High-resolution assessment of coal mining methane emissions by satellite in Shanxi, China.

Accurate assessment of coal mine methane (CMM) emissions is a prerequisite for defining baselines and assessing the effectiveness of mitigation measures. Such an endeavor is jeopardized, however, by large uncertainties in current CMM estimates. Here, we assimilated atmospheric methane column concentrations observed by the TROPOMI space borne instrument in a high-resolution regional inversion to estimate CMM emissions in Shanxi, a province representing 15% of the global coal production. The emissions are estimated to be 8.5 ± 0.6 and 8.6 ± 0.6 Tg CH4 yr-1 in 2019 and 2020, respectively, close to upper bound of current bottom-up estimates. Data from more than a thousand of individual mines indicate that our estimated emission factors increase significantly with coal mining depth at prefecture level, suggesting that ongoing deeper mining will increase CMM emission intensity. Our results show robustness of estimating CMM emissions utilizing TROPOMI images and highlight potential of monitoring methane leakages and emissions from satellites.

IMPLEMENTATION OF OTTAWA ANKLE RULES IN UNIVERSITY HOSPITAL EMERGENCY ROOM: PILOT STUDY.

Ankle injuries are the most common musculoskeletal injuries in emergency rooms and are associated with a great social and economic impact. The need to request additional tests for ankle sprains is based on suspicion of fracture. The Ottawa Ankle Rules (OAR) establish criteria for ordering radiographs to avoid performing unnecessary examinations. OBJECTIVE: To evaluate the implementation of the Ottawa Rules as a protocol for treating ankle sprains in the emergency department of a university hospital. METHODS: This is a retrospective observational study, conducted over a period of three months before and three months after implementation of the protocol. RESULTS: In the first phase, all patients complaining of ankle sprain underwent radiographs. In the second phase, after the application of the OAR, out of 85 patients evaluated, only 58 underwent complementary exams, showing a reduction of 31.8% in the request for imaging exams. There was no significant difference in fracture detection between the two groups (p=0.476). CONCLUSION: The OAR can be used as a tool in diagnosing ankle sprains, and their implementation reduced the request for imaging exams. Level of Evidence III, Retrospective Comparative Study.

Os traumatismos de tornozelo são as lesões musculoesqueléticas mais comuns nas salas de emergência e estão associadas a um grande impacto social e econômico. A solicitação de exames complementares para a entorse de tornozelo baseia-se na suspeita de fratura. As Regras de Ottawa para Tornozelo (ROT) estabelecem critérios para a solicitação de radiografias com o intuito de evitar a realização de exames desnecessários. Objetivo: Avaliar a implementação das ROT como protocolo de atendimento das entorses de tornozelo no pronto-socorro de um hospital universitário. Métodos: Estudo observacional retrospectivo que visou comparar a solicitação de radiografias e a presença de fraturas três meses antes e três meses após a implantação do protocolo. Resultados: Na primeira fase, todos os pacientes com queixa de entorse de tornozelo realizaram radiografias. Na segunda fase, após aplicação das ROT, de 85 pacientes avaliados, apenas 58 realizaram exames complementares, apresentando uma redução de 31,8% na solicitação dos exames de imagem. Não houve diferença na detecção de fraturas entre os dois grupos (p=0,476). Conclusão: As ROT podem ser utilizadas como ferramenta no atendimento das entorses de tornozelo e sua implantação reduziu a solicitação de exames de imagem. Nível de Evidência III, Estudo Comparativo Retrospectivo.

Study protocol of a prospective single-arm multicenter clinical study to assess the safety and performance of the aXess hemodialysis graft: The pivotal study.

