O paciente obeso internado pode e deve emagrecer

Introduction: The number of obese patients has grown in parallel with increasing obesity in the population. Objective: To discuss the importance of diet therapy for healthy weight loss for acutely ill obese patients. Material and Methods: Reviewed the following databases: Cochrane, Lilacs, PubMed / Medline and Scielo articles related to the topic. Results and Discussion: The literature recommends the weight loss for obese patients, even when acutely ill, since obesity negatively predicts the majority of metabolic and infectious diseases that bring the patient to the hospital. Conclusions: A low-calorie diet therapy, with high protein levels is indicated for morbidly obese patients admitted except those hypercatabolic, which improves overall prognosis

The Time for Parenteral Nutrition is Now: 12 Months Caring for Patients with Severe COVID-19

The coronavirus disease 2019 (COVID-19) pandemic has brought new challenges to adequate nutrition, especially in critically ill patients. Physicians caring for these patients face great difficulties, including a different pathophysiology compared with other diseases, inadequately trained personnel, pressure from the media and family members, logistical and economic obstacles, and lack of robust medical evidence. Although the literature on COVID-19 is still limited, evidence demonstrates the need to reevaluate the use of effective nutritional support in this unprecedented, challenging clinical context. Supplemental parenteral nutrition must be considered due to the energy expenditure from COVID-19, the difficulty in achieving protein and energy goals in patients under enteral nutrition in prone position, and the worsened gastroparesis related to high doses of sedative/neuromuscular blocking agents

Analysis of spinning reserves in systems with variable power sources

In this paper is studied an approach based on risk assessment to solve the scheduling of a power production system with variable power sources. The spinning reserves resulting from the unit commitment are analyzed too. In this methodology there are no infeasible solutions, only more or less costly solutions associated to the operation risks, such as, load or renewable production curtailment. The uncertainty of forecasted production and load demand are defined by probability distribution functions. The methodology is tested in a real case study, an island with high penetration of renewable power production. Finally, forecasted and measured reserves are compared, once the reserves are strongly linked with the forecasting quality. The results of a real case study are presented and discussed. They show the difficulty to achieve complete robust solutions.info:eu-repo/semantics/publishedVersio

Muscle residual force enhancement: a brief review

Muscle residual force enhancement has been observed in different muscle preparations for more than half a century. Nonetheless, its mechanism remains unclear; to date, there are three generally accepted hypotheses: 1) sarcomere length non-uniformity, 2) engagement of passive elements, and 3) an increased number of cross-bridges. The first hypothesis uses sarcomere non-homogeneity and instability to explain how "weak" sarcomeres would convey the higher tension generated by an enhanced overlap from "stronger" sarcomeres, allowing the whole system to produce higher forces than predicted by the force-length relationship; non-uniformity provides theoretical support for a large amount of the experimental data. The second hypothesis suggests that passive elements within the sarcomeres (i.e., titin) could gain strain upon calcium activation followed by stretch. Finally, the third hypothesis suggests that muscle stretch after activation would alter cross-bridge kinetics to increase the number of attached cross-bridges. Presently, we cannot completely rule out any of the three hypotheses. Different experimental results suggest that the mechanisms on which these three hypotheses are based could all coexist

TECHNOLOGICAL CAPABILITY IN THE BRAZILIAN NAVAL INDUSTRY: A METRIC FOR OFFSHORE SUPPORT VESSELS

The objective of this study is to present an adapted technological capability metric for the offshore support vessel construction segment. Based on a literature review, a preliminary metric was developed and used to interview a group of researchers, professors, and managers from the naval industry. Through a qualitative approach, the collected empirical evidence was analyzed and organized in an analytical framework. A pilot test of the metric was then carried out at a shipyard in the city of Rio de Janeiro. The study’s results indicate that the metric’s application can offer firm managers and government policy-makers relevant information for the design and implementation of business and technological strategies for the supply vessel segment

Evaluación de la capacidad antioxidante y contenido de lípidos y carotenoides totales en un extracto hexánico de Haematococcus pluvialis en distintos periodos de estrés.

