Local climate, air quality and leaf litter cover shape foliar fungal communities on an urban tree.

Foliar fungi on urban trees are important for tree health, biodiversity and ecosystem functioning. Yet, we lack insights into how urbanization influences foliar fungal communities. We created detailed maps of Stockholm region's climate and air quality and characterized foliar fungi from mature oaks (Quercus robur) across climatic, air quality and local habitat gradients. Fungal richness was higher in locations with high growing season relative humidity, and fungal community composition was structured by growing season maximum temperature, NO2 concentration and leaf litter cover. The relative abundance of mycoparasites and endophytes increased with temperature. The relative abundance of pathogens was lowest with high concentrations of NO2 and particulate matter (PM2.5), while saprotrophs increased with leaf litter cover. Our findings show that urbanization influences foliar fungi, providing insights for developing management guidelines to promote tree health, prevent disease outbreaks and maintain biodiversity within urban landscapes.

Multidisciplinary rehabilitation in intensive care for COVID-19: randomised controlled trial.

Coronavirus disease 2019 (COVID-19) has led to an increasing number of patients in intensive care units (ICUs). The size of this post-ICU cohort will be unprecedented, with many patients vulnerable to post-intensive care syndrome. We analysed the respiratory and functional effects of a multidisciplinary rehabilitation programme on functional performance, in patients hospitalised in the ICU due to COVID-19. We conducted a randomised controlled clinical trial. 96 patients who fulfilled the eligibility criteria were randomised into control or intervention group. The control group received standard of care in the ICU, and the intervention group received a functional and respiratory rehabilitation protocol that included medical, nursing, physiotherapy and occupational therapy interventions. At discharge, the intervention group showed significantly better muscular strength and respiratory capacity, and significantly fewer days of hospitalisation (12.90±5.8 versus 15.60±6.7 days, p=0.037). At the 4- and 12-week follow-up, we applied our main outcome measure, the 6-min walk test (6MWT). The intervention group had significantly better results than the control group on the 6MWT at the 4-week follow-up (604±67 versus 571±57 m, p=0.018) and at the 12-week follow-up (639±53 versus 611±67 m, p=0.025). These results support the role of a multidisciplinary rehabilitation programme in COVID-19 patients hospitalised in the ICU and adds evidence that the implementation of rehabilitation programmes in ICUs could result in beneficial outcomes for critically ill patients.

Self-care during the COVID-19 pandemic: Development of a virtual educational booklet for postmenopausal women with osteoporosis.

OBJECTIVE: To describe the development of a virtual educational booklet for self-care promotion of postmenopausal women with osteoporosis during the COVID-19 pandemics. METHOD: This methodological study was conducted in three steps: bibliographic search, development of virtual educational booklet by 12 evaluators and ten representatives of the target audience. A questionnaire adapted from the literature was used to evaluate the educational booklet. The questionnaire consisted of seven items: scientific accuracy, content, language, illustrations, specificity and comprehension, readability, and quality of information. A minimum score of 0.75 in the content validity index (CVI) of each questionnaire item and minimum agreement of 75% among positive responses of postmenopausal women were required to validate the virtual booklet. RESULTS: Health professionals and representatives of the target audience suggested changes regarding layout, illustrations, and content of the virtual booklet. CVI of the final version was 0.84 between health professionals and agreement among the target audience was 90%. CONCLUSION: The virtual educational booklet with exercises and instructions for postmenopausal women with osteoporosis was valid and should be used by health professionals for advice on self-care and health promotion during the COVID-19 pandemic.

Therapeutic respiratory and functional rehabilitation protocol for intensive care unit patients affected by COVID-19: a structured summary of a study protocol for a randomised controlled trial.

