Intraoperative thoracic interfascial plane block with levobupivacaine versus levobupivacaine with dexmedetomidine for postoperative analgesia after modified radical mastectomy: A randomised controlled double-blinded trial.

Background and Aims: Nearly half of the patients following breast cancer surgery experience postoperative pain. The interfascial plane for the pectoral nerve (PECS) block, along with dexmedetomidine, can alleviate this pain. Methods: After institutional ethics committee clearance and written informed consent, this randomised, double-blind study was conducted on 60, 18-60 years female patients, who were scheduled for modified radical mastectomy (MRM) under general anaesthesia. Patients were randomised into Group L (20 ml of 0.25% levobupivacaine) and Group DL (20 ml of 0.25% levobupivacaine with 0.5 µg/kg of dexmedetomidine). After resection of the tumour and securing haemostasis, under strict aseptic precaution, 10 ml of the study drug was injected under direct vision between the pectoralis major and pectoralis minor and 10 ml between pectoralis minor and serratus anterior muscles by the operating surgeon (direct PECS block). The primary outcome was to compare the duration of analgesia. Normally distributed variables were compared using Student's t-test, and non-normally distributed variables were compared using the Mann-Whitney U-test. Qualitative data were analysed using Chi-square/Fisher's exact test. Statistical significance was kept at P < 0.05. Results: The median time of the first analgesic requirement was 8 [inter-quartile range (IQR): 6-8] h in Group L and 18 (IQR: 16-20) h in Group DL (W = 17.000, P < 0.001). The mean total opioid consumption of Group L was 12.53 [standard deviation (SD): 2.29] mg in the first 24 h and 6.93 (SD: 1.89) mg in Group DL. Conclusion: Adding 0.5 µg/kg dexmedetomidine to 20 ml of levobupivacaine enhances the duration of analgesia of direct PECS block in patients undergoing MRM.

Pectoral Nerve Block II for Cardiac Implantable Electronic Devices.

AIM: This study aimed to assess the feasibility and effectiveness of the pectoral nerves (PECS) II block in facilitating cardiac implantable electronic device (CIED) insertion in a sample of 120 patients, with a focus on the percentage of cases completed without additional intraoperative local anesthesia. METHODS: PECS II blocks were performed on the left side using ultrasound guidance in all 120 patients. Feasibility was assessed by the proportion of cases completed without the need for extra intraoperative local anesthetic. Secondary outcomes included the amount of additional local anesthetic used, intraoperative opioid requirements, postoperative pain scores, time to first postoperative analgesia, analgesic consumption, patient satisfaction, and block-related complications. RESULTS: Of the 120 patients, 78 (65%) required additional intraoperative local anesthetic, with a median volume of 8.2 mL (range 3-13 mL). Fifteen patients (12.5%) needed intraoperative opioid supplementation. Nine patients (7.5%) required postoperative tramadol for pain relief. In total, 98 patients (81.7%) reported high satisfaction levels with the procedure. CONCLUSIONS: The PECS II block, when combined with supplementary local anesthetic, provided effective postoperative analgesia for at least 24 h in 120 patients undergoing CIED insertion. While it did not completely replace surgical anesthesia in most cases, the PECS II block significantly contributed to a smoother intraoperative experience for patients.

The effect of a local anesthetic cocktail in a serratus anterior plane and PECS 1 block for implant-based breast reconstruction.

Introduction: Enhanced recovery after surgery (ERAS) protocols have been implemented to decrease opioid use and decrease patient hospital length of stay (LOS, days). Serratus anterior plane (SAP) blocks anesthetize the T2 through T9 dermatomes of the breast and can be applied intraoperatively. The purpose of this study was to compare postoperative opioid (OME) consumption and LOS between a control group, an ERAS group, and an ERAS/local anesthetic cocktail group in patients who underwent implant-based breast reconstruction. Methods: In this study, 142 women who underwent implant-based breast reconstruction between 2004 and 2020 were divided into Group A (46 patients), a historical cohort; Group B (73 patients), an ERAS/no-block control group; and Group C (23 patients), an ERAS/anesthetic cocktail study group. Primary outcomes of interest were postanesthesia care unit (PACU), inpatient and total hospital OME consumption, and PACU LOS. Results: A significant decrease was observed from Group A to C in PACU LOS (103.3 vs. 80.2 vs. 70.5; p = 0.011), OME use (25.1 vs. 11.4 vs. 5.7; p < 0.0001), and total hospital OME (120.3 vs. 95.2 vs. 35.9; p < 0.05). No difference was observed in inpatient OMEs between the three groups (95.2 vs. 83.8 vs. 30.8; p = 0.212). Despite not reaching statistical significance, Group C consumed an average of 50-60 % less opioids per patient than did Group B in PACU, inpatient, and total hospital OMEs. Conclusion: Local anesthetic blocks are important components of ERAS protocols. Our results demonstrate that a combination regional block with a local anesthetic cocktail in an ERAS protocol can decrease opioid consumption in implant-based breast reconstruction.