BACKGROUND: Arteriovenous grafts (AVGs) are used for patients deemed unsuitable for the creation of an autogenous arteriovenous fistula (AVF) or unable to await maturation of the AVF before starting hemodialysis. However, AVGs are prone to infection and thrombosis resulting in low long-term patency rates. The novel aXess Hemodialysis Graft consists of porous polymeric biomaterial allowing the infiltration by cells and the growth of neotissue, while the graft itself is gradually absorbed, ultimately resulting in a fully functional natural blood vessel. The Pivotal Study will examine the long-term effectiveness and safety of the aXess Hemodialysis Graft. METHODS: The Pivotal Study is a prospective, single-arm, multicenter study that will be conducted in 110 subjects with end-stage renal disease who are not deemed suitable for the creation of an autogenous vascular access. The primary efficacy endpoint will be the primary patency rate at 6 months. The primary safety endpoint will be the freedom from device-related serious adverse events at 6 months. The secondary endpoints will include the procedural success rate, time to first cannulation, patency rates, the rate of access-related interventions to maintain patency, the freedom from device-related serious adverse events and the rate of access site infections. Patients will be followed for 60 months. An exploratory Health Economic and Outcomes Research sub-study will determine potential additional benefits of the aXess graft to patients, health care institutions, and reimbursement programs. DISCUSSION: The Pivotal study will examine the long-term performance and safety of the aXess Hemodialysis Graft and compare the outcome measures with historical data obtained with other graft types and autogenous AVFs. Potential advantages may include superior long-term patency rates and lower infection rates versus currently available AVGs and a shorter time to first cannulation compared to an autologous AVF. As such, the aXess Hemodialysis Graft may fulfill an unmet clinical need in the field of hemodialysis access.

Post-earthquake damage classification and assessment: case study of the residential buildings after the M w = 5 earthquake in Mila city, Northeast Algeria on August 7, 2020.

On August 7th, 2020, a magnitude Mw = 5.0 earthquake shook 5 km north of Mila city center, northeast of Algeria, causing substantial damage directly to structures, and indirectly from induced impacts of landslides and rock falls, ultimately disrupt to everyday civilian life. Given the recent significant seismic occurrences in the region, a detailed and comprehensive examination and assessment of post-earthquake damage is critical to Algeria. This is primarily because masonry, concrete, and colonial-era structures are sensitive to horizontal motions caused by seismic waves, and because masonry and concrete structures constitute a substantial portion of today's Algeria's build environment. We present a post-earthquake investigation of the Mila earthquake, starting from the earthquake source, and a catalogue of buildings type, damage categorization, and failure patterns of residential structures in Mila's historic old town, where colonial-era brick buildings prevail. We find that structures that represent notable architectural achievements were severely damaged as a result of the earthquake. Data acquired during the immediate post-earthquake analysis was also evaluated and discussed. The graphical representations of the damages are detailed and complemented by photos. This seismic event has shown the fragility of Algeria's building stock, which must be addressed properly in future years. This study reports on an overall estimate of residential buildings in Mila's lower city, as well as an evaluation of the seismic vulnerability of three neighborhood towns (El-Kherba, Grareme-Gouga, and Azzeba). A generic database for graphical surveys and geometric research was developed and implemented making it possible to evaluate the shear strength on-site. The broad observations, collated data, and consequences were then loaded into the 3Muri structural verification program. Nonlinear static analysis was conducted to analyze probable failure paths and compare the real damage to the software results.

Implementation of ottawa ankle rules in university hospital emergency room: pilot study / Implementação das regras de ottawa para tornozelo em pronto-socorro de hospital universitário: estudo piloto

ABSTRACT Ankle injuries are the most common musculoskeletal injuries in emergency rooms and are associated with a great social and economic impact. The need to request additional tests for ankle sprains is based on suspicion of fracture. The Ottawa Ankle Rules (OAR) establish criteria for ordering radiographs to avoid performing unnecessary examinations. Objective: To evaluate the implementation of the Ottawa Rules as a protocol for treating ankle sprains in the emergency department of a university hospital. Methods: This is a retrospective observational study, conducted over a period of three months before and three months after implementation of the protocol. Results: In the first phase, all patients complaining of ankle sprain underwent radiographs. In the second phase, after the application of the OAR, out of 85 patients evaluated, only 58 underwent complementary exams, showing a reduction of 31.8% in the request for imaging exams. There was no significant difference in fracture detection between the two groups (p=0.476). Conclusion: The OAR can be used as a tool in diagnosing ankle sprains, and their implementation reduced the request for imaging exams. Level of Evidence III, Retrospective Comparative Study.

