Statement of the problem. Hypernasality resulting from velopharyngeal insufficiency or incompetency is a resonance disorder that has negative consequences for speech production and intelligibility of afflicted individuals. Purpose. The purpose of this prospective study is to ascertain if a palatal lift prosthesis with a generic silicon velar lamina, termed the Toronto Palatal Lift Prosthesis (TPLP), can assist velopharyngeal valve function to reduce hypernasality in patients. Methods. A prospective study of six patients treated with the TPLP was compared by the outcome measures of nasalance scores, perceptual evaluations, and patient satisfaction to those obtained using a contemporary acrylic palatal lift prosthesis. Results. The six patients had varying degrees of reduction in hypernasality and acceptance of the TPLP. Conclusion. On the basis of this preliminary study on the TPLP it is possible to fabricate a palatal lift prosthesis with a generic silicon velar lamina that reduces hypernasality in select patients.

Made available in DSpace on 2015-07-22T20:50:42Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-11-25. Added 1 bitstream(s) on 2015-08-11T03:25:54Z : No. of bitstreams: 1 Publico-11760a.pdf: 1069601 bytes, checksum: 88c7a2d10e394e1888e3b93a69070de4 (MD5). Added 1 bitstream(s) on 2015-08-11T03:25:54Z : No. of bitstreams: 2 Publico-11760a.pdf: 1069601 bytes, checksum: 88c7a2d10e394e1888e3b93a69070de4 (MD5) Publico-11760b.pdf: 1959621 bytes, checksum: 2665d88fb8fec237d73fdc84aa78a26a (MD5) / Introdução: A insuficiência cardíaca congestiva (ICC) descompensada pode ser definida como a evidência de sinais e sintomas de insuficiência cardíaca (IC) ao repouso e representa estado de ativação neuro-hormonal intensa, secundária ao déficit de perfusão renal. Regurgitações valvares funcional mitral e tricúspide são causas reversíveis de diminuição de fluxo sanguíneo sistêmico eficaz. O impacto de tais regurgitações sobre o débito cardíaco, sobre o conteúdo de fluido torácico, sobre as dimensões de câmaras cardíacas e sobre a função do aparato valvular pode ser monitorado de forma não-invasiva, antes e após a otimização do tratamento clínico. Objetivo: Avaliar o papel das regurgitações valvares funcional mitral e tricúspide como causas reversíveis de redução do débito cardíaco em ICC descompensada, e que acompanham a disfunção ventricular sistólica em miocardiopatias isquêmica e não-isquêmica. Métodos: catorze pacientes do sexo masculino (66 ± 8 anos de idade), fração de ejeção (24 ± 5%) secundária às miocardiopatias isquêmica (71%) e não-isquêmica (29%), apresentaram ICC descompensada com evidência clínica de regurgitações valvares mitral e tricúspide, foram avaliados por Bioimpedância cardíaca e ecocardiografia antes e uma semana após otimização de tratamento clínico. Resultados: o tratamento farmacológico de ICC descompensada foi acompanhado de redução de peso corpóreo de 82,9 a 76 kg (P<0,01), elevação no índice cardíaco (de 2,1 para 2,6 L/min/m2; P<0,01), redução na pressão sistólica da artéria pulmonar (de 58 para 35 mm Hg; P<0,001), conteúdo de fluido torácico (de 39 para 32 kOhm; P<0,001) e resistência vascular sistêmica (de 1633 para 1209 dinas/seg/cm5; P<0.001). A melhora dessas regurgitações incluiu redução nas dimensões das câmaras atriais esquerda e direita (de 27 para 24 cm2 e de 26 para 23 cm2, respectivamente; (P<0,001), diminuição das regurgitações mitral e tricúspide detectadas pelo Doppler colorido (P < 0,01), do volume regurgitante mitral (de 105 para 65 ml; P<0,001), e do tamanho efetivo do orifício regurgitante mitral (de 0,8 para 0,6 cm2; P<0,01). Conclusões: Na ICC descompensada, as regurgitações funcionais mitral e tricúspide contribuem para redução do débito cardíaco, aumento do conteúdo fluido torácico e da resistência vascular sistêmica, simultaneamente ao aumento de câmaras atriais e do orifício valvar, os quais podem ser melhorados com tratamento clínico. A bioimpedância cardíaca e a ecocardiografia fornecem avaliação seriada não-invasiva de parâmetros hemodinâmicos e função valvar nestes pacientes. / Objective: We hypothesized that functional mitral and tricuspid valvular incompetence (MR and TR, respectively) are reversible causes of reduced cardiac output in decompensated heart failure (DF) that accompanies systolic dysfunction in ischemic or nonischemic cardiomyopathy. Background: DF, defined as signs and symptoms of heart failure at