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IMPORTANCE: Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. OBJECTIVE: To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS: In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non-critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS: Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES: The primary outcome was organ support-free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS: On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support-free days among critically ill patients was 10 (-1 to 16) in the ACE inhibitor group (n = 231), 8 (-1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support-free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE: In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02735707.

Importance The optimal first-line mode of noninvasive respiratory support for acutely ill children is not known. Objective To evaluate the noninferiority of high-flow nasal cannula therapy (HFNC) as the first-line mode of noninvasive respiratory support for acute illness, compared with continuous positive airway pressure (CPAP), for time to liberation from all forms of respiratory support. Design, Setting, and Participants Pragmatic, multicenter, randomized noninferiority clinical trial conducted in 24 pediatric critical care units in the United Kingdom among 600 acutely ill children aged 0 to 15 years who were clinically assessed to require noninvasive respiratory support, recruited between August 2019 and November 2021, with last follow-up completed in March 2022. Interventions Patients were randomized 1:1 to commence either HFNC at a flow rate based on patient weight (n = 301) or CPAP of 7 to 8 cm H2O (n = 299). Main Outcomes and Measures The primary outcome was time from randomization to liberation from respiratory support, defined as the start of a 48-hour period during which a participant was free from all forms of respiratory support (invasive or noninvasive), assessed against a noninferiority margin of an adjusted hazard ratio of 0.75. Seven secondary outcomes were assessed, including mortality at critical care unit discharge, intubation within 48 hours, and use of sedation. Results Of the 600 randomized children, consent was not obtained for 5 (HFNC: 1; CPAP: 4) and respiratory support was not started in 22 (HFNC: 5; CPAP: 17); 573 children (HFNC: 295; CPAP: 278) were included in the primary analysis (median age, 9 months; 226 girls [39%]). The median time to liberation in the HFNC group was 52.9 hours (95% CI, 46.0-60.9 hours) vs 47.9 hours (95% CI, 40.5-55.7 hours) in the CPAP group (absolute difference, 5.0 hours [95% CI –10.1 to 17.4 hours]; adjusted hazard ratio 1.03 [1-sided 97.5% CI, 0.86-∞]). This met the criterion for noninferiority. Of the 7 prespecified secondary outcomes, 3 were significantly lower in the HFNC group: use of sedation (27.7% vs 37%; adjusted odds ratio, 0.59 [95% CI, 0.39-0.88]); mean duration of critical care stay (5 days vs 7.4 days; adjusted mean difference, −3 days [95% CI, −5.1 to −1 days]); and mean duration of acute hospital stay (13.8 days vs 19.5 days; adjusted mean difference, −7.6 days [95% CI, −13.2 to −1.9 days]). The most common adverse event was nasal trauma (HFNC: 6/295 [2.0%]; CPAP: 18/278 [6.5%]). Conclusions and Relevance Among acutely ill children clinically assessed to require noninvasive respiratory support in a pediatric critical care unit, HFNC compared with CPAP met the criterion for noninferiority for time to liberation from respiratory support. Trial Registration ISRCTN.org Identifier: ISRCTN60048867

Background Obtaining accurate estimates of the risk of COVID-19-related death in the general population is challenging in the context of changing levels of circulating infection. Methods We propose a modelling approach to predict 28-day COVID-19-related death which explicitly accounts for COVID-19 infection prevalence using a series of sub-studies from new landmark times incorporating time-updating proxy measures of COVID-19 infection prevalence. This was compared with an approach ignoring infection prevalence. The target population was adults registered at a general practice in England in March 2020. The outcome was 28-day COVID-19-related death. Predictors included demographic characteristics and comorbidities. Three proxies of local infection prevalence were used: model-based estimates, rate of COVID-19-related attendances in emergency care, and rate of suspected COVID-19 cases in primary care. We used data within the TPP SystmOne electronic health record system linked to Office for National Statistics mortality data, using the OpenSAFELY platform, working on behalf of NHS England. Prediction models were developed in case-cohort samples with a 100-day follow-up. Validation was undertaken in 28-day cohorts from the target population. We considered predictive performance (discrimination and calibration) in geographical and temporal subsets of data not used in developing the risk prediction models. Simple models were contrasted to models including a full range of predictors. Results Prediction models were developed on 11,972,947 individuals, of whom 7999 experienced COVID-19-related death. All models discriminated well between individuals who did and did not experience the outcome, including simple models adjusting only for basic demographics and number of comorbidities: C-statistics 0.92–0.94. However, absolute risk estimates were substantially miscalibrated when infection prevalence was not explicitly modelled. Conclusions Our proposed models allow absolute risk estimation in the context of changing infection prevalence but predictive performance is sensitive to the proxy for infection prevalence. Simple models can provide excellent discrimination and may simplify implementation of risk prediction tools.

