NOVO MARCO LEGAL À GERAÇÃO DISTRIBUÍDA DE ENERGIA ELÉTRICA NO BRASIL: UMA ABORDAGEM DAS PRINCIPAIS MUDANÇAS / New legal framework for the distributed generation of electric energy in Brazil: an approach to the main changes

This article presents the main changes in the distributed generation of electricity in Brazil, contemplating the approval of the new legal framework (Law 14.300/2022) for the area, which took its effect in January 2022.To answer the research in the field of energy generation, the research relies on bibliographic, documentary, exploratory-descriptive and qualitative studies. It starts from the understanding of the new legislation, which in a way provides greater legal certainty to the area, and ensures economic sustainability to the different agents of the Brazilian electricity sector. This way, despite the change in legislation being quite recent, with ongoing developments, and having impacts to be even better measured, it was concluded that the new legal framework balances the incentive for distributed generation and gives technical-economic feasibility in the medium and long term over Brazilian electric system, especially to electric energy distributors.El presente estudio presenta los principales cambios en la generación distribuida de energía eléctrica en Brasil, contemplando la aprobación del nuevo marco legal (Ley 14.300/2022) para el sector, que entró en vigor en enero de 2022. Para dar respuestas a la investigación acerca de generación de energía, esta pesquisa cuenta con estudios bibliográficos documentales y descriptivos, siendo en su mayoría un estudio exploratorio y cualitativo.  El punto inicial es la comprensión de la nueva legislación, que de alguna manera otorga mayor seguridad jurídica al sector y asegura sostenibilidad económica a los diferentes agentes del sector eléctrico brasileño. Así, a pesar de que el cambio de legislación es bastante reciente, con desarrollos continuos, con impactos aún mejor medidos, se concluyó que el nuevo marco legal equilibra el incentivo a la generación distribuida y la viabilidad técnico-económica en el mediano y largo plazo al sistema eléctrico brasileño, de manera especial a las distribuidoras de energía eléctrica.O presente artigo apresenta as principais mudanças na geração distribuída de energia elétrica no Brasil, contemplando a aprovação do novo marco legal (Lei 14.300/2022) do setor, que entrou em vigor em janeiro de 2022. Para responder à investigação no campo da geração de energia, a pesquisa conta com estudos bibliográficos, documentais, exploratório-descritiva e de natureza qualitativa. Parte-se da compreensão da nova legislação, que de certa forma apresenta maior segurança jurídica ao setor, assegura sustentabilidade econômica aos diferentes agentes do setor elétrico brasileiro. Desta forma, apesar de a mudança na legislação ser bastante recente, com desdobramentos em curso, com impactos a serem ainda melhor mensurados, concluiu-se que o novo marco legal equilibra o incentivo à geração distribuída e viabilidade técnico-econômica no médio e longo prazo ao sistema elétrico brasileiro, em especial às distribuidoras de energia elétrica. Abstract: This article presents the main changes in the distributed generation of electricity in Brazil, contemplating the approval of the new legal framework (Law 14.300/2022) for the area, which took its effect in January 2022.To answer the research in the field of energy generation, the research relies on bibliographic, documentary, exploratory-descriptive and qualitative studies. It starts from the understanding of the new legislation, which in a way provides greater legal certainty to the area, and ensures economic sustainability to the different agents of the Brazilian electricity sector. This way, despite the change in legislation being quite recent, with ongoing developments, and having impacts to be even better measured, it was concluded that the new legal framework balances the incentive for distributed generation and gives technical-economic feasibility in the medium and long term over Brazilian electric system, especially to electric energy distributors

NOVO MARCO LEGAL À GERAÇÃO DISTRIBUÍDA DE ENERGIA ELÉTRICA NO BRASIL: UMA ABORDAGEM DAS PRINCIPAIS MUDANÇAS / New legal framework for the distributed generation of electric energy in Brazil: an approach to the main changes

O presente artigo apresenta as principais mudanças na geração distribuída de energia elétrica no Brasil, contemplando a aprovação do novo marco legal (Lei 14.300/2022) do setor, que entrou em vigor em janeiro de 2022. Para responder à investigação no campo da geração de energia, a pesquisa conta com estudos bibliográficos, documentais, exploratório-descritiva e de natureza qualitativa. Parte-se da compreensão da nova legislação, que de certa forma apresenta maior segurança jurídica ao setor, assegura sustentabilidade econômica aos diferentes agentes do setor elétrico brasileiro. Desta forma, apesar de a mudança na legislação ser bastante recente, com desdobramentos em curso, com impactos a serem ainda melhor mensurados, concluiu-se que o novo marco legal equilibra o incentivo à geração distribuída e viabilidade técnico-econômica no médio e longo prazo ao sistema elétrico brasileiro, em especial às distribuidoras de energia elétrica. Abstract: This article presents the main changes in the distributed generation of electricity in Brazil, contemplating the approval of the new legal framework (Law 14.300/2022) for the area, which took its effect in January 2022.To answer the research in the field of energy generation, the research relies on bibliographic, documentary, exploratory-descriptive and qualitative studies. It starts from the understanding of the new legislation, which in a way provides greater legal certainty to the area, and ensures economic sustainability to the different agents of the Brazilian electricity sector. This way, despite the change in legislation being quite recent, with ongoing developments, and having impacts to be even better measured, it was concluded that the new legal framework balances the incentive for distributed generation and gives technical-economic feasibility in the medium and long term over Brazilian electric system, especially to electric energy distributors