rest, is rooted in a salt-avid state transduced by neurohormonal activation secondary to impaired renal perfusion. Functional MR and TR are reversible causes of reduced systemic blood flow. Their impact on cardiac output, thoracic fluid content, cardiac chamber dimensions, and valvular apparatus function can be monitored noninvasively, before and after optimized medical management. Methods: Fourteen male subjects (66 ± 8 years old) with reduced ejection fraction (24 ± 5%) secondary to ischemic (71%) or nonischemic (29%) cardiomyopathy, who developed DF with clinical evidence of mitral (MR) and tricuspid (TR) valvular incompetence, were each assessed by bioimpedance and echocardiography before and 1 week after optimized medical management restored compensated failure. Results: Pharmacologic elimination of DF was accompanied by a reduction in body weight (p<0.01). Hemodynamic improvements included a rise in cardiac index (2.1 to 2.6 L/min/m2; p<0.01) and a reduction in predicted pulmonary artery systolic pressure (58 to 35 mm Hg; p<0.001), thoracic fluid content (39 to 32 kOhm; p<0.001), and systemic vascular resistance (1633 to 1209 dynes/sec/cm5; p<0.001). Improvements in functional MR and TR included reductions in left and right atrial areas (27 to 24 cm and 26 to 23 cm2, respectively; p<0.001), color-flow grading of MR and TR severity (p<0.01), mitral regurgitant volume (105 to 65 mL; p<0.001), and effective MR orifice size (0.8 to 0.6 cm2; p<0.01). Conclusions: In DF, functional MR and TR contribute to reduced cardiac output, increased thoracic fluid content, and systemic vascular resistance, together with enlarged atria and valvular orifice size, which can be improved by medical management. Bioimpedance and echocardiography provide for serial noninvasive assessments of hemodynamic status and valvular function in such cases. / TEDE / BV UNIFESP: Teses e dissertações

Vários materiais têm sido introduzidos nas pregas vocais na tentativa de solucionar a incompetência glótica, porém poucos são os estudos que avaliam o processo cicatricial decorrente da enxertia destes materiais. O objetivo desta pesquisa foi quantificar o processo inflamatório celular na prega vocal de coelhos submetidos a enxerto unilateral de gordura ou fáscia muscular. Estudamos 24 coelhos, divididos em 2 grupos, nos quais gordura ou fáscia foi enxertada. O grupo controle foi formado pela prega vocal contralateral, a qual foi submetida ao mesmo procedimento, excetuando-se a colocação do enxerto. Metade dos coelhos de cada grupo foi sacrificada após 90 dias, enquanto a outra metade foi sacrificada após 180 dias da cirurgia. A densidade celular inflamatória peri-enxerto foi avaliada em todas as pregas vocais. Houve um aumento do infiltrado inflamatório no grupo submetido à enxertia de gordura, quando comparado ao submetido à enxertia de fáscia. Bem como ao grupo controle, após 90 dias. Quanto aos coelhos sacrificados após 180 dias, não houve diferença entre os grupos entre si e em relação ao grupo controle. Esse estudo sugere que o enxerto de fáscia parece ser mais aceitável que o enxerto de gordura para a prega vocal, uma vez que origina menor reação inflamatória tecidual / Several material have been introduced into the vocal folds in attempt to solve glottic incompetence, however just a few studies are related with the consequent inflammatory process. The aim of this article was to quantify the cellular inflammatory process in rabbit vocal fold, which have undergone unilateral fat or muscular fascia introduction. Twenty-four rabbits were allocated into two groups, in which muscular fascia or fat were implanted. The control group, formed by the contra-lateral vocal fold, underwent the same surgical procedure, except for the grafting. Half the rabbits from each group were sacrificed after 90 days from the surgery, while the other half was sacrificed after 180 days. The inflammatory cellular density around the graft was measured in all vocal folds. There was a higher cellular inflammatory reaction in the group submitted to fat grafting when compared to the group submitted to muscular fascia grafting, and to the control group, after 90 days. As for the rabbits sacrificed after 180 days, there was no significant difference between the implanted groups with each other, and with the control group. This study suggests that muscular fascia graft seems to be more acceptable than fat grafts for the vocal fold, as it produces a lower local inflammatory reaction