RESUMO Os traumatismos de tornozelo são as lesões musculoesqueléticas mais comuns nas salas de emergência e estão associadas a um grande impacto social e econômico. A solicitação de exames complementares para a entorse de tornozelo baseia-se na suspeita de fratura. As Regras de Ottawa para Tornozelo (ROT) estabelecem critérios para a solicitação de radiografias com o intuito de evitar a realização de exames desnecessários. Objetivo: Avaliar a implementação das ROT como protocolo de atendimento das entorses de tornozelo no pronto-socorro de um hospital universitário. Métodos: Estudo observacional retrospectivo que visou comparar a solicitação de radiografias e a presença de fraturas três meses antes e três meses após a implantação do protocolo. Resultados: Na primeira fase, todos os pacientes com queixa de entorse de tornozelo realizaram radiografias. Na segunda fase, após aplicação das ROT, de 85 pacientes avaliados, apenas 58 realizaram exames complementares, apresentando uma redução de 31,8% na solicitação dos exames de imagem. Não houve diferença na detecção de fraturas entre os dois grupos (p=0,476). Conclusão: As ROT podem ser utilizadas como ferramenta no atendimento das entorses de tornozelo e sua implantação reduziu a solicitação de exames de imagem. Nível de Evidência III, Estudo Comparativo Retrospectivo.

Reconstrução das subunidades nasais após ressecção tumoral / Reconstruction of the nasal subunits after tumor resection

Introdução: A maioria dos defeitos nasais que se apresentam para reconstrução são secundários à excisão tumoral. O Objetivo é analisar a eficácia da técnica reconstrutora utilizada para a cobertura do defeito após exérese tumoral de acordo com a subunidade anatômica nasal acometida. Método: Estudo retrospectivo dos prontuários de 118 pacientes que durante o período de agosto de 2012 a março de 2017 foram submetidos à ressecção dos tumores nasais no Instituto Mário Penna em Belo Horizonte/MG. Resultados: A incidência foi maior em mulheres (56%) e brancos (54,3%) com idade média de 71,3 anos. Foram ressecados 125 tumores e realizadas 122 reconstruções nasais. O carcinoma basocelular (90,4%) foi o tumor de pele não melanoma mais prevalente, sendo o subtipo histológico sólido (33,6%) o mais frequente. As técnicas para reconstrução dos defeitos que acometiam apenas uma subunidade nasal foram em sua maioria utilizando o retalho bilobado (26,5%). Nas reconstruções nasais complexas, o retalho miocutâneo bilobado (45,8%) com extensão para a região glabelar (englobando os músculos prócero, corrugador e nasal) foi o mais utilizado, principalmente em defeitos no terço inferior do nariz. Cerca de 78 pacientes apresentaram acompanhamento oncológico superior a um ano, sendo avaliados 82 tumores no total. Sete (8,5%) tumores recidivaram mesmo após ressecção completa e, entre os seis pacientes com margens comprometidas, apenas um (1,2%) recidivou. Conclusão: As técnicas reconstrutoras utilizadas foram eficazes para o tratamento do câncer de pele nasal e cobertura dos defeitos após ressecção, apresentando baixos índices de complicação e recidiva.

Introduction: A majority of the nods present for reconstruction are secondary to tumor excision. The objective is to analyze the efficacy of the reconstructive technique used to cover the defect after tumor exeresis according to the affected nasal anatomical subunit. Method: Retrospective study of the medical records of 118 patients submitted to resection of the nasal tumors at the Mário Penna Institute in Belo Horizonte/ MG from August 2012 to March 2017. Results: Incidence was higher in women (56%) and whites (54.3%) average age of 71.3 years. A total of 125 tumors were resected, and 122 nose reconstructions were performed. Basal cell carcinoma (90.4%) was the most prevalent nonmelanoma skin tumor, the most frequent solid histological subtype (33.6%). The techniques for reconstruction of defects that affect only one nasal subunit were mostly using the bilobed flap (26.5%). In complex nose reconstructions, the bilobed myocutaneous flap (45.8%) with extension to a glabella region (encompassing the procerus, corrugator and nasal muscles) was the most used, mainly in defects in the lower third of the nose. About 78 patients had cancer follow-up of more than one year, and 82 total sin tumors were evaluated. Seven (8.5%) Tumors retreated even after complete resection, and, among the six patients with compromised margins, only one (1.2%) relapsed. Conclusion: The reconstructive techniques used were effective for treating nasal skin cancer and coverage of defects after resection, with low rates of complication and recurrence.