ObjectiveTo determine the feasibility of Fluids in Shock, a randomised controlled trial (RCT) of restricted fluid bolus volume (10 mL/kg) versus recommended practice (20 mL/kg).DesignNine-month pilot RCT with embedded mixed-method perspectives study.Setting13 hospitals in England.PatientsChildren presenting to emergency departments with suspected infection and shock after 20 mL/kg fluid.InterventionsPatients were randomly allocated (1:1) to further 10 or 20 mL/kg fluid boluses every 15 min for up to 4 hours if still in shock.Main outcome measuresThese were based on progression criteria, including recruitment and retention, protocol adherence, separation, potential trial outcome measures, and parent and staff perspectives.ResultsSeventy-five participants were randomised; two were withdrawn. 23 (59%) of 39 in the 10 mL/kg arm and 25 (74%) of 34 in the 20 mL/kg arm required a single trial bolus before the shock resolved. 79% of boluses were delivered per protocol in the 10 mL/kg arm and 55% in the 20 mL/kg arm. The volume of study bolus fluid after 4 hours was 44% lower in the 10 mL/kg group (mean 14.5 vs 27.5 mL/kg). The Paediatric Index of Mortality-2 score was 2.1 (IQR 1.6–2.7) in the 10 mL/kg group and 2.0 (IQR 1.6–2.5) in the 20 mL/kg group. There were no deaths. Length of hospital stay, paediatric intensive care unit (PICU) admissions and PICU-free days at 30 days did not differ significantly between the groups. In the perspectives study, the trial was generally supported, although some problems with protocol adherence were described.ConclusionsParticipants were not as unwell as expected. A larger trial is not feasible in its current design in the UK.Trial registration numberISRCTN15244462.

Background Although high-flow nasal cannula therapy (HFNC) has become a popular mode of non-invasive respiratory support (NRS) in critically ill children, there are no randomised controlled trials (RCTs) comparing it with continuous positive airway pressure (CPAP). We performed a pilot RCT to explore the feasibility, and inform the design and conduct, of a future large pragmatic RCT comparing HFNC and CPAP in paediatric critical care. Methods In this multi-centre pilot RCT, eligible patients were recruited to either Group A (step-up NRS) or Group B (step-down NRS). Participants were randomised (1:1) using sealed opaque envelopes to either CPAP or HFNC as their first-line mode of NRS. Consent was sought after randomisation in emergency situations. The primary study outcomes were related to feasibility (number of eligible patients in each group, proportion of eligible patients randomised, consent rate, and measures of adherence to study algorithms). Data were collected on safety and a range of patient outcomes in order to inform the choice of a primary outcome measure for the future RCT. Results Overall, 121/254 eligible patients (47.6%) were randomised (Group A 60%, Group B 44.2%) over a 10-month period (recruitment rate for Group A, 1 patient/site/month; Group B, 2.8 patients/site/month). In Group A, consent was obtained in 29/33 parents/guardians approached (87.9%), while in Group B 84/118 consented (71.2%). Intention-to-treat analysis included 113 patients (HFNC 59, CPAP 54). Most reported adverse events were mild/moderate (HFNC 8/59, CPAP 9/54). More patients switched treatment from HFNC to CPAP (Group A: 7/16, 44%; Group B: 9/43, 21%) than from CPAP to HFNC (Group A: 3/13, 23%; Group B: 5/41, 12%). Intubation occurred within 72 h in 15/59 (25.4%) of HFNC patients and 10/54 (18.5%) of CPAP patients (p = 0.38). HFNC patients experienced fewer ventilator-free days at day 28 (Group A: 19.6 vs. 23.5; Group B: 21.8 vs. 22.2). Conclusions Our pilot trial confirms that, following minor changes to consent procedures and treatment algorithms, it is feasible to conduct a large national RCT of non-invasive respiratory support in the paediatric critical care setting in both step-up and step-down NRS patients. Trial registration clinicaltrials.gov, NCT02612415. Registered on 23 November 2015.

