrollada en dos escuelas rurales, una en Brasil y otra en Colombia. Para el análisis de los datos se adoptó el Análisis Crítico del Discurso. La sexualidad del adolescente en el contexto de la escuela rural está atravesada por dispositivos que producen el silenciamiento. La construcción de la sexualidad está señalada por los modelos biomédico, biológico y sexista que se exacerban en el contexto rural. Es preciso reeducar el concepto de sexualidad como dimensión humanizadora y avanzar en la discusión sobre cómo la tecnología y los medios interfieren en los modos de vida y en la sexualidad de los adolecentes en el contexto rural. (AU)

Voluntary leadership and the emergence of institutions for self-governance.

Strong local institutions are important for the successful governance of common-pool resources (CPRs), but why do such institutions emerge in the first place and why do they sometimes not emerge at all? We argue that voluntary local leaders play an important role in the initiation of self-governance institutions because such leaders can directly affect local users' perceived costs and benefits associated with self-rule. Drawing on recent work on leadership in organizational behavior, we propose that voluntary leaders can facilitate a cooperative process of local rule creation by exhibiting unselfish behavior and leading by example. We posit that such forms of leadership are particularly important when resource users are weakly motivated to act collectively, such as when confronted with "creeping" environmental problems. We test these ideas by using observations from a laboratory-in-the-field experiment with 128 users of forest commons in Bolivia and Uganda. We find that participants' agreement to create new rules was significantly stronger in group rounds where voluntary, unselfish leaders were present. We show that unselfish leadership actions make the biggest difference for rule creation under high levels of uncertainty, such as when the resource is in subtle decline and intragroup communication sparse.

Evaluation of Heat and pH Treatments on Degradation of Ceftiofur in Whole Milk.

Waste milk feeding practices have been implicated as a potential source for disseminating antimicrobial resistant bacteria among animals and the environment. Two interventions that have shown potential for degrading antimicrobial drugs in milk are heat and pH treatment. The aim of this study was to evaluate the effect of heat and pH treatments on the degradation of ceftiofur and ceftiofur free acid equivalents in milk at concentrations previously found in waste milk on dairy farms by spiking saleable pasteurized whole milk with ceftiofur sodium. Three heat treatments of ceftiofur sodium spiked milk were evaluated for their ability to degrade ceftiofur: 63°C for 30 min (LTLT), 72°C for 15 s (HTST) and 92°C for 20 min (HTLT). Two pH treatments of ceftiofur sodium spiked milk were evaluated: pH 4.0 (LpH) and pH 10 (HpH). Control samples spiked with ceftiofur sodium were kept at room temperature and samples collected at corresponding times for heat and pH treatments. Four treatment replicates were performed for each treatment group. Ceftiofur was quantified in milk samples using liquid chromatography mass spectrometry (LC-MS/MS) and ceftiofur free acid equivalents (CFAE) were measured using high-performance liquid chromatography (HPLC). HTLT resulted in a degradation of 35.24% of the initial concentration of ceftiofur. Ceftiofur degradation did not differ between control and the remaining two heat treatment groups (LTLT and HTST). HpH resulted in degradation of the 95.72 and 96.28% of the initial concentration of ceftiofur and CFAE, respectively. No significant changes in degradation of ceftiofur or CFAE were observed for control or LpH treatments. In conclusion, our study results were that alkalinizing milk to pH 10 and heating milk to 92°C for 20 min degraded ceftiofur and CFAE in spiked simulated waste milk demonstrated promising potential as treatment options for degrading ceftiofur and CFAE in waste milk, and further research is needed to evaluate the viability for implementation of these treatments in dairy farms.

Educação crítica libertadora para a sexualidade do adolescente na escola rural, na Colômbia e no Brasil / Critical education liberating for adolescent sexuality in rural schools in Colombia and Brazil