Application of the single-minute exchange of die system to the CNC sector of a shoe mold company

The aim of this work is to present a quantitative evaluation of the benefits of applying the Single-Minute Exchange of Die (SMED) implemented in a shoe mold company. Based on the application of this methodology, we noticed that real gains were obtained with very little financial investment. The improvements observed in the sector were the reduction of set-up time by 60%, with an average set-up time of approximately 7 min, and an increase in the productive capacity of the sector by around 3%. There was a reduction in the incidence of errors in the machined parts due to the standardization of the processes performed by the operators. Among the advantages presented with the new system are reduced material exchange time, reduced time spent fine-tuning, less chance of errors during exchanges, improved product quality, greater reliability with respect to reduction of dissociation stocks and the flexibilization of the production system

Impact of a medication therapy management service offered to patients in treatment of breast cancer

Cancer has high morbidity and mortality rates related to medication use and produce a costly impact in health care. Thus, patients require constant monitoring and proper coordination of care between different professionals. This study aimed to evaluate the impact generated by a Medication Therapy Management service (MTM) offered to patients with breast cancer in use of polypharmacy. Observational, exploratory, descriptive and retrospective study of a MTM service that included 93 patients. Sociodemographic and clinical data related to pharmacotherapy and the processes associated with the systematization of the service were collected and analyzed. Patients were followed-up by the MTM service on average for 18 months (±4.31) and 185 drug-related problems (DRP) were identified, an average of two DRP per patient. Of these DRP, 48.11% were resolved and 49.73% were in the resolution process. The most common DRP were in the categories of Indication (37.84%), followed by Safety (23.78%). The safety category showed the highest resolution rate (59.09%). The study revealed an increased risk of DRP for patients with three or more comorbidities and using 5 or more medications. The process of systematization of a MTM service in oncology was associated with positive outcomes

HFMEA-Fuzzy: evaluation of the main lean wastes in an Emergency Care Unit (ECU) in Rio de Janeiro

The aim of the article was to use HFMEA-Fuzzy modeling to evaluate the eight lean wastes and identify critical processes related to them. To achieve this, data was collected from an Emergency Care Unit (ECU) in Rio de Janeiro. The results showed that the Processing/Creativity waste was the most frequent, followed by Defects, Waiting/Inventory, and Overproduction waste. Additionally, it was possible to identify critical processes related to each waste and suggest improvements to reduce or eliminate these wastes

Periodontal diseases: is it possible to prevent them? A populational and individual approach

Periodontal diseases are infectious inflammatory chronic diseases of a multifactorial nature. They are primarily caused by dysbiotic ecological changes in dental biofilm, which may be influenced by risk factors. The prevention of periodontal diseases may involve different strategies focused on reducing distal, intermediate, and proximal risk factors at both the population and individual levels. Effective prevention depends on interdisciplinary and common risk factor approaches. Also, patient-centered preventive models are more effective than professional-centered models in the management of periodontal diseases. Regular and periodic control of dental biofilm is an essential measure for the different levels of prevention of periodontal diseases. The effectiveness of periodontal disease prevention largely depends on positive modifications of behavior, knowledge, health literacy, patient empowerment, motivation, and compliance.publishedVersio

