Pontifícia Universidade Católica de São Paulo (PUC-SP)
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Objective To provide guidelines on the coronavirus disease 2019 (COVID-19) vaccination in patients with immune-mediated rheumatic diseases (IMRD) to rheumatologists considering specific scenarios of the daily practice based on the shared-making decision (SMD) process. Methods A task force was constituted by 24 rheumatologists (panel members), with clinical and research expertise in immunizations and infectious diseases in immunocompromised patients, endorsed by the Brazilian Society of Rheumatology (BSR), to develop guidelines for COVID-19 vaccination in patients with IMRD. A consensus was built through the Delphi method and involved four rounds of anonymous voting, where five options were used to determine the level of agreement (LOA), based on the Likert Scale: (1) strongly disagree; (2) disagree, (3) neither agree nor disagree (neutral); (4) agree; and (5) strongly agree. Nineteen questions were addressed and discussed via teleconference to formulate the answers. In order to identify the relevant data on COVID-19 vaccines, a search with standardized descriptors and synonyms was performed on September 10th, 2021, of the MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and LILACS to identify studies of interest. We used the Newcastle–Ottawa Scale to assess the quality of nonrandomized studies. Results All the nineteen questions-answers (Q&A) were approved by the BSR Task Force with more than 80% of panelists voting options 4—agree—and 5—strongly agree—, and a consensus was reached. These Guidelines were focused in SMD on the most appropriate timing for IMRD patients to get vaccinated to reach the adequate covid-19 vaccination response. Conclusion These guidelines were developed by a BSR Task Force with a high LOA among panelists, based on the literature review of published studies and expert opinion for COVID-19 vaccination in IMRD patients. Noteworthy, in the pandemic period, up to the time of the review and the consensus process for this document, high-quality evidence was scarce. Thus, it is not a substitute for clinical judgment.
Purpose To evaluate the impact of a paediatric radiological protection campaign, implemented in the emergency units of a healthcare provider network in Brazil. This campaign aimed to promote awareness among emergency department physicians, regarding justification of paediatric X-ray referrals for paranasal sinus, chest and CT exams, as a strategy to reduce exposure to ionising radiation. Method Frequency analysis of common paediatric imaging referrals from 19 emergency departments was performed for a 3-year period (2015–2018) to coincide with before, during and after the implementation of the radiation protection campaign. The campaign was multifaceted and involved dissemination of educational materials and imaging referral guidelines along with quarterly meetings with participating centres' leaderships. Additionally, patient dose cards were distributed to patients/carers. The Chi-Square test was used to examine the association between the type of examination and the patient's age group. Exact-Fisher test was performed to check for an association between participant engagement and the existence of the radiation protection committee. Results Referrals reduced by 25% following the campaign with no reports of misdiagnosis. Many referrals in the youngest age groups. In 15 units, a radiological protection committee was created to raise awareness and to create a multi professional team to communicate the risks and benefits of radiological procedure in children. Conclusion The campaign resulted in a substantial reduction in radiological referrals while promoting a radiation protection culture. Simple education initiatives can contribute to savings in both finances and radiation doses, particularly important in radiosensitive cohorts.
Resumo: Este artigo busca produzir uma leitura da investigação arqueológica empreendida por Michel Foucault como um trabalho de diagnóstico do presente, que se estabelece como uma crítica ao pensamento antropológico dominante no cenário francês da década de sessenta. Para essa tarefa, parte-se de uma descrição do aparato conceitual forjado por sua Arqueologia do saber, a fim de acompanhar um duplo movimento, de forte presença nietzschiana: ao mesmo tempo que efetiva a sua crítica aos humanismos que permeiam o pensamento filosófico então vigente, Foucault ensaia um outro modo de pensar, liberado de amarras antropológicas e de qualquer instância fundadora.
The paper aims to analyze the development of the urban environmental policy in the city of Vila Velha, state of Espírito Santo, during two municipal administrations between 2009 and 2016. It intends to investigate how the city, located in the Metropolitan Region of Grande Vitória, fills its urban environmental policy agenda, in an urban sustainability perspective, with elements of environmental justice and political ecology, based on the debate about ecocentric environmental rationality. The analysis focuses on the two municipal administration plans and on interviews with authorities who occupied relevant positions in Vila Velha, to investigate the concern about the way in which public administration deals with the disorganized occupation of the territory and with social conflicts in the distribution of the impacts of the environmental degradation on its urban environment.