Clinical application value of pre-pregnancy carrier screening in Chinese Han childbearing population.

BACKGROUND: To explore the clinical application value of pre-conception expanded carrier screening (PECS) in the Chinese Han ethnicity population of childbearing age. METHODS: The results of genetic testing of infertile parents who underwent PECS in the Reproductive Medicine Center of the Second Affiliated Hospital of Zhengzhou University, China, from September 2019 to December 2021, were retrospectively analyzed. The carrier rate of single gene disease, the detection rate of high-risk parents, and the clinical outcome of high-risk parents were statistically analyzed. RESULTS: A total of 1372 Chinese Han ethnicity patients underwent PECS, among which 458 patients underwent the extended 108-gene test, their overall carrier rate was 31.7%, and the detection rate of high-risk parents was 0.3%. The highest carrier rates were SLC22A (2.4%), ATP7B (2.4%), MMACHC (2.2%), PAH (1.8%), GALC (1.8%), MLC1 (1.3%), UNC13D (1.1%), CAPN3 (1.1%), and PKHD1 (1.1%). There were 488 women with fragile X syndrome-FMR1 gene detection, and 6 patients (1.2%) had FMR1 gene mutation. A total of 426 patients were screened for spinal muscular atrophy-SMN1, and the carrier rate was 3.5%, and the detection rate of parents' co-carrier was 0.5%. CONCLUSION: Monogenic recessive hereditary diseases had a high carrier rate in the population. Pre-pregnancy screening could provide good prenatal and postnatal care guidance for patients and preimplantation genetic testing for monogenic/single gene disorders (PGT-M) and prenatal diagnosis could provide more precise reproductive choices for high-risk parents.

Pesticide Residues in Organic and Conventional Agricultural Soils across Europe: Measured and Predicted Concentrations.

During the growing season of 2021, 201 soil samples from conventionally and organically managed fields from 10 European countries and 8 cropping systems were taken, and 192 residues of synthetic pesticides were analyzed. Pesticide residues were found in 97% of the samples, and 88% of the samples contained mixtures of at least 2 substances. A maximum of 21 substances were found in conventionally managed fields, and a maximum of 12 were found in organically managed fields. The number and concentration of pesticide residues varied significantly between conventional and organic fields in 70 and 50% of the case study sites, respectively. Application records were available for a selected number of fields (n = 82), and these records were compared to the detected substances. Residues from 52% of the applied pesticides were detected in the soils. Only 21% of the pesticide residues detected in the soil samples were applied during the 2021 growing season. From the application data, predicted environmental concentrations of residues in soil were calculated and compared to the measured concentrations. These estimates turned out not to be accurate. The results of this study show that most European agricultural soils contain mixtures of pesticide residues and that current calculation methods may not reliably estimate their presence.

Salty treatment increased bioactive compounds accumulation during agarwood development in Aquilaria sinensis trees.

To compare the bioactive compounds in agarwood induced by different methods in Aquilaria sinensis(Lour.) Gilg trees, a two dimensional thin layer chromatograph(2D-TLC) combined with effect directive analysis(EDA) was developed. Three antioxidants were found by 2D-TLC-DPPH and further identified as 2-(2-phenylethyl) chromones(PECs) with LC-MS/MS. The 3 antioxidants decreased along agarwood formation and their compositions in drilling induced agarwood differed with those in microbe culture induced agarwood. Further study showed NaCl treatment promoted antioxidants accumulation in agarwood induced by drilling or hot drilling. Hot drilling combined with salty stimulation was most efficient in some chemicals accumulation, which were identified as PECs with antioxidant, tyrosinase or ß-glucosidase inhibiting activities by 2D-TLC-EDA-LC-MS/MS. This study provided a 2D-TLC-EDA-LC-MS/MS method for bioactive compounds screen and qualification of agarwood. Based on this method, non-conventional methods were found to accelerate the accumulation of some bioactive PECs in A. sinensis trees.