OBJECTIVES: The primary objective of the presented study is to analyze the respiratory and functional effects of a rehabilitation program in patients affected by hospitalization in Intensive Care Unit (ICU) due to COVID-19, in comparison with the group treated with standard of care, at discharge endpoint. The secondary objectives of the presented study are to evaluate different outcomes of the rehabilitation program in comparison to standard of care regarding: functional performance at 4-week and 12-week post- discharge mark; health-related quality of life, the impact on the health services (namely days of hospitalization), the cost-effectiveness of the intervention proposed. TRIAL DESIGN: This is a randomized, controlled, double-blind, double-arm clinical trial of treatment, with an allocation ratio 1:1 and framework of superiority. PARTICIPANTS: The study will be conducted at Centro Hospitalar Entre Douro e Vouga, Santa Maria da Feira, Portugal. Potential participants will be adult patients (≥18 years old) hospitalized in ICU with respiratory insufficiency due to COVID-19, who are referred to respiratory and functional rehabilitation. Only patients approved by physical rehabilitation doctors to perform respiratory and functional rehabilitation will be considered potential participants. To be eligible for inclusion participants must have been independent in their activities of daily living before the onset of critical illness (verbal statement by their proxy) and have to meet the safety criteria defined by the Portuguese Society of Physical Rehabilitation Medicine. INTERVENTION AND COMPARATOR: Both groups will receive usual medical and nursing care in the ICU, which involves assessment and treatment of the respiratory system and may include positioning, hyperinflation techniques and suctioning. The physical function of the patient is assessed, and active bed exercises and mobility are encouraged as soon as possible and may include sitting out of bed. The intervention group will receive a functional and respiratory multidisciplinary rehabilitation protocol (that includes medical, nursing, physiotherapy and occupational therapy interventions) during their entire hospital stay. After reassurance that the patients fulfil the safety criteria, they will initiate the rehabilitation protocol, individualized to each patient based on the clinical status. The rehabilitation interventions and exercises implemented will be consistent with recommendations from the Portuguese Society of Physical Rehabilitation Medicine. The intervention will occur 6 days per week (Monday to Saturday), fifteen minutes, twice per day for each participant. Throughout all activities, progression will be increased successively, depending on the individual's tolerance and stability. After discharge, the intervention group will continue with rehabilitation exercises, prescribed by physical rehabilitation doctors. These exercises are designed for the patient to do at home, and then report their execution to rehabilitation nurses through teleconsultation, until 12 weeks after ICU discharge. MAIN OUTCOMES: Baseline descriptive data collection will include age, sex, comorbidities and date of admission to ICU. The need of mechanical ventilation and length of use, as well as the need for oxygen therapy, length of ICU stay (days/hours), incidence of ICU readmission, discharge destination and survival will also be recorded. Prior to intervention, every two days and at discharge, participants will be evaluated using the following scales: Glasgow Coma Scale, Richmond Agitation Sedation Scale, Chelsea Critical Care Physical Assessment, 5 standardized questions for cooperation, Medical Research Council Sum-Score, Handgrip strength test and Medical Research Council dyspnea scale. At discharge, Borg Rating of Perceived Exertion will be evaluated. The primary outcome measure will be functional capacity using the 6-Minute Walk Test, and it will be measured at discharge and at the 4-week and 12-week mark. Medical Research Council Sum-Score, Handgrip strength test, Medical Research Council dyspnea scale and Borg Rating of Perceived Exertion will also be re-evaluated at the 4-week and 12-week mark. The health related quality of life will also be used as an outcome measure, using the 12-Item Short Form Survey, at 12 weeks of follow-up. RANDOMISATION: Participants will be divided into two groups, standard care and intervention, by means of balanced randomization at a 1:1 ratio using blocks of 10 participants. The randomization sequence is going to be created using a free software ( http://www.randomized.org/ ). In order to ensure the confidentiality of the randomisation sequence, this process will be conducted by an assessor external to the study. BLINDING (MASKING): The evaluators in the study will be blinded during the entire process. The evaluators will be unaware of the study objectives and the randomized distribution of patients to study groups and will not have access to the randomization sequence. Although blinding for patients will not be possible to achieve completely, subjects will be unaware of other treatment modalities, and they will not know if they belong to the intervention or standard group. As for the treating physiotherapists and ICU staff, blinding will not be possible to achieve, but they will not be responsible for assessing outcomes. NUMBERS TO BE RANDOMISED (SAMPLE SIZE): We plan to randomise 40 participants to each group. 80 participants in total. TRIAL STATUS: This is the second and definitive protocol version, dated from 26th February 2021. Recruitment started on 8th March 2021. Participants will be recruited between March 8, 2021, and June 8, 2021. Study completion is expected to be October 2021. TRIAL REGISTRATION: ReBEC RBR-7rvhpq9 . Registry name: The effect of rehabilitation in hospitalized COVID-19 patients. Registered on 17 March 2021.Retrospectively registered. FULL PROTOCOL: "The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol".

Respiratory Health Effects of Wildfire Smoke during Summer of 2018 in the Jämtland Härjedalen Region, Sweden.

During the summer of 2018 Sweden experienced a high occurrence of wildfires, most intense in the low-densely populated Jämtland Härjedalen region. The aim of this study was to investigate any short-term respiratory health effects due to deteriorated air quality generated by the smoke from wildfires. For each municipality in the region Jämtland Härjedalen, daily population-weighted concentrations of fine particulate matter (PM2.5) were calculated through the application of the MATCH chemistry transport model. Modelled levels of PM2.5 were obtained for two summer periods (2017, 2018). Potential health effects of wildfire related levels of PM2.5 were examined by studying daily health care contacts concerning respiratory problems in each municipality in a quasi-Poisson regression model, adjusting for long-term trends, weekday patterns and weather conditions. In the municipality most exposed to wildfire smoke, having 9 days with daily maximum 1-h mean of PM2.5 > 20 µg/m3, smoke days resulted in a significant increase in daily asthma visits the same and two following days (relative risk (RR) = 2.64, 95% confidence interval (CI): 1.28-5.47). Meta-estimates for all eight municipalities revealed statistically significant increase in asthma visits (RR = 1.68, 95% CI: 1.09-2.57) and also when grouping all disorders of the lower airways (RR = 1.40, 95% CI: 1.01-1.92).

How Computer-Assisted Learning Influences Medical Students' Performance in Anatomy Courses.

Anatomy is an essential subject of the medical curriculum. Despite its relevance, the curricular time and logistical resources devoted to teaching anatomy are in decline, favoring the introduction of new pedagogical approaches based on computer-assisted learning (CAL). This new pedagogical approach provides an insight into students' learning profiles and features, which are correlated with knowledge acquisition. The aim of this study was to understand how training with CAL platforms can influence medical students' anatomy performance. A total of 611 medical students attending Musculoskeletal Anatomy (MA) and Cardiovascular Anatomy (CA) courses were allocated to one of three groups (MA Group, CA Group, and MA + CA Group). An association between the performance in these anatomy courses and the number of CAL training sessions was detected. In the MA Group (r = 0.761, P < 0.001) and the MA + CA Group (r = 0.786, P < 0.001), a large positive correlation was observed between musculoskeletal anatomy performance and the number of CAL training sessions. Similarly, in the CA Group (r = 0.670, P < 0.001) and the MA + CA Group (r = 0.772, P < 0.001), a large positive correlation was observed between cardiovascular anatomy performance and the number of CAL training sessions. Multiple linear regression models were performed, considering either musculoskeletal or cardiovascular anatomy performance as the dependent variable. The results suggest that using CAL platforms to study has a positive dose-dependent effect on anatomy performance. Understanding students' individual features and academic background may contribute to the optimization of the learning process.

Cystic partially differentiated nephroblastoma: a rare pediatric renal tumor-case report.

Cystic partially differentiated nephroblastoma is a rare renal tumor of childhood. It is part of a spectrum of multicystic renal tumors that also includes cystic nephroma and cystic Wilms' tumor. We present a case of cystic partially differentiated nephroblastoma, highlighting the clinical and imaging diagnostic challenge. Although the histological diagnostic criteria for all these 3 entities are well established, they are clinically and radiologically indistinguishable. Cystic partially differentiated nephroblastoma is often observed in male children under 2 years old. Typical clinical presentations include abdominal masses, abdominal pain and/or hematuria. Patients should be treated according to tumor histology and stage.