Introdução: a educação para sexualidade é um pilar fundamental da saúde sexual e reprodutiva dos adolescentes sendo discutida predominantemente no contexto das escolas urbanas. Pressupõe-se que existem elementos diferenciadores da sexualidade do adolescente inserido no contexto da escola rural e um distanciamento entre a educação para a sexualidade tradicional e as necessidades e desafios destes adolescentes. Objetivos: construir um processo educativo-libertador para a sexualidade dos adolescentes no contexto escolar rural, analisando a cultura, valores e saberes sobre a sexualidade dos adolescentes; identificando os elementos, singularidades e necessidades relacionadas com a sexualidade e promovendo o diálogo crítico da realidade da sexualidade no contexto da escola rural. Metodologia: foi desenvolvida uma pesquisa-ação de abordagem qualitativa, ancorada no referencial teórico-metodológico da educação crítica e libertadora de Paulo Freire. O cenário foi duas escolas de ensino fundamental e médio: uma localizada no distrito rural de Ipoema, Minas Gerais, Brasil e outra no município de Supatá, Cundinamarca, Colômbia. Foram implementadas as quatro fases do itinerário freiriano: investigação vocabular, tematização, problematização e avaliação por meio de sete círculos de cultura em cada escola. Participaram onze estudantes da escola brasileira e dezenove adolescentes da escola colombiana. Os dados foram produzidos no período de maio de 2017 a junho 2018, por meio de observação participante, grupos focais e mapa corporal na fase de avaliação. Para análise dos dados foi adotada a Análise Crítica do Discurso. Resultados: Há similaridades das duas escolas referentes às visões conservadoras e tradicionais sobre a sexualidade, com ausência de ações permanentes e falta de articulação entre área da saúde e educação para efetivar os processos educativos com caráter emancipador. O silenciamento foi identificado como prática social em torno da educação para a sexualidade, produzindo e reproduzindo vulnerabilidades corpóreas e sociais. A construção da sexualidade do adolescente é marcada, interdiscursivamente, pelo modelo biomédico, biológico e sexista, utilizando a tecnologia como forma de contestação frente às ausências e precariedades de um processo pedagógico crítico e libertador. As possiblidades de ruptura do silenciamento, das ideologias dominantes e a mudança de um ato esporádico, bancário e determinista para uma prática educativa crítica e democrática da sexualidade orientada pelo referencial de Paulo Freire em que o lúdico foi representativo, sendo os adolescentes protagonistas do processo. Conclusão: O processo educativo construído numa perspectiva ativa e crítica com os adolescentes, valorizando seus sonhos, opiniões, acolhendo suas dúvidas, sentimentos e medos apontou para uma ressignificação da educação para a sexualidade com potencial de transformação social e possibilitou uma pedagogia do corpo crítica e social. Neste aspecto coloca a sexualidade como uma dimensão humanizadora, reconhecendo os adolescentes como sujeitos criadores e agentes de mudança. Contribuições e recomendações: espera-se que os resultados contribuam para uma prática transformadora na educação para a sexualidade de adolescentes no contexto rural, no Brasil e na Colômbia, problematizando a formação de enfermeiros como agentes educadores para as populações na área rural e para a abordagem da sexualidade de forma crítica e libertadora; é preciso reeducar o conceito de sexualidade como dimensão humanizadora e avançar na discussão sobre como a tecnologia e a mídia interferem nos modos de vida e na construção da sexualidade dos adolescentes . Por fim, espera-se subsidiar discursos e práticassociais que superem os processos que usam o corpo e a sexualidade como dispositivos segregadores das infâncias e adolescências, retirando-lhes o direito de viver a saúde sexual e reprodutiva.(AU)

Introduction: Sex education is a fundamental pillar of adolescent sexual and reproductive health, which is predominantly discussed in the context of urban schools. It is assumed that there are different elements of adolescent sexuality in the context of rural schools that could create a gap between traditional sex education and the needs and challenges of these adolescents. Objective: This research aims to build an educational-liberating process for adolescent sexuality in the rural school context, analyzing the culture, values and knowledge around it; identifying the elements, singularities and needs related to sexuality and promoting the critical dialogue in the rural school context. Methodology: This study follows an active qualitative research anchored in Paulo Freire's theoretical-methodological framework of critical and liberating education. The scenario was two elementary and middle schools: the former located in the rural district of Ipoema, Minas Gerais, Brazil and the latter in the municipality of Supatá, Cundinamarca, Colombia. The four phases of the Freireian itinerary were implemented: vocabulary investigation, thematization, problematization and evaluation through seven culture circles in each school. Eleven students from the Brazilian school and nineteen teenagers from the Colombian school participated. Observations of the participants were carried out from May 2017 to June 2018, focusing on groups and body map in the evaluation phase. For data analysis, the Critical Discourse Analysis was adopted. Results: There are similarities between the two schools regarding the conservative and traditional views on sexuality, with the absence of permanent actions and the lack of connection between the health and education areas to effect the emancipatory educational processes. Silencing has been identified as a social practice around sex education, producing and reproducing health and social vulnerabilities. The construction of adolescent sexuality is interdiscursively marked by a biomedical, a biological and a sexist model, using technology as a way of fullfilling the absences and precariousness of a critical and liberating pedagogical process. The possibilities of breaking the silence, the dominant ideologies and the change from a sporadic, banking and deterministic act to a critical and democratic educational practice of sexuality guided by Paulo Freire's framework in which the playful was representative, being the adolescents protagonists of the process. Conclusion: The educational process built on an active and critical perspective with adolescents, valuing their dreams, opinions, welcoming their doubts, feelings and fears pointed to a resignification of sexuality education with the potential for social transformation and enabled a social and critical pedagogy of the body. In this respect, it places sexuality as a humanizing dimension, recognizing adolescents as creative subjects and agents of change. Contributions and recommendations: the results are expected to contribute to a transformative practice in adolescent sex education in the rural context in Brazil and Colombia, problematizing the training of nurses as educators for rural populations and the approach of sexuality in a critical and liberating way; It is necessary to re-educate the concept of sexuality as a humanizing dimension and to advance the discussion about how technology and the media interfere with the lifestyles and the construction of adolescent sexuality. Finally, we hope to subsidize social discourses and practices that surpass the processes that use the body and sexuality as segregating devices of childhood and adolescence, removing their right to live sexual and reproductive health.(AU)