Exploring the Use of the Picture Exchange Communication System (PECS) in Special Education Settings.

The Picture Exchange Communication System (PECS) is an Augmentative and Alternative Communication (AAC) system which is widely used to support children with developmental disabilities. In the present study, we surveyed individuals responsible for implementing PECS in special educational settings in the United Kingdom (N=283). We explored knowledge of and adherence to the  intervention, with a view to identifying training and support needs. Specifically, we examined participants' knowledge, implementation accuracy, training experiences, access to resources, and attitudes towards PECS. We developed hierarchical logistic regression models to explore the association between training experience and both knowledge and use of PECS. We pre-registered our methods, predictions and the analysis plan on the Open Science Framework (OSF).We found considerable variation in practitioner knowledge and implementation of PECS. Formal training predicted greater knowledge and more accurate implementation when practitioner role and the degree of setting support were accounted for. While PECS was rated by a large majority to be effective and practical, many participants identified that time and the availability of resources were barriers to implementation. We also found that the purpose of PECS was not always fully understood by practitioners, and we identified some consistent gaps in knowledge and implementation.  This study contributes new information regarding the real-world  use of PECS in educational settings and offers new insights for supporting practitioners.

Clinical research of ultrasound-guided PECS-Ⅱ blocks in surgery of patients with benign tumor of breast / 中国医学装备

Objective:To explore the application effect of ultrasound-guided pectoralis Ⅱ(PECS-Ⅱ)blocks anesthesia in benign tumor resection of breast.Methods:A total of 60 female patients who underwent benign tumor resection of breast were selected from Maternity and Child Care Center of Qinhuangdao from January 2021 to December 2021,and they were divided into the thoracic nerve block group(nerve block group)and local infiltration anesthesia group(local anesthesia group)according to the random number table method.The nerve block group used ultrasound-guided PECS-Ⅱ anesthesia,and the local anesthesia group used local infiltration anesthesia for tumor.The hemodynamic indicators,postoperative visual analogue score,first intervention time of postoperative analgesic drugs,and the use of sufentanil within 24 hours after surgery were compared and analyzed between the two groups of patients.Results:The average operation time of the nerve block group was(127.32±34.56)min,and the difference of that between the nerve block group and local anesthesia group(128.11±33.84)min was no statistically significant(P>0.05).The differences of the heart rate(HR)and mean arterial pressure(MAP)before anesthesia(T0)between two groups of patients were not statistically significant(P>0.05).The HR and MAP levels at the time of skin incision(T1),at the 0.5 h after the surgery was conducted(T2)and the time of completing surgery(T3)in nerve block group were significantly lower than those of the local anesthesia group,respectively.The differences were statistically significant(tHR=5.709,5.836,5.662,tMAP=3.501,3.223,3.128,P<0.05),respectively.Compared with the local anesthesia group,the pain level at the same time point in the nerve block group was significantly reduced,and the difference was statistically significant(t=4.501,6.575,8.197,8.262,P<0.05),respectively.The intervention time of analgesic medication at the first time of the nerve block group was significantly later than that of the local anesthesia group,and the consumption of sufentanil within 24 hours after surgery of the nerve block group was also significantly reduced,and the differences of them were statistically significant(t=13.741,9.482,P<0.05),respectively.Conclusion:Ultrasound-guided PECS-Ⅱ can effectively relieve postoperatively early pain in patients with benign tumors of breast,and delay the intervention time of postoperative analgesic medication,and reduce the intake amount of opioid drugs.

Multiple Thoracic Wall Blocks for Awake Breast Surgery: A Case Report.

Awake breast surgeries under nerve blocks have been a challenge for anaesthesiologists, and different block combinations have been used for surgery under sedation. Thoracic paravertebral block (TPVB) was thought to be sufficient alone for surgical anaesthesia of the breast. We performed a combination of TPVB, pectoralis nerve I block, and serratus anterior plane block for awake breast surgery in an elderly patient with serious comorbidities. Surgical anaesthesia was achieved, excluding skin incision. Any regional anaesthesia technique alone is not sufficient; rather, multiple thoracic wall blocks are needed for surgical anaesthesia of the breast.