Resumo Este texto objetiva analisar o desenvolvimento da política ambiental urbana do município de Vila Velha-ES nos dois mandatos de gestão municipal entre 2009 e 2016. Busca, assim, verificar de que forma o município situado na Região Metropolitana da Grande Vitória-RMGV ocupa sua agenda política ambiental urbana numa ótica de sustentabilidade urbana com elementos de justiça ambiental e ecologia política, baseado no debate de racionalidade ambiental ecocêntrica. Tal análise se perfaz nos dois planos de gestão municipal e em entrevistas com autoridades que ocuparam cargos de relevância em Vila Velha-ES, para verificar a preocupação quanto àa maneira como a administração pública trata a ocupação desordenada do território e os conflitos sociais na distribuição dos impactos da degradação ambiental em seu ambiente urbano.
Resumo Este artigo tem o objetivo de analisar a percepção das eleitoras e dos eleitores da cidade de São Paulo sobre dois memes políticos com dados falsos que circularam nas redes digitais durante as eleições 2020, também abordando a dieta informacional e o comportamento de checagem de informação dos participantes. Para a metodologia, foi adotada a pesquisa qualitativa, a partir de grupos de discussão e entrevistas em profundidade. Por meio da expressão de valores (atitudinais) evidenciados pelos participantes divididos entre conservadores e progressistas, identificaram-se quatro mecanismos que estimularam uma espécie de aderência ao conteúdo dos memes, principalmente entre conservadores: 1) associar com seu repertório particular; 2) despertar um sentimento de medo/preocupação; 3) ter convicção sobre o tema; 4) não ter conhecimento da informação exposta.
Given the sharp electoral swings in Latin America in the last twenty years and ensuing effects on regional cooperation, current literature has emphasized the importance of presidential ideology for regional institutionalization in this part of the world. This focus on domestic and regional factors, however, ignores the role played by extra-regional forces, notably the involvement of external powers; an increasingly salient variable in the current scenario of global competition between the US, China and Russia. We propose a framework combining these systemic and regional factors in explaining regional institution-building. We test the effects of great power intrusion/disengagement and ideological divergence/convergence in producing institutional strengthening or weakening via four case studies, analyzed through secondary sources and interviews: Mercosur’s reformulation, Venezuela’s exit from the Andean Community, the creation of the Pacific Alliance and the paralysis of Unasur. Our conclusions suggest that ideology defines institutional outcomes, whereas the effect of intrusion depends on whether these engagements occur under unipolarity or great power competition.
Introduction The acoustic analysis of speech (measurements of the fundamental frequency and formant frequencies) of different vowels produced by speakers with the Angle class II, division 1, malocclusion can provide information about the relationship between articulatory and phonatory mechanisms in this type of maxillomandibular disproportion. Objectives To investigate acoustic measurements related to the fundamental frequency (F0) and formant frequencies (F1 and F2) of the oral vowels of Brazilian Portuguese (BP) produced by male speakers with Angle class II, division 1, malocclusion (study group) and compare with men with Angle class I malocclusion (control group). Methods In total, 60 men (20 with class II, 40 with class I) aged between 18 and 40 years were included in the study. Measurements of F0, F1 and F2 of the seven oral vowels of BP were estimated from the audio samples containing repetitions of carrier sentences. The statistical analysis was performed using the Student t -test and the effect size was calculated. Results Significant differences ( p -values) were detected for F0 values in five vowels ([e], [i], [ᴐ], [o] and [u]), and for F1 in vowels [a] and [ᴐ], with high levels for class II, division 1. Conclusion Statistical differences were found in the F0 measurements with higher values in five of the seven vowels analysed in subjects with Angle class II, division 1. The formant frequencies showed differences only in F1 in two vowels with higher values in the study group. The data suggest that data on voice and speech production must be included in the protocol's assessment of patients with malocclusion.