Objetivos: Avaliar e descrever os desfechos maternos e neonatais de gestantes com diagnóstico de cervicodilatação precoce submetidas à cerclagem de emergência ou à conduta expectante com repouso. Avaliar os fatores relacionados com melhores resultados nas gestantes submetidas à cerclagem de emergência. Métodos: Análise retrospectiva de gestantes internadas na Clínica Obstétrica do HCFMUSP, entre 2001 e 2017, com diagnóstico de cervicodilatação precoce e/ou bolsa protrusa. Foram incluídas gestantes com feto único, entre 16 semanas e 25 semanas e 6 dias, com dilatação cervical entre 1 e 3 cm e excluídas gestantes que evoluíram para parto ou aborto em até 2 dias após a internação. Resultados: O estudo envolveu 30 gestantes, 19 no grupo cerclagem e 11 no grupo repouso. Houve diferença significativa entre os grupos para dois dos desfechos primários, com o grupo cerclagem apresentando os melhores resultados: idade gestacional no parto 28,65 versus 23,35 semanas (p=0,031), latência entre a internação e o aborto/parto 48,63 versus 16 dias (p=0,016). Dentro do grupo cerclagem, as gestantes sem bolsa protrusa apresentaram maior idade gestacional no parto: 33,91 versus 26,82 semanas (p=0,032). Na comparação de gestantes com desfecho favorável e desfavorável entre aquelas submetidas à cerclagem, não houve diferença significante para os fatores de risco analisados (antecedentes obstétricos, dilatação cervical, exames laboratoriais ou corioamnionite clínica). Conclusões: A cerclagem de emergência foi superior que à conduta expectante no tratamento de gestantes com cervicodilatação precoce no segundo trimestre da gestação, apresentando melhores resultados gestacionais. Dentre as gestantes submetidas à cerclagem, a ausência de bolsa protrusa esteve relacionada a maior prolongamento da gestação. Não foi possível caracterizar fatores de risco para o sucesso da cerclagem (determinado como taxa de \"bebê em casa\") / Objectives: To evaluate and describe the maternal and neonatal outcomes of pregnant women with early cervical dilatation diagnosis submitted to emergency cerclage or to expectant management with bedrest. To evaluate factors related to better outcomes in pregnants submitted to emergency cerclage. Methods: Retrospective analysis of pregnants hospitalized at the Obstetrics Clinic of HCFMUSP between 2001 and 2017 with diagnosis of early cervical dilatation and/or protruding membranes. Pregnants of singleton gestation between 16 weeks and 25 weeks and 6 days, with cervical dilatation of 1 to 3 cm were included. Those ones who have had delivery or miscarriage within 2 days after admission were excluded. Results: The study involved 30 pregnant women, 19 in the cerclage group and 11 in the rest group. There was a significant difference between groups for 2 of the primary outcomes, with the cerclage group showing the best results: gestational age at delivery 28.65 versus 23.35 weeks (p=0.031), latency between hospitalization and abortion / delivery 48.63 versus 16 days (p=0.016). In cerclage group, pregnants without protruding membranes presented higher gestational age at delivery: 33.91 versus 26.82 weeks (p=0.032). In comparison of patients with favorable and unfavorable outcome between those submitted to cerclage, there was no significant difference for the risk factors analyzed (obstetric history, cervical dilatation, laboratory exams or clinical chorioamnionitis). Conclusions: Emergency cerclage was superior to expectant management in the treatment of pregnants with early cervical dilatation in the second trimester of gestation, with better gestational outcomes. Among the pregnants submitted to cerclage, the absence of a protruding membranes was related to a better prolongation of gestation. It was not possible to characterize risk factors for cerclage success (determined as take-home baby rate)