Articulações entre o Pensamento de Leibniz e Robine: A Gestalt-terapia Inspirada através da Dobra / Joints between Leibniz and Robine's Thought: The Gestalt-therapy Inspired through the Fold / Articulaciones entre el Pensamiento de Leibniz y Robine: La terapia Gestalt Inspirada por el Pliegue

Este artigo visa aprofundar o conceito de "dobra", mencionado pelo livro "O Self Desdobrado", de Jean-Marie Robine, articulando este conceito às contribuições de Deleuze, através de sua obra intitulada "A Dobra - Leibniz e o Barroco". Para realizar tal articulação, será realizada uma contextualização histórica em relação às críticas leibnizianas ao pensamento cartesiano. Tomando a noção de dobra, segundo a interpretação de Deleuze sobre o trabalho leibniziano, como uma nova fundamentação paradigmática, serão apresentadas algumas possibilidades de utilização na prática clínica da abordagem gestáltica. Serão trazidas novas contribuições de Jean-Marie Robine ao conceito de Self da Gestalt-terapia. Concluindo o artigo, serão apresentadas argumentações tecendo uma plausível analogia entre o pensamento cartesiano tomado como fundamento, e algumas tendências contemporâneas da política brasileira. Reconhecendo como a base de pensamento a partir de um plano cartesiano, pode sugerir uma forma simplificada e reducionista de encarar temas complexos, sistemáticos, e como tal tendência de pensamento é encontrada presentemente em discursos de líderes políticos brasileiros. (AU)

This article aims to deepen the concept of "fold", mentioned in the book "The Unfolded Self", by Jean-Marie Robine, articulating this concept to the contributions of Deleuze, through his work entitled "The Fold - Leibniz and the Baroque". In order to accomplish this articulation, a historical contextualization will be made in relation to the lebnizian critiques of Cartesian thought. Taking the notion of fold, according to Deleuze's interpretation of the leibnizian work, as a new paradigmatic foundation, some possibilities of use in clinical practice of the gestation approach will be presented. New contributions from Jean-Marie Robine will be brought to the concept of Self of Gestalt-therapy. Concluding the article, arguments will be presented that make a plausible analogy between Cartesian thought taken as a foundation, and some contemporary tendencies of Brazilian politics. Recognizing how the basis of thought from a Cartesian plan can suggest a simplified and reductionist way of facing complex and systematic issues, and how such a trend of thought is currently found in speeches of Brazilian political leaders. (AU)

Este artículo pretende profundizar el concepto de "pliegue", mencionado en el libro "El Self Desdoblado", de Jean-Marie Robine, articulando este concepto a las aportaciones de Deleuze, a través de su obra titulada "El pliegue - Leibniz y el Barroco". Para lograr esta articulación, se hará una contextualización histórica en relación con las críticas lebnizianas del pensamiento cartesiano. Tomando la noción de pliegue, según la interpretación de Deleuze de la obra leibniziana, como nuevo fundamento paradigmático, se presentarán algunas posibilidades de uso en la práctica clínica del enfoque gestáltico. Nuevas contribuciones de Jean-Marie Robine serán aportadas al concepto de Self de la terapia Gestalt. Concluyendo el artículo, se presentarán argumentos que hacen una analogía plausible entre el pensamiento cartesiano tomado como base, y algunas tendencias contemporáneas de la política brasileña. Reconocer cómo la base del pensamiento de un plan cartesiano puede sugerir una forma simplificada y reduccionista de enfrentar temas complejos y sistemáticos, y cómo esa tendencia de pensamiento se encuentra actualmente en los discursos de los líderes políticos brasileños. (AU)

Risk management in water supply networks: Aveiro case study.