International audience; Road construction demonstrably accelerates deforestation rates in tropical forests, but its consequences for forest degradation remain less clear. We estimated a series of forest value metrics including components of biodiversity, carbon stocks, and timber and non-timber forest product resources, along the recently paved Inter-Oceanic Highway (IOH) integrating Brazil and Peru along the Bolivian border. We installed 69 vegetation plots in intact terra firme forests representative of local community holdings near and far from the IOH, and we characterized 15 components of forest value for each plot. We observed strong geographic gradients in forest value components across the region, with increases from west to east in aboveground biomass and in the abundance of timber and non-timber forest product trees and regeneration. Plots in communities in Pando, Bolivia, where the IOH remains in part unpaved, had the highest aboveground biomass, standing timber volumes and Brazil nut tree density. In contrast, communities in Madre de Dios, Peru, where settlements and unpaved portions of the IOH have existed for decades, and in Acre, Brazil, where paving of the IOH has been underway for more than a decade, were more degraded. Seven of the fifteen forest value components we measured increased with increasing distance from the IOH, although the magnitude of these effects was weak. Landscape scale remote sensing analyses showed much stronger effects of road proximity on deforestation. We suggest that remote sensing techniques including canopy spectral signatures might be calibrated to characterize multiple components of forest value, so that we can estimate landscape scale-impacts of infrastructure developments on both deforestation and forest degradation in tropical regions. (C) 2015 Elsevier B.V. All rights reserved.

Objectives: Organizational factors are associated with outcome of critically ill patients and may vary by time of day and day of week. We aimed to identify the association between out-of-hours admission to critical care and mortality. Data Sources: MEDLINE (via Ovid) and EMBASE (via Ovid). Study Selection: We performed a systematic search of the literature for studies on out-of-hours adult general ICU admission on patient mortality. Data Extraction: Meta-analyses were performed and Forest plots drawn using RevMan software. Data are presented as odds ratios ([95% CIs], p values). Data Synthesis: A total of 16 studies with 902,551 patients were included in the analysis with a crude mortality of 18.2%. Fourteen studies with 717,331 patients reported mortality rates by time of admission and 11 studies with 835,032 patients by day of admission. Admission to ICU at night was not associated with an increased odds of mortality compared with admissions during the day (odds ratio, 1.04 [0.98–1.11]; p = 0.18). However, admissions during the weekend were associated with an increased odds of death compared with ICU admissions during weekdays (1.05 [1.01–1.09]; p = 0.006). Increased mortality associated with weekend ICU admissions compared with weekday ICU admissions was limited to North American countries (1.08 [1.03–1.12]; p = 0.0004). The absence of a routine overnight on-site intensivist was associated with increased mortality among weekend ICU admissions compared with weekday ICU admissions (1.11 [1.00–1.22]; p = 0.04) and nighttime admissions compared with daytime ICU admissions (1.11 [1.00–1.23]; p = 0.05). Conclusions: Adjusted risk of death for ICU admission was greater over the weekends compared with weekdays. The absence of a dedicated intensivist on-site overnight may be associated with increased mortality for acute admissions. These results need to be interpreted in context of the organization of local healthcare resources before changes to healthcare policy are implemented.