História da construção de saberes em enfermagem traumato-ortopédica / History of knowledge construction in trauma and orthopedic nursing care / Historia de la construcción del conocimiento en enfermería traumatológica ortopédica

Objetivo: analisar o desenvolvimento da enfermagem traumato-ortopédica a partir da primeira turma de residentes de um hospital especializado. Método: o estudo seguiu a metodologia histórica com abordagem qualitativa. As fontes foram documentos escritos e orais. Resultados: trabalhar em uma instituição especializada foi o ponto de partida para a busca por especialização de enfermeiras atuantes no cuidado traumato-ortopédico, que perceberam o saber/poder adquirido no trabalho assistencial, além da intenção de qualificar a assistência e elevar o hospital a instituto. Estratégias empregadas reúnem a busca por parcerias com instituições universitárias e associativas, além da criação de uma associação própria. Considerações finais: a enfermagem traumato-ortopédica ampliou seu espaço científico ao criar um curso de especialização com uma unidade acadêmica. Foi possível delimitar o poder acadêmico e institucional da enfermagem na instituição de saúde pela formação de enfermeiras especialistas constituindo um grupo de reconhecido pelo saber científico.

Objective: to analyze the development of trauma and orthopedic nursing care from the very first class of residents of a specialized hospital. Method: historical methodology study with a qualitative approach. The sources consisted of written and oral documents. Results: working in a specialized institution was the starting point for nurses who were seeking specialization in the field of trauma and orthopedic care as they noticed the power-knowledge acquired through care work, plus they were willing to improve assistance and take the hospital up to an institute level. Strategies used include the search for partnerships with universities and associative-type institutions, in addition to creating their own association. Final considerations: trauma and orthopedic nursing care expanded its scientific space by creating a specialization course together with an academic unit. It was possible to define the academic and institutional power of the nursing staff in the health institution by considering the training process of its nurse specialists, who consisted of a group recognized for their scientific knowledge.

Objetivo: analizar el desarrollo de la enfermería traumatológica ortopédica a partir del primer grupo de residentes de un hospital especializado. Método: estudio con metodología histórica con un enfoque cualitativo. Las fuentes fueron documentos escritos y orales. Resultados: el trabajo en una institución especializada fue el punto de partida para la búsqueda de la especialización de las enfermeras que trabajaban en la atención traumatológica ortopédica, quienes notaron el saber/poder adquirido en el trabajo asistencial, además de la intención de cualificar la atención y elevar el hospital al nivel de instituto. Las estrategias empleadas incluyen la búsqueda de alianzas con instituciones universitarias y asociaciones, y la creación de una asociación propia. Consideraciones finales: la enfermería traumatológica ortopédica amplió su espacio científico mediante la creación de un curso de especialización con una unidad académica. Se logró delimitar el poder académico e institucional de la enfermería en la institución de salud a través de la formación de enfermeros especialistas, que es un grupo reconocido por el conocimiento científico.

Residência multiprofissional em saúde mental: atuação de enfermeiros no processo de ensino-aprendizagem / Residencia multiprofesional en salud mental: el papel del enfermero en el proceso de enseñanza-aprendizaje / Multiprofessional residence in mental health: nursing of the nurses in the teaching-learning process

Na saúde mental nos deparamos com desafios ao longo dos anos, avançamos com políticas públicas direcionadas ao atendimento dos pressupostos da Reforma Psiquiátrica Brasileira. Com a ampliação de redes substitutivas a psiquiatria, novas práticas foram produzidas, influenciando o processo de formação de enfermeiros desde a graduação quanto na pós-graduação. Objetivo: analisar estratégias de enfermeiros para a integração ensino-assistência junto à residentes multiprofissionais em Saúde Mental. Métodos: Estudo qualitativo, descritivo, com dez enfermeiros de uma instituição psiquiátrica universitária. Os dados foram coletados de fevereiro/17 a maio/17, por entrevista semiestruturada e submetidos à análise de conteúdo, na modalidade temática. Resultados: Identificamos como estratégias: interação interprofissional; trabalho em equipe; estímulo ao cuidado psicossocial. Conclusão: Os enfermeiros atuam como facilitadores do processo de ensino-aprendizagem independentemente de serem preceptores ou não, porquanto permanentemente atuam na assistência. Sugerimos a formalidade no preparo de enfermeiros-preceptores utilizadores de metodologias de ensino apropriadas para o campo da saúde mental.(AU)

In mental health we have faced challenges over the years, we have advanced with public policies aimed at meeting the assumptions of the Brazilian Psychiatric Reform. With the expansion of substitutive networks for psychiatry, new practices were produced, influencing the process of training nurses from undergraduate and graduate levels. Objective: to analyze nurses' strategies for teaching-care integration with multiprofessional residents in Mental Health. Methods: Qualitative, descriptive study with ten nurses from a university psychiatric institution. Data were collected from February/17 to May/17, through semi-structured interviews and submitted to content analysis, in the thematic mode. Results: We identified as strategies: interprofessional interaction; team work; stimulus to psychosocial care. Conclusion: Nurses act as facilitators of the teaching-learning process regardless of whether they are preceptors or not, as they permanently work in care. We suggest formality in the preparation of nurse-preceptors who use appropriate teaching methodologies for the field of mental health.(AU)

En salud mental hemos enfrentado desafíos a lo largo de los años, hemos avanzado con políticas públicas dirigidas a cumplir con los presupuestos de la Reforma Psiquiátrica Brasileña. Con la expansión de las redes sustitutivas de la psiquiatría, se produjeron nuevas prácticas que influyeron en el proceso de formación de enfermeros de pregrado y posgrado. Objetivo: analizar las estrategias de los enfermeros para la integración enseñanza-cuidado con residentes multiprofesionales en Salud Mental. Métodos: Estudio cualitativo, descriptivo con diez enfermeras de una institución psiquiátrica universitaria. Los datos fueron recolectados del 17/02 al 17/05, por medio de entrevista semiestructurada y sometidos a análisis de contenido, en la modalidad temática. Resultados: Identificamos como estrategias: interacción interprofesional; trabajo en equipo; estímulo a la atención psicosocial. Conclusión: Los enfermeros actúan como facilitadores del proceso de enseñanza-aprendizaje independientemente de que sean preceptores o no, ya que actúan permanentemente en el cuidado. Sugerimos formalidad en la preparación de enfermeros-preceptores que utilicen metodologías de enseñanza adecuadas al campo de la salud mental.(AU)