Objectives The aim of the present study is to analyze if aquaporin-4 ( AQP4 ) may also be a tumor progression marker for meningiomas. Methods This is an immunohistochemistry study realized at the Universidade de São Paulo, São Paulo, state of São Paulo, Brazil: frozen meningioma samples from 81 patients (57 females and 24 males, age range from 22 to 81 years old, average 56.5 ± 14.1 years old), including 57 meningiomas World Health Organization (WHO) grade I (GI); 19 grade II (GII), and 5 grade III (GIII) were analyzed. The relative expression level of AQP4 was analyzed by quantitative polymerase chain reaction (qPCR), using the SYBR Green approach and for staining detection. Tissue sections were routinely processed and subjected to antigen retrieval. Results The expression of AQP4 in meningioma samples ranged from 0 to 10.26, with a median of 0.001 in GI cases, of 0.008 in GII cases, and of 0.006 in GIII cases. Although not statistically significant ( p = 0.942), GI meningiomas have a lower median AQP4 expression level than higher malignant grade cases. Conclusion The AQP4 gene and protein expressions presented no association with meningioma malignant progression.
The COVID-19 pandemic has been (re)creating new global geographies of death, which specifically impact the Global South and expose its continuum of vulnerabilities – unequally distributed in terms of race, gender, class, and so on. In the Americas, we can identify the emergence of a new regional governance of death, associated with a set of practical recommendations by the Organization of American States (OAS) constraining states’ policy responses to COVID-19 and installing a new global governance lexicon. Recommendations concerning the disposal of dead bodies, full respect for both collective and family grief, and indications of alternative ways to conduct funerals and memorial services, for instance, seem to evoke new multilateral responses, paving the way for a new governance model: one that centres death within regional policymaking. This points to a change in the treatment of death from a purely private to a politically infused issue. Theoretically, this article aims to bridge the gap between Death Studies and Global Governance literatures. Supported by Michel Foucault’s genealogical method, the goal is to critically reconceptualise the meanings and framings of death landscapes in the Americas, pointing us to the correlation of forces that enabled the normative emergence of death in the OAS in this particular historical moment.
This chapter presents an overview of the current panorama of technological innovations offered by Brazilian educational startups, the so-called edtechs. The focus is on discussing the innovative products and services of these edtechs to meet needs related to inclusion. The concept of inclusion itself is quite broad, so in the specific case of this survey, in the form of mapping, innovations were found that meet: (a) assistive technologies aimed at special needs; (b) technologies aimed at social groups at an educational disadvantage; (c) technologies aimed at education for ethnic and cultural diversity; and (d) technologies oriented toward the elderly. For this chapter, an exploratory methodology was applied, in which we focused on the innovations presented by edtechs in the area of inclusion for people with special needs. This study involved a survey carried out by the Distrito innovation hub, which mapped 424 edtechs in Brazil in 2019 and 559 edtechs in 2020, of which we surveyed those oriented toward inclusivity and accessibility. In these 2 years, the inclusive and accessible focus delimited 18 startups, 13 of which were mapped in 2019 and 17 in 2020 (with 12 of them appearing in both reports).KeywordsEdtechsInclusive educationAccessibilityAssistive technologiesSpecial learning needs
Arterial hypertension (AH) after renal transplantation (RTX) is correlated with worse cardiovascular and renal outcomes, with loss of renal function, decreased graft survival and higher mortality. RTX recipients have discrepant blood pressure (BP) values when measured in the office or by systematic methodologies, such as Ambulatory Blood Pressure Monitoring (ABPM), with significant prevalence of no nocturnal dipping or nocturnal hypertension, white coat hypertension and masked hypertension. The aim of the present study was to review the issue of hypertension in RTX, addressing its multifactorial pathophysiology and demonstrating the importance of ABPM as a tool for monitoring BP in these patients. Treatment is based on lifestyle changes and antihypertensive drugs, with calcium channel blockers considered first-line treatment. The best blood pressure target and treatment with more favorable outcomes in RTX are yet to be determined, through well-conducted scientific studies, that is, in terms of AH in RTX, we currently have more questions to answer than answers to give.
Resumo Hipertensão arterial (HA) no póstransplante renal (TXR) se correlaciona com piores desfechos cardiovasculares e renais, com perda de função renal, diminuição da sobrevida do enxerto e maior mortalidade. Receptores de TXR apresentam valores discrepantes de pressão arterial (PA) quando ela é obtida em consultório ou por metodologias sistematizadas, como a Monitorização Ambulatorial da PA (MAPA), com prevalências significantes de ausência de descenso noturno ou hipertensão noturna, hipertensão do avental branco e hipertensão mascarada. O objetivo do presente estudo foi rever a temática da hipertensão no TXR, abordando sua fisiopatologia multifatorial e demonstrando a importância da MAPA como ferramenta de acompanhamento da PA nesses pacientes. O tratamento é baseado em mudanças no estilo de vida e em fármacos anti-hipertensivos, sendo os bloqueadores de canais de cálcio considerados de primeira linha. A melhor meta pressórica e o tratamento com desfechos mais favoráveis no TXR ainda estão por ser determinados, por meio de estudos bem conduzidos cientificamente, ou seja, em termos de HA no TXR temos atualmente mais questões a responder do que respostas a dar.