Objective The Fluids in Shock (FiSh) Trial proposes to evaluate whether restrictive fluid bolus therapy (10 mL/kg) is more beneficial than current recommended practice (20 mL/kg) in the resuscitation of children with septic shock in the UK. This qualitative feasibility study aimed to explore acceptability of the FiSh Trial, including research without prior consent (RWPC), potential barriers to recruitment and participant information for a pilot trial. Design Qualitative interview study involving parents of children who had presented to a UK emergency department or been admitted to a paediatric intensive care unit with severe infection in the previous 3 years. Participants Twenty-one parents (seven bereaved) were interviewed 16 (median) months since their child’s hospital admission (range: 1–41). Results All parents said they would have provided consent for the use of their child’s data in the FiSh Trial. The majority were unfamiliar with RWPC, yet supported its use. Parents were initially concerned about the change from currently recommended treatment, yet were reassured by explanations of the current evidence base, fluid bolus therapy and monitoring procedures. Parents made recommendations about the timing of the research discussion and content of participant information. Bereaved parents stated that recruiters should not discuss research immediately after a child’s death, but supported a personalised postal ‘opt-out’ approach to consent. Conclusions Findings show that parents whose child has experienced severe infection supported the proposed FiSh Trial, including the use of RWPC. Parents’ views informed the development of the pilot trial protocol and site staff training. Trial registration number ISRCTN15244462—results.

BACKGROUND: For critically ill adult patients with acute traumatic brain injury (TBI), we assessed the clinical and cost-effectiveness of: (a) Management in dedicated neurocritical care units versus combined neuro/general critical care units within neuroscience centres. (b) 'Early' transfer to a neuroscience centre versus 'no or late' transfer for those who present at a non-neuroscience centre. METHODS: The Risk Adjustment In Neurocritical care (RAIN) Study included prospective admissions following acute TBI to 67 UK adult critical care units during 2009-11. Data were collected on baseline case-mix, mortality, resource use, and at six months, Glasgow Outcome Scale Extended (GOSE), and quality of life (QOL) (EuroQol 5D-3L). We report incremental effectiveness, costs and cost per Quality-Adjusted Life Year (QALY) of the alternative care locations, adjusting for baseline differences with validated risk prediction models. We tested the robustness of results in sensitivity analyses. FINDINGS: Dedicated neurocritical care unit patients (N = 1324) had similar six-month mortality, higher QOL (mean gain 0.048, 95% CI -0.002 to 0.099) and increased average costs compared with those managed in combined neuro/general units (N = 1341), with a lifetime cost per QALY gained of £14,000. 'Early' transfer to a neuroscience centre (N = 584) was associated with lower mortality (odds ratio 0.52, 0.34-0.80), higher QOL for survivors (mean gain 0.13, 0.032-0.225), but positive incremental costs (£15,001, £11,123 to £18,880) compared with 'late or no transfer' (N = 263). The lifetime cost per QALY gained for 'early' transfer was £11,000. CONCLUSIONS: For critically ill adult patients with acute TBI, within neuroscience centres management in dedicated neurocritical care units versus combined neuro/general units led to improved QoL and higher costs, on average, but these differences were not statistically significant. This study finds that 'early' transfer to a neuroscience centre is associated with reduced mortality, improvement in QOL and is cost-effective.

Contemporary conservation interventions must balance potential trade-offs between multiple ecosystem services. In tropical forests, much attention has focused on the extent to which carbon-based conservation provided by REDD+ policies can also mitigate biodiversity conservation. In the nearly one-third of tropical forests that are community owned or managed, conservation strategies must also balance the multiple uses of forest products that support local livelihoods. Although much discussion has focused on policy options, little empirical evidence exists to evaluate the potential for trade-offs among different tropical forest value components. We assessed multiple components of forest value, including tree diversity, carbon stocks, and both timber and nontimber forest product resources, in forest communities across the trinational frontier of Brazil, Peru, and Bolivia. We installed 69 0.5-ha vegetation plots in local communities, and we characterized 15 components of forest value for each plot. Principal components analyses revealed two major axes of forest value, the first of which defined a trade-off between diversity of woody plant communities (taxonomic and functional) versus aboveground biomass and standing timber volume. The second axis described abundance of commercial species, with strong positive loadings for density of timber and nontimber forest products, including Brazil nut (Bertholletia excelsa) and copaiba oil (Copaifera spp.). The observed trade-off between different components of forest value suggests a potential for management conflicts prioritizing biodiversity conservation versus carbon stocks in the region. We discuss the potential for integrative indices of forest value for tropical forest conservation.