Estudo de tecnologias de investigação ambiental em alta resolução para refinamento do modelo conceitual — estudo de caso: Duque de Caxias (RJ), Brasil / Study of high-resolution site characterization technologies for the improvement of the conceptual site model — case study: Duque de Caxias (RJ), Brazil

RESUMO Este trabalho apresenta os resultados da utilização de duas técnicas de investigação geoambiental em alta resolução: investigação passiva de vapores do solo e investigação com o uso de Membrane Interface Probe (MIP), em uma área contaminada por hidrocarbonetos de petróleo, localizada no município de Duque de Caxias, Rio de Janeiro. O processo de gerenciamento ambiental da área iniciou-se em 2012 e contemplou as etapas preconizadas nas legislações vigentes. Os resultados obtidos a partir das investigações tradicionais foram insuficientes para a compreensão das características físicas e geoquímicas necessária para o sucesso das fases de diagnóstico e, consequentemente, da remediação. Portanto, duas investigações em alta resolução foram conduzidas com o objetivo de refinar o modelo conceitual de forma a atender adequadamente à Resolução CONAMA nº 420/09 e à Resolução CONEMA nº 44/12, permitindo ações futuras mais eficientes. A investigação passiva de vapores do solo utilizou amostradores compostos por materiais adsorventes granulares, encapsulados em uma membrana microporosa hidrofóbica e quimicamente inerte que permite a difusão dos vapores presentes no meio. Os resultados representam qualitativamente a presença de contaminação no subsolo. O MIP é uma ferramenta de direct push com medição em tempo real, que detecta a presença da contaminação tanto em meios insaturados quanto saturados inconsolidados. A partir dos resultados integrados, foi possível constatar que a distribuição de compostos orgânicos voláteis (volatile organic compounds (VOCs)) em água subterrânea ocorre de forma descontínua ao longo da área, sendo possível identificar cinco hotspots distintos e suas diferentes áreas fonte, incluindo uma região com presença de fase livre.

ABSTRACT This paper presents the results of two high-resolution site characterization (HRSC) techniques: passive investigation of soil vapors and investigation using Membrane Interface Probe (MIP), in an area contaminated by petroleum hydrocarbon, located in the municipality of Duque de Caxias, Rio de Janeiro. The environmental management process in the area began in 2012 and contemplated the stages recommended by the current legislation. The results obtained from the traditional investigations were insufficient for the understanding of the physical and geochemical aspects for the success of the diagnostic phases and, consequently, the remediation phase. Therefore, it was conducted two high-resolution investigations with the objective of improving the conceptual model in order to comply adequately with CONAMA Resolution 420/09 and CONEMA Resolution 44/12, allowing future actions more efficient. The soil gas passive investigation used samplers composed of granular adsorbent materials, encapsulated in a hydrophobic and chemically inert microporous membrane that allows the diffusion of the vapors present in the media. The results qualitatively represent the presence of contamination in the subsoil. MIP is a direct push tool with real-time measurement, which detect the presence of contamination in both unsaturated and saturated media. From the integrated results, it was possible to verify that the distribution of volatile organic compounds (VOCs) in groundwater occurs in a discontinuous way throughout the area. It was possible to identify five distinct hotspots and their different source areas, including a region with the presence of free-phase.

[Amniotic membrane transplantation associated with conjunctival autograft for primary pterygium treatment]. / Transplante de membrana amniótica associado ao transplante de conjuntiva autólogo no tratamento do pterígio primário.

PURPOSE: To evaluate the effectiveness of amniotic membrane transplantation associated with conjunctival autograft in primary pterygium treatment. METHODS: We have analyzed, prospectively, 26 patients (14 women and 12 men), from 20 to 60 years old, examined at the Evangelic Hospital Ophthalmology Outpatient Clinic. They were submitted to primary pterygium treatment with pterygium excision surgery, amniotic membrane transplantation and conjunctival autograft, from April to November, 2001. The evaluated aspects were: degree of pterygium, postoperative complications and recurrence. RESULTS: Four cases (15.38%) showed complications, none of them considered serious, conjunctival graft contraction in 2 cases being the most frequent. After a follow-up of 6 months, 24 patients (92.3%) had a successful result and 2 patients (7.69%) had corneal or conjunctival recurrence. Among the patients with complications 50% presented pterygium recurrence (P<0.05). CONCLUSION: It is a safe surgical procedure with a low degree of recurrence rate. Complications are associated with a greater chance of relapse. This procedure is also an option in cases where there is not sufficient conjunctiva to cover all excised area.

Centro Acadêmico de Enfermagem da Universidade Federal do Rio de Janeiro (1979-1991) / Centro Académico de Enfermería de la Universidad Federal de Rio de Janeiro (1979-1991) / Federal University of Rio de Janeiro Academic Nursing Center (1979-1991)

Objetivos: historicizar as atividades do caenf e as circunstâncias de como se deu sua renomeação em 1991. Métodos: estudo histórico social de abordagem qualitativa em que foram utilizadas fontes históricas, escritas e orais, estas coletadas por entrevistas mediante a técnica da história oral temática. os resultados foram interpretados e discutidos baseados nos conceitos de memória de michael pollak e identidade social e profissional de claude dubar. Resultados: as atividades do caenf acompanhavam as nuances do movimento estudantil na universidade, sendo mais marcantes as reuniões estudantis, nas quais se discutia, dentre outras questões, o contexto político-social do país. nessas, surgiu o interesse pela renomeação. Conclusões: o caenf atuou na construção do senso de pertencimento à classe estudantil. sua renomeação se deu em contexto de exaltação perante o falecimento inesperado de uma estudante admirada, que foi transformada em ícone.

