Influence of loneliness and social isolation before and during the COVID-19 pandemic on mood, cognition and sleep.

BACKGROUND: Social isolation and loneliness are public health problems and are related to poor physical and mental health in older persons, especially during the COVID-19 pandemic. We investigated the influences of social isolation and loneliness on mood, cognition and sleep quality in older persons. METHODS: This study evaluated 82 older persons, with a median age of 69.16 years (range: 60.00-85.97). The older persons were assessed before and during the period of the COVID-19 pandemic. Cognition was assessed using the Montreal Cognitive Assessment, symptoms of depression using the Beck Depression Inventory II, symptoms of anxiety using the Beck Anxiety Inventory, quality of sleep by the Pittsburgh Sleep Quality Index, daytime sleepiness by the Epworth Sleepiness Scale, isolation by the Duke Social Support Index and three-item UCLA Loneliness Scale. RESULTS: Our results revealed that loneliness is related to worsening anxiety symptoms (P = 0.008), and sleep quality (P = 0.011). Isolation is related to worsening sleep quality (P = 0.011). On the other hand, participants who did not isolate themselves during the pandemic felt more anxious (P = 0.021). In addition, older persons who were not isolated (P = 0.035) and had no loneliness (P = 0.007), have higher cognitive performance over time. CONCLUSION: Loneliness is related to worsening symptoms of anxiety and sleep quality. Our results showed that social isolation is related to worsening sleep quality. On the other hand, high social support during the COVID-19 pandemic increased anxiety. Furthermore, better cognitive performance is related to non-isolated and non-lonely participants.

Therapeutic Management with Airway Clearance in Children with Robin Sequence and Association with Swallowing Outcomes: A Systematic Review and Meta-analysis.

Dysphagia in Robin Sequence can be present in varying degrees, requiring multidisciplinary management and specific swallowing assessment by a specialist. Most studies published to date have evaluated only respiratory outcomes, and the available evidence on the improvement of swallowing is questionable. To conduct a systematic review and meta-analysis of studies evaluating swallowing in children with Robin Sequence before and after airway clearance procedures. The research question was developed based on the PICO strategy. The literature search was performed in electronic databases and gray literature. Studies were selected by 3 independent reviewers. The risk of bias and level of evidence of the studies were assessed. A proportion meta-analysis was performed to calculate the prevalence of dysphagia after airway clearance procedures. The search identified 4938 studies, 5 of which were included. All studies had limitations in terms of design and sample size. The prevalence of dysphagia after airway clearance was obtained by analyzing treatment subgroups: mandibular distraction osteogenesis, mandibular distraction osteogenesis + tracheostomy tube, and nasopharyngeal tube. Clinical and/or instrumental assessment was assessed by a swallowing specialist. The meta-analysis was precluded by the limitations of the studies, especially regarding sample size, which affected the accuracy of the findings. Dysphagia remained unresolved in 55% of children (95% CI 1-99%). The methodological quality of the studies indicated a high risk of bias and very low level of evidence. It was not possible to confirm that airway clearance techniques used in Robin Sequence improve dysphagia.

Effect of pharmacotherapy on fibromyalgia: an overview of systematic reviews / Efeito da farmacoterapia na fibromialgia: uma overview de revisões sistemáticas

Fibromyalgia is a debilitating and chronic pain processing disorder, in which the proportion of patients who achieve good results with pharmacotherapy is small. However, choosing the best available evidence on pharmacotherapy can optimize patient clinical outcomes. Objective: This overview aimed to identify in systematic reviews the effects of pharmacotherapy on fibromyalgia, considering the quality of the reviews and the efficacy of the outcomes. Methods: This search was performed in seven databases: PubMed, Web of Science, COCHRANE, Lilacs, Embase, Scopus and IPA. The methodological quality was evaluated using A MeaSurement Tool to Assess Systematic Reviews 2. The protocol was registered in the PROSPERO database (CRD42018095943). Results: A total of 63 systematic reviews were selected after reading full texts, but only 8 of them were of moderate to high quality and were included in this overview. All included reviews were published in English, between 2012 and 2018, performed meta-analysis, used the American College of Rheumatology (1990) diagnostic criteria for fibromyalgia, and jointly assessed pain improvement, adverse reactions, and withdrawal. Most reviews included only randomized controlled trials. Of the fourteen drugs addressed in systematic reviews evaluated, duloxetine, milnacipran, and pregabalin showed evidence of improvement in pain (Moderate: ≤30%) and other fibromyalgia symptoms, as depression and fatigue. However, these medications presented significant withdrawals due to adverse reactions (mainly nausea, headache, dizziness and constipation). The rate of treatment withdrawal reached 36%. Conclusion: Few studies have high quality and sufficient evidence on the effect of medicines on fibromyalgia, resulting in a lack of support for prescribers to choose drugs that meet criteria for need, effectiveness, safety and compliance.

Fibromialgia é um distúrbio de processamento da dor debilitante e crônico, em que a proporção de pacientes que obtêm bons resultados com a farmacoterapia é pequena. No entanto, escolher a melhor evidência disponível sobre a farmacoterapia pode otimizar os resultados clínicos do paciente. Objetivo: Esta overview teve como objetivo identificar em revisões sistemáticas os efeitos da farmacoterapia na fibromialgia, considerando a qualidade das revisões e a eficácia dos resultados. Métodos: Esta busca foi realizada em sete bases de dados: PubMed, Web of Science, COCHRANE, Lilacs, Embase, Scopus e IPA. A qualidade metodológica foi avaliada usando A MeaSurement Tool to Assess Systematic Reviews 2. O protocolo foi registrado no PROSPERO (CRD42018095943). Resultados: Um total de 63 revisões sistemáticas foram selecionadas após a leitura de textos completos, mas apenas 8 delas eram de qualidade moderada a alta e foram incluídas nesta overview. Todas as revisões incluídas foram publicadas em inglês, entre 2012 e 2018, realizaram meta-análises, utilizaram os critérios de diagnósticos do American College of Rheumatology (1990) para fibromialgia e avaliaram conjuntamente a melhora da dor, reações adversas e retiradas. A maioria das revisões incluiu apenas ensaios clínicos randomizados. Dos quatorze medicamentos abordados nas revisões sistemáticas avaliadas, duloxetina, milnaciprano e pregabalina mostraram evidências de melhora da dor (moderada: ≤30%) e de outros sintomas da fibromialgia como depressão e fadiga. No entanto, esses medicamentos apresentaram retiradas significativas devido a reações adversas (principalmente náusea, cefaleia, tontura e constipação). A taxa de abandono ao tratamento chegou a 36%. Conclusão: Poucos estudos apresentam evidências suficientes e de alta qualidade sobre o efeito dos medicamentos na fibromialgia, resultando na falta de apoio para os prescritores escolherem medicamentos que atendam aos critérios de necessidade, eficácia, segurança e adesão.

