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IMPORTANCE:. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has evolved through multiple phases in the United States, with significant differences in patient centered outcomes with improvements in hospital strain, medical countermeasures, and overall understanding of the disease. We describe how patient characteristics changed and care progressed over the various pandemic phases; we also emphasize the need for an ongoing clinical network to improve the understanding of known and novel respiratory viral diseases. OBJECTIVES:. To describe how patient characteristics and care evolved across the various COVID-19 pandemic periods in those hospitalized with viral severe acute respiratory infection (SARI). DESIGN:. Severe Acute Respiratory Infection-Preparedness (SARI-PREP) is a Centers for Disease Control and Prevention Foundation-funded, Society of Critical Care Medicine Discovery-housed, longitudinal multicenter cohort study of viral pneumonia. We defined SARI patients as those hospitalized with laboratory-confirmed respiratory viral infection and an acute syndrome of fever, cough, and radiographic infiltrates or hypoxemia. We collected patient-level data including demographic characteristics, comorbidities, acute physiologic measures, serum and respiratory specimens, therapeutics, and outcomes. Outcomes were described across four pandemic variant periods based on a SARS-CoV-2 sequenced subsample: pre-Delta, Delta, Omicron BA.1, and Omicron post-BA.1. SETTING:. Multicenter cohort of adult patients admitted to an acute care ward or ICU from seven hospitals representing diverse geographic regions across the United States. PARTICIPANTS:. Patients with SARI caused by infection with respiratory viruses. MAIN OUTCOMES AND RESULTS:. Eight hundred seventy-four adult patients with SARI were enrolled at seven study hospitals between March 2020 and April 2023. Most patients (780, 89%) had SARS-CoV-2 infection. Across the COVID-19 cohort, median age was 60 years (interquartile range, 48.0–71.0 yr) and 66% were male. Almost half (430, 49%) of the study population belonged to underserved communities. Most patients (76.5%) were admitted to the ICU, 52.5% received mechanical ventilation, and observed hospital mortality was 25.5%. As the pandemic progressed, we observed decreases in ICU utilization (94% to 58%), hospital length of stay (median, 26.0 to 8.5 d), and hospital mortality (32% to 12%), while the number of comorbid conditions increased. CONCLUSIONS AND RELEVANCE:. We describe increasing comorbidities but improved outcomes across pandemic variant periods, in the setting of multiple factors, including evolving care delivery, countermeasures, and viral variants. An understanding of patient-level factors may inform treatment options for subsequent variants and future novel pathogens.

Resumo: O objetivo deste artigo é discutir como ocorre a mediação do literário no curso de Letras de uma universidade do sul do Brasil da rede da Associação Catarinense das Fundações Educacionais (Acafe) e o impacto dessa mediação na formação do(a) futuro(a) docente. É uma pesquisa qualitativa de natureza exploratória. O instrumento de coleta utilizado consistiu em entrevista por meio de grupo focal com oito acadêmicos do curso de Letras, na disciplina de Estudos Literários. A professora de Literatura não foi entrevistada, mas é considerada sujeito de pesquisa porque, mediante os depoimentos dos acadêmicos, identificamos as percepções sobre a atuação dela em sala de aula, suas escolhas metodológicas e teóricas. A análise dos dados ocorreu de acordo com a análise de conteúdo segundo Franco (2008). O estudo fundamentou-se em Barthes (2015, 1992), Duarte Júnior (2010, 2012), Mirian Martins (2005, 2014), Neitzel et al. (2017), Todorov (2020), entre outros. Os resultados indicam que: a mediação da leitura do literário ocorreu a partir da concepção da professora de que mediar implica uma postura de valorização do outro; a mediação deu-se por meio de objetos e espaços propositores - livros, pinturas, músicas, cartões-postais, trechos de filmes, entre outros -, os quais a professora explorou para oportunizar aos(às) acadêmicos(as) a apreciação do texto literário como objeto estético e artístico; os espaços propositores, como corredores, escadas, bibliotecas, espaços ao ar livre e a própria sala de aula, foram experimentados para ampliar as percepções dos(as) acadêmicos(as) sobre a obra e por ela serem afetados(as). As experiências reverberaram e há indícios de que contribuíram para a educação estética dos(as) futuros(as) docentes.