Micropropagation of two species of foliage anthurium by direct organogenesis / Micropropagação por organogênese direta de duas espécies de antúrio para folhagem

ABSTRACT: The objective of the present research was to develop a protocol for micropropagation of Anthurium bonplandii and Anthurium maricense by direct organogenesis. Nodal segments, with two or three nodes, were used as explants. The cultures were kept in a growth chamber at a temperature of 25±2ºC, under a photoperiod of 16 hours and a luminosity of 30μmol m-2 s-1. At 60 days, the number of regenerated buds per explant (NBE) was counted. The experiment was carried out in an entirely randomised design consisting of six treatments for six different concentrations of 6-benzylaminopurine (6-BA) added to the P2 (Pierik) medium (0.0, 1.11, 2.22, 3.33, 4.44, and 5.55µM). All the treatments were performed in four repetitions with 10 culture tubes containing one explant each. The regression analyses were adjusted to a quadratic model, with R2 = 88.7% and 62.4% for A. maricense and A. bonplandii, respectively. The regressions indicate that the addition of 6-BA to the P2 medium resulted in larger values of NBE in both the species. The ideal 6-BA concentration for micropropagation varied depending on the species, with 2.5 and 1.7 NBE determined at 6-BA concentrations of 4.70 and 3.37µM for A. maricense and A. bonplandii, respectively.

RESUMO: O objetivo do trabalho foi desenvolver um protocolo para micropropagação de Anthurium bonplandii e A. maricense por meio da organogênese direta. Foram utilizados como explantes, segmentos nodais contendo de dois a três nós. As culturas foram mantidas em sala de crescimento com temperatura de 25±2ºC, fotoperíodo de 16 horas e intensidade luminosa de 30μmol m-2 s-1. Aos 60 dias, avaliou-se o número de brotações regeneradas por explante (NBE). O experimento foi em um delineamento inteiramente casualizado composto por seis tratamentos referentes ao meio P2 (Pierik) adicionado de seis concentrações de 6-benzilaminopurina (6-BA): 0,0; 1,11; 2,22; 3,33; 4,44 e 5,55µM, com quatro repetições de dez tubos de ensaio, contendo um explante cada. As análises de regressão se ajustaram ao modelo quadrático com R2=88,7% e 62,4% para A. maricense e A. bonplandii, respectivamente. As regressões indicaram que adições de 6-BA ao meio P2, promoveram maior número de NBE em ambas as espécies. A concentração de 6-BA estimada como ideal para a micropropagação varia de acordo com a espécie, sendo estimado 2,5 e 1,7 NBE, quando a concentração de 6-BA for igual a 4,70 e 3,37µM para as espécies de A. maricense e A. bonplandii, respectivamente.

Gestação heterotópica: diagnóstico ultrassonográfico com gravidez ectópica não rota em serviço de emergência - Relato de caso / Heterotopic pregnancy: ultrasonographic diagnosis with non - route ectopic pregnancy in emergency service - Case report

A gravidez heterotópica é uma entidade rara, caracterizada por uma gravidez tópica associada a uma gravidez ectópica, sobretudo quando ocorre de forma espontânea. Os fatores de risco são semelhantes aos vistos em ectópicas, sendo a maior incidência nas mulheres que se submetem a técnicas de reprodução assistida. O diagnostico é feito com ß-HCG positivo e exame ultrassonográfico, geralmente após quadro de abdome agudo hemorrágico decorrente do rompimento da prenhez ectópica, com o tratamento divergindo em relação ao quadro e da idade gestacional da paciente. (AU)

The heterotopic pregnancy is a rare disease characterized by a topical pregnancy associated with an ectopic pregnancy, especially when it occurs spontaneously. Risk factors are similar to those seen in ectopic pregnancy, with the highest incidence in women undergoing assisted reproduction techniques . Diagnosis is made with a positive ß -HCG and ultrasound examination, usually after hemorrhagic acute abdomen due to the rupture of the ectopic pregnancy, with treatment differing in relation to the frame and the gestational age of the patient. (AU)

Ecos de uma identidade profissional: trajetória profissional de enfermeiras em ortopedia e traumatologia / Echoes of a professional identity: professional trajectory of nurses in orthopedics and traumatology