A incompetência istmo cervical é uma importante causa de prematuridade. Atualmente, o componente genético está relacionado ao parto prematuro, dentre os quais os polimorfismos de nucleotídeo único (SNPs) de alguns genes candidatos estão associados. Os SNPs nos genes do colágeno, da matrix extracelular e das de interleucinas têm relação direta com o comprimento do colo uterino podendo relacionar-se com o encurtamento do colo uterino, como também ocorre na incompetência cervical. Este estudo tem o objetivo de associar a frequência dos SNPs dos genes do COL1 A1, COL 4A3, TGF-B e TIMP2 à história de incompetência cervical. Foi realizado estudo de caso controle com grupo de pacientes, que realizaram cerclagem do colo uterino na última gestação e o grupo de pacientes com antecedente de gestação a termo (controle). Em sangue periférico, foi extraído DNA, realizadas reações de PCR com primers específicos para os SNPs de interesse em 62 amostras preparadas para sequenciamento de última geração pelo Ion Torrent. Houve leitura satisfatória em 57 amostras, sendo 28 casos e 29 controles. A frequência do SNPS do COL1A1 no grupo caso foi de 70,4% versus 33,3% no grupo controle (p=0,03). Os SNPs do COL4A3 e do TIMP2 apresentaram associação com o antecedente de abortos totais (p=0,02 e p=0,023) e abortos tardios (p=0,001 e p=0,034); para os demais SNPs não houve diferença em frequência entre os grupos caso e controle. Foram identificados SNPs exônicos ainda não descritos na literatura. O presente estudo observou uma maior taxa de homozigoze T/T para o SNP COL1A1 no grupo caso, que é um gene associado ao metabolismo do colágeno, além de identificar SNPs ainda não descritos na literatura, que poderão ser objeto de estudo no futuro para conhecimento da sua repercussão na composição do colágeno / Cervical incompetence is one of the most important causes of prematurity. It has already been suggested that genetic factors plays a significant hole in determining the risk of preterm birth and the single nucleotide polimofisms (SNPS) from candidate genes are associated. Polymorfisms in several genes such as the collagen, the extracelular matrix and the interleucins, are related to abnormal cervical length, as it occurs in cervical incompetence. The aim of this study, was to associate the frequency of the SNPs in the COL1A1, COL4A3, TGF-B and TIMP2 genes to the cervical incompetence. We conduced a case control study with patients submitted to cervical cerclage and a control group with women who delivery at term. DNA was isolated from blood samples and amplifications of the genomic DNA were performed by PCR protocol with specific primers for the SNPs. DNA sequencing of 62 samples, was obtained from next generation sequencing on the Ion Torrent. A total of 57 samples, including 28 cases and 29 controls had results available. The frequency of the SNP in COL1A1 in the case group was 70,4% versus 33% in the control group (p=0,03). The SNPS in COL4A3 and TIMP2 were significant related to the history of miscarriages (p=0,2 and p=0,023) and fetal losses (p=0,001 and p=0,034) No significant differences were observed in the frequencies for the others SNPs in the two groups. In the present study, non described exonic SNPs were discovered. Higher frequencies of the homozygous T/T genotype in COL1A1 were observed in the case group involving the collagen metabolism and the non described exonic SNPs might be associated to collagen abnormalities in future studies

A incompetência istmo cervical é uma importante causa de prematuridade. Atualmente, o componente genético está relacionado ao parto prematuro, dentre os quais os polimorfismos de nucleotídeo único (SNPs) de alguns genes candidatos estão associados. Os SNPs nos genes do colágeno, da matrix extracelular e das de interleucinas têm relação direta com o comprimento do colo uterino podendo relacionar-se com o encurtamento do colo uterino, como também ocorre na incompetência cervical. Este estudo tem o objetivo de associar a frequência dos SNPs dos genes do COL1 A1, COL 4A3, TGF-B e TIMP2 à história de incompetência cervical. Foi realizado estudo de caso controle com grupo de pacientes, que realizaram cerclagem do colo uterino na última gestação e o grupo de pacientes com antecedente de gestação a termo (controle). Em sangue periférico, foi extraído DNA, realizadas reações de PCR com primers específicos para os SNPs de interesse em 62 amostras preparadas para sequenciamento de última geração pelo Ion Torrent. Houve leitura satisfatória em 57 amostras, sendo 28 casos e 29 controles. A frequência do SNPS do COL1A1 no grupo caso foi de 70,4% versus 33,3% no grupo controle (p=0,03). Os SNPs do COL4A3 e do TIMP2 apresentaram associação com o antecedente de abortos totais (p=0,02 e p=0,023) e abortos tardios (p=0,001 e p=0,034); para os demais SNPs não houve diferença em frequência entre os grupos caso e controle. Foram identificados SNPs exônicos ainda não descritos na literatura. O presente estudo