IMPORTANCE:. Vascular dysfunction and capillary leak are common in critically ill COVID-19 patients, but identification of endothelial pathways involved in COVID-19 pathogenesis has been limited. Angiopoietin-like 4 (ANGPTL4) is a protein secreted in response to hypoxic and nutrient-poor conditions that has a variety of biological effects including vascular injury and capillary leak. OBJECTIVES:. To assess the role of ANGPTL4 in COVID-19–related outcomes. DESIGN, SETTING, AND PARTICIPANTS:. Two hundred twenty-five COVID-19 ICU patients were enrolled from April 2020 to May 2021 in a prospective, multicenter cohort study from three different medical centers, University of Washington, University of Southern California and New York University. MAIN OUTCOMES AND MEASURES:. Plasma ANGPTL4 was measured on days 1, 7, and 14 after ICU admission. We used previously published tissue proteomic data and lung single nucleus RNA (snRNA) sequencing data from specimens collected from COVID-19 patients to determine the tissues and cells that produce ANGPTL4. RESULTS:. Higher plasma ANGPTL4 concentrations were significantly associated with worse hospital mortality (adjusted odds ratio per log2 increase, 1.53; 95% CI, 1.17–2.00; p = 0.002). Higher ANGPTL4 concentrations were also associated with higher proportions of venous thromboembolism and acute respiratory distress syndrome. Longitudinal ANGPTL4 concentrations were significantly different during the first 2 weeks of hospitalization in patients who subsequently died compared with survivors (p for interaction = 8.1 × 10–5). Proteomics analysis demonstrated abundance of ANGPTL4 in lung tissue compared with other organs in COVID-19. ANGPTL4 single-nuclear RNA gene expression was significantly increased in pulmonary alveolar type 2 epithelial cells and fibroblasts in COVID-19 lung tissue compared with controls. CONCLUSIONS AND RELEVANCE:. ANGPTL4 is expressed in pulmonary epithelial cells and fibroblasts and is associated with clinical prognosis in critically ill COVID-19 patients.

OBJECTIVES:. Respiratory virus infections cause significant morbidity and mortality ranging from mild uncomplicated acute respiratory illness to severe complications, such as acute respiratory distress syndrome, multiple organ failure, and death during epidemics and pandemics. We present a protocol to systematically study patients with severe acute respiratory infection (SARI), including severe acute respiratory syndrome coronavirus 2, due to respiratory viral pathogens to evaluate the natural history, prognostic biomarkers, and characteristics, including hospital stress, associated with clinical outcomes and severity. DESIGN:. Prospective cohort study. SETTING:. Multicenter cohort of patients admitted to an acute care ward or ICU from at least 15 hospitals representing diverse geographic regions across the United States. PATIENTS:. Patients with SARI caused by infection with respiratory viruses that can cause outbreaks, epidemics, and pandemics. INTERVENTIONS:. None. MEASUREMENTS AND MAIN RESULTS:. Measurements include patient demographics, signs, symptoms, and medications; microbiology, imaging, and associated tests; mechanical ventilation, hospital procedures, and other interventions; and clinical outcomes and hospital stress, with specimens collected on days 0, 3, and 7–14 after enrollment and at discharge. The primary outcome measure is the number of consecutive days alive and free of mechanical ventilation (VFD) in the first 30 days after hospital admission. Important secondary outcomes include organ failure-free days before acute kidney injury, shock, hepatic failure, disseminated intravascular coagulation, 28-day mortality, adaptive immunity, as well as immunologic and microbiologic outcomes. CONCLUSIONS:. SARI—Preparedness is a multicenter study under the collaboration of the Society of Critical Care Medicine Discovery, Resilience Intelligence Network, and National Emerging Special Pathogen Training and Education Center, which seeks to improve understanding of prognostic factors associated with worse outcomes and increased resource utilization. This can lead to interventions to mitigate the clinical impact of respiratory virus infections associated with SARI.

O objetivo deste artigo foi problematizar as imagens das bibliotecas, de modo a identificar como elas repercutem nos(as) usuários(as) e se elas se caracterizam como espaços de mediação cultural e de experiência. O estudo foi de caráter qualitativo e de natureza narrativa, construído a partir de vivências das pesquisadoras em duas bibliotecas de Paris: Biblioteca Sainte-Geneviève e a Biblioteca Pública de Informação Centro Pompidou (Bpi). Os instrumentos de coleta de dados utilizados foram: observação in loco e diário de campo analisado segundo a perspectiva da Pesquisa Educacional Baseada em Arte (PEBA), fundamentada em Hernández (2013). O aporte teórico principal que sustentou essa discussão foi Bachelard (1993), Failla (2015), Manguel (2006), Milanesi (2003) e Sandoz (2010), entre outros(as). Como resultados, sinalizam-se os principais fatores que geram a repercussão de imagens nos(as) usuários(as): a mediação cultural; a experiência; a organização física do espaço e os objetos propositores que o compõem; as ações culturais e de acolhimento; e as possibilidades de movimentação que a biblioteca oportuniza no seu interior.