An Overview of the Methodologies and the Quality of Studies on Pharmacotherapy for the Treatment of Fibromyalgia.

BACKGROUND: It is often unclear whether systematic reviews and primary studies are de-signed to elucidate the efficacy or effectiveness of interventions. This may compromise the use of the information in clinical or policy decisions. OBJECTIVE: This overview aimed to evaluate the methodological profiles of studies on fibromyalgia pharmacotherapy in terms of the quality and nature of the interventions (efficacy versus effective-ness). METHODS: The protocol was registered in the International Prospective Register of Systematic Re-views database. Seven databases were searched for relevant publications. Systematic reviews inves-tigating the effectiveness or efficacy of fibromyalgia pharmacotherapy were included. Methodolog-ical quality was investigated using A MeaSurement Tool to Assess Systematic Reviews (AM-STAR), and efficacy andeffectiveness were evaluated using Rating of Included Trials on the Effica-cy-effectiveness Spectrum (RITES). RESULTS: In this overview, 4,107 studies were initially identified. 8 systematic reviews and 34 prima-ry studies remained after overlaps were removed. Of the eight systematic reviews, 4.76% (n=3) and 7.93% (n=5) were of moderate and high quality, respectively. An analysis of systematic reviews clearly showed the criteria "participants characteristics" and "trial setting" with the most frequent answers as scales 1 and 2 (strong emphasis on efficacy or rather strong emphasis on efficacy), re-spectively. RITES analysis revealed that the most frequent response was "strong emphasis on effi-cacy" in 68% (92/136) of primary studies. CONCLUSION: This analysis showed, in both systematic reviews and primary studies, a predominantly strong emphasis on efficacy, suggesting the need for methodological quality improvement in future studies, especially those designed to provide evidence related to effectiveness. The protocol for this overview has been registered in the International Prospective Register of Sys-tematic Reviews (PROSPERO; CRD42018095943).

Comparison of different frequencies of transcutaneous electrical diaphragmatic stimulation in healthy subjects: a randomized crossover clinical trial / Comparação de diferentes frequências da estimulação diafragmática elétrica transcutânea em indivíduos saudáveis: ensaio clínico randomizado cruzado

Most transcutaneous electric diaphragmatic stimulation (TEDS) studies use a stimulation frequency (SF) of 30 Hz, although the reason for this SF value is not completely understood. Objective:The purpose of this study was to compare the acute effect of two TEDS frequencies on the respiratory muscle strength and endurance, muscle activation, muscle thickness, diaphragmatic mobility, cardiovascular variables and safety in healthy subjects. Methods:Randomized crossover clinical trial with 20 healthy subjects subjected to two interventions: SF=30 Hz group and SF=80 Hz group. TEDS was applied at the diaphragm motor points with a symmetric biphasicpulsed current (pulse duration= 500 µs) for 30 minutes. The evaluated outcomes were systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), respiratory muscle strength by maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), inspiratory peak flux (PIF), diaphragm thickness during inspiration (DTI) and expiration (DTE), diaphragm mobility and activation, and endurance (S-Index). Results:SF-30 Hz showed a reduction with respect to baseline values for SBP (p=0.04), HR (p<0.001), DTE (p=0.02), IPF (p=0.01), and S-Index (p=0.03). SF-80 Hz showed a reduction with respect to baseline values for HR (p<0.001) and an increase in MEP (p<0.001). However, these changes were not clinically important and there were no between-groups differences for any of the evaluated outcomes. No complications were observed. Conclusion:TEDS with SF-80 Hz produces similar effects to SF-30 Hz in healthy subjects and bothfrequencies proved to be safe (NCT03844711).

A maioria dos estudos utilizam a estimulação diafragmática elétrica transcutânea (EDET) com frequência (F) de estímulo de 30Hz e testar diferentes frequências torna-se necessário para uma aplicação otimizada. Objetivo: Foi comparar o efeito agudo de duas frequências diferentes da EDET sobre a força muscular respiratória e endurance, ativação diafragmática, espessura muscular e mobilidade diafragmática, variáveis cardiovasculares e segurança em indivíduos saudáveis. Métodos: Estudo randomizado cruzado com 20 indivíduos saudáveis submetidos a duas intervenções: Grupo I com F= 30Hz e Grupo II com F= 80Hz. A aplicação foi nos pontos motores do diafragma, com duração do pulso de 500µs, durante 30 minutos. Foram avaliados a pressão arterial sistólica (PAS) e diastólica (PAD), frequência cardíaca (FC), força muscular respiratória pela pressão inspiratória máxima (PImax), pressão expiratória máxima (PEmax), endurance e espessura muscular em inspiração (EDI) e expiração (EDE), mobilidade e ativação diafragmática. Resultados: O GI apresentou redução significativa em comparação às condições basais para os desfechos de PAS (p= 0.04), FC (p<0.001), EDI (p= 0,02), PIF (p= 0.01), e S-Index (p= 0.03). O GII apresentou redução significativa em comparação às condições basais para FC (p<0.001) e aumento da PEmax (p<0.001). Porém, estas alterações não foram clinicamente importantes e não houve diferença entre os grupos para nenhum desfecho avaliado. Nenhuma intercorrência foi observada. Conclusão: A EDET com F-80Hz produz efeitos semelhantes a F-30Hz em indivíduos saudáveis e ambas as frequências provaram ser seguras (NCT03844711).

Microbiological and physicochemical characteristics of buffalo milk used for dairy products in southern Brazil.