Intraoperative ultrasound-guided pectoral nerve blocks for cardiac implantable device procedures.

BACKGROUND: Pectoral nerve (PECs) blocks are established regional anesthesia techniques that can provide analgesia to the anterior chest wall. Although commonly performed preoperatively by anesthesiologists, the feasibility of electrophysiologist-performed PECs blocks from within cardiac implantable electronic device (CIED) pockets at the time of implantation has not been established. The objective of this study is to assess the feasibility of routine PECs blocks performed by the electrophysiologist from within the exposed device pocket at the time of CIED procedures. METHODS: Patients undergoing CIED procedures underwent a PECs I block (15 cc of 1% lidocaine/0.25% bupivacaine) injected between the pectoralis major and minor muscles guided by ultrasound placed in the device pocket, or PECs II block, which included a second injection (15 cc) between pectoralis minor and serratus anterior muscles. Postoperatively, pain was assessed on a numeric scale (0-10) at 1, 2, 4, and 24 h, and 2 weeks after the procedure. RESULTS: Among 20 patients (age 65 ± 16 years, 70% male, 55% with history of chronic pain), PECs I (75%) and PECs II (25%) blocks were performed. The procedures were de novo implantation (n = 17) or device revision (n = 3). The average pain score in the first 4 h was 0.4 ± 0.8 and 0.3 ± 0.6 at 24 h after the procedure. During the 24-h postoperative period, 4 patients received opioids. Two patients were discharged with opioids for pain unrelated to the procedure. CONCLUSIONS: Intraoperative PECs blocks can be feasibly performed from within an exposed pocket at the time of CIED procedures with minimal postoperative pain.

Effect of Interpectoral-Pectoserratus Plane (PECS II) Block on Recovery Room Discharge Time in Breast Cancer Surgery.

Background and Objectives: The increase in the incidence and diagnosis rate of breast cancer demands the optimization of resources. The aim of this study was to assess whether the supplementation of the interpectoral-pectoserratus plane block (PECS II) reduces surgery and post-anesthesia care unit (PACU) time in patients undergoing breast cancer surgery. Materials and methods: This was a retrospective data-analysis study. In 2016, PECS II block was introduced as a supplement to general anesthesia for all mastectomies with or without axillary resections in South Jutland regional hospital, Denmark. The perioperative data of patients operated 3 years before and 3 years after 2016 was retrieved through the Danish anesthesia database and patient journals and systematically analyzed. Female patients aged over 18 years, with no use of muscle relaxant, intubation, and inhalation agents, were included. The eligible data was organized into two groups, i.e., Block and Control, where the Block group received PECS II Block, while the Control group received only general anesthesia. Parameters such as surgery time, anesthesia time, PACU time, opioid consumption, and the incidence of postoperative nausea and vomiting (PONV) in PACU were retrieved and statistically analyzed. Results: A total of 172 patients out of 358 patients met eligibility criteria. After applying exclusion criteria, 65 patients were filtered out. A total of 107 patients, 51 from the Block and 56 from the Control group, were eligible for the final analysis. The patients were comparable in demographic parameters. The median surgery time was significantly less in the Block group (78 min (60-99)) in comparison to the Control group (98.5 min (77.5-139.5) p < 0.0045). Consequently, the median anesthesia time was also shorter in the Block group (140 min (115-166)) vs. the Control group (160 min (131.5 to 188), p < 0.0026). Patients from the Block group had significantly lower intraoperative fentanyl consumption (60 µg (30-100)) as compared with the Control group (132.5 µg (80-232.5), p < 0.0001). The total opioid consumption during the entire procedure (converted to morphine) was significantly lower in the Block group (16.37 mg (8-23.6)) as compared with the Control group (31.17 mg (16-46.5), p < 0.0001). No statistically significant difference was found in the PACU time, incidences of PONV, and postoperative pain. Conclusions: The interpectoral-pectoserratus plane (PECS II) block supplementation reduces surgery time, anesthesia time, and opioid consumption but not PACU time during breast cancer surgery.