Water supply networks are critical infrastructures essentials to health, safety, economic and social well-being which have to be maintained and preserved to ensure their proper functioning. Considering the importance of these critical infrastructures, the risks to which they are exposed and the consequences of such risks must be analysed. Thus, it is important that companies responsible for the management of these assets incorporate risk management in their activities. In the scope of risk management, this paper intends to identify the vulnerabilities of water supply infrastructures, by analysing the risks they are exposed and identifying the measures that need to be implemented or reinforced. Risk assessment methodologies were analysed to identify the advantages and disadvantages of each one. As a case study, the water supply network of the Aveiro municipality in mainland Portugal was used. This network was analysed resourcing ArcMap, ArcGIS desktop software, which allows a better understanding of the water supply network. Risk management was applied and the probability and possible consequences of six distinct categories of threats were determined in eight scenarios, allowing the development of risk maps concluding that all these scenarios are in a low or medium level of risk. To decrease the vulnerability of the water network, a set of plans and specific measures have to be developed.

Experimental Study of Rubberized Concrete Stress-Strain Behavior for Improving Constitutive Models.

Inclusion of rubber into concrete changes its behavior and the established shape of its stress-strain curve. Existing constitutive stress-strain models for concrete are not valid in case of rubberized concrete, and currently available modified models require additional validation on a larger database of experimental results, with a wider set of influential parameters. By executing uniaxial compressive tests on concrete with rubber substituting 10%, 20%, 30%, and 40% of aggregate, it was possible to study and evaluate the influence of rubber content on its mechanical behavior. The stress-strain curve was investigated in its entirety, including compressive strength, elastic modulus, strains at significant levels of stress, and failure patterns. Experimental results indicated that increase of rubber content linearly decreases compressive strength and elastic modulus, but increases ductility. By comparing experimental stress-strain curves with those plotted using available constitutive stress-strain models it was concluded that they are inadequate for rubberized concrete with high rubber content. Based on determined deviations an improvement of an existing model was proposed, which provides better agreement with experimental curves. Obtained research results enabled important insights into correlations between rubber content and changes of the stress-strain curve required when utilizing nonlinear material properties.

Burnout syndrome among medical residents: A systematic review and meta-analysis.

BACKGROUND: Burnout is a psychological syndrome that is very common among medical residents. It consists of emotional exhaustion (EE), depersonalization (DP) and reduced personal accomplishment (PA). OBJECTIVE: To estimate burnout among different medical residency specialties. METHODS: A systematic review with meta-analysis was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search of bibliographic databases and grey literature was conducted, from inception to March 2018. The following databases were accessed: Embase, PubMed, Web of Science, Google Scholar and Scopus, and 3,575 studies were found. Methodological quality was evaluated by Agency for Healthcare Research and Quality Methodology Checklist for Cross-Sectional/Prevalence Study. In the final analysis, 26 papers were included. Their references were checked for additional studies, but none were included. RESULTS: 4,664 medical residents were included. High DP, EE and low PA proportions were compared. Specialties were distributed into three groups of different levels of burnout prevalence: general surgery, anesthesiology, obstetrics/gynecology and orthopedics (40.8%); internal medicine, plastic surgery and pediatrics (30.0%); and otolaryngology and neurology (15.4%). Overall burnout prevalence found for all specialties was 35.7%. CONCLUSION: The prevalence of burnout syndrome was significantly higher among surgical/urgency residencies than in clinical specialties. PROSPERO REGISTRATION: CRD42018090270.