OBJECTIVES: To validate risk prediction models for acute traumatic brain injury (TBI) and to use the best model to evaluate the optimum location and comparative costs of neurocritical care in the NHS. DESIGN: Cohort study. SETTING: Sixty-seven adult critical care units. PARTICIPANTS: Adult patients admitted to critical care following actual/suspected TBI with a Glasgow Coma Scale (GCS) score of < 15. INTERVENTIONS: Critical care delivered in a dedicated neurocritical care unit, a combined neuro/general critical care unit within a neuroscience centre or a general critical care unit outside a neuroscience centre. MAIN OUTCOME MEASURES: Mortality, Glasgow Outcome Scale - Extended (GOSE) questionnaire and European Quality of Life-5 Dimensions, 3-level version (EQ-5D-3L) questionnaire at 6 months following TBI. RESULTS: The final Risk Adjustment In Neurocritical care (RAIN) study data set contained 3626 admissions. After exclusions, 3210 patients with acute TBI were included. Overall follow-up rate at 6 months was 81%. Of 3210 patients, 101 (3.1%) had no GCS score recorded and 134 (4.2%) had a last pre-sedation GCS score of 15, resulting in 2975 patients for analysis. The most common causes of TBI were road traffic accidents (RTAs) (33%), falls (47%) and assault (12%). Patients were predominantly young (mean age 45 years overall) and male (76% overall). Six-month mortality was 22% for RTAs, 32% for falls and 17% for assault. Of survivors at 6 months with a known GOSE category, 44% had severe disability, 30% moderate disability and 26% made a good recovery. Overall, 61% of patients with known outcome had an unfavourable outcome (death or severe disability) at 6 months. Between 35% and 70% of survivors reported problems across the five domains of the EQ-5D-3L. Of the 10 risk models selected for validation, the best discrimination overall was from the International Mission for Prognosis and Analysis of Clinical Trials in TBI Lab model (IMPACT) (c-index 0.779 for mortality, 0.713 for unfavourable outcome). The model was well calibrated for 6-month mortality but substantially underpredicted the risk of unfavourable outcome at 6 months. Baseline patient characteristics were similar between dedicated neurocritical care units and combined neuro/general critical care units. In lifetime cost-effectiveness analysis, dedicated neurocritical care units had higher mean lifetime quality-adjusted life-years (QALYs) at small additional mean costs with an incremental cost-effectiveness ratio (ICER) of £14,000 per QALY and incremental net monetary benefit (INB) of £17,000. The cost-effectiveness acceptability curve suggested that the probability that dedicated compared with combined neurocritical care units are cost-effective is around 60%. There were substantial differences in case mix between the 'early' (within 18 hours of presentation) and 'no or late' (after 24 hours) transfer groups. After adjustment, the 'early' transfer group reported higher lifetime QALYs at an additional cost with an ICER of £11,000 and INB of £17,000. CONCLUSIONS: The risk models demonstrated sufficient statistical performance to support their use in research but fell below the level required to guide individual patient decision-making. The results suggest that management in a dedicated neurocritical care unit may be cost-effective compared with a combined neuro/general critical care unit (although there is considerable statistical uncertainty) and support current recommendations that all patients with severe TBI would benefit from transfer to a neurosciences centre, regardless of the need for surgery. We recommend further research to improve risk prediction models; consider alternative approaches for handling unobserved confounding; better understand long-term outcomes and alternative pathways of care; and explore equity of access to postcritical care support for patients following acute TBI. FUNDING: The National Institute for Health Research Health Technology Assessment programme.