Homocysteine plasma levels as a marker of clinical severity in septic patients

OBJECTIVE: Homocysteine and sepsis are both associated with inflammation and endothelial activation. Therefore this study was aimed to evaluate if the plasma homocystein level is related with the septic patient clinical severity. METHODS: Severe sepsis or septic shock patients, with less than 48 hours from organ dysfunction start, were admitted to this prospective observational study. Homocysteine levels were determined by the time of study admission and then on the Days 3, 7 and 14. The homocysteine association with the Sequential Organ Failure Assessment (SOFA) score was evaluated using the Sperman test, and its association with mortality using the Mann-Whitney test. A p<0.05 value was considered statistically significant. RESULTS: Twenty one patients were enrolled, and 60 blood samples were collected to measure total homocysteine [median 6.92 (5.27 - 9.74 μmol/L)]. The Sperman correlation test showed no association between homocysteine and SOFA ( r=0.15 and p=0.26). Also no correlation was found for the homocysteine level by the study admission time and the difference between the Day 3 SOFA score versus by study admission (deltaSOFA) (r=0.04 and p=0.87). Homocysteine variation between the Day 3 and the study admission (deltaHmc) and SOFA score variation in the same period were not correlated (r=-0.11 and p=0.66). Homocysteine by the study admission was not correlated with death in intensive care unit rate (p= 0.46) or in-hospital death rate (p = 0.13). This was also true for deltaHmc (p=0.12 and p=0.99, respectively). CONCLUSION: Baseline homocysteine levels and its variations within the first dysfunction days were not related with septic patients' worsened organ function parameters or mortality.OBJETIVO: Homocisteína e a sepse estão ambos associados à inflamação e ativação endotelial. O objetivo desse estudo foi verificar se o nível plasmático de homocisteína está relacionado à gravidade do quadro séptico. MÉTODOS: Estudo clínico, prospectivo e observacional, incluindo pacientes com sepse grave ou choque séptico com menos de 48 horas de instalação da disfunção orgânica. Os níveis de homocisteína foram determinados no dia da inclusão no estudo e nos dias 3, 7, 14. A associação entre homocisteína com o escore Sequential Organ Failure Assessment (SOFA) foi avaliada pelo teste de Sperman e com mortalidade pelo teste de Mann-Whitney. Os resultados foram considerados significativos se p<0,05. RESULTADOS: Foram incluídos 21 pacientes e feitas 60 coletas para avaliação da homocisteina total (mediana de 6,92 (5,27 - 9,74 μmol/l). O teste de correlação Spearman não mostrou associação entre homocisteina e SOFA (r = -0,15 e p = 0,26). Também não foi encontrada correlação da medida de homocisteína na data de admissão do estudo e a diferença do SOFA obtido no 3º dia e o SOFA da admissão (deltaSOFA) (r = 0,04 e p = 0,87). A variação da homocisteína do 3º dia e a admissão no estudo (deltaHmc) e a variação do SOFA no mesmo período não estavam correlacionadas (r = -0,11 e p = 0,66). A homocisteina da admissão não se correlacionou com mortalidade na UTI (p=0,46) ou com a mortalidade hospitalar.(p=0,13). Mesmo quando foi utilizado o deltaHmc não houve correlação (p=012 e p=0,99, respectivamente). CONCLUSÃO: O nível basal de homocisteína ou sua variação nos primeiros dias da disfunção não estiveram relacionadas com a piora dos parâmetros funcionais dos sistemas orgânicos ou mortalidade nos pacientes sépticos.Universidade Federal de São Paulo (UNIFESP) Setor de Terapia Intensiva da Disciplina de Anestesiologia, Dor e Terapia IntensivaUniversidade Federal de São Paulo (UNIFESP)UNIFESP, Setor de Terapia Intensiva da Disciplina de Anestesiologia, Dor e Terapia IntensivaUNIFESPSciEL

Evaluation of T tube trial as a strategy of weaning from mechanical ventilation

BACKGROUND AND OBJECTIVES: Weaning from mechanical ventilation (MV) is an important strategy to reduce morbidity and mortality in critical care patients. In this setting, this study aimed at evaluation of T-tube trial (TT) in weaning from MV. METHODS: Patient admitted in the ICU were included if they present the following inclusion criteria: MV > 24 hours, no neuromuscular disorders, PaO2/FiO2 ratio >200, hemodynamic stability, reversion of the cause of respiratory failure, adequate respiratory drive. All were submitted to TT. Failure was defined by the presence of one of these symptoms: RR > 30 ipm, hypoxemia, tachycardia, arrhythmia, hypertension or hypotension. After two hours of TT, patients without failure criteria were extubated. After 48 hours of adequate spontaneous respiration the patient was considered successful weaned. Results were considered significant if p 24 horas, ausência de doença neuromuscular, relação PaO2/FiO2 > 200, estabilidade hemodinâmica, reversão da causa da intubação traqueal e drive respiratório adequado. Todos foram submetidos ao teste de tubo T. Considerou-se falha a ocorrência de FR > 30 irpm, hipoxemia, taquicardia, disritmias cardíacas, hipertensão ou hipotensão arterial. Após 2 horas de teste TT sem critérios de falha, os pacientes foram extubados. Considerou-se como sucesso na retirada da VM a manutenção por 48 horas de autonomia ventilatória. RESULTADOS: Foram incluídos 49 pacientes com idade média de 51,8 ± 21,7 anos. As incidências de SDRA e choque séptico foram 26,5% e 32,7% e o tempo médio de VM foi 11,9 ± 13 dias. A retirada da VM ocorreu em 79,2%, re-intubação em 31,6%, com tempo médio 13 ± 8,7 horas, sendo 75% devido à falência respiratória. Não houve correlação entre extubação e níveis de hemoglobina, PaO2/FiO2, idade, sexo, SDRA ou choque séptico prévios. O sucesso da retirada da VM (48 horas de autonomia) não se correlacionou com nenhuma das variáveis descritas. Os resultados foram considerados significativos se p < 0,05. CONCLUSÕES: O tubo T mostrou ser método adequado para a retirada da VM na maioria dos pacientes. Entretanto, a taxa de re-intubação foi elevada, podendo ser conseqüência do longo tempo do TT, da ventilação mecânica prévia ou da falha dos critérios de indicação de extubação traqueal.UNIFESP-EPM Unidade de Terapia Intensiva da Disciplina de Anestesiologia, Dor e Terapia IntensivaUNIFESP-EPMUNIFESP, EPM, Unidade de Terapia Intensiva da Disciplina de Anestesiologia, Dor e Terapia IntensivaUNIFESP, EPMSciEL