Este texto busca refletir sobre a politica educacional e sua relação com o contexto politico e econômico do período em questão. O estudo tem como foco central uma análise da política educacional desenvolvida no Brasil no período que compreende os governos de Fernando Henrique Cardoso, Luís Inácio Lula da Silva e Dilma Rousseff (1995-2016). Para tanto, busca e explicitar quais pressupostos econômicos e políticos fundamentaram as políticas educacionais no Brasil de 1995 a 2016, bem como as influências internacionais na organização do Estado e na promoção da política educacional brasileira. O estudo demonstra que os princípios do liberalismo e, portanto, da lógica do mercado tem sido a referência par a organização das políticas educacionais no período em estudo. Constata-se uma mudança significativa nos governos Lula e Dilma no sentido de ampliar os direitos sociais e o acesso à educação por parte das camadas sociais menos favorecidas.

Este artigo é resultado de leituras e discussões iniciais sobre o currículo na perspectiva da pedagogia histórico-crítica. A metodologia adotada baseia-se no materialismo histórico-dialético com revisão bibliográfica nos escritos de Dermeval Saviani (2013a, 2013b), de Antônio Gramsci (2000), de Newton Duarte (2016) e de Júlia Malanchen (2014). O objetivo do trabalho é analisar a construção social do currículo visualizando-o como um produto histórico, principalmente no tocante aos seus condicionantes históricos da década de 1990, que influenciaram, de forma significativa, o rumo dessa política pública. Sendo assim, a problemática central no texto refere-se a necessidade de uma organização curricular que supere a visão burguesa de educação. Os resultados expõem a pedagogia histórico-crítica como a perspectiva curricular mais adequada, pois a partir desta visão a classe trabalhadora é munida do conhecimento científico acumulado historicamente e instrumentalizada para a revolução.

LGBTQ+ communities experience significant healthcare and academic success disparities due to barriers in care, negative attitudes towards them, and lack of awareness among healthcare providers and educators. Addressing the unique health and wellbeing concerns of LGBTQ+ individuals in the classroom and clinic requires cultural competency among educators and health professionals, yet knowledge and training in this content is lacking. Thus, we created, piloted, and assessed a six-month interdisciplinary professional development program to enhance knowledge, attitudes, awareness, and cultural humility around LGBTQ+ health for educators, administrators, and clinicians in higher education. Participants were surveyed with standardized assessments pre- and post-program to measure their knowledge, skills, and readiness to teach these topics and incorporate them into their curricula and practice. Participants (n = 33) completed LGBTQ+ inclusivity training including six structured learning sessions, small group mentoring meetings, and a virtual visit to an LGBTQ+ community center. Participants consistently displayed interest and engaged actively in training sessions. In a follow-up survey seven months post-intervention, respondents reported changes in their practice to create inclusive environments. Data analysis demonstrated improved knowledge and comfort with LGBTQ+ care and readiness and willingness to integrate LGBTQ+ care into their curricula and interactions with students. These findings suggest that this interdisciplinary professional development pilot offers a useful program to enable educators and clinicians to support the unique needs of LGBTQ+ communities.

Objectives:. To describe the impact of coronavirus disease 2019 on family engagement among ICUs participating in a multicenter collaborative promoting implementation of family-centered care projects and to report sites’ experiences with the collaborative itself prior to its cancelation due to the pandemic in March 2020. Design:. Cross-sectional survey. Setting:. Twenty-seven academic and community ICUs in the United States and South Korea. Subjects:. Site leaders. Interventions:. Prior to March 2020, all sites had participated in 6 months of webinars, monthly calls, and listserv communication to facilitate projects and to collect preimplementation family satisfaction and clinician perception data. Measurements and Main Results:. Planned projects included ICU orientation initiatives (12, 44.4%), structured family care conferences (6, 22.2%), and ICU diaries (5, 18.5%). After cancelation of the collaborative, 22 site leaders (81.5%) were surveyed by phone from June 2020 to July 2020. Twenty (90.1%) reported having stopped their site project; projects that continued were 1) a standardized palliative extubation protocol and 2) daily written clinical summaries for families. Sites described significant variability in visitor restriction policies and uncertainty regarding future policy changes. Four sites (18.2%) reported that their hospital did not provide personal protective equipment to visitors. Regarding video conferencing with families, 11 sites (52.4%) reported clinicians’ using their own personal devices. Two-hundred twelve family surveys and 346 clinician surveys collected prior to cancelation highlighted a broad need for family support. When leaders were asked on a scale from 0 to 10 how helpful collaborative activities had been prior to cancelation, mean response was 8.0 (sd 2.5). Conclusions:. While the collaborative model can help promote ICU family engagement initiatives, coronavirus disease 2019 has impeded implementation of these initiatives even among motivated units. ICUs need adequate personal protective equipment for visitors and video conferencing capabilities on hospital devices while strict visitor restrictions continue to evolve.

