Comparison between noninvasive mechanical ventilation and standard oxygen therapy in children up to 3 years old with respiratory failure after extubation: a pilot prospective randomized clinical study

Objectives: The effectiveness of noninvasive positive-pressure ventilation in preventing reintubation due to respiratory failure in children remains uncertain. A pilot study was designed to evaluate the frequency of extubation failure, develop a randomization approach, and analyze the feasibility of a powered randomized trial to compare noninvasive positive-pressure ventilation and standard oxygen therapy post extubation for preventing reintubation within 48 hours in children with respiratory failure.Design: Prospective pilot study.Setting: PICU at a university-affiliated hospital.Patients: Children aged between 28 days and 3 years undergoing invasive mechanical ventilation for greater than or equal to 48 hours with respiratory failure after programmed extubation.Interventions: Patients were prospectively enrolled and randomly assigned into noninvasive positive-pressure ventilation group and inhaled oxygen group after programmed extubation from May 2012 to May 2013.Measurements and Main Results: Length of stay in PICU and hospital, oxygenation index, blood gas before and after tracheal extubation, failure and reason for tracheal extubation, complications, mechanical ventilation variables before tracheal extubation, arterial blood gas, and respiratory and heart rates before and 1 hour after tracheal extubation were analyzed. One hundred eight patients were included (noninvasive positive-pressure ventilation group, n = 55 and inhaled oxygen group, n = 53), with 66 exclusions. Groups did not significantly differ for gender, age, disease severity, Pediatric Risk of Mortality at admission, tracheal intubation, and mechanical ventilation indications. There was no statistically significant difference in reintubation rate (noninvasive positive-pressure ventilation group, 9.1%; inhaled oxygen group, 11.3%; p > 0.05) and length of stay (days) in PICU (noninvasive positive-pressure ventilation group, 3 [116]; inhaled oxygen group, 2 [1-25]; p > 0.05) or hospital (noninvasive positive-pressure ventilation group, 19 [7-141]; inhaled oxygen group, 17 [8-80]).Conclusions: The study indicates that a larger randomized trial comparing noninvasive positive-pressure ventilation and standard oxygen therapy in children with respiratory failure is feasible, providing a basis for a future trial in this setting. No differences were seen between groups. The number of excluded patients was high.

Cosmos evolutivo e plano da criação na filosofia peirceana

O uso da metáfora da sob-existência do plano de um velho fórum na mente de seu arquiteto, a fim de entender o modo de ser do estado inicial do cosmos poderia dar origem a uma postulação de um plano na mente divina ou na natureza. A perfeição divina e o processo evolucionário do cosmos e da Razão, tais como são expostos na filosofia de PEIRCE, parecem opor-se à realidade de um tal plano. O presente artigo é um ensaio de discussão desta questão.

Referral letters in oral medicine: an approach for the general dental practitioner

The aim of this study was to analyze the contents of referral letters related to clinical history and reason for consultation. A total of 236 consecutive referral letters were evaluated. Analysis of the referral letters was based on key items concerning patient identification. chief complaint, previous consultation. laboratory investigation and use of drugs for the chief complaint. A database was organized (Epinfo 6.04) and the chi (2) test (a = 0.05) was applied to the results. of the 800 files examined. only 30%, (236) had a referral letter. of the 236 referral letters. 67% were from dentists, 22% from physicians and 11% from unidentified professionals. Patient age did not appear in 70%, of the letters and the chief complaint was mentioned only in 55%. The letters had no details such as description of the oral lesion (80%), anatomical site (34%), size (99%), symptoms (83%), or period of evolution (92%). Clinical diagnosis was not included in 84% of the letters. Less than 5% of the referral letters contained information about previous consultation and laboratory investigation. The chi (2) test showed significant differences for ail items of the referral letter. Referral letters did not satisfy minimal requirements about clinical history or reason for consultation. leading to failed communication among professionals. Based on this study, we suggest that standard letters are important to improve the quality of the letters, reducing the rate of omission of relevant items.

Livros didáticos de ensino religioso: Análise da construção da polêmica no discurso da mídia

This text aims to identify the discursive relations and the mechanisms used by sources - discourses gathered at press and specialized sites - in composing of viewpoints presented about the religious education textbooks and, a result of that, of controversial relationship built thereafter. The theoretical foundation of this work rests largely on the concepts of global semantics and constitutive intermisunderstanding (MAINGUENEAU, 1997, 2008) and discursive heterogeneity (AUTHIER-REVUZ, 1990, 1998). The research corpus consisted of four texts, three of which were published in 2010 and another in 2011, two reports and two opinion articles about the subject. From our analysis, we could see the construction of a controversial relationship between a discursive formation that challenges the teaching of religion in Brazilian public education, on the grounds that benefit the Christian faith and, moreover, one that supports the continuation of this practice and consider it important for the formation of the student and also as a promoter of diversity and equality.