In Brazil, the buffalo milk market has been growing. However, identity and quality standards have not been established for this raw material, nor have proper distinctions between buffalo milk and bovine milk been defined. Currently, the State of Rio Grande do Sul (RS) has only three producers that supply raw material for officially marketed derivatives. The aim of this study was to determine the identity and quality standards of raw buffalo milk in this region. Samples were obtained biweekly from three farm cooling tanks between June 2017 and August 2018, to reach a total of 69 samples. The averages for the results of the physicochemical parameters fat, protein, lactose, total solids, SNF (solids-not-fat), calcium, density, FP, acidity and SCC were 5.5 g/100 g, 4.06 g/100 g, 5.07 g/100 g, 15.5 g/100 g, 9.96 g/100 g, 0.161 g/100 g, 1.034 g/ml, -0.527°C, 16°D and 95 × 103 cells/ml, respectively. With reference to the microbiological parameters, the mean of the Standard Plate Count (SPC) and thermotolerant coliforms were 9,0 × 104 CFU/ml and 1.6 × 102 MPN/ml, respectively. Regarding coagulase-positive staphylococci, 36 samples tested positive (52% of total). Neither Salmonella spp. nor Listeria monocytogenes, nor antibiotic or antiparasitic residues were detected in any sample. In conclusion, the buffalo milk used as raw material for dairy products in southern Brazil demonstrated satisfactory physicochemical and microbiological characteristics, in accordance with recent scientific literature.

Inspiratory Muscle Training in COPD.

BACKGROUND: The benefits of inspiratory muscle training (IMT) for patients with COPD are documented in the literature, but its isolated effect or association with other interventions, the best training methods, and what type of patient benefits the most are not clear. We sought to assess the effects of IMT on respiratory muscle strength, pulmonary function, dyspnea, functional capacity, and quality of life for subjects with COPD, considering IMT isolated or association with other interventions, presence of inspiratory muscle weakness, training load, and intervention time. METHODS: We searched the MEDLINE, EMBASE, PEDro, Cochrane CENTRAL, and LILACS databases in June 2018. We also performed a manual search of references in the studies found in the database search and included in this analysis. We included randomized controlled trials that investigated the above-mentioned outcomes and assessed IMT, either isolated or associated with other interventions, in comparison with a control group, placebo, or other interventions, in subjects with COPD. We used the GRADE approach to evaluate the quality of the evidence. RESULTS: Of 1,230 search results, 48 were included (N = 1,996 subjects). Isolated IMT increased PImax (10.64 cm H2O, 95% CI 7.61-13.66), distance walked in 6-min-walk test (34.28 m; 95% CI 29.43-39.14), and FEV1 (0.08, 95% CI 0.02-0.13). However, there was no improvement in dyspnea and quality of life. The presence of inspiratory muscle weakness did not change the results; higher loads (60-80% of PImax) promoted a greater improvement in these outcomes, and a shorter intervention time (4 weeks) improved PImax, but longer intervention times (6-8 weeks) are required to improve functional capacity. IMT associated with other interventions only showed an increase in PImax (8.44 cm H2O; 95% CI 4.98-11.91), and the presence of inspiratory muscle weakness did not change this result. CONCLUSIONS: Isolated IMT improved inspiratory muscle strength, functional capacity, and pulmonary function, without changing dyspnea and quality of life. Associated IMT only increased inspiratory muscle strength. These results indicate that isolated IMT can be considered as an adjuvant intervention in patients with COPD.

Synthetic Studies toward the Total Synthesis of Tautomycetin.

The studies culminating in the synthesis of two large subunits of tautomycetin are described. The first one, fragment C1-C12 that has an anti-1,3-dimethyl system and a terminal diene unit, was accomplished in 10 linear steps in 7.4% overall yield. The second one, fragment C13-C25 which bears the sensitive anhydride framework and the majority of the stereogenic centers, was prepared in 13 linear steps (longest sequence) in 8% overall yield. Among the key transformations used, a regioselective epoxide opening, a Pd-catalyzed addition of terminal alkyne to acceptor alkyne, a Mukaiyama aldol reaction, a Yamaguchi esterification, and a homemade mild di-esterification can be cited. The chosen strategies allowed good yields, stereoselectivity, reproducibility, and scalability for several important intermediates.

Índice de inteligibilidade (SII) e variação da intensidade do sinal de fala em crianças com deficiência de audição / Speech Intelligibility Index (SII) and variation of speech signal intensity in hearing impaired children

RESUMO Objetivo Comparar valores do índice de inteligibilidade de fala amplificado, para diferentes entradas de sinal de fala (75, 65 e 55 dBNPS), gerados no processo de verificação dos aparelhos de amplificação sonora, nos diferentes graus e configurações de perdas auditiva. Métodos Foram selecionadas 41 crianças com idades entre 3 e 80 meses, totalizando 78 orelhas (quatro orelhas foram excluídas). As perdas auditivas foram classificadas conforme grupos de audibilidade e intervalos do índice de inteligibilidade de fala. Foram analisados 234 valores do índice de inteligibilidade de fala para os estímulos de fala e estes foram também analisados, em relação aos grupos e intervalos de audibilidade. Resultados Os grupos de audibilidade se deslocaram entre os intervalos do índice de inteligibilidade de fala, indicando a variação, conforme o nível de apresentação do sinal de entrada. Duas equações foram geradas para prever valores do índice de inteligibilidade de fala a partir do valor deste índice para o sinal de entrada de 65. Conclusão Menores níveis de pressão sonora do estímulo de fala produzem menores índices de inteligibilidade de fala. Esta diferença é mais acentuada nos deficientes auditivos, que apresentam valores do índice de inteligibilidade de fala de 65 entre 36% e 55%.

ABSTRACT Purpose To compare aided speech intelligibility index (SII) values in different speech signal inputs (75, 65, and 55 dBNPS), generated from the verification process of hearing aids, under different hearing loss severities and configurations. Methods 41 children aged between three and 80 months old were selected, totalizing 78 ears (after exclusion of four ears). Hearing loss was classified according to audibility groups and SII intervals. Two hundred and thirty-four (234) SII values were analyzed as per speech stimulus and with regard to groups and audibility intervals. Results Movement of audibility groups along SII intervals was observed, which indicates variation associated with the input signal intensity, as well as with the distance between the sound source and the hearing aid microphone. Two equations were generated to predict SII values from input signal SII65. Conclusion Lower levels of speech stimulus sound pressure produce lower levels of speech intelligibility. This difference is more pronounced in hearing-impaired persons, who present SII values between 36 and 55%.