Generalização de mandos aprendidos pelo PECS (Picture Exchange Communication System) em crianças com transtorno do espectro autista / Generalization of mands learned by PECS (Picture Exchange Communication System) in children with autism / Generalización de mandos aprendidos por PECS (Picture Exchange Communication System) en los niños autistas

O ensino de comportamento verbal com o uso de comunicação alternativa é um instrumento para melhorar a interação social de crianças com Transtorno do Espectro Autista (TEA). O objetivo do estudo foi ensinar mandos com o Picture Exchange Communication System (PECS) e avaliar a sua generalização entre ambientes. Os mandos treinados consistem na troca de cartões com estímulos visuais pelos próprios itens. Participaram do estudo quatro crianças diagnosticadas com TEA, com idade entre 6 e 12 anos. Após treino do PECS, professora e mães receberam instruções e registraram a emissão de mandos (teste de generalização) nos ambientes escolar e domiciliar. Os resultados mostraram que para três crianças o ensino de mandos foi bem sucedido e que ocorreu a generalização para outros itens nos dois contextos avaliados. É discutida a necessidade de maior controle de variáveis que interfiram no treino para a aquisição de mandos, além de planejamento da generalização pelas crianças para ambientes, pessoas e itens diferentes.

Verbal training with the use of alternative communication is a tool for improving the social interaction of children with Autism Spectrum Disorder (TEA). The aim of this study was to promote generalization of trained mands through the Picture Exchange Communication System (PECS). Trained mands comprise the exchange of pictures with visual stimuli by the items themselves. There were 4 autists aged between 6 and 12 years old, who took part in the study. After the PECS training, the teacher and the mothers were instructed to take notes of the mands performed in school and home settings. Results have shown that 3 children met the learning criterion for PECS and that there was a generalization for other settings. The need for greater control of the variables that interfere with mand acquisitions and the children planning for generalization of environment, people and different items have been discussed.

Entrenamiento verbal con el uso de la comunicación alternativa es una herramienta para mejorar la interacción social de los niños con trastorno del espectro autista (TEA). El objetivo era enseñar a los comandos con el Sistema Picture Exchange Communication (PECS) y evaluar su generalización. Mandos entrenados consisten en el intercambio de cartas con los estímulos visuales por elementos propios. Los participantes del estudio fueron cuatro niños diagnosticados con TEA, de 6 a 12 años. Después del entrenamiento del PECS, profesor y madres fueron instruidos y grabó las exigencias de emisiones (prueba de generalización) en el entorno escolar y el hogar. Los resultados mostraron que a tres hijos demandas del entrenamiento fue un éxito y lo que pasó generalización a otros artículos en los dos contextos evaluados. Se discutió la necesidad de mayores variables de control que interfieren con lo entrenamiento para adquirir comandos y la generalización de la planificación para los niños a los ambientes, personas y diferentes elementos.

Surgical excision of the breast giant fibroadenoma under regional anesthesia by Pecs II and internal intercostal plane block: a case report and brief technical description: a case report / 대한마취과학회지

A 22-years-old female patient at 171 cm and 67 kg visited the Department of Breast Surgery of the hospital with a mass accompanied with pain on the left side breast as chief complaints. Since physical examination revealed a suspected huge mass, breast surgeon decided to perform surgical excision and requested anesthesia to our department. Surgery of breast tumor is often under local anesthesia. However, in case of big size tumor, surgery is usually performed under general anesthesia. The patient feared general anesthesia. Unlike abdominal surgery, there is no need to control visceral pain for breast and anterior thoracic wall surgery. Therefore, we decided to perform resection under regional anesthesia. Herein, we report a successful anesthetic and pain management of the patient undergoing excision of a huge breast fibroadenoma under regional anesthesia using Pecs II and internal intercostal plane block.