Fine particulate matter (PM2.5) is a complex mixture of components with diverse chemical and physical characteristics associated with increased respiratory and cardiovascular diseases mortality. Our study aimed to investigate the effects of exposure to concentrated PM2.5 on LPS-induced lung injury onset. BALB/c male mice were exposed to either filtered air or ambient fine PM2.5 in an ambient particle concentrator for 5 weeks. Then, an acute lung injury was induced with nebulized LPS. The animals were euthanized 24 h after the nebulization to either LPS or saline. Inflammatory cells and cytokines (IL-1β, IL-4, IL-5, IL-6, IL-10, IL-17, TNF) were assessed in the blood, bronchoalveolar lavage fluid (BALF), and lung tissue. In addition, lung morphology was assessed by stereological methods. Our results showed that the PM+LPS group showed histological evidence of injury, leukocytosis with increased neutrophils and macrophages, and a mixed inflammatory response profile, with increased KC, IL-6, IL-1β, IL-4, and IL-17. Our analysis shows that there is an interaction between the LPS nebulization and PM2.5 exposure, differently modulating the inflammatory response, with a distinct response pattern as compared to LPS or PM2.5 exposure alone. Further studies are required to explain the mechanism of immune modulation caused by PM2.5 exposure.

Esta pesquisa tem como tema a Educação Superior e o objetivo é discutir as pluralidades que compõem o mosaico juvenil e envolvem a transição do Ensino Médio para o Superior por meio do perfil do acadêmico ingressante. Buscamos, ainda, pontuar ações que interferem na permanência do estudante na universidade. A metodologia utilizada é quali-quantitativa. O instrumento de coleta de dados foi um questionário online com 19 questões objetivas aplicado junto aos ingressantes da graduação em 2016-1. A análise do instrumento pautou-se na estratégia da triangulação metodológica, que permite a combinação e o cruzamento de métodos e técnicas de pesquisa. Como resultados sinalizamos: a) o perfil dos ingressantes revela, entre outros dados, que a maioria é do sexo feminino, são economicamente dependentes da família e oriundos das escolas públicas; b) há fragilidades na participação em atividades culturais como teatro, cinema, shows e em atividades de lazer como a prática de esportes, dança e academia; c) que as ações de acolhimento e atendimento ao discente, no curso e ações institucionais são fundamentais para que a transição do acadêmico dê-se de forma mais tranquila, assim como, para sua permanência; d) a maioria deseja desenvolver habilidades para diferentes possibilidades profissionais e adquirir conhecimento específico da área de cultura geral. Observamos que a transição do acadêmico é dependente não apenas da formação dos ingressantes, mas também da estrutura que os acolhe. A universidade necessita atuar como um campo de formação específica, mas também oferecer oportunidades de ampliar seu capital cultural.

Type 2 diabetes (T2D) is a heterogeneous disease that develops through diverse pathophysiological processes1,2 and molecular mechanisms that are often specific to cell type3,4. Here, to characterize the genetic contribution to these processes across ancestry groups, we aggregate genome-wide association study data from 2,535,601 individuals (39.7% not of European ancestry), including 428,452 cases of T2D. We identify 1,289 independent association signals at genome-wide significance (P

Com a pretensão de convidar à reflexão acerca das relações entre a academia e a escola, recorremos à indagação sobre o cotidiano no ensino de Geografia como elemento para fortalecer indícios da relevancia desse debate. Fomentamos a discurssão na perspectiva de considerar as posibilidades de uma interação dialógica. Utilizamos o cotidiano como conceito e categoría propondo pensar a vida e a educação escolar e assim, apresentamos alguns elementos envolvendo a vinculação e a insperabilidade entre a escola como mundo da experiencia e academia como mundo teorico. Nessa pretensão que tem como pressuposto a relação dinámica e dialéctica entre o viver e o pensar, constituimos a argumentação tomando as categorías e conceitos como objeto para a análise que vincula as produções teóricas e o cotidiano no ensino. Analisamos, então, o cotidiano como conceito e categoría, e, no contexto de sua relevancia a pertinência espacial, o cotidiano no ensino de Geografia, evidenciado na produção teorica da academia. Para tensionar o debate, utilizamos como referencia uma pesquisa realizada no RS e que visou constituir o estado da arte do ensino de Geografia na primeira década do século vinte e um. Ao final, apresentamos algumas constatações e desafíos de uma educação geográfica e encaminamos, reconhecendo a fundamentalidade da escola e da academia, ambas na perspectiva de qualificar a vida. PALABRAS-CHAVE: Educação, Cobhecimento, Conceitos, Categorias, Espaço.