Tese (doutorado)—Universidade de Brasília, Instituto de Letras, Departamento de Linguística, Português e Línguas Clássicas Programa de Pós-Graduação em Linguística, Doutorado em Linguística, 2012. Há muito anos, percorro os caminhos da Revisão de Texto, como profissional e professor dessa área. Nessa experiência, tenho tido felicidades, agruras e feito questionamentos teóricos sobre essa atividade profissional. No primeiro caso, vejo a Revisão como um rico instrumento de trabalho simbólico com a linguagem, que ajuda a entender seu funcionamento, e como uma alternativa profissional para as licenciaturas que, quase sempre, destinam os alunos ao Magistério. No segundo caso, vejo-a como uma atividade de pouca expan- são e com baixa remuneração fora dos portões do Serviço Público; além disso, monopolizada pelo Jornalismo por uma legislação que favorece este segmen- to profissional. No último caso, segundo uma perspectiva discursiva e crítica, questiono a abordagem da Revisão de Texto tradicional preocupada com a mancha gráfica, calcada na modalidade padrão escrita, que desconsidera ou- tras formas de representação. Este foi o ponto mais importante nesta pesquisa. Por isso, meu objetivo geral foi repensar, em uma perspectiva discursiva e crí- tica a prática da Revisão de Texto. Meus objetivos específicos foram a) definir Revisão de Texto; b) situar a legislação sobre Revisão de Texto e a posição do profissional de Letras no mercado de trabalho de Revisão de Texto; c) desvelar as práticas discursivas que sustentam a visão tradicional de revisar texto; d) postular a importância da teoria do discurso, da Teoria dos Gêneros Textuais e da Teoria da Multimodalidade para se repensar a Revisão Tradicional grafocên- trica. Esta pesquisa justifica-se pelo fato de que há fatos ocorrendo no cenário comunicacional que me instigaram a repensar minha prática profissional, quais sejam: a) o texto escrito não ocupa mais o lugar central na interação; b) a noção de linguagem não pode estar associada apenas à variedade padrão escrita; c) o discurso multissemiótico foi valorizado e muitos gêneros textuais passaram a ter características mais multimodais. Para cumprir meus objetivos, mobilizei os pressupostos teóricos do discurso, da Teoria dos Gêneros Textuais, da Teoria da Multimodalidade e da Ideologia. Minha pesquisa teve cunho qualitativo por- que me permitiu analisar o objeto da pesquisa, no caso a Revisão de Texto, de diferentes ângulos: análise documental, entrevista semiestruturada, confron- tação de dados com a teoria, análise de gêneros textuais em uma perspectiva discursiva e multissemiótica. Os resultados apontam para a preocupação de que o revisor de texto deve ter uma visão crítica diante do gênero textual a ser revisado e levar em consideração, não só os aspectos verbais escritos, e, ainda, outros recursos semióticos (não verbais) também responsáveis pela construção de sentido e de efeitos discursivos em contextos sociais. _______________________________________________________________________________________ ABSTRACT I have been travelling through the paths of Recension as a professional and teacher in this area for many years. With this experience I have had happiness, bitterness and I have also asked some theoretical questions about this professional activity. In the first case I see Recension as a rich instrument of symbolic work with the language that helps to understand its function and as a professional alternative to the college degrees that have oftentimes directed the students to Teaching. In the second case I see it as an activity of little expansion and low payment out of the Civil Services, monopolized by Journalism because of legislation in favour of this professional segment. In the last case, since a Critical Discoursive perspective, I question the approach of traditional Recension, concerned about the graphic stain, based on the standard written form, disregarding the other ways of representation. This was the most important topic in this research. Thus, my general purpose was to rethink the practice of Recension from a Critical Discoursive perspective. My specific purposes were a) providing a definition to Recension; b) placing the legislation about Recension and the situation of the professional of Portuguese in the business area; c) unveiling the discoursive practices that support the traditional view of Recension; d) postulating the importance of discourse theory, textual genres theory and Multimodality rethinking the graphocentric Traditional Recension. This research is legitimated by the fact that there are things happening in the communicational scenario that urge me to rethink my professional practice, such as: a) the written text does not occupy the centre in terms of interaction; b) the notion of language cannot be associated only with the standard written variety; c) the multisemiotic discourse was enriched and many textual genres became more multimodal. To fulfill my purposes I mobilized the theoretical assumptions of discourse, from the textual genre theory, the Multimodality theory and Ideology. This research is qualitative because it allowed me to analyze its object – Recension – from different perspectives: documental analysis, semi structured interview, confrontation of data and theory and textual genres analysis in a Multissemiotic Discoursive perspective. The results indicate to the concern that the professional of Recension must have a critical view towards the textual genre he will revise, as well as taking into account not only the written verbal aspects, but also other semiotic resources (non verbal), is likewise responsible to the meaning making and its effects in social contexts.