Estratégias para produção de mudas de tomateiro utilizando paclobutrazol

The modern tomato production, either for fruit table production or for processing, has required quality seedlings, able to withstand environmental adversities after planting and maintaining the standard genotype productive. The aim of this study was to evaluate the effect of three concentrations of PBZ (0, 50 and 100 mg L-1) and two methods of application (seed treatment and watering seedlings) on seedling emergence and seedling production of tomato growth indeterminate. We adopted a completely randomized in a 2x3 factorial scheme with four replications. We evaluated the seedling emergence, the rate of speed of emergence, seedling height and diameter of hypocotyl and their absolute growth rate (TCA), leaf area, dry weight of shoots, roots and total, and reason leaf area (RAF). Results were subjected to analysis of variance and the mean levels of the factor methods of application compared by Tukey test at 5% and the mean levels of the factor concentrations subjected to regression analysis. The application of paclobutrazol via seedlings watering did not affect seedling emergence, significantly reduced the rate of seedling growth and, consequently, the size of the seedlings without affecting the diameter of hypocotyl, plus allow accumulation of dry roots. A concentration of 50 mg L-1 was shown to be sufficient to obtain seedlings more compact, subject to leaf area, the application via watering, beyond allowing an increase of about 37% in dry weight of roots.

Construções de causa, razão, explicação e motivação na lusofonia: uma abordagem discursivo-funcional

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Filosofia da história hegeliana: liberdade, razão e o mundo germânico

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Corpo, contemporaneidade, juventudes e escola

Pós-graduação em Educação para a Ciência - FC

As hagiografias como instrumentos de difusão do cristianismo católico nos meios rurais da Espanha visigótica

Pós-graduação em História - FCLAS

A trajetória ética e estética dos narradores da Obra reunida, de Campos de Carvalho

Pós-graduação em Letras - IBILCE

Infância, experiência e trabalho docente

Pós-graduação em Educação - FFC

Poder e memória: o autoritarismo na igreja presbiteriana do Brasil no período da ditadura militar

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Análise documental das imagens fotográficas de romarias no Nordeste do Brasil

A discussion, through a literature review, on the use of photographic documents and Documentary Analysis (DA) for the preservation, description and retrieval of images of pilgrimages in northeastern Brazil, which are archived at the Laboratory of Information Science and Memory (LACIM). The photograph acts as an expression of faith and devotion; it is a witnesses and documents, through images, the records of the day-to-day folk religion in its multiple meanings and situations, linked to the sacred. The DA —as a set of procedures performed after the reading of documents— facilitates the analysed collection location or query through the documentary language. This paper tries to show that the particular form of the information contained in a photographic archive echoes submerged memories of the pilgrims, authenticating a social fact in the country, capturing the sacredness from specific moments of celebration.

As passagens do sagrado: da mercadoria ao ex-voto no Santuário Nacional de Nossa Senhora Aparecida/Brasil

This article reflects on the votive objects exhibited in the room of promises situated in the National Sanctuary of Nossa Senhora da Conceição Aparecida, located in the city named Aparecida (São Paulo, Brazil). At the sanctuary, there is an area to receive and exhibit votive offerings, which are donated as payment or to initiate a relationship of faith. This article’s aim is to understand how, from entering the room of promises, the votive object is selected and receives new directions, within the Sanctuary or outside it. Nonetheless, a small number are kept in this specific room dedicated to votive offerings. These objects become documents, social agents, because they reveal stabilization within associative relationships. With the help of readings from Information Science and other areas, and after carrying out ethnographic research over three years, this article shows how the materiality of information is indispensable for apprehending the relationship between society and information. Through contact with the votive offerings, the visitor establishes inferences, interpretations, which assist in comprehending the space, faith, and Nossa Senhora da Conceição Aparecida.

Hibridismo cultural: o imaginário europeu na construção da sexualidade feminina do primeiro século de colonização brasileira

The aim of this study is to investigate and analyze the conceptions of sexuality and female sexual behavior and conduct, formed from the merger of information and securities purchased under the eyes, rules and guidelines established relations with the Holy Office during his visit to Inquisitorial Brazil in the late sixteenth century. It is a survey of historical methodology in which we used as the exploratory research and literature. In the sixteenth century the Church increases the pressure to change the sexual mores that were free in the Middle Ages, a fact which influences the rules and regulations that are adopted by the Holy Office regarding the person's sex life. The first structure was based on Brazilian sexual alliance between Indians and settlers, which led to sugar, by the Portuguese, the customs of the land, which included sexual practices free since the Indians were out of Christian influence. Supported by the absence of white women, the settlers took them wives of the earth, usually more than one, creating conflict with the Jesuits who condemned Indian polygamy. In this context, in 1591, landed on Brazilian soil Heitor Furtado de Mendonca, and with it, the First Visitation of the Holy Office to investigate, arguing, exploring feelings and behaviors, to discover the true facts, finally, to demonstrate the errors Faith and punish them with the rigor of ecclesiastical law. His passing opens us to visualize traces of sexuality in the current "Tropic" a racist, misogynist world where black women and degraded land could be subject to the wishes of the white man, with whom he could mate at will. Alone and forgotten, women have not found the colony margin to denounce or to speak and were stigmatized by the look of travelers and writers have been through here.