Introdução: A construção de identidade profissional está relacionada ao processo de socialização que se inicia a partir da construção da identidade pessoal no seio familiar, tendendo a permanecer em contínuo desenvolvimento. O presente estudo tem como objeto a identidade profissional de enfermeiras em traumato-ortopedia a partir de elementos constituintes identificáveis como tal, em suas trajetórias profissionais. A tese defendida foi de que na trajetória de enfermeiras com prática profissional na área de traumato-ortopedia em um hospital de referência localizado no Rio de Janeiro estão presentes características de perfil dessa prática especializada, que revelam sua importância histórica no desenvolvimento institucional e na qualificação da assistência, o que permite identificar a existência de uma especialidade de enfermagem e sua correspondente identidade profissional. Objetivo Geral: Reconhecer, nas trajetórias profissionais de enfermeiras de referência em uma instituição de traumatologia e ortopedia, elementos constitutivos da identidade profissional. Objetivos Específicos: Descrever a trajetória profissional de enfermeiras de referência de um hospital de traumatologia e ortopedia; destacar o contexto político do plano institucional em que se deu a construção da identidade de enfermeiras em traumato-ortopedia, segundo relatos biográficos; e analisar os elementos constituintes da identidade profissional de enfermeiras em suas características específicas de cuidado em traumato-ortopedia. Metodologia: Estudo de História Oral que se aplica à metodologia de pesquisa qualitativa. Foi utilizada a História Oral Temática, tendo como marco inicial o ano de 1973, que se refere ao surgimento do Hospital de Traumato Ortopedia, e como marco final o ano de 2013, quando todas as colaboradoras do estudo se aposentaram. As fontes primárias foram documentos localizados no acervo do Hospital de Traumato Ortopedia/ Instituto Nacional de Traumato-Ortopedia (HTO/INTO) e entrevistas coletadas com auxílio de um roteiro semiestruturado. O referencial teórico adotado foi o pensamento de Claude Dubar sobre a construção das identidades sociais e o conceito de identidade profissional para reconhecer os atributos para a formação profissional, contidos nas histórias das enfermeiras que atuaram por mais de três décadas no cuidado às pessoas em tratamento no HTO, depois INTO. A análise se deu em duas etapas distintas: transcrição e transcriação das entrevistas, a fim de se chegar à narrativa da biografia das colaboradoras pela pesquisadora; na segunda etapa, as entrevistas transcritas foram organizadas por fatos, considerando o período em que estes ocorreram: até 1969, décadas de 1970, 1980, 1990, 2000 e 2010. Os documentos escritos foram separados também em relação aos fatos e foi realizada a triangulação das fontes para a interpretação e construção da narrativa histórica. A partir disso, as experiências narradas em comum foram separadas e, uma nova leitura do texto transcrito das entrevistas foi necessária em busca de detalhamentos que pudessem caracterizar a construção da identidade profissional, com base no referencial teórico. Fontes indiretas foram usadas para contextualizar os períodos em que os fatos ocorreram e permitir a crítica sobre cada evento destacado pelas colaboradoras no contexto em que estavam inseridos. Resultados: Os resultados foram apresentados em três capítulos que tratam das biografias das colaboradoras, suas trajetórias no contexto político-social e os atributos da identidade profissional a partir do processo de socialização dessas enfermeiras. Foi possível revelar os elementos constituintes da identidade profissional, sob o pensamento de Claude Dubar que mostraram: autonomia de escolha da carreira profissional de Enfermeira, o pertencimento face à especialidade de Enfermagem em Traumato-Ortopedia, a construção de conhecimento científico em Enfermagem Traumato-Ortopédica e a conquista de espaços na instituição HTO/INTO e na profissão de Enfermeira, o patrimônio específico da Enfermagem e o poder através do conhecimento e, finalmente, suas heranças/legados deixados à Enfermagem em Traumato-Ortopedia. Considerações Finais: O cuidado de enfermagem em traumato e ortopedia, apresentada neste estudo através de narrativas de enfermeiras da área, é uma especialidade que, no Brasil, só foi legitimada em 2011, requerendo atenção dos cursos de formação, tanto de graduação como de pós-graduação, para o ensino voltado para essa área em expansão na assistência em saúde, devido ao crescente aumento da violência nas cidades do país, que vem gerando demandas cada vez maiores de cuidado traumato-ortopédico. Soma-se a destacada participação das enfermeiras que trouxeram suas histórias vividas desde a infância, passando pela academia e no âmbito profissional, que qualificou a pesquisa tornando possível a divulgação deste material científico para a História da Enfermagem brasileira.

Introduction: The construction of professional identity is related to the socialization process that starts with the construction of personal identity within the family, tending to remain in continuous development. The object of the present study is the professional identity of nurses in trauma and orthopedics based on constituent elements identifiable as such, in their professional trajectories. The thesis defended was that in the trajectory of nurses with professional practice in the area of trauma and orthopedics at a reference hospital located in Rio de Janeiro, profile characteristics of this specialized practice are present, which reveal its historical importance in institutional development and in the qualification of assistance, which allows identifying the existence of a nursing specialty and its corresponding professional identity. Main Objective: Recognize, in the professional trajectories of nurses of reference in an institution of traumatology and orthopedics, constitutive elements of professional identity. Specific Objectives: Describe the professional trajectory of reference nurses at a traumatology and orthopedics hospital; highlight the political context of the institutional plan in which the identity of nurses in trauma-orthopedics was constructed, according to biographical reports; and to analyze the constituent elements of the professional identity of nurses in their specific characteristics of care in trauma and orthopedics. Methodology: Study of Oral History that applies to qualitative research methodology. Thematic Oral History was used, starting in 1973, which refers to the emergence of the Hospital de Traumato Orthopedics, and as the final milestone in 2013, when all the collaborators in the study retired. The primary sources were documents located in the collection of the Hospital de Traumato Orthopedics/National Institute of Traumato-Orthopedics (HTO/INTO) and interviews collected with the aid of a semi-structured script. The theoretical framework adopted was the thought of Claude Dubar on the construction of social identities and the concept of professional identity to recognize the attributes for professional training, contained in the stories of nurses who worked for more than three decades in the care of people undergoing treatment in the HTO, then INTO. The analysis took place in two distinct stages: transcription and transcreation of the interviews to arrive at the narrative of the collaborators' biography by the researcher; in the second stage, the transcribed interviews were organized by facts, considering the period in which they occurred: until 1969, 1970s, 1980s, 1990s, 2000 and 2010. The written documents were also separated in relation to the facts and triangulation was performed sources for the interpretation and construction of the historical narrative. From this, the experiences narrated in common were separated and a new reading of the transcribed text of the interviews was necessary in search of details that could characterize the construction of the professional identity, based on the theoretical framework. Indirect sources were used to contextualize the periods in which the facts occurred and allow criticism of each event highlighted by the collaborators in the context in which they were inserted. Results: The results were presented in three chapters dealing with the biographies of the collaborators, their trajectories in the political-social context and the attributes of their professional identity based on the socialization process of these nurses. It was possible to reveal the constituent elements of professional identity, under the thought of Claude Dubar, which showed: autonomy in choosing the professional career of a Nurse, belonging to the specialty of Traumato-Orthopedic Nursing, the construction of scientific knowledge in Traumato-Orthopedic Nursing and the conquest of spaces in the HTO/INTO institution and in the Nursing profession, the specific heritage of Nursing and power through knowledge and, finally, their legacy/legacy left to Nursing in Traumato-Orthopedics. Final Considerations: The nursing care in trauma and orthopedics, presented in this study through the narratives of nurses in the area, is a specialty that, in Brazil, was only legitimized in 2011, requiring attention from training courses, both undergraduate and graduate, for teaching aimed at this expanding area in health care, due to the growing increase in violence in the country's cities, which has been generating increasing demands for trauma and orthopedic care. In addition to the outstanding participation of nurses who rought their stories from childhood, through academia and in the professional sphere, which qualified the research, making it possible to disseminate this scientific material to the History of Brazilian Nursing.