Audibilidade e desenvolvimento de linguagem oral em crianças com deficiência de audição / Audibility and oral language development in children with hearing loss / Audibilidad y desarrollo del lenguaje oral en niños con discapacidad auditiva

Introdução: A audibilidade, medida pelo SII (Índice de Inteligibilidade de fala), tem se mostrado uma condição necessária para o desenvolvimento de linguagem, pois permite o acesso ao input linguístico. O desenvolvimento de vocabulário tem provado ser um bom indicador do desenvolvimento de linguagem. Objetivo: investigar as características audiológicas e de desenvolvimento de linguagem oral em crianças com deficiência auditiva usuárias de aparelho de amplificação sonora individual. Método: Foram avaliadas 65 crianças entre 6 e 17 anos, usuárias de aparelho de amplificação sonora individual, quanto ao desempenho de vocabulário receptivo (Peabody Picture Vocabulary Test - PPVT-4) e audibilidade (SII 65). Resultados: A audibilidade para sons de fala revelou que, 9% dos sujeitos tinham SII 65 menor que 37, 47% tinham SII 65 entre 38 e 57 e 43% maior que 58. A pontuação média de escore padrão no teste de vocabulário foi de 51,8 pontos. Ao relacionar a audibilidade com o vocabulário, a tendência linear de aumento no desempenho de vocabulário com o aumento da audibilidade não foi significativa. Conclusões: As características e heterogeneidade da população pareceram representar as diferentes condições dos sujeitos acompanhados em um serviço de saúde auditiva no Brasil. Para a população estudada, a audibilidade não determinou o desempenho do vocabulário, sendo condição necessária, mas não suficiente para o desenvolvimento e crescimento do vocabulário.

Introduction: Audibility, measured by SII, has been shown to be a necessary condition for language development, since it allows access to the linguistic input. Likewise, vocabulary development has been shown to be a good indicator of language development. Objective: To investigate the audiological characteristics and the development of oral language characteristics in hearing impaired children who are hearing aid users. Methods: Sixty-five children aged 6 to 17 years old, hearing aid users, and based in the state of São Paulo, were evaluated for their receptive vocabulary performance (Peabody Picture Vocabulary Test ­ 4) and their relation to audibility (SII 65). Results: Audibility for speech sounds assessed by the SII values revealed that 9% of the subjects had SII scores lower than 37, 47% had SII scores between 38 and 57, and 43% scored greater than 58. The overall mean of the standard score values in the receptive vocabulary test was 51.8. When relating audibility (SII 65) with vocabulary, the linear tendency of (i) the increase vocabulary performance with (ii) the increase of audibility was not significant. Conclusions: The characteristics and heterogeneity of the studied population sample seemed to represent different conditions of the subjects attended in an auditory health service in Brazil. Within the population analyzed, audibility did not determine vocabulary performance, being a critical but not sufficient factor to ensure adequate vocabulary development and growth.

Introducción: La audibilidad, medida por SII(Índice de Inteligibilidad del Habla), ha demostrado ser una condición necesaria para el desarrollo del lenguaje, ya que permite el acceso al input lingüístico. El desarrollo del vocabulario ha demostrado ser un buen indicador del desarrollo del lenguaje. Objetivo: investigar las característicasaudiológicasy del desarrollo del lenguaje oral en niños con discapacidad auditiva,usuarios de audífonos. Método: Sesenta y cinco niños entre 6 y 17 años, usuarios de audífonos fueron evaluados por su desempeño en vocabulario receptivo (Peabody Picture VocabularyTest-PPV- 4) y su audibilidad (SII 65) . Resultados: La audibilidad para los sonidos del habla reveló que el 9% de los sujetos tenían SII65 inferiores a 37, el 47% tenían SII65 entre 38 y 57, y el 43% mayor de 58. El promedio de la puntuación estándar en la prueba de vocabulario fue de 51.8. Al relacionar la audibilidad con el vocabulario, la tendencia lineal de aumento en el rendimiento del vocabulario con el aumento de la audibilidad no fue significativa. Conclusión: las características y la heterogeneidad de la población estudiada parecieron representar las diferentes condiciones de los sujetos atendidos en un servicio de salud auditiva en Brasil. En la población analizada, la audibilidad no determinó el rendimiento del vocabulario, siendo condición necesaria pero no suficiente para el desarrollo y crecimiento del vocabulario.

Systemic oxidative stress in Suffolk and Santa Ines sheep experimentally infected with Haemonchus contortus.

The mechanisms responsible for the imbalance between oxidants and antioxidants in sheep infected with Haemonchus contortus are not well established. This study aimed to prove the hypothesis that oxidative stress occurring during infection by H. contortus varies according to breed, and that the parasite burden correlates with hypoalbuminaemia and anaemia. Thus, after deworming and confirming the absence of infection, two different sheep breeds, Suffolk (n = 15) and Santa Ines (n = 22), were orally inoculated with a single dose of 5,000 L3 of H. contortus. The egg counts per gram of faeces (EPG), packed cell volume (PCV) and concentrations of several plasma markers of oxidative stress (lipid peroxidation, albumin, uric acid, total bilirubin, total antioxidant capacity [TAC], total oxidant concentration [TOC] and the oxidative stress index [OSI]) were quantified before (control group) and during the experimental infection (28, 34 and 42 days post-inoculation). In both breeds, TOC increased at 28 days and TAC increased at 42 days. In Suffolk sheep, there was a positive correlation of EPG with oxidant components (28 days) and a negative correlation of EPG with PCV (42 days). In Santa Ines sheep, there was a positive correlation of EPG with bilirubin (r = 0.492; p = 0.020). H. contortus infection caused oxidative stress, which varied according to the breed. Parasite burden was not associated with hypoalbuminaemia, whereas there was a negative correlation with PCV. This research provides the first evidence that the antioxidant status contributes more to the resilience to H. contortus in Santa Ines sheep compared to Suffolk sheep.