As culturas nacionais sao compostas nao apenas de instituicoes culturais, mas, tambem, de simbolos e representacoes, e o discurso e o instrumento de construcao/reconstrucao/manutencao de sentidos que influencia e organiza tanto nossas acoes quanto a concepcao que temos de nos mesmos. Nesse sentido, o discurso da midia exerce papel preponderante na formacao de consciencias e, principalmente, de identidades. Mas qual e a relacao entre midia e ideologia? Nosso trabalho tem o objetivo de apresentar a relacao entre o discurso midiatico, por meio de analise de textos publicados, e a ideologia, notadamente em relacao as minorias etnicas, o negro brasileiro. Para responder ao questionamento, recorremos aos pressupostos teoricos e a metodologia critica da Analise de Discurso Critica, Fairclough (2001), e, interdisciplinarmente, a Giddens (1997), a Hall (2000), Thompson (2000), a Egleton (1997) e van Dijk (1997). Apos analise do corpus, chegou-se a conclusao de que, ao se publicarem as materias, ha todo um crivo ideologico. A maioria dos produtores de texto, na midia, faz parte de culturas – politicas e ideologicas – diferentes das que pertencem as minorias etnicas. Nossa midia, ao seguir o paradigma perverso, acumula antigas manifestacoes do imaginario racista: inferioridade intelectual do negro, perpetuacao, por incapacidade congenita, de condicao servil, animalizacao, transposicao de relacao de dominacao.

A Revisao de Texto nao envolve apenas a adequacao do genero a ser revisado a modalidade-padrao da lingua portuguesa. Pensar-se assim torna a atividade superficial, uma vez que essa pratica se insere em uma subjetividade cujos elementos se revelam muito mais complexos. Por isso a importância deste trabalho para contribuir na transformacao da atividade de Revisao de Texto em uma perspectiva critica. De outra parte, a Revisao de Texto possui funcao social. Desse modo, deve-se considerar, veementemente, que tal pratica alcanca horizontes que vao alem do texto escrito. Sendo assim, sua pratica precisa ser analisada a partir de visoes macros, que considerem as relacoes suscitantes dessa atividade – entre linguagem e sociedade; linguagem e poder; linguagem e identidade. Dessa forma, o objetivo desta pesquisa e Repensar a atividade de Revisao de Texto em uma perspectiva critica para acompanhar as novas mudancas nos estudos da linguagem e aplica-la nas atividades que envolvem analise de texto. Minha fundamentacao teorica baseia-se, principalmente, na Analise de Discurso Critica (ADC), nos trabalhos de Fairclough (2001, 2003); na Teoria dos Generos Discursivos, Bakhtin (1997) e Marcuschi (2002).

A linguagem escrita esta se tornando, cada vez mais, apenas um dos muitos modos de representacao do dominio publico. A Analise de Discurso Critica constitui-se a partir da percepcao do discurso como um elemento das praticas sociais em uma perspectiva dialetica entre linguagem e sociedade. Assim, essa teoria considera o discurso como uma integracao de diversas formas de modos semioticos, em que os falantes e as falantes, ao fazerem uso das linguagens disponiveis, agem sobre as outras pessoas e sobre o mundo. De outra parte, a comunicacao sempre foi multissemiotica, mas assumir essa perspectiva torna-se algo novo e assustador, principalmente para as sociedades grafocentricas. As mudancas no cenario comunicacional tem ficado fora do ensino de Lingua Portuguesa no Brasil porque, em grande parte, valoriza-se, ainda, o modelo autonomo do Letramento, centrando-se no entendimento da nomenclatura gramatical em atividades fossilizadas, nao-significativas e fora do contexto social dos alunos e alunas. Nossa perspectiva se justifica porque devemos acompanhar as mudancas hodiernas e preparar os futuros docentes para as atividades de linguagem mais amplas, trazendo as praticas sociais, os eventos discursivos e as praticas de texto para sala de aula. Meu projeto tem como fundamentacao teorica Barton, Hamilton & Ivanic (2000); Street (1993); Fairclough (1992, 2003); Chouliaraki & Fairclough (1999); e Kress & van Leeuwen (1996).