El alga verde Haematococcus pluvialis se encuentra comúnmente en climas templados de todo el mundo y es una de las fuentes biológicas más importantes de carotenoides; Los cuales se acumulan en forma de vesículas alrededor del núcleo y se forman sometiéndola a condiciones de estrés como limitación de nutrientes o exposición a la luz ultravioleta. Lo cual origina cambios morfológicos que van de fases flageladas y palmeloides a fases prequísticas y quísticas las cuales varían en función del medio de cultivo. El contenido de astaxantina en H. pluvialis en las fases prequísticas y quísticas representa el 90% de los carotenoides totales y tiene una extraordinaria capacidad antioxidante (500 veces mayor que el β-caroteno). Aparte de los carotenoides, H. pluvialis es productora de grandes cantidades de lípidos, los cuales hasta el 50% de su peso seco. La extracción de los carotenoides de H. pluvialis a nivel industrial se realiza en la fase quística (o de hematocisto

Intelligent products: the grace experience

Product intelligence is a new industrial manufacturing control paradigm aligned with the context of cyber-physical systems and addressing the current requirements of flexibility, reconfigurability and responsiveness. This paradigm introduces benefits in terms of improvement of the entire product׳s life-cycle, and particularly the product quality and customization, aiming the customer satisfaction. This paper presents an implementation of a system of intelligent products, developed under the scope of the GRACE project, where an agent-based solution was deployed in a factory plant producing laundry washing machines. The achieved results show an increase of the production and energy efficiency, an increase of the product quality and customization, as well as a reduction of the scrap costs.info:eu-repo/semantics/publishedVersio

Congenital adrenal hyperplasia in the adult women: management of old and new challenges

Due to major improvements in the management and therapy of patients with congenital adrenal hyperplasia owing to 21-hydroxylase deficiency (21OHD) along childhood and adolescence, affected women are able to reach adulthood. Therefore, management throughout adult life became even more complex, leading to new challenges. Both the protracted use of corticosteroids (sometimes in supraphysiologic doses), and excess androgen (due to irregular treatment and/or inadequate dosage) may impair the quality of life and health outcomes in affected adult women, causing osteoporosis, metabolic disturbances with high cardiovascular risk, cosmetic damage, infertility, and psychosocial and psychosexual changes. However, long-term follow-up studies with 21OHD adult women are still required. In this review, we discuss some important and controversial aspects of the follow-up of adult women with 21OHD, and recommend the use of a customized multi-disciplinary therapeutic approach while further studies with these patients do not provide distinct understanding and well-defined attitudes towards better quality of life.Graças ao significativo avanço na conduta e no tratamento de pacientes com as diversas formas de hiperplasia adrenal congênita por deficiência de 21-hidroxilase (D21OH) durante a infância e a adolescência, essas mulheres puderam atingir a idade adulta. Dessa maneira, o manejo nessa fase tornou-se ainda mais complexo, originando novos desafios. Tanto a exposição continuada à corticoterapia (pelo uso de doses muitas vezes suprafisiológicas), quanto ao hiperandrogenismo (pelo tratamento irregular ou uso de doses insuficientes), pode causar resultados pouco favoráveis à saúde e à qualidade de vida dessas mulheres, como: osteoporose, complicações metabólicas com risco cardiovascular, prejuízos cosméticos, infertilidade e alterações psicossociais e psicossexuais. No entanto, há poucos estudos de seguimento de longo prazo nas pacientes adultas. Nessa revisão procuramos abordar alguns aspectos importantes e mesmo controversos no seguimento de mulheres adultas com D21OH, recomendando a adoção de terapia individualizada e de caráter multidisciplinar, enquanto novos estudos não proponham atitudes mais bem definidas e consensuais visando à melhora da qualidade de vida dessas mulheres.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de MedicinaUNIFESP, EPM, Depto. de MedicinaSciEL

Authoritarian spaces: the railroad Noroeste do Brasil and the empire's bureaucracy

