828 resultados para Level 3 evidence


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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

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Pós-graduação em Educação Escolar - FCLAR

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Estuda a relação entre o Programa de Interiorização do Curso de Formação de Professores para Pré-Escolar e 1ª a 4ª do Ensino Fundamental, da Universidade do Estado do Pará e as políticas oficiais de formação de professores(as) desencadeadas no Brasil no período de 1999 a 2004. O objetivo é analisar a política de interiorização desenvolvida pela Universidade do Estado do Pará (UEPA) nesse Programa e sua relação com as políticas oficiais de formação de professores(as) implementadas no Brasil, a partir da década de 1990. A hipótese inicial era de que a política de formação de professores(as) adotada pela UEPA, no referido Programa, favoreceu a ampliação do mercado formativo no estado do Pará e, com isso, ocasionou uma corrida de professores(as) e de prefeituras àquela instituição, para a realização de processos de qualificação em nível superior. Para constatar essa hipótese, fez-se uma investigação do problema, orientada por pressupostos da abordagem qualitativa. Para coleta dos dados, realizou-se uma pesquisa bibliográfica, tendo como fonte: literatura especializada e documental; na pesquisa de campo, utilizou-se de entrevistas com os(as) alunos(as), professores(as), gestores(as) e os(as) secretários(as) de educação dos municípios atendidos pelo programa. Para análise dos dados, utilizou-se o critério de categorização temática para perceber e identificar as informações manifestadas nos enunciados dos conteúdos. A análise dos dados confirmou a relação do Programa de Interiorização do CFP com as políticas oficiais de formação de professores(as), especialmente, quando o Estado se desresponsabilizou dessa formação em nível superior, ao tornar a educação uma atividade não-exclusiva do Estado, o que favoreceu a ampliação do mercado formativo no Pará. A UEPA, sem apoio do Governo Estadual, oferta o Programa de Interiorização do CFP por meio de contrato de prestação de serviços educacionais.

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PURPOSE: Systematic reviews are criticized for frequently offering inconsistent evidences and absence of straightforward recommendations. Their value seems to be depreciated when the conclusions are uncertain. To describe an alternative approach of evaluating case series studies in health care when there is absence of clinical trials. METHODS: We provide illustrations from recent experiences. Proportional meta-analysis was performed on surgical outcomes: (a) case series studies, (b) use of cryoablation or radiofrequency ablation, and (c) patients with small renal cell carcinoma. The statistically significant difference between both interventions studied was defined if their combined 95% confidential interval (CI) did not overlap. RESULTS: As demonstrated by the example, this analysis is an alternative approach to provide some evidence of the intervention´s effects under evaluation and plotting all available case series in the absence of clinical trials for the health field. CONCLUSIONS: Although we are leading to a low level of evidence to determine efficacy, effectiveness and safety of interventions this alternative approach can help surgeons, physicians and health professionals for a provisionally decision in health care along with their clinical expertise and the patient´s wishes and circumstances in the absence of high-quality primary studies. It´s not a replacement for the gold standard randomized clinical trial, but an alternative analysis for clinical research.

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The goal of mentoplasty is to improve chin projection. Traditionally, this is accomplished by either mandibular osteotomy or alloplastic implants. However, these procedures are not free of complications. This report describes gliding mentoplasty, a novel, simple technique for chin projection.The 12 patients in this study underwent gliding mentoplasty. By means of a 2-cm intraoral incision, a subcutaneous dissection was made in the caudal direction. The dissection then proceeded in the subperiosteal plane, leaving a 1-cm cuff of muscle attached to the bone, and advanced toward the lower border of the chin. Subsequently, the dissection was extended laterally, and the whole mental area was dissected from the surrounding tissue. Three 2-0 monofilament nylon sutures were placed in the submandibular periosteum and connected through the remaining muscle cuff to the periosteum. These key sutures allowed the submandibular region to slide forward, project the subcutaneous tissue and mentalis muscle, define the labiomental fold, and improve the pogonion projection.Gliding mentoplasty resulted in a symmetric projection of the chin in all cases. In two patients, a submandibular dimple developed, which spontaneously resolved in 1 month. No revision surgery was performed, and no tissue relapse was noted. The mean follow-up period was 24.7 +/- A 5.17 months (range 19-33 months). All the patients were satisfied with the result.Gliding mentoplasty is a simple, easy-to-perform, rapid surgical technique of chin projection that produces low pain, rapid recovery, and excellent cosmetic results.This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