observou uma maior taxa de homozigoze T/T para o SNP COL1A1 no grupo caso, que é um gene associado ao metabolismo do colágeno, além de identificar SNPs ainda não descritos na literatura, que poderão ser objeto de estudo no futuro para conhecimento da sua repercussão na composição do colágeno / Cervical incompetence is one of the most important causes of prematurity. It has already been suggested that genetic factors plays a significant hole in determining the risk of preterm birth and the single nucleotide polimofisms (SNPS) from candidate genes are associated. Polymorfisms in several genes such as the collagen, the extracelular matrix and the interleucins, are related to abnormal cervical length, as it occurs in cervical incompetence. The aim of this study, was to associate the frequency of the SNPs in the COL1A1, COL4A3, TGF-B and TIMP2 genes to the cervical incompetence. We conduced a case control study with patients submitted to cervical cerclage and a control group with women who delivery at term. DNA was isolated from blood samples and amplifications of the genomic DNA were performed by PCR protocol with specific primers for the SNPs. DNA sequencing of 62 samples, was obtained from next generation sequencing on the Ion Torrent. A total of 57 samples, including 28 cases and 29 controls had results available. The frequency of the SNP in COL1A1 in the case group was 70,4% versus 33% in the control group (p=0,03). The SNPS in COL4A3 and TIMP2 were significant related to the history of miscarriages (p=0,2 and p=0,023) and fetal losses (p=0,001 and p=0,034) No significant differences were observed in the frequencies for the others SNPs in the two groups. In the present study, non described exonic SNPs were discovered. Higher frequencies of the homozygous T/T genotype in COL1A1 were observed in the case group involving the collagen metabolism and the non described exonic SNPs might be associated to collagen abnormalities in future studies

Objetivos: Avaliar e descrever os desfechos maternos e neonatais de gestantes com diagnóstico de cervicodilatação precoce submetidas à cerclagem de emergência ou à conduta expectante com repouso. Avaliar os fatores relacionados com melhores resultados nas gestantes submetidas à cerclagem de emergência. Métodos: Análise retrospectiva de gestantes internadas na Clínica Obstétrica do HCFMUSP, entre 2001 e 2017, com diagnóstico de cervicodilatação precoce e/ou bolsa protrusa. Foram incluídas gestantes com feto único, entre 16 semanas e 25 semanas e 6 dias, com dilatação cervical entre 1 e 3 cm e excluídas gestantes que evoluíram para parto ou aborto em até 2 dias após a internação. Resultados: O estudo envolveu 30 gestantes, 19 no grupo cerclagem e 11 no grupo repouso. Houve diferença significativa entre os grupos para dois dos desfechos primários, com o grupo cerclagem apresentando os melhores resultados: idade gestacional no parto 28,65 versus 23,35 semanas (p=0,031), latência entre a internação e o aborto/parto 48,63 versus 16 dias (p=0,016). Dentro do grupo cerclagem, as gestantes sem bolsa protrusa apresentaram maior idade gestacional no parto: 33,91 versus 26,82 semanas (p=0,032). Na comparação de gestantes com desfecho favorável e desfavorável entre aquelas submetidas à cerclagem, não houve diferença significante para os fatores de risco analisados (antecedentes obstétricos, dilatação cervical, exames laboratoriais ou corioamnionite clínica). Conclusões: A cerclagem de emergência foi superior que à conduta expectante no tratamento de gestantes com cervicodilatação precoce no segundo trimestre da gestação, apresentando melhores resultados gestacionais. Dentre as gestantes submetidas à cerclagem, a ausência de bolsa protrusa esteve relacionada a maior prolongamento da gestação. Não foi possível caracterizar fatores de risco para o sucesso da cerclagem (determinado como taxa de \"bebê em casa\") / Objectives: To evaluate and describe the maternal and neonatal outcomes of pregnant women with early cervical dilatation diagnosis submitted to emergency cerclage or to expectant management with bedrest. To evaluate factors related to better outcomes in pregnants submitted to emergency cerclage. Methods: Retrospective analysis of pregnants hospitalized at the Obstetrics Clinic of HCFMUSP between 2001 and 2017 with diagnosis of early cervical dilatation and/or protruding membranes. Pregnants of singleton gestation between 16 weeks and 25 weeks