Aplicabilidade do peso ideal na titulação do volume corrente em pacientes no pós operatório imediato de cirurgia cardíaca / Ideal weight applicability in tidal volume titration in immediate postoperative cardiac surgery patients

INTRODUÇÃO: A ventilação mecânica (vm) é indispensável nas intervenções cirúrgicas; porém mesmo que por curto período de tempo, a vm pode causar prejuízo pulmonar com lesões do parênquima pulmonar por excesso de pressão e/ou volume nas vias aéreas. Na titulação do volume corrente (vc) é comum utilizar o peso (p.) real e não o p. ideal, aquele calculado baseando-se pela altura, o que poderia gerar alterações gasométricas e na mecânica pulmonar. OBJETIVO: Comparar a titulação do vc pelo p. ideal e pelo p. real durante o uso da vm no pós-operatório imediato de cirurgia cardíaca (cc). MÉTODOS: Ensaio clínico prospectivo, randomizado, aprovado pelo CEP da instituição. Incluímos pacientes (pc) de ambos os sexos, idade entre 18 e 80 anos e foram divididos em dois grupos: peso real (PR) e peso ideal (PI) e analisados em quatro grupos: PR com IMC adequado; PR com IMC alto; PI com IMC adequado e PI com IMC alto. O exame gasométrico era realizado no ato de admissão (M0), 30 minutos após a mesma (M1) e extubação (M2). Foram comparados entre os grupos resultados gasométricos, pressão platô, pressão de pico, complacência estática e complacência dinâmica...(AU)

Detecção de genes de enterotoxinas em staphylococcus aureus isolados de leite cru de búfala / Detection of enterotoxin genes in staphylococcus aureus isolated from raw buffalo milk

Atualmente, a principal causa de intoxicação alimentar está associada ao consumo de alimentos contendo enterotoxinas produzidas, principalmente, pela espécie Staphylococcus aureus. Vários estudos descrevem a prevalência de S. aureus e suas enterotoxinas no leite bovino. Entretanto, essas informações em leite bubalino ainda são escassas. O crescente consumo de derivados de leite bubalino alerta para a questão de saúde pública, visto que essas enterotoxinas são resistentes aos processos térmicos pelos quais é submetida a sua matéria-prima. O objetivo deste estudo foi analisar a presença de genes que codificam enterotoxinas estafilocócicas em isolados de S. aureus obtidos de leite cru de búfala. (AU)

Terapia baseada em realidade virtual usando o Leap Motion Controller para reabilitação do membro superior após acidente vascular cerebral / Virtual reality therapy using the Leap Motion Controller for post-stroke upper limb rehabilitation

OBJETIVOS: Avaliar a aplicabilidade de um sensor de movimento, baseado em realidade virtual, para promover a reabilitação do membro superior após um acidente vascular cerebral. RELATO DOS CASOS: Três pacientes após acidente vascular cerebral realizaram um treino para reabilitação do membro superior com realidade virtual usando a tecnologia Leap Motion Controller e o jogo Playground 3D®, durante três dias consecutivos. No primeiro e no terceiro dia, foram avaliados com os testes Caixa e Blocos, Coordenação Óculo-Manual de Melo e Estimulação Magnética Transcraniana. No último dia, foram aplicadas Fichas de Avaliação da Experiência do paciente. Após o treinamento proposto, observou-se diminuição do limiar motor em ambos os hemisférios cerebrais e melhores desempenhos nos testes que avaliaram a habilidade manual e óculo-manual. A terapia proposta foi bem recebida pelos pacientes testados. CONCLUSÕES: Não foram observados efeitos adversos e os resultados mostram-se promissores e precisos no treinamento realizado com realidade virtual usando a tecnologia Leap Motion Controller e o jogo Playground 3D®. O treinamento proporcionou uma participação ativa dos pacientes na reabilitação das sequelas de extremidade superior após um acidente vascular cerebral.

AIMS: To evaluate the applicability of a virtual reality-based motion sensor for post-stroke upper limb rehabilitation. CASES DESCRIPTION: Three post-stroke patients were subjected to virtual reality training for rehabilitation of their upper limbs using the Leap Motion Controller technology and the game Playground 3D® for 3 consecutive days. On the first and last days, the Box and Blocks test, the De Melo Eye-Hand Coordination Test, and transcranial magnetic stimulation were applied. On the last day, the patients were evaluated with the Experience Evaluation Form. After the proposed training, a lower motor threshold was observed in both cerebral hemispheres, as well as better performance in the tests that evaluated hand and eye-hand coordination skills. The proposed therapy was well received by the patients. CONCLUSIONS: No adverse effects were observed, and promising and precise results were obtained for the virtual reality-based training using the Leap Motion Controller and Playground 3D®. The training allowed patients to have an active role in the rehabilitation of strokeinduced upper limb sequelae.

Hearing loss classification by degree, configuration and relationship with amplified Speech Intelligibility Index (SII). / Classificação de perdas auditivas por grau e configuração e relações com Índice de Inteligibilidade de Fala (SII) amplificado.

PURPOSE: To establish the relationship between speech intelligibility index (SII) values generated at the verification of hearing aids programmed according to DSLm [i/o] v5 prescription rule and a proposed individual classification that considers the combination of hearing loss degree and configuration. METHODS: Forty-one children aged between 4 and 80 months were selected, totaling 78 ears for analysis. We considered hearing thresholds at the frequencies of 250, 500, 1000, 2000 and 4000 Hz; and analyzed values of the Speech Intelligibility Index (SII) for the input signal of 65 dB SPL obtained during the verification of hearing aids using the equipment Verifit®Audioscan. RESULTS: Hearing losses were classified into five homogeneous groups regarding audiometric degree and configuration. The groups were heterogeneous when compared to each other. From the groups, three ranges of SII values were determined. Equations were developed for classification of hearing loss according to groups and for determination of the adjusted SII values. CONCLUSION: The SII value is a useful indicator of audibility for speech sounds in different characteristics of hearing losses, and can guide observations of auditory skills. The SII has stronger relationship with the association of the audiometric degree and configuration when compared with degree of hearing loss alone.