ANÁLISE DE SISTEMA DE COMUNICAÇÃO ALTERNATIVA NO ENSINO DE REQUISITAR POR AUTISTAS / Analysis of an Alternative Communicative Training for Teaching Request to Autistic / Examinar un sistema de comunicación alternativo en la enseñanza de pedidos por autistas

O Picture Exchange Communication System (PECS) é um sistema alternativo de comunicação no qual há o ensino da troca de cartões com figuras pelos itens representados nos cartões. Estudos visam avaliar seu uso na educação especial e a sua eficácia na promoção da comunicação por autistas. O objetivo deste estudo foi delimitar as condições contextuais sob as quais o protocolo de comunicação é efetivo, analisando algumas variáveis na aplicação das suas três primeiras fases, que ensinam comportamento de requisitar (emitir mandos). Quatro crianças autistas com idade entre 6 e 12 anos receberam treino sistemático das três primeiras fases do PECS, sendo documentadas as possíveis variáveis de controle para aquisição de mandos. Os resultados mostraram que a aplicação do PECS foi efetiva, porém que há necessidade de descrição das especificidades do treino para maximizar seu uso na educação. É discutida a necessidade de maior identificação e controle de variáveis no ensino do PECS para que seja atestada a sua eficácia, corroborando a necessidade identificada na literatura de mais estudos que avaliem a efetividade do protocolo.(AU)

The Picture Exchange Communication System (PECS) is an alternative communication system teaching to exchange figures for the items represented in cards. Many studies attempt to assess PECS effectiveness in special education, in promoting autistic communication for autistic people. The aim of this study was to define the contextual conditions under which the teaching protocol is effective, analyzing some variables to conduct its first three phases, teaching order behavior (expressing orders). Four autistic children aged between 6 and 12 years received systematic training of PECS first three phases, and the possible control variables for order acquisition were measured. The results showed that the application of PECS was effective, but there is need for description of the specific training to be used in special education. The paper discusses the need for greater identification and control variables in PECS teaching to attest its effectiveness, corroborating the need identified in the literature for further studies to evaluate the effectiveness of the Protocol.(AU)

El Picture Exchange Communication System (PECS) es un sistema de comunicación en el cual hay la enseñanza de cambio de tarjetas con dibujos por los elementos representados en ellas. Los estudios objetivan evaluar el uso en educación especial y su eficacia en la promoción de la comunicación por autista. El objetivo de este estudio fue definir las condiciones contextuales en las que el protocolo de comunicación es efectivo, analizando algunas variables en la aplicación de sus primeras tres fases, que enseñan comportamientos de pedir (emitir mandos). Cuatro niños autistas con edades entre 6 y 12 años recibieron capacitación sistemática en las tres primeras fases del PECS, documentando las posibles variables de control para la adquisición de mandos. Los resultados mostraron que la aplicación del PECS fue efectiva, pero hay necesidad de describir las especificidades del entrenamiento para maximizar su uso en la educación. Es discutida la necesidad de mayor identificación y control de variables en la enseñanza con uso del PECS para que sea testada su eficacia, corroborando la necesidad identificada en la literatura de más estudios para evaluar la eficacia del protocolo.(AU)

Análise de sistema de comunicação alternativa no ensino de requisitar por autistas / Analysis of an alternative communicative training for teaching request to autistic / Examinar un sistema de comunicación alternativo en la enseñanza de pedidos por autistas

O Picture Exchange Communication System (PECS) é um sistema alternativo de comunicação no qual há o ensino da troca de cartões com figuras pelos itens representados nos cartões. Estudos visam avaliar seu uso na educação especial e a sua eficácia na promoção da comunicação por autistas. O objetivo deste estudo foi delimitar as condições contextuais sob as quais o protocolo de comunicação é efetivo, analisando algumas variáveis na aplicação das suas três primeiras fases, que ensinam comportamento de requisitar (emitir mandos). Quatro crianças autistas com idade entre 6 e 12 anos receberam treino sistemático das três primeiras fases do PECS, sendo documentadas as possíveis variáveis de controle para aquisição de mandos. Os resultados mostraram que a aplicação do PECS foi efetiva, porém que há necessidade de descrição das especificidades do treino para maximizar seu uso na educação. É discutida a necessidade de maior identificação e controle de variáveis no ensino do PECS para que seja atestada a sua eficácia, corroborando a necessidade identificada na literatura de mais estudos que avaliem a efetividade do protocolo.