Introducción: La construcción de la identidad profesional está relacionada con el proceso de socialización que comienza con la construcción de la identidad personal dentro de la familia, tendiendo a permanecer en continuo desarrollo. El objeto del presente estudio es la identidad profesional de los enfermeros en trauma y ortopedia a partir de elementos constitutivos identificables como tales, en sus trayectorias profesionales. La tesis defendida fue que en la trayectoria de enfermeras con práctica profesional en el área de trauma y ortopedia en un hospital de referencia ubicado en Río de Janeiro, se encuentran presentes características de perfil de esta práctica especializada, que revelan su importancia histórica en el desarrollo institucional y en la calificación de la asistencia, lo que permite identificar la existencia de una especialidad de enfermería y su correspondiente identidad professional. Objetivo General: Reconocer, en las trayectorias profesionales de enfermeras de referencia en una institución de traumatología y ortopedia, elementos constitutivos de la identidad profesional. Objetivos Específicos: Describir la trayectoria profesional de enfermeras de referencia en un hospital de traumatología y ortopedia; destacar el contexto político del plan institucional en el que se construyó la identidad del enfermero en traumatología-ortopedia, según relatos biográficos; y analizar los elementos constitutivos de la identidad profesional del enfermero en sus características específicas de atención en trauma y ortopedia. Metodología: Estudio de Historia Oral que se aplica a la metodología de investigación cualitativa. Se utilizó la Historia Oral Temática, a partir de 1973, que hace referencia al surgimiento del Hospital de Traumato Ortopedia, y como hito final en 2013, cuando se retiraron todos los colaboradores del estudio. Las fuentes primarias fueron documentos ubicados en la colección del Hospital de Traumato Ortopedia/Instituto Nacional de Traumato-Ortopedia (HTO/INTO) y entrevistas recogidas con la ayuda de un guión semiestructurado. El marco teórico adoptado fue el pensamiento de Claude Dubar sobre la construcción de identidades sociales y el concepto de identidad profesional para reconocer los atributos para la formación profesional, contenidos en los relatos de enfermeros que trabajaron durante más de tres décadas en el cuidado de personas en tratamiento. en el HTO, luego INTO. El análisis se realizó en dos etapas diferenciadas: transcripción y transcreación de las entrevistas, para llegar a la narrativa de la biografía de los colaboradores por parte del investigador; En la segunda etapa, las entrevistas transcritas fueron organizadas por hechos, considerando el período en que ocurrieron: hasta 1969, 1970, 1980, 1990, 2000 y 2010. Los documentos escritos también fueron separados en relación a los hechos y se realizó triangulación de fuentes. para la interpretación y construcción de la narrativa histórica. A partir de esto, se separaron las experiencias narradas en común y fue necesaria una nueva lectura del texto transcrito de las entrevistas en busca de detalles que pudieran caracterizar la construcción de la identidad profesional, a partir del marco teórico. Se utilizaron fuentes indirectas para contextualizar los períodos en los que ocurrieron los hechos y permitir la crítica de cada hecho destacado por los colaboradores en el contexto en el que fueron insertados. Resultados: Los resultados se presentaron en tres capítulos que abordan las biografías de las colaboradoras, sus trayectorias en el contexto político-social y los atributos de su identidad profesional a partir del proceso de socialización de estas enfermeras. Se pudo revelar los elementos constitutivos de la identidad profesional, bajo el pensamiento de Claude Dubar, que evidenciaron: autonomía en la elección de la carrera profesional de Enfermera, perteneciente a la especialidad de Enfermería Traumato-Ortopédica, la construcción del conocimiento científico en Traumato- La Enfermería Ortopédica y la conquista de espacios en la institución HTO/INTO y en la profesión de Enfermería, la herencia específica de la Enfermería y el poder a través del conocimiento y, finalmente, su legado dejado a la Enfermería en Traumato-Ortopedia. Consideraciones Finales: La atención de enfermería en trauma y ortopedia, presentada en este estudio a través de las narrativas de enfermeras del área, es una especialidad que, en Brasil, solo fue legitimada en 2011, requiriendo atención de cursos de capacitación, tanto de pregrado como de posgrado, para la docencia dirigida a este Expansión del área de atención a la salud, debido al aumento creciente de la violencia en las ciudades del país, lo que ha venido generando una creciente demanda de atención traumatológica y ortopédica. Además de la destacada participación de enfermeras que aportaron sus historias vividas desde la niñez, a través de la academia y en el ámbito profesional, lo que calificó la investigación, posibilitando la difusión de este material científico a la Historia de la Enfermería Brasieña.

Interaction between resistance training and flexibility training in healthy young adults.

To test the hypothesis that increases in muscle strength and flexibility are developed by specific training programs, 43 healthy young adults were tested before and after 4 different interventions conducted twice a week for 12 weeks: (a) resistance training only (n = 13); (b) flexibility training only (n = 11); (c) resistance and flexibility training (n = 9); and (d) no intervention (n = 10). There was no change in either strength or flexibility in the control group (p > 0.05). Resistance training improved muscle strength either alone (+14%; effect size = 0.53; p < 0.001) or in combination with flexibility training (+16%; effect size = 0.66; p = 0.032), but did not change flexibility (p = 0.610). Flexibility increased with specific training alone (+33%; p < 0.001) or in combination with resistance training (+18%; p < 0.001). In conclusion, in young, healthy subjects, resistance training alone did not increase flexibility, but resistance training did not interfere with the increase in joint range of motion during flexibility training. These results support the concept that specific training should be employed in order to increase either muscle strength or flexibility.