Liberating critical pedagogy of Paulo Freire in the scientific production of Nursing 1990-2017.

OBJECTIVE: To analyze the theoretical and methodological application of Paulo Freire's critical pedagogy in the scientific production of nursing. METHOD: An integrative review was carried out with consultation of the databases: LILACS, BDENF, MEDLINE, PUDMED and CINHAL. We included studies in the Spanish, English and Portuguese languages, published from 1990 to 2017. RESULTS: A total of 38 articles were analyzed, of which the main concepts adopted were: dialogue/dialogicity, awareness/critical awareness and questioning. Regarding the application of the method, it was noticed the predominance of the adoption of elements such as culture circles, thematic phase and horizontality relation of the nurse with the individuals involved. CONCLUSION: Nursing has partially appropriated the Freire's referential. However, it reveals the intentionality of a transformative practice that requires deepening for the implementation of the method in its full.

Liberating critical pedagogy of Paulo Freire in the scientific production of Nursing 1990-2017 / La pedagogía crítica liberadora de Paulo Freire en la producción científica de la enfermería 1990-2017 / Pedagogia crítica libertadora de Paulo Freire na produção científica da Enfermagem 1990-2017

ABSTRACT Objective: To analyze the theoretical and methodological application of Paulo Freire's critical pedagogy in the scientific production of nursing. Method: An integrative review was carried out with consultation of the databases: LILACS, BDENF, MEDLINE, PUDMED and CINHAL. We included studies in the Spanish, English and Portuguese languages, published from 1990 to 2017. Results: A total of 38 articles were analyzed, of which the main concepts adopted were: dialogue/dialogicity, awareness/critical awareness and questioning. Regarding the application of the method, it was noticed the predominance of the adoption of elements such as culture circles, thematic phase and horizontality relation of the nurse with the individuals involved. Conclusion: Nursing has partially appropriated the Freire's referential. However, it reveals the intentionality of a transformative practice that requires deepening for the implementation of the method in its full.

RESUMEN Objetivo: Analizar la aplicación teórica y metodológica de la pedagogía crítica liberadora de Paulo Freire en la producción científica de la enfermería. Método: Se realizó una revisión integrativa con consulta a las bases de datos: LILACS, BDENF, MEDLINE, PUDMED y CINHAL. Se incluyeron estudios en Español, Inglés y Portugués, publicados desde 1990 hasta 2017. Resultados: Se analizaron 38 artículos, de los cuales se aprehendió que los principales conceptos adoptados del referencial fueron: el diálogo/la dialogicidad, la concientización/conciencia crítica y la problematización. En relación a la aplicación del método, se notó la predominancia de la adopción de elementos como: círculos de cultura, la fase de tematización y relación de horizontalidad del enfermero con los sujetos participantes. Conclusión: La enfermería se ha apropiado parcialmente del referencial de Freire. Sin embargo, se revela la intencionalidad de una práctica transformadora que requiere profundización para la implementación del método en su totalidad.