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

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Individuals with facial paralysis of 6 months or more without evidence of clinical or electromyographic improvement have been successfully reanimated utilizing an orthodromic temporalis transfer in conjunction with end-to-side cross-face nerve grafts. The temporalis muscle insertion is released from the coronoid process of the mandible and sutured to a fascia lata graft that is secured distally to the commissure and paralyzed hemilip. The orthodromic transfer of the temporalis muscle overcomes the concave temporal deformity and zygomatic fullness produced by the turning down of the central third of the muscle (Gillies procedure) while yielding stronger muscle contraction and a more symmetric smile. The muscle flap is combined with cross-face sural nerve grafts utilizing end-to-side neurorrhaphies to import myelinated motor fibers to the paralyzed muscles of facial expression in the midface and perioral region. Cross-face nerve grafting provides the potential for true spontaneous facial motion. We feel that the synergy created by the combination of techniques can perhaps produce a more symmetrical and synchronized smile than either procedure in isolation.Nineteen patients underwent an orthodromic temporalis muscle flap in conjunction with cross-face (buccal-buccal with end-to-side neurorrhaphy) nerve grafts. To evaluate the symmetry of the smile, we measured the length of the two hemilips (normal and affected) using the CorelDRAW X3 software. Measurements were obtained in the pre- and postoperative period and compared for symmetry.There was significant improvement in smile symmetry in 89.5 % of patients.Orthodromic temporalis muscle transfer in conjunction with cross face nerve grafts creates a synergistic effect frequently producing an aesthetic, symmetric smile.This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors at www.spinger.com/00266.

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The Amazon River floodplain is an important source of atmospheric CO2 and CH4. Aquatic herbaceous vegetation (macrophytes) have been shown to contribute significantly to floodplain net primary productivity (NPP) and methane emission in the region. Their fast growth rates under both flooded and dry conditions make herbaceous vegetation the most variable element in the Amazon floodplain NPP budget, and the most susceptible to environmental changes. The present study combines multitemporal Radarsat-1 and MODIS images to monitor spatial and temporal changes in herbaceous vegetation cover in the Amazon floodplain. Radarsat-1 images were acquired from Dec/2003 to Oct/2005, and MODIS daily surface reflectance products were acquired for the two cloud-free dates closest to each Radarsat-1 acquisition. An object-based, hierarchical algorithm was developed using the temporal SAR information to discriminate Permanent Open Water (OW), Floodplain (FP) and Upland (UL) classes at Level 1, and then subdivide the FP class into Woody Vegetation (WV) and Possible Macrophytes (PM) at Level 2. At Level 3, optical and SAR information were combined to discriminate actual herbaceous cover at each date. The resulting maps had accuracies ranging from 80% to 90% for Level 1 and 2 classifications, and from 60% to 70% for Level 3 classifications, with kappa values ranging between 0.7 and 0.9 for Levels 1 and 2 and between 0.5 and 0.6 for Level 3. All study sites had noticeable variations in the extent of herbaceous cover throughout the hydrological year, with maximum areas up to four times larger than minimum areas. The proposed classification method was able to capture the spatial pattern of macrophyte growth and development in the studied area, and the multitemporal information was essential for both separating vegetation cover types and assessing monthly variation in herbaceous cover extent.

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

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Objectives: Retrospective evaluation of cases of limb replantation after avulsion injuries. Evaluation of the techniques and tactics used, that contributed to success and good functional results. Methods: Forty-three patients' records were assessed. All the cases had been submitted to limb replantation after avulsion injuries. Results: The majority of the cases were young men. The most common injury was to the thumbs. The surgical techniques and tactics used were: nerve grafting, vein grafting, transposition of the digital vessels, limb shortening, and heterotopic replantation. The most commonly used technique was vein graft. The limb survival rate was high (93%), as was patient satisfaction. Conclusion: Replantation after avulsion injury depends on the correct diagnosis of the limb viability and the use of appropriate surgical techniques and tactics for each case. The experience of the team of surgeons and a good hospital structure are essential for good results. There are few articles in medical literature about the indications, techniques and results of limb replantation after avulsion injuries. We believe that this retrospective evaluation can bring new information and contributions to the correct management of this highly complex situation. Level of evidence IV, Case Series.

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Objective: To carry out an anatomical study of the medial collateral ligament, an important elbow stabilizer in different degrees of elbow flexion-extension. Methods: Forty elbows were dissected in order to analyze the functional behavior of the anterior, posterior and transverse ligament bands during valgus stress maneuvers of the elbow in different degrees of flexion and extension. Two groups were determined; in the group GPA the posterior band of the ligament was sectioned initially, then the articular capsule and finally the anterior band; in group GAP this order was reversed. Results: Instability was observed in GPA only in the third stage, when there was a greater mean elbow's opening during the flexion (between 50 degrees and 70 degrees); in GAP the instability was present since the first stage; the degrees of flexion with greater instability were the same as in group GPA. Conclusion: The anterior band of the medial collateral ligament of the elbow is the most important stabilizer of the elbow valgus instability, and its principal action occurs between 50 degrees and 70 degrees of elbow flexion. Level of Evidence III, Diagnostic Studies Investigating a diagnostic test.

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Objetives: Determine the stability of tibial and femoral components of 20 cementless knee arthroplasties with rotating platform. Methods: The 20 patients (20 knees) underwent an analysis of dynamic radiographs with an image amplifier and maneuvers of varus and valgus which were compared to static frontal and lateral radiographs of the knees and analyzed by two experienced surgeons in a double-blind way. Results: We could observe in this study that both methods showed very similar results for the stability of the tibial and femoral components (p<0.001) using the Kappa method for comparison. Conclusion: The tibial component was more unstable in relation to the femoral component in both static and dynamic studies. Level of Evidence IV, Case Series.