Expectativas sobre vias de parto entre acadêmicas de psicologia / Expectations regarding the types of delivery among psychology students

Introdução: vários fatores interferem de maneira significativa na escolha da via de parto. No início da gravidez a maioria das mulheres indica preferência pelo parto normal, entretanto, a maior parte termina por fazer a cesárea. No Brasil, 55% dos partos realizados são cesáreas e há um predomínio deste tipo de parto, especialmente no sistema privado de saúde. Objetivo: compreender as expectativas de acadêmicas de Psicologia que nunca passaram pela experiência de parto, sobre as vias de parto. Metodologia: foi utilizado como instrumento de coleta de dados um questionário semiestruturado de autoaplicação individual com questões abertas referentes a expectativas em relação ao parto. A pesquisa configura-se como um estudo qualitativo e para análise de dados foi utilizada a análise de conteúdo. Resultados: participaram da pesquisa 109 mulheres, com média de idade de 22,7 anos, desvio padrão de 4,6, que nunca passaram pela experiência de parto. Estas mulheres demonstraram esperar, principalmente, uma assistência médica de qualidade, desejavam o parto normal por este possibilitar uma recuperação melhor e mais rápida, afirmaram sentirem medo que haja complicações e sofrimento no parto e tinham medo da dor. Conclusão: é necessário fornecer à mulher mais informações, apoio e suporte no momento da escolha da via de parto.

Introduction: various factors significantly interfere in the type of delivery choice. At the start of a pregnancy, the majority of women indicate a preference for a normal delivery, however, a greater part end up having a caesarean delivery. In Brazil, 55% of deliveries performed are Caesarean, and there is a predominance of this type of delivery especially in the private health care system. Objective: to understand the expectations of Psychology students who have never gone through the experience of delivery regarding the types of delivery. Methodology: a self-administrated semi-structured questionnaire with open questions regarding expectations relating to delivery was utilized as a data collection instrument. The research was configured as a qualitative study, and for the data analysis, content analysis was utilized. Results: the participants were 109 women, averaging 22.7 years old with a standard error of 4.6, who never passed through the childbirth experience. These women hoped, principally, for quality medical assistance, and wished for this to enable a better and faster recovery from normal delivery. They stated that they feared that there would be complications and pain during the delivery, and that they were afraid of the pain. Conclusion: it´s necessary to provide more information and support to the woman when choosing the type of delivery.

Acute upper limb ischemia, a rare presentation of giant cell arteritis.

Giant cell arteritis (GCA) is a systemic large vessel vasculitis, with extracranial arterial involvement described in 10-15% of cases, usually affecting the aorta and its branches. Patients with GCA are more likely to develop aortic aneurysms, but these are rarely present at the time of the diagnosis. We report the case of an 80-year-old Caucasian woman, who reported proximal muscle pain in the arms with morning stiffness of the shoulders for eight months. In the previous two months, she had developed worsening bilateral arm claudication, severe pain, cold extremities and digital necrosis. She had no palpable radial pulses and no measurable blood pressure. The patient had normochromic anemia, erythrocyte sedimentation rate of 120 mm/h, and a negative infectious and autoimmune workup. Computed tomography angiography revealed concentric wall thickening of the aorta extending to the aortic arch branches, particularly the subclavian and axillary arteries, which were severely stenotic, with areas of bilateral occlusion and an aneurysm of the ascending aorta (47 mm). Despite corticosteroid therapy there was progression to acute critical ischemia. She accordingly underwent surgical revascularization using a bilateral carotid-humeral bypass. After surgery, corticosteroid therapy was maintained and at six-month follow-up she was clinically stable with reduced inflammatory markers. GCA, usually a chronic benign vasculitis, presented exceptionally in this case as acute critical upper limb ischemia, resulting from a massive inflammatory process of the subclavian and axillary arteries, treated with salvage surgical revascularization.

Incidência de fistula após palatoplastia à Von Langenbeck com veloplastia intravelar estendida / Incidence of cleft palate fistula after von Langenbeck palatoplasty with extended intravelar veloplasty