and 6 days, with cervical dilatation of 1 to 3 cm were included. Those ones who have had delivery or miscarriage within 2 days after admission were excluded. Results: The study involved 30 pregnant women, 19 in the cerclage group and 11 in the rest group. There was a significant difference between groups for 2 of the primary outcomes, with the cerclage group showing the best results: gestational age at delivery 28.65 versus 23.35 weeks (p=0.031), latency between hospitalization and abortion / delivery 48.63 versus 16 days (p=0.016). In cerclage group, pregnants without protruding membranes presented higher gestational age at delivery: 33.91 versus 26.82 weeks (p=0.032). In comparison of patients with favorable and unfavorable outcome between those submitted to cerclage, there was no significant difference for the risk factors analyzed (obstetric history, cervical dilatation, laboratory exams or clinical chorioamnionitis). Conclusions: Emergency cerclage was superior to expectant management in the treatment of pregnants with early cervical dilatation in the second trimester of gestation, with better gestational outcomes. Among the pregnants submitted to cerclage, the absence of a protruding membranes was related to a better prolongation of gestation. It was not possible to characterize risk factors for cerclage success (determined as take-home baby rate)

This study was conducted in the context of the regulation of professional nursing and midwifery practice in the Australian health care system. In this environment, professional regulatory authorities established by State and Territory legislation in all jurisdictions, regulate and control the work of health professionals. In Queensland, registered nurses, enrolled nurses and midwives are regulated by the Queensland Nursing Council, the statutory body created by the Nursing Act 1992 (Qld). Part of the regulatory role of this and other authorities is to discipline professionals whose conduct or behaviour falls short of appropriate and acceptable standards of practice. All regulated health professionals, including nurses and midwives, are potentially subject to professional disciplinary action if a complaint is lodged in relation to their conduct. This being an important issue in the management and delivery of health care, and an increased trend among health care consumers, the dearth of existing research into the disciplinary process is a major concern. This exploratory study examined the disciplinary role of the Queensland Nursing Council in adhering to its legislative mandate to ensure safe and competent nursing practice. The study focused on the extent to which structural (legislation and policy), professional, and process factors impacted on the outcomes of disciplinary Tribunals and Committees in cases of incompetent or unsafe practice and sexual misconduct. The study was situated within the interpretive paradigm using a case study approach. Specifically, it investigated cases of sexual misconduct by nurses and unsafe or incompetent practice by midwives. The study was guided by Donabedian's conceptual framework of structure-process-outcome. This framework was seen to be most suited to the aims of the study and provided a template for in-depth analysis of the data emerging from the two cases. The findings of this study provided insight into the factors underpinning the decisions of the disciplinary bodies in making determinations and formulating outcomes. There was found to be a lack of consistency and predictability in both the legislative frameworks and the interpretation of terms and concepts used to identify conduct warranting a disciplinary response from regulatory authorities. Although the processes of disciplinary proceedings are prescribed by both legislation and policy, their practical application was characterised by considerable challenges, which resulted in varying outcomes. The thesis reports this information so that it can be used as an initial basis to build a body of knowledge from practical experience with disciplinary proceedings that will inform future processes. Subsequent case studies in other contexts and systems will increase the level of knowledge available to nurses, other health care providers, health care institutions and regulatory authorities. The initial base of evidence suggests implications for practice, education and further research which are outlined in the final chapter of the thesis.