Classificação de perdas auditivas por grau e configuração e relações com Índice de Inteligibilidade de Fala (SII) amplificado / Hearing loss classification by degree, configuration and relationship with amplified Speech Intelligibility Index (SII)

RESUMO Objetivo estabelecer relações entre valores do índice de inteligibilidade de fala - SII gerados na verificação dos aparelhos de amplificação sonora programados conforme regra prescritiva DSLm[i/o]v5 e uma proposta de classificação de indivíduos que considere a associação de grau e configuração de perdas auditivas. Método foram selecionadas 41 crianças com idades entre 4 e 80 meses, totalizando 78 orelhas para análise. Foram considerados os limiares auditivos nas frequências 250, 500, 1000, 2000 e 4000 Hz e analisados valores de SII para os sinais de entrada 65 dB NPS, obtidos na verificação dos AASI no equipamento Verifit®Audioscan. Resultados as perdas auditivas foram classificadas em cinco grupos homogêneos quanto às características audiológicas (grau e configuração audiométrica) e heterogêneos entre si. A partir dos grupos, determinaram-se três intervalos de valores de SII. Foram determinadas equações para classificação da perda auditiva conforme grupos e equações para determinação de valores de SII ajustado. Conclusão o valor de SII pode ser considerado um indicador da audibilidade para sons de fala para diferentes características de perdas auditivas e nortear avalições de comportamento auditivo. O SII tem relação mais forte com a associação das variáveis grau e configuração audiométrica, quando comparado com sua relação com o grau da perda auditiva isoladamente.

ABSTRACT Purpose To establish the relationship between speech intelligibility index (SII) values generated at the verification of hearing aids programmed according to DSLm [i/o] v5 prescription rule and a proposed individual classification that considers the combination of hearing loss degree and configuration. Methods Forty-one children aged between 4 and 80 months were selected, totaling 78 ears for analysis. We considered hearing thresholds at the frequencies of 250, 500, 1000, 2000 and 4000 Hz; and analyzed values of the Speech Intelligibility Index (SII) for the input signal of 65 dB SPL obtained during the verification of hearing aids using the equipment Verifit®Audioscan. Results Hearing losses were classified into five homogeneous groups regarding audiometric degree and configuration. The groups were heterogeneous when compared to each other. From the groups, three ranges of SII values were determined. Equations were developed for classification of hearing loss according to groups and for determination of the adjusted SII values. Conclusion The SII value is a useful indicator of audibility for speech sounds in different characteristics of hearing losses, and can guide observations of auditory skills. The SII has stronger relationship with the association of the audiometric degree and configuration when compared with degree of hearing loss alone.

Valores de referência para o índice de Inteligibilidade de fala (SII) amplificado de acordo com a regra prescritiva DSLm[i/o]v5 / Reference values for amplified speech Intelligibility index (SII) according to the DSLm[i/o]v5 prescription / Valores de referencia para el índice de inteligibilidad del habla (SII) amplificado según la regla prescriptiva DSLm[i/o]v5

Objetivo:construir curvas de referência para valores de SII amplificado com sinal de fala nas intensidades de 55 e 65 dB NPS, considerando as diferenças entre os alvos prescritos pela regra DSLm[i/o]v5 e as curvas de resposta obtidas na verificação da amplificação, em função de frequências obtidas na verificação dos AASI, como critério para uma amplificação adequada, observando as limitações da amplificação para os diferentes graus e configurações de perda auditiva. Métodos: foram selecionadas 41 crianças com idades entre três e 80 meses, totalizando 78 orelhas. Foram considerados limiares auditivos nas frequências de 250 a 4000 Hz e analisados valores de SII para os sinais de entrada 55 e 65 dB NPS, obtidos na verificação da amplificação no equipamento Verifit®Audioscan. Resultados: A partir das curvas de resposta obtidas na verificação da amplificação registraram-se valores de SII. Todos os aparelhos de amplificação foram ajustados o mais próximo do alvo possível. Limitações na amplificação foram observadas de acordo com grau e configuração da perda auditiva. Curvas de referência e equações para prever valores de SII amplificado nas intensidades de 55 e 65 dBNPS foram geradas. Conclusão: Curvas de referência para valores de SII amplificado foram construídas e equações foram geradas para prever e avaliar os valores de SII de acordo com as características audiológicas e podem ser incluídas nos protocolos de indicação da amplificação sonora e acompanhamento audiológico. As curvas de referência e equações não substituem o processo de verificação dos aparelhos de amplificação.

Objective: build the reference curves for amplified SII values of speech signal in the intensities of 55 and 65 dB NPS, considering the differences between targets prescribed by DSLm[i/o] v5 and the curves obtained in the verification process, as a criterion for a proper amplification, noting the limitations of amplification for the different degrees of hearing loss configurations. Methods: 41 children aged between 3 and 80 months participated in the study, totalizing 78 ears. Auditory thresholds at 250, 500, 1000, 2000, 4000 Hz were considered and SII values for the input signals 55 and 65 dB NPS were obtained in the Verifit®Audioscan hearing aid analyzer. Results: All hearing aids were set as close to the target as possible. According to degree and configuration of the hearing loss limitations in amplification were observed. Reference curves and equations to predict amplified SII values for the intensities of 55 and 65 dBNPS were generated. Conclusion: reference curves for amplified SII values were built and equations were generated to predict SII values according to audiological characteristics and features can be included in protocols of indication of sound amplification and indicate the audiologic follow-up. Reference curves and equations do not override the verification process.

OObjetivo: construir curvas de referencia para los valores de SII amplificado con señal de habla en las intensidades 55 y 65dB NPS, teniendo en cuenta las diferencias entre las metas prescritas por la regla DSLm[i/o]v5 y las curvas de respuesta obtenidas en la verificación de la amplificación, en función de frecuencias obtenidas en la verificación de los audífonos, como criterio para una amplificación adecuada, teniendo en cuenta las limitaciones de amplificación para los diferentes grados y configuraciones de pérdida auditiva. Métodos: se seleccionaron 41 niños entre 3 y 80 meses, en un total de 78 orejas. Se consideraron umbrales auditivos en las frecuencias de 250 - 4000Hz y se analizaron valores SII para los señales de entrada 55 y 65 dB NPS, obtenidos en la verificación de la amplificación en el equipo Verifit®Audioscan. Resultados: de las curvas de respuesta obtenidas en la verificación de la amplificación, se registraron los valores de SII. Se ajustaron todos los dispositivos de amplificación lo más cerca posible de la meta. Se observaron limitaciones de amplificación según el grado y la configuración de la pérdida auditiva. Se generaron curvas de referencia y ecuaciones para predecir valores de SII amplificado en las intensidades 55 y 65 dBNPS. Conclusión: se construyeron curvas de referencia para valores de SII amplificado, se generaron ecuaciones para predecir y evaluar los valores de SII según las características audiológicas y pueden ser incluidos en los protocolos de indicación de amplificación de sonido e acompañamiento audiológico. Ecuaciones y curvas de referencia no substituyen el proceso de verificación de dispositivos de amplificación.