Introdução: A fissura labiopalatina é a deformidade craniofacial mais frequente e sua incidência é estimada em 1:600 nascidos vivos no Brasil. O objetivo desse estudo é avaliar a incidência de fístulas para os pacientes submetidos à palatoplastia com veloplastia intravelar estendida. Métodos: Trata-se de estudo descritivo retrospectivo com 25 pacientes que foram operados pelo mesmo cirurgião no período de setembro de 2011 a setembro de 2012. A técnica de Von Langenbeck, juntamente com a veloplastia intravelar estendida, foi realizada em todos os pacientes. Foram excluídos do estudo os pacientes com fístulas palatinas, portadores de síndromes ou outras malformações. A idade média da realização da palatoplastia foi de 30,6 meses, variando de 12 meses a 159 meses. Foram selecionados 19 pacientes: onze (58%) do gênero masculino e oito (42%) do gênero feminino. A fissura palatal isolada foi a mais comum, encontrada em nove (47%) pacientes. A fissura transforame esquerda estava presente em sete (37%) pacientes e três (16%) pacientes eram portadores de fissura transforame bilateral. Resultados: Somente dois (11%) pacientes evoluíram com fístula palatina até o acompanhamento pós-operatório de 6 meses. Conclusão: A técnica de Von Langenbeck associada à veloplastia estendida mostrou-se com baixa incidência de fístulas palatinas (11%) quando comparada ao índice encontrado na literatura mundial (7% a 42%).

Introduction: Cleft lip and palate is the most common craniofacial deformity, with an estimated incidence of 1 case per 600 live births in Brazil. The aim of this study was to determine the incidence of fistula among patients undergoing palatoplasty with extended intravelar veloplasty. Methods: This retrospective descriptive study evaluated 25 patients operated between September 2011 and September 2012 by the same surgeon. The von Langenbeck technique combined with extended intravelar veloplasty was performed in all patients. The study excluded patients with palatal fistulas, syndromes, or other malformations. The age at palatoplasty varied between 12 and 159 months, and the average age was 30.6 months. Nineteen patients were selected, comprising 11 (58%) male patients and 8 (42%) female patients. Isolated cleft palate was the most common deformity, found in 9 (47%) patients. Unilateral (left) trans-foramen cleft was present in 7 (37%) patients, and bilateral trans-foramen cleft was seen in 3 (16%) patients. Results: Only 2 (11%) patients had palatal fistula in a postoperative follow-up period of 6 months. Conclusion: The von Langenbeck technique associated with extended veloplasty resulted in a low incidence of cleft palate fistulas (11%) compared with the rate found in previous studies (7%-42%).

Safety, tolerability and side effects of human papillomavirus vaccines: a systematic quantitative review

Recently, many studies have evaluated HPV vaccine safety and adverse effects. Two vaccine shave been recently evaluated in randomized controlled trials: the bivalent vaccine for HPV 16 and 18 (Cervarix, GlaxoSmithKline Biologicals, Rixensart, Belgium) and the quadrivalent vaccine for HPV 6, 11, 16, and 18 (Gardasil, Merck and Co., Inc., Whitehouse Station, NJ). We have performed a systematic review of all randomized controlled trials in which HPV vaccines were compared with placebo regarding safety, tolerability and adverse effects. Studies were searched up to March 2013 in the databases: Pubmed, Embase, Scielo and Cancerlit. Odds Ratios (OR) of most incident adverse effects were obtained. Twelve reports, involving 29,540 subjects, were included. In the HPV 16/18 group, the most frequently reported events related to the vaccine were pain (OR 3.29; 95% CI: 3.00–3.60), swelling (OR 3.14; 95% CI: 2.79–3.53) and redness (OR 2.41; 95% CI: 2.17–2.68). For the HPV 6/11/16/18 group the events were pain (OR 2.88; 95% CI: 2.42–3.43) and swelling (OR 2.65; 95% CI: 2.0–3.44). Concerning the HPV 16/18 vaccine, pain was the most common outcome detected. These effects can be due to a possible VLP-related inflammation process. Fatigue was the most relevant general effect observed followed by fever, gastrointestinal symptoms, and headache. In the HPV 6/11/16/18 group, only general symptoms, pain and swelling were observed. Pain and swelling were the most frequent. Comparing HPV 16/18 to HPV 6/11/16/18 vaccines, the former presented more adverse effects, perhaps because there are many more trials evaluating the bivalent vaccine. Other studies are needed to clarify this issue.