The early-life gut microbiome development has long-term health impacts and can be influenced by factors such as infant diet. Human milk oligosaccharides (HMOs), an essential component of breast milk that can only be metabolized by some beneficial gut microorganisms, ensure proper gut microbiome establishment and infant development. However, how HMOs are metabolized by gut microbiomes is not fully elucidated. Isolate studies have revealed the genetic basis for HMO metabolism, but they exclude the possibility of HMO assimilation via synergistic interactions involving multiple organisms. Here, we investigate microbiome responses to 2-fucosyllactose (2FL), a prevalent HMO and a common infant formula additive, by establishing individualized microbiomes using fecal samples from three infants as the inocula. Bifidobacterium breve, a prominent member of infant microbiomes, typically cannot metabolize 2FL. Using metagenomic data, we predict that extracellular fucosidases encoded by co-existing members such as Ruminococcus gnavus initiate 2FL breakdown, thus critical for B. breves growth. Using both targeted co-cultures and by supplementation of R. gnavus into one microbiome, we show that R. gnavus can promote extensive growth of B. breve through the release of lactose from 2FL. Overall, microbiome cultivation combined with genome-resolved metagenomics demonstrates that HMO utilization can vary with an individuals microbiome.

United States policymakers and education leaders continue to assess young children as if their learning contexts are neutral and harmless. This article draws upon examples from the multi-sited Civic Action and Young Children study to show why contexts that actively refuse deficit, racist thinking and support agency have the best chance of showing children's diverse ranges of skills and knowledge and so should be the focus of assessment.

This longitudinal inductive research unpacks the process of African post-secondary students' Chinese language identity (CLI) with the purpose of exploring a model of CLI development. We traced how 12 multilingual African students developed their CLI during the first year in a Chinese university. Data coded from three rounds of interviews conducted at different times reveal that over time, there are fewer distractors and more contributors to the development of CLI. We also found three bidirectional factors that both facilitate and impede CLI construction. In terms of dimensions of language identity, Chinese language expertise and positive affiliation with the new language increased over time without change in students' original language inheritance. Results inform both African students' adaptation in China and the instruction and administration of African students in Chinese universities. This study helps to discover patterns of change in language identity from a micro perspective and informs models of language identity development among multilingual adult learners.

How can academic developers support Early Career Academics (ECAs) to increase in confidence as they step into their new responsibilities? Previous work has demonstrated the negative impacts of ECAs' low self-efficacy, focusing recommendations on the need for systemic changes. Going further than previous academic development work to apply social cognitive theories of personality, we explore how ECAs can be equipped to understand, reflect on and increase their own confidence. We point to evidence-based approaches and recommend practical steps that can be taken to implement this approach in increasing the confidence of ECAs.

Despite growing recognition of the need for increased diversity among students, trainees, and faculty in health care, the medical workforce still lacks adequate representation from groups historically underrepresented in medicine (URiM). The subspecialty field of pediatric pulmonology is no exception. Although there have been efforts to address issues of diversity, equity, and inclusion (DEI) in our own field, gaps persist. To address these gaps, the members of the Diversity, Equity, and Inclusion Advisory Group (DEI-AG) of the American Thoracic Society Pediatrics Assembly created and distributed a Needs Assessment Survey in the United States and Canada to better understand the racial and ethnic demographics of the pediatric pulmonary workforce and to learn more about successes, gaps, and opportunities to enhance how we recruit, train, and retain a diverse workforce. The DEI-AG leadership cochairs convened a workshop to review the findings of the DEI Needs Assessment Survey and to develop strategies to improve the recruitment and retention of URiM fellows and faculty. This Official ATS Workshop Report aims to identify barriers and opportunities for recruitment, training, and career development within the field of pediatric pulmonology. Additionally, we offer useful strategies and resources to improve the recruitment of URiM residents, the mentorship of trainees and junior faculty, and the career development of URiM faculty in academic centers. This Workshop Report is an important first deliverable by the DEI-AG. We hope that this work, originating from within the Pediatrics Assembly, will serve as a model for other Assemblies, disciplines across the ATS, and other fields in Pediatrics.