O uso frequente do conceito de polarização em contexto político pede atenção, sobretudo por dois equívocos: torna equivalente o que instala nos seus dois polos, e se assenta na transformação do divergente em inimigo a ser eliminado. O objetivo do texto é compreender os danos do uso inadequado deste conceito recorrendo ao que a natureza já nos ensina, com os polos magnéticos e geográficos, e agregando o que vem sucedendo com o corpo na sua relação com as telas. Autores como Pariser (2011), Ugresic (2011), Brugnago e Chaia (2014-2015) e Arantes (2014) fundamentam a argumentação aqui reunida na forma de revisão bibliográfica. A hipótese é a de que a fabricação do sujeito me, myself and I (KATZ, 2016, 2017) favorece a falta de rigor que vem caracterizando a comunicação, com consequências ameaçadoras à democracia.
The paper addresses the scope of privatization in education on Mises, Hayek and Rothbard views, considering its concepts of State, market and individual. The authors providing grounds for questioning compulsory and public education as well as the use of taxes to finance it. They treat public education as indoctrination, identifying formal education as a private decision of the family or, at most, a service provided by the market, refusing education as a right.
Resumo Objetivos Os objetivos deste estudo foram analisar a segurança da artroplastia total bilateral de joelho simultânea (ATJBS) e investigar a satisfação dos pacientes com o procedimento realizado de forma concomitante. Métodos Em um estudo prospectivo, avaliamos 45 pacientes submetidos à ATJBS feita por duas equipes cirúrgicas. A idade média dos pacientes foi 66,9 anos, sendo 33 do gênero feminino (73,3%) e 12 (26,6%) do gênero masculino. No período intra- e pós-operatório foi seguido um protocolo de medidas visando a segurança do procedimento. Avaliamos o tempo de cirurgia, a perda sanguínea pelo hematócrito (Ht) e hemoglobina (Hb), obtidos no primeiro dia de pós-operatório, a porcentagem de pacientes que receberam transfusão de concentrado de hemácias e quantidade de unidades que foram necessárias. Verificamos as complicações no período perioperatório e, ao final de três meses, inquirimos aos pacientes sobre a preferência entre o procedimento simultâneo ou estagiado. Resultados O tempo médio de cirurgia foi de 169 minutos; no pós-operatório houve um decréscimo médio de 28,2% do Ht e de 27,0% da Hb. Ao todo, 16 pacientes (35,5%) receberam transfusão de concentrado de hemácias (média de 1,75 unidades por paciente que precisou de reposição). Tivemos 12 complicações menores (26,6%) e 2 complicações maiores (4,4%); além disso, nenhum paciente teve o diagnóstico clínico de trombose venosa profunda e não houve mortes. Conclusões A ATJBS pode ser considerada um procedimento seguro, se realizada em pacientes selecionados e com um protocolo de cuidados para prevenir complicações. Esse procedimento teve a aprovação unânime dos pacientes.
Resumo Neste trabalho realizamos uma análise documental em livros didáticos usados no ensino médio brasileiro para avaliar como é apresentado o contexto histórico sobre a descrição da transformação bacteriana, que consiste em um episódio histórico importante para o reconhecimento do DNA como molécula hereditária. Além disso, utilizamos a epistemologia de Ludwik Fleck (1896-1961) para análise dessa contextualização. Apenas quatro dentre os dez livros analisados apresentaram o episódio de transformação bacteriana. Com relação à análise epistemológica, detectamos que a contextualização histórica apresentada nesses quatro livros algumas vezes está descrita de forma descontextualizada e linear, impossibilitando o aluno vislumbrar a ciência como uma produção humana e coletiva, bem como os aspectos sociais que caracterizam a forma de produção do conhecimento científico segundo o pensamento de Fleck, tais como: estilos de pensamento, circulação de ideias, complicações, transformações, e coerção do pensamento hegemônico da área.
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