S’autoévaluer, c’est porter un regard de valeur sur soi, c’est aussi accepter de montrer quelque chose de soi. Mais pour montrer à qui ? Si le tiers, enseignant, parent ou camarade, est nécessaire, il est indispensable de s’interroger sur sa fonction et sur son regard. Cette relation questionne la transmission dans l’expérience éducative (Vieille-Grosjean, 2009). Si le but de l’enseignant est de rendre l’enfant compétent (Reboul, 1980), quel est le but de l’enfant qui apprend à l’école ? Cette étude empirique interroge la pratique de l’autoévaluation des compétences auprès des élèves du primaire. La pratique de l’autoévaluation, à condition qu’elle se situe dans le champ de la pédagogie, amène un espace de rencontre entre l’enseignant, l’élève et le savoir. Elle agit comme un révélateur des attendus des uns et des perceptions des autres et permet à l’élève de tendre vers un apprentissage expansif (Holzkamp, 1993). L’enfant en prenant conscience de sa responsabilité peut passer d’un être évalué à un être apprenant. / Self-evaluation involves making a value judgement of oneself. It also involves accepting to reveal something about oneself, but to whom ? If another person, such as a teacher, a parent or friend, is a necessary part of the process, it is vital to wonder about his or her role and his or her view. This relation calls into question the idea of transmission in educational experience (Vieille-Grosjean, 2009). If the goal of the teacher is to make a child competent (Reboul, 1980), what is the goal of the child who learns at school ? This empirical study examines the practice of skill self-evaluation among primary school students. The practice of self-evaluation, if situated in the area of pedagogy, creates a meeting space between the teacher, the student and knowledge. It reveals the expectations of some and the perceptions of others, and allows the student to work toward expansive learning (Holzkamp, 1993). The child can, by becoming aware of his/her responsibility, move from being a person who is being evaluated to a person who is learning.

Objetivos: Determinar quais características ultrassonográficas obtidas por meio da ultrassonografia transvaginal bidimensional (USG TV 2D) e da ultrassonografia transvaginal tridimensional (USG TV 3D) associam-se ao parto prematuro em gestantes submetidas à cerclagem profilática e terapêutica. Métodos: Sessenta e seis gestações únicas, submetidas a cerclagem profilática ou terapêutica, e acompanhadas no ambulatório de Aborto Habitual da Clínica Obstétrica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), entre 1 de junho de 2012 e 30 de outubro de 2015, foram avaliadas longitudinalmente, por meio da USG TV 2D e USG TV 3D associado ao power Doppler, nos três trimestres da gestação. Na análise dos resultados, as gestantes foram primeiramente avaliadas longitudinalmente nos três trimestres da gestação. Depois, foram classificadas de acordo com a idade gestacional de parto (IG parto) = 34 semanas. As gestantes também foram avaliadas considerando-se a IG parto como uma variável contínua. Resultados: Na avaliação longitudinal, o comprimento do colo uterino (CC) e a distância do ponto de cerclagem ao orifício cervical interno (POI) diminuíram significativamente entre o segundo e o terceiro trimestres (32,6 vs 28,3 mm; p < 0,001 e 14,3 vs 10,7 mm; p=0,001, respectivamente) enquanto a largura do afunilamento cervical aumentou significativamente no mesmo período (13,6 vs 20,7 mm; p= 0,011). Dez gestantes (15,2%) tiveram idade gestacional de parto < 34 semanas. O CC, a POI e a presença do afunilamento