RESUMO Objetivo: Analisar a aplicação teórica e metodológica da pedagogia crítica libertadora de Paulo Freire na produção científica da Enfermagem. Método: Realizou-se uma revisão integrativa com consulta às bases de dados: LILACS, BDENF, MEDLINE, PUDMED e CINHAL. Foram incluídos estudos nos idiomas espanhol, inglês e português, publicados desde 1990 até 2017. Resultados: Foram analisados 38 artigos, dos quais apreendeu-se que os principais conceitos adotados do referencial foram: diálogo/dialogicidade, conscientização/consciência crítica e problematização. Em relação à aplicação do método, notou-se a predominância da adoção de elementos como: círculos de cultura, fase de tematização e relação de horizontalidade do enfermeiro com os sujeitos participantes. Conclusão: A Enfermagem tem se apropriado parcialmente do referencial freireano. Contudo, revela-se a intencionalidade de uma prática transformadora que exige aprofundamento para a implementação do método na sua integralidade.

Efectividad y seguridad de temozolamida, en monoterapia o como terapia combinada con radioterapia, comparada con radioterapia o bevacizumab para gliomas malignos / Effectiveness and safety of temozolomide, as monotherapy or as combination therapy with radiotherapy, compared to radiotherapy or bevacizumab for malignant gliomas

Introducción: en países desarrollados la incidencia de tumores malignos del SNC es de 7,27 casos por cada 100.000 habitantes. Los gliomas representan el 28 % de todas las neoplasias del SNC y el 80% de los tumores malignos. Estos últimos son más frecuentes en hombres (55%) que en mujeres (45%), y su subtipo histológico más común es el glioblastoma (3.19 casos por cada 100.000 habitantes). El estándar actual de tratamiento para las neoplasias cerebrales consiste, para los casos en los que es posible, de una resección del tumor, seguido por un tratamiento concurrente de radioterapia y temozolamida. La administración de radioterapia, en ciclos diarios de 2 Gy hasta completar un 60 Gy, ligada a dosis diarias de temozolamida, y seguida por ciclos mensuales de esta última al término de la Radioterapia, se denomina Protocolo Stupp. Objetivo: examinar los beneficios y riesgos del uso de la temozolamida en pacientes con gliomas malignos, como uno de los criterios para informar la toma de decisiones relacionada con la posible inclusión de tecnologías en el Plan Obligatorio de Salud, en el marco de su actualización integral para el año 2015. Metodología: a partir de la pregunta PICO se establecieron los criterios de elegibilidad para la realización de la búsqueda de la evidencia científica (a ensayos clínicos, revisiones sistemáticas de estudios observacionales y estudios de cohortes analíticas), se realizó la tamización y selección de la evidencia evaluando su calidad y posteriormente se realizó la extracción de datos y la síntesis de la evidencia. Resultados: tres experimentos clínicos, abarcando un total de 745 pacientes, que evaluaron la temozolamida en combinación con radioterapia y en comparación con Radioterapia sola, para el tratamiento del glioblastoma multiforme. La temozolamida aumento Supervivencia Global [hazard ratio (HR) 0,60; intervalo de confianza del 95% (IC) 0,46 a 0,79; valor de p 0,0003] y el aumento de la Supervivencia Libre de Progresión (HR 0,63, IC del 95%: 0,43 a 0,92; valor P 0,02), en comparación con la radioterapia sola. Conclusiones: cuando la temozolamida se administra tanto en fases concomitante y adyuvante, es una terapia primaria eficaz para los glioblastomas malignos en comparación con la Radioterapia sola. Estos efectos se expresan tanto en la Supervivencia Global como en la Supervivencia Libre de Progresión. (AU)

Afrontamiento cognitivo y adaptación de padres o madres con hijos en post-operatorio de cardiopatía congénita en la fundación Cardioinfantil de Bogotá / Cognitive coping and adaptation of fathers or mothers with children in the postoperative period of congenital heart disease in the Fundación Cardioinfantil de Bogotá

Dentro de los defectos congénitos, las cardiopatías congénitas se encuentran en el grupo con mayor riesgo de mortalidad a nivel mundial y teniendo en cuenta que la Fundación CardioInfantil se encuentra entre las primeras instituciones que ofrece un programa de tratamiento de estos, se decidió medir el proceso de afrontamiento y adaptación en un grupo de padres que se encuentren solos o acompañados por su pareja durante el postoperatorio de cardiopatía congénita de su hijo. Como herramienta principal, se utilizó la escala de medición del proceso de afrontamiento y adaptación, versión en español (ECAPS), diseñada por Callista Roy y se concluyó que la pareja, como apoyo social favorece el proceso de afrontamiento de estos padres, promoviendo la adaptación a la situación. (AU)