Aclimatização de mudas micropropagadas de helicônia em ambiente protegido em função do tipo de substrato / Acclimatization of micropropagated heliconia plants in different substrates

A etapa de aclimatização é uma fase crítica da micropropagação vegetal, podendo ser responsável por altos índices de mortalidade, baixas taxas de crescimento e desuniformidade das plantas. Um fator fundamental na aclimatização é tipo de substrato a ser utilizado. Nesse trabalho, objetivou-se avaliar o efeito de diferentes substratos na aclimatização de mudas micropropagadas de helicônia (Heliconia lingulata Ruiz & Pav.). A pesquisa foi conduzida em um túnel alto de cultivo forçado pertencente à Embrapa Agroindústria Tropica,l situada no município de Fortaleza - CE, Brasil (3º44'S e 38º33'W). O delineamento experimental utilizado foi em blocos casualizados com cinco tratamentos e cinco repetições. Os substratos testados foram: T1 -pó-de-coco seco + húmus de minhoca + solo (PCS+H+S); T2 -pó-de-coco verde + vermiculita + composto de cama de frango (PCV+V+CCF); T3 -pó-de-coco verde + húmus de minhoca + solo (PCV+H+S); T4 -pó-de-coco seco + vermiculita + composto de cama de frango (PCS+V+CCF); e T5 - substrato comercial Hortimix® (HORT). As variáveis agronômicas, avaliadas no experimento foram: altura da planta, número de folhas e diâmetro do pseudocaule. Os resultados do experimento evidenciaram o maior desenvolvimento das mudas micropropagadas de helicônia, quando o substrato utilizado foi a combinação pó de coco verde + húmus de minhoca + solo (PCV + H + S).

Acclimatization is the most important and critical plant micropropagation phase. It can be responsible for high mortality rate, low growth rate, and plant heterogeneity. One of the limiting factors in plant acclimatization is the substrate. The objective of this work was to evaluate the effect of different substrates on the acclimatization of micropropagated heliconia plants (Heliconia lingulata Ruiz & Pav.). The research was carried out in a greenhouse at the Embrapa Tropical Agroindustry located in Fortaleza, Ceará, Brazil (3º44' S and 38º33' W). The experimental design was a randomized block with five treatments and five repetitions. The substrates tested were: T1 - dry 'coir' dust + earthworm humus + soil (DCD+EH+S); T2 - green 'coir' dust + vermiculite + poultry litter (GCD+V+PL); T3 - green 'coir' dust + earthworm humus + soil (GCD+EH+S); T4 - dry 'coir' dust + vermiculite + poultry litter (DCD+V+PL) and T5 -Hortimix® (HORT). The variables evaluated in the experiments were plant height, number of leaves, and diameter of the pseudostem. The results revealed that the best development of micropropagated heliconia plants was with a combination of green 'coir' dust + earthworm humus + soil (GCD+EH+S).

Análise da capacidade funcional de indivíduos submetidos a tratamento cirúrgico após fratura do planalto tibial / Assessment of the functional capacity of individuals submitted to surgical treatment after tibial plateau fracture

As fraturas articulares são consideradas graves e ocasionam incapacidade, principalmente quando atingem uma articulação de carga, como o joelho. É necessário tratamento imediato a fim de obter estabilização dos fragmentos, evitando complicações secundárias. O objetivo do presente estudo foi analisar a capacidade funcional, durante as atividades de vida diária, de indivíduos que sofreram fraturas do planalto tibial e foram submetidos a tratamento cirúrgico entre os anos de 2002 a 2005. Foram analisados 20 pacientes com a aplicação do questionário ADLS (Activities of Daily Living Scale). Concluímos que 85 por cento dos indivíduos apresentaram capacidade funcional próximo ao normal, de acordo com a pontuação estabelecida pela escala utilizada.

Joint fractures are regarded as serious, causing disability, especially when involving a load joint, as the knee. Early treatment is required in order to get stabilization of fragments, preventing the occurrence of secondary complications. The present study was aimed at assessing functional capacity during daily life activities, on individuals who experienced tibial plateau fractures and submitted to surgical treatment between the years 2002 to 2005. Twenty patients were assessed by using the ADLS questionnaire (Activities of Daily Living Scale). We concluded that 85 percent of the individuals presented close-to-normal functional capacity, according to the scale's scoring system.

Transplante de membrana amniótica associado ao transplante de conjuntiva autólogo no tratamento do pterígio primário / Amniotic membrane transplantation associated with conjunctival autograft for primary pterygium treatment

OBJETIVO: Determinar a eficácia do transplante de membrana amniótica associada ao transplante de conjuntiva autólogo no tratamento do pterígio primário. MÉTODOS: Analisou-se prospectivamente 26 pacientes (14 mulheres e 12 homens) com idade entre 20 e 60 anos, atendidos no ambulatório de oftalmologia do Hospital Universitário Evangélico de Curitiba e que foram submetidos ao tratamento do pterígio primário com cirurgia de exérese do pterígio e uso de membrana amniótica associada ao transplante de conjuntiva autólogo, entre abril e novembro de 2001. Foram analisados: grau do pterígio, complicações pós-operatórias e recidivas. RESULTADOS: No pós-operatório 4 casos (15,38 por cento) tiveram complicações, nenhuma considerada séria, sendo a mais freqüente a retração do enxerto em 2 casos. No sexto mês após a cirurgia, 24 pacientes (92,3 por cento) obtiveram sucesso cirúrgico e 2 pacientes (7,69 por cento) tiveram recidiva corneana ou conjuntival. Dos pacientes que tiveram complicações, 50 por cento sofreram recidiva do pterígio (P<0,05). CONCLUSÃO: Trata-se de procedimento seguro e com baixo grau de recidiva. As complicações pós-operatórias estão associadas com maior chance de recidiva. É também opção nos casos em que não há conjuntiva doadora suficiente para cobrir toda a área a ser incisada.

Paresia bilateral assimétrica de nervo troclear associada a trombose de seio transverso pós-otite: relato de caso / Asymmetric bilateral paresia of trochlear nerv associated the post-otitis transverse sinus thrombosis: case report

Os autores descrevem um caso de otite média aguda pós-perfuraçäo de membrana timpânica, que evoluiu com trombose de seio transverso esquerdo, paresia facial central à direita e paresia troclear bilateral assimétrica. O exame oftalmológico mostrou hipofunçäo do OS e hiperfunçäo do OI nos dois olhos, mais intensas no olho direito. O sinal de Bielchowsky era positivo à direita e negativo à esquerda. A acuidade visual estava preservada, além de ausência de papiledema à fundoscopia. A arteriografia cerebral revelou unicamente trombose do seio transverso à esquerda. O tratamento institui do foi antibioticoterapia via oral e cumarínico. Após seis meses de evoluçäo a diplopia persistia apenas em infralevoversäo, porém persistia a paresia facial central à direita. Näo se encontrou na literatura relato semelhante ao descrito.