cervical, avaliados no terceiro trimestre da gestação, tiveram relação significativa com a IG parto < 34 semanas (16,27 mm, p= 0,009; zero, p= 0,003; 66,67%, p= 0,041, respectivamente). O CC < 28,1 mm, p= 0,0083, o volume do colo uterino (VOL) < 18,17 cm3, p= 0,0152, a POI < 10 mm, p= 0,0151, e os índices vasculares do colo uterino, FI < 33,83, p= 0,0338, VI < 2,153%, p= 0,0044, e VFI < 0,961, p= 0,0059 avaliados no segundo trimestre tiveram relação significativa com idades gestacionais de parto mais precoces, assim como, o CC < 20,4 mm, p= 0,0009, o VOL >= 47,48 cm3, p= 0,0107, FI < 44,336, p= 0,0038, VI>= 0,54 %, p= 0,0327 e o VFI >= 2,275, p= 0,0479 avaliados no terceiro trimestre. Nos modelos de regressão de COX, em que a variável de interesse foi o tempo até o parto, o VOL no segundo trimestre foi significativo, ao passo que no terceiro trimestre, o FI e o VFI foram significativos. Conclusões: Em gestantes submetidas a cerclagem profilática e terapêutica, o VOL do colo avaliado no segundo trimestre, e o FI e o VFI avaliados no terceiro trimestre foram as únicas variáveis independentes que se relacionaram com o tempo até o parto / Objectives: To determine which cervical sonographic characteristics on twodimensional transvaginal ultrasonography (2DTVUS) and three-dimensional transvaginal ultrasonography (3DTVUS) could be related to gestational age at birth after placement of history-indicated cerclage or ultrasound-indicated cerclage. Methods: Sixty six pregnant women, with a singleton gestation, submitted to history-indicated cerclage or ultrasound-indicated cerclage and followed at the Recurrent Miscarriage Clinic of Department of Obstetrics and Gynecology of São Paulo University Medical School between June 1, 2012 and October 30, 2015, were longitudinaly evaluated by 2DTVUS and 3DTVUS associated to power Doppler, in the three trimesters of pregnancy. For the analysis, pregnant women were, firstly, evaluated longitudinally, in the three trimesters of pregnancy. After that, they were classified according to gestational age (GA) at delivery = 34 weeks. Pregnant women were evaluated considering GA at delivery as a continuous variable already. Results: In the longitudinal evaluation, cervical length (CL) and proximal cervical length decreased between the second and the third trimestrers (32.6 vs 28.3 mm, p < 0.001; 14.3 vs 10.7, p= 0.001, respectivelly), while width of funneling increased at the same period (13.6 vs. 20.7 mm; p = 0.011). Ten pregnant women (15.2%) delivered < 34 weeks. CL, proximal cervical length and present cervical funneling, in the third trimester, were significantly related to GA at delivery < 34 weeks (16.27 mm, p= 0.009; zero, p= 0.003; 66.67%, p= 0.041, respectively). CL < 28.1mm, p=0.0083, cervical volume < 18.17 cm3, p= 0.0152, proximal cervical length < 10 mm, p = 0.0151, and cervical vascularization index, FI < 33.83, p= 0.0338, VI < 2.153 %, p= 0.0044, VFI < 0.961, p = 0.0059, in the second trimester, were related to earlier delivery, as, CL < 20.4 mm, p= 0.0009, cervical volume >= 47.48 cm3, p = 0.0107, FI < 44.336, p: 0.0038, VI >= 0.54, p = 0.0327 and VFI >= 2.275, p= 0.479 in the third trimester. Using COX regression analysis, it was demonstrated that cervical volume in the second trimester, and FI and VFI in the third trimester were significantly associated to gestational age at birth .Conclusions: In women with history-indicated cerclage or ultrasound indicated cerclage, 2nd trimester cervical volume and 3rd trimester FI and VFI are the only indenpendent significant sonographic findings associated whith time to delivery