The Picture Exchange Communication System (PECS) is an alternative communication system teaching to exchange figures for the items represented in cards. Many studies attempt to assess PECS effectiveness in special education, in promoting autistic communication for autistic people. The aim of this study was to define the contextual conditions under which the teaching protocol is effective, analyzing some variables to conduct its first three phases, teaching order behavior (expressing orders). Four autistic children aged between 6 and 12 years received systematic training of PECS first three phases, and the possible control variables for order acquisition were measured. The results showed that the application of PECS was effective, but there is need for description of the specific training to be used in special education. The paper discusses the need for greater identification and control variables in PECS teaching to attest its effectiveness, corroborating the need identified in the literature for further studies to evaluate the effectiveness of the Protocol.

El Picture Exchange Communication System (PECS) es un sistema de comunicación en el cual hay la enseñanza de cambio de tarjetas con dibujos por los elementos representados en ellas. Los estudios objetivan evaluar el uso en educación especial y su eficacia en la promoción de la comunicación por autista. El objetivo de este estudio fue definir las condiciones contextuales en las que el protocolo de comunicación es efectivo, analizando algunas variables en la aplicación de sus primeras tres fases, que enseñan comportamientos de pedir (emitir mandos). Cuatro niños autistas con edades entre 6 y 12 años recibieron capacitación sistemática en las tres primeras fases del PECS, documentando las posibles variables de control para la adquisición de mandos. Los resultados mostraron que la aplicación del PECS fue efectiva, pero hay necesidad de describir las especificidades del entrenamiento para maximizar su uso en la educación. Es discutida la necesidad de mayor identificación y control de variables en la enseñanza con uso del PECS para que sea testada su eficacia, corroborando la necesidad identificada en la literatura de más estudios para evaluar la eficacia del protocolo.

Revisão de estudos sobre o Picture Exchange Communication System (PECS) para o ensino de linguagem a indivíduos com autismo e outras dificuldades de fala / Review of studies on the Picture Exchange Communication System (PECS) for teaching language to individuals with autism and other speech difficulties

O Picture Exchange Communication System (PECS) é um sistema de comunicação frequentemente utilizado em indivíduos com autismo e/ou pouca fala funcional. Até a data, nenhuma revisão sobre intervenções com o PECS foi publicada no Brasil. Assim, os objetivos deste estudo foram revisar as literaturas brasileira e estrangeira sobre o estado da arte do PECS como um instrumento de ensino de linguagem a indivíduos com autismo e dificuldades de fala, apontar o que tem sido pesquisado, os resultados mais encontrados e direções para novos estudos, principalmente para a literatura brasileira. Quatro artigos foram encontrados na literatura estrangeira e seis na literatura brasileira. Dados referentes ao número de participantes, delineamento de pesquisa, duração do estudo, setting, fases implementadas, resultados encontrados, fidedignidade inter-observador e de procedimento, validade social, manutenção e generalização foram sumarizados. Os estudos revisados mostraram que, em consonância com a literatura, o PECS parece ser efetivo no ensino da comunicação a indivíduos com autismo ou com pouca fala funcional, apesar de o pequeno número de participantes de cada estudo indicar que o PECS é uma estratégia de ensino individual.

The Picture Exchange Communication System (PECS) is a communication system frequently used with people with autism and/or with little functional speech. To date, no review has been published on PECS interventions in the Brazilian literature. Thus, the aims of this study were to review Brazilian and foreign literature on the state of art of PECS as a language teaching instrument for individuals with autism and speech difficulties, and to point out what has been researched, the main results and directions for further research, especially regarding Brazilian literature. Four articles were found in foreign literature and six in the Brazilian one. Data on the number of participants, research design, study duration, setting, implemented phases, main outcomes, inter-observer reliability and procedure data, social validity, generalization and maintenance data were summarized. In consonance with the existing literature, the reviewed studies show that PECS seems to be effective in teaching communication to individuals with autism or little functional speech, despite the small number of participants in each study, suggesting that PECS is an individual teaching strategy.

Ensaio crítico sobre a cooperação internacional em saúde / Critical essay on international cooperation in health

Este ensaio discute as necessidades de cooperação internacional em saúde, o modelo dominante da cooperação neste campo, algumas alternativas ao mesmo − que inclui a cooperação Sul-Sul - e prognósticos para o cenário cooperação internacional, considerada parte da diplomacia da saúde

This essay discusses the need for international cooperation in health, the current dominant model of cooperation in the area, as well as a few alternatives to this model - such as South-South cooperation - and prognoses for the international cooperation sphere, considered a part of health diplomacy