Os cuidados paliativos e a intervenção social / Palliative care and social intervention

O presente relatório de estágio visa apresentar todo um percurso do estágio de natureza profissional desenvolvido no serviço de cuidados paliativos da Unidade de Cuidados Continuados WECARE, com o objetivo de desenvolver competências na área dos cuidados paliativos. Os cuidados paliativos são cuidados prestados à pessoa com doença incurável e/ou grave, e suas famílias, realizados por uma equipa multidisciplinar, quando a doença já não responde a tratamentos que visem a cura efetiva, mas sim o cuidar. Na construção deste relatório procuramos descrever, analisar e refletir as competências desenvolvidas ao longo do estágio, que se centraram essencialmente nas áreas da comunicação em cuidados paliativos, do trabalho em equipa, do apoio social aos doentes/famílias em situação de sofrimento e/ou em processo de luto, reforçando a importância do assistente social neste processo. Neste percurso, procuramos identificar as necessidades dos doentes e suas famílias, procurando garantir apoio e bem-estar em todo o internamento, e ao mesmo tempo requerer os benefícios sociais, sempre que a situação assim o exigisse, assimilando sempre a lógica de intervenção em equipa multidisciplinar. A metodologia utilizada na construção deste relatório foi sobretudo uma metodologia crítico-reflexiva. A realização deste estágio possibilitou-nos o desenvolvimento de uma maior autonomia e capacidade no processo de tomada de decisão na prestação de cuidados aos doentes e suas famílias, respondendo desta forma às necessidades demonstradas pelos mesmos

This report serves the purpose of presenting the course of my professional internship which took place in the palliative care unit, in the WECARE continuous care unit. Palliative care is care given by a multi-disciplined team, not only to people with an incurable disease and/or a serious one, but also to their relatives, when the patient's illness no longer responds to treatments that aim to cure, but effective caring. In the construction of this report we try to describe, analyze and reflect upon the activities developed during the internship, which focused in communication area in palliative care, team work, social support to patients/families in suffering and/or grieving process, reinforcing the importance of the social worker in this process. In this way, we try to identify needs to patients and their relatives, looking ensure support and well-being throughout the internment, and at the same time, apply for social benefits if necessary, always working in a team. The methodology used in the elaboration of this report was mainly a critical-reflexive methodology. The fulfillment of this internship allowed us to develop more autonomy and capacity in making decisions in the care of provision of services to patients and their relatives, responding the needs demonstrated by them.

Safety, tolerability and side effects of human papillomavirus vaccines: a systematic quantitative review.

Recently, many studies have evaluated HPV vaccine safety and adverse effects. Two vaccines have been recently evaluated in randomized controlled trials: the bivalent vaccine for HPV 16 and 18 (Cervarix, GlaxoSmithKline Biologicals, Rixensart, Belgium) and the quadrivalent vaccine for HPV 6, 11, 16, and 18 (Gardasil, Merck and Co., Inc., Whitehouse Station, NJ). We have performed a systematic review of all randomized controlled trials in which HPV vaccines were compared with placebo regarding safety, tolerability and adverse effects. Studies were searched up to March 2013 in the databases: Pubmed, Embase, Scielo and Cancerlit. Odds Ratios (OR) of most incident adverse effects were obtained. Twelve reports, involving 29,540 subjects, were included. In the HPV 16/18 group, the most frequently reported events related to the vaccine were pain (OR 3.29; 95% CI: 3.00-3.60), swelling (OR 3.14; 95% CI: 2.79-3.53) and redness (OR 2.41; 95% CI: 2.17-2.68). For the HPV 6/11/16/18 group the events were pain (OR 2.88; 95% CI: 2.42-3.43) and swelling (OR 2.65; 95% CI: 2.0-3.44). Concerning the HPV 16/18 vaccine, pain was the most common outcome detected. These effects can be due to a possible VLP-related inflammation process. Fatigue was the most relevant general effect observed followed by fever, gastrointestinal symptoms, and headache. In the HPV 6/11/16/18 group, only general symptoms, pain and swelling were observed. Pain and swelling were the most frequent. Comparing HPV 16/18 to HPV 6/11/16/18 vaccines, the former presented more adverse effects, perhaps because there are many more trials evaluating the bivalent vaccine. Other studies are needed to clarify this issue.