Contribuições da Fonoaudiologia para a integração social e profissional dos clientes / Contributions of Speech, Language and Hearing Sciences for social and professional integration of customers / Contribuciones de la Fonoaudiología para la integración social y profesional de los clientes

Introdução: o fonoaudiólogo atua em diferentes contextos profissionais, realizando diversas intervenções, que podem ser analisadas quanto às possibilidades de participação da Fonoaudiologia na inserção social e profissional de seus clientes. Objetivo: investigar a percepção dos fonoaudiólogos sobre como sua atuação contribui para a integração social e profissional de seus clientes. Métodos: Casuística:60 fonoaudiólogos.Foi utilizada a técnica de amostragem por bola de neve, a partir de divulgação feita por Email em listas de contatos de fonoaudiólogos. Os fonoaudiólogos responderam um questionário, aplicado em formato online (Googledocs®) para a caracterização dos participantes e duas questões dissertativas referentes à integração social/profissional dos clientes. A análise qualitativa estabeleceu 12 categorias de analise à posteriori a partir das respostas às questões dissertativas. Resultados: Os sujeitos eram predominantemente mulheres(93,3%), com idade inferior a 41 anos (71,7%), formadas a menos de 10 anos (57,3%), atuantes na área de Voz (35%), Linguagem (21,3%), Motricidade Oral (18,4%), Audição (16,5%), Saúde Coletiva (8,8%), no estado de São Paulo (73,3%), em contexto clínico e hospitalar (56,7%). Sobre a importância da Fonoaudiologia para inserção/integração social/profissional a categoria mais mencionada foi ?melhora da comunicação? (18-32,2%) e ?melhora na qualidade devida? (25-33,4%). Conclusões: Os fonoaudiólogos percebem sua atuação como importante para a integração social e profissional de seus clientes/pacientes, principalmente, por contribuir para melhora da comunicação. Questionamentos e pesquisas nesse âmbito são importantes para alertar conselhos e outras entidades de classe sobre a necessidade de projetos que viabilizem o acesso da população aos serviços de Fonoaudiologia.

Introduction: the speech therapist works in various professional contexts, making various interventions, which can be analyzed as the possibilities for participation of Speech in social integration and professional customers. Objective: To investigate the perception of interviewees about its performance contributes to the social and professional integration of its customers. Methods: Patients: (60 audiologists) the technique of snowball sampling from disclosure made by mail on the contact lists of speech was used. They answered a questionnaire administered in an online format (GoogleDocs®) for the characterization of participants and two essay questions related to social/ professional integration of customers. After characterizing this group of subjects, the qualitative analysis established12 categories to subsequent analysis from the answers to essay questions. Results: The subjects were predominantly women (93.3%), with less than 41 years old (71.7%), formed less than 10 years (57.3%), working in the area of voice (35%), language (21.3%), Motricity/oral (18.4%), hearing (16.5%), Health/Public (8.8%) in the state of SãoPaulo (73.3%), in the context clinical and hospital (56.7%). On the importance of Speech, Language and Hearing Sciences for insertion/social integration/professional category was the most mentioned ?improved communication? (18 to 32.2%) and ?improved quality of life? (25-33.4%). Conclusions: The speech therapists perceive their role as important for social and professional integration of their clients/patients, mainly by contributing to improved communication. Inquiries and research in this is important to alert councils and other associations of the need for projects that enable access of the population to Speech, Language and Hearing Sciences.

Introducción: el fonoaudiólogo trabaja en varios contextos profesionales, haciendo varias intervenciones, que pueden ser analizadas en cuanto a las posibilidades de participación de la Fonoaudiología en la integración social y profesionales sus clientes.Objetivo: Investigar la percepción de los fonoaudiólogos acerca de cómo su desempeño contribuye a la integración social y profesional de sus clientes. Métodos:Casuística: 60 fonoaudiólogos.Se utilizó la técnica de muestreo de bola de nieve a partir de la divulgación hecha por email en las listas de contactos defonoaudiólogos. Los fonoaudiólogos respondieron un cuestionario administrado en un formato online (GoogleDocs®) para la caracterización de los participantes y dos preguntas de desarrollo relacionados con la integración social/ profesional de los clientes. El análisis cualitativo estableció 12 categorías à posteriori a partir de las respuestas a las preguntas de desarrollo. Resultados: Los sujetos eran predominantemente mujeres (93,3%), con menos de 41 años (71,7%), formadas hace menos de 10 años (57,3%), que trabajan en el área de la Voz (35%), Lenguaje(21,3%), Motricidad Oral (18,4%), Audición (16.5%), Salud Colectiva (8.8%) el estado de São Paulo (73,3%), en contexto clínico y hospitalar (56,7%). Sobre la importancia de la Fonoaudiología para la inserción/integración social/profesional la categoría más mencionada fue ?mejora en la comunicación? (18-32,2%) y ?mejora en la calidad de vida? (25-33,4%). Conclusiones: Los fonoaudiólogos perciben su actividad como importante para la integración social y profesional de sus clientes/pacientes, principalmente por contribuir para la mejora de la comunicación. Cuestionamientos e investigaciones a respeto son importantes para alertar los consejos y otras asociaciones profesionales sobre la necesidad de proyectos que permitan el acceso de la población a los servicios de Fonoaudiología.

Contribuições da Fonoaudiologia para a integração social e profissional dos clientes / Contributions of Speech, Language and Hearing Sciences for social and professional integration of customers / Contribuciones de la Fonoaudiología para la integración social y profesional de los clientes

Introdução: o fonoaudiólogo atua em diferentes contextos profissionais, realizando diversas intervenções, que podem ser analisadas quanto às possibilidades de participação da Fonoaudiologia na inserção social e profissional de seus clientes. Objetivo: investigar a percepção dos fonoaudiólogos sobre como sua atuação contribui para a integração social e profissional de seus clientes. Métodos: Casuística:60 fonoaudiólogos.Foi utilizada a técnica de amostragem por bola de neve, a partir de divulgação feita por Email em listas de contatos de fonoaudiólogos. Os fonoaudiólogos responderam um questionário, aplicado em formato online (Googledocs®) para a caracterização dos participantes e duas questões dissertativas referentes à integração social/profissional dos clientes. A análise qualitativa estabeleceu 12 categorias de analise à posteriori a partir das respostas às questões dissertativas. Resultados: Os sujeitos eram predominantemente mulheres(93,3%), com idade inferior a 41 anos (71,7%), formadas a menos de 10 anos (57,3%), atuantes na área de Voz (35%), Linguagem (21,3%), Motricidade Oral (18,4%), Audição (16,5%), Saúde Coletiva (8,8%), no estado de São Paulo (73,3%), em contexto clínico e hospitalar (56,7%). Sobre a importância da Fonoaudiologia para inserção/integração social/profissional a categoria mais mencionada foi ?melhora da comunicação? (18-32,2%) e ?melhora na qualidade devida? (25-33,4%). Conclusões: Os fonoaudiólogos percebem sua atuação como importante para a integração social e profissional de seus clientes/pacientes, principalmente, por contribuir para melhora da comunicação. Questionamentos e pesquisas nesse âmbito são importantes para alertar conselhos e outras entidades de classe sobre a necessidade de projetos que viabilizem o acesso da população aos serviços de Fonoaudiologia.(AU)

Introduction: the speech therapist works in various professional contexts, making various interventions, which can be analyzed as the possibilities for participation of Speech in social integration and professional customers. Objective: To investigate the perception of interviewees about its performance contributes to the social and professional integration of its customers. Methods: Patients: (60 audiologists) the technique of snowball sampling from disclosure made by mail on the contact lists of speech was used. They answered a questionnaire administered in an online format (GoogleDocs®) for the characterization of participants and two essay questions related to social/ professional integration of customers. After characterizing this group of subjects, the qualitative analysis established12 categories to subsequent analysis from the answers to essay questions. Results: The subjects were predominantly women (93.3%), with less than 41 years old (71.7%), formed less than 10 years (57.3%), working in the area of voice (35%), language (21.3%), Motricity/oral (18.4%), hearing (16.5%), Health/Public (8.8%) in the state of SãoPaulo (73.3%), in the context clinical and hospital (56.7%). On the importance of Speech, Language and Hearing Sciences for insertion/social integration/professional category was the most mentioned ?improved communication? (18 to 32.2%) and ?improved quality of life? (25-33.4%). Conclusions: The speech therapists perceive their role as important for social and professional integration of their clients/patients, mainly by contributing to improved communication. Inquiries and research in this is important to alert councils and other associations of the need for projects that enable access of the population to Speech, Language and Hearing Sciences.(AU)

Introducción: el fonoaudiólogo trabaja en varios contextos profesionales, haciendo varias intervenciones, que pueden ser analizadas en cuanto a las posibilidades de participación de la Fonoaudiología en la integración social y profesionales sus clientes.Objetivo: Investigar la percepción de los fonoaudiólogos acerca de cómo su desempeño contribuye a la integración social y profesional de sus clientes. Métodos:Casuística: 60 fonoaudiólogos.Se utilizó la técnica de muestreo de bola de nieve a partir de la divulgación hecha por email en las listas de contactos defonoaudiólogos. Los fonoaudiólogos respondieron un cuestionario administrado en un formato online (GoogleDocs®) para la caracterización de los participantes y dos preguntas de desarrollo relacionados con la integración social/ profesional de los clientes. El análisis cualitativo estableció 12 categorías à posteriori a partir de las respuestas a las preguntas de desarrollo. Resultados: Los sujetos eran predominantemente mujeres (93,3%), con menos de 41 años (71,7%), formadas hace menos de 10 años (57,3%), que trabajan en el área de la Voz (35%), Lenguaje(21,3%), Motricidad Oral (18,4%), Audición (16.5%), Salud Colectiva (8.8%) el estado de São Paulo (73,3%), en contexto clínico y hospitalar (56,7%). Sobre la importancia de la Fonoaudiología para la inserción/integración social/profesional la categoría más mencionada fue ?mejora en la comunicación? (18-32,2%) y ?mejora en la calidad de vida? (25-33,4%). Conclusiones: Los fonoaudiólogos perciben su actividad como importante para la integración social y profesional de sus clientes/pacientes, principalmente por contribuir para la mejora de la comunicación. Cuestionamientos e investigaciones a respeto son importantes para alertar los consejos y otras asociaciones profesionales sobre la necesidad de proyectos que permitan el acceso de la población a los servicios de Fonoaudiología.(AU)

Characterization of Printed Circuit Boards for Metal and Energy Recovery after Milling and Mechanical Separation.

The proper disposal of electrical and electronic waste is currently a concern of researchers and environmental managers not only because of the large volume of such waste generated, but also because of the heavy metals and toxic substances it contains. This study analyzed printed circuit boards (PCBs) from discarded computers to determine their metal content and characterized them as solid waste and fuel. The analysis showed that PCBs consist of approximately 26% metal, made up mainly of copper, lead, aluminum, iron and tin, as well as other heavy metals such as cadmium and nickel. Comparison with the results of other studies indicated that the concentration of precious metals (gold and silver) has declined over time. Analysis of the leachate revealed high concentrations of cadmium and lead, giving the residue the characteristics of hazardous waste. After milling the PCBs, we found that larger amounts of metal were concentrated in smaller fractions, while the lightest fraction, obtained by density separation, had a gross calorific value of approximately 11 MJ/kg, although with a high ash content. Milling followed by density separation proved potentially useful for recovery of metals and energy-rich fractions.