Este ensayo se ocupa de los espacios del poder autoritario en el gobierno de Brasil. Se inicia con la estructura administrativa, así como los espacios de sus oficinas bajo la influencia de la administración monografía científica Principios del ingeniero industrial Frederick Taylor en el ferrocarril del noroeste de Brasil. Sin embargo, ya se sabía que las administraciones autoritarias desde la llegada de la familia real portuguesa al país cuando trajeron el modelo administrativo en la forma de una burocracia. El advenimiento del organigrama y diagrama de flujo para gestionar espacios de producción social siempre se ha guiado por el diseño de la extrema división del trabajo asociado con los controles y prácticas de vigilancia. La separación entre los gobernantes de los que obedecen fue el tema central de esta división del trabajo. Incluso cuando el taylorismo fue reemplazado por otras llamadas teorías democráticas, como la Teoría de las Relaciones Humanas, la intención fue siempre la de intensificar la explotación de la fuerza de trabajo a través de la desestimación de su poder. La práctica de las organizaciones administrativas diseñadas por cartas de extrema división del trabajo ha servido para separar los gobernantes de marcha con la ayuda de diagramas de flujo dirigido el curso de la información que mantiene desinformados e informado a los que obedecen los que deciden y dificultando el acceso de los primeros a los segundos . Se puede decir que esta gestión práctica autoritaria persiste hoy en el gobierno brasileño.This essay deals with the Strength of Authority in the Brazilian Public Administration. It discusses the administrative structure and draws attention to the influence of The Principles of Scientific Administration by Frederick Taylor used at the Northwestern Brazillian Railroad, as regards the the distribution of office space and right of speech. As legatees of the authoritarian administration brought over by the Portuguese Royal Family, we were already quite familiar with a bureaucratic model. The organogram and fluxogram tools of social production have always taken for granted the division of work associated to practices of control and close inspection.The gap between those who order, and those who must obey, has always been the main feature of the duties allocation practice. Even when Taylorism was later replaced by other so called “democratic theories”, such as the Theory of Human Relations , the aim has always been that of intensifying the exploitation of the labourers by destituting them of their power. The practice of administrative organizations following organograms has set apart and and helped increase the gap between those who were in command and those who were there to obey unquestioningly, and unknowingly.Fluxograms were very effective tools when it came to installing the power of those who must detain the information and those who must needs remain uninformed. Any form of approximation between the two groups was made virtually impossible.This authoritarian managerial model still persists and pervades through the Brazilian Public Administration.Este ensaio trata dos espaços do poder autoritário nas administrações públicas do Brasil. Parte-se da estrutura administrativa assim como dos espaços de seus escritórios sob a influência da monografia Princípios de administração cientifica do engenheiro mecânico Frederick Taylor na Estrada de Ferro Noroeste do Brasil. No entanto, já se conhecia as gestões autoritárias desde a vinda da família Real Portuguesa ao país quando trouxeram o modelo administrativo no formato de uma Burocracia. O advento do organograma e do fluxograma para gerenciar espaços da produção social sempre se pautou pelo desenho da extrema divisão do trabalho associada a práticas de controles e vigilância. A separação entre os que mandam dos que obedecem foi a tônica desta divisão do trabalho. Mesmo quando o taylorismo foi substituído por outras teorias ditas democráticas, como a Teoria das Relações Humanas, o intuito sempre foi intensificar a exploração da força de trabalho através da destituição de seu poder. A prática das organizações administrativas desenhadas por organogramas de extrema divisão do trabalho tem servido para separar os que mandam dos que executam auxiliadas por fluxogramas direcionados ao curso das informações que mantém desinformados os que obedecem e informados os que decidem e dificultando o acesso dos primeiros aos segundos. É possível dizer que esta pratica autoritária de gestão persiste ainda hoje nas administrações públicas brasileiras.

Chemical variability and biological activities of Eucalyptus spp. essential oils

Many plant species produce mixtures of odorous and volatile compounds known as essential oils (EOs). These mixtures play important roles in Nature and have been utilized by mankind for different purposes, such as pharmaceuticals, agrochemicals, aromatherapy, and food flavorants. There are more than 3000 EOs reported in the literature, with approximately 300 in commercial use, including the EOs from Eucalyptus species. Most EOs from Eucalyptus species are rich in monoterpenes and many have found applications in pharmaceuticals, agrochemicals, food flavorants, and perfumes. Such applications are related to their diverse biological and organoleptic properties. In this study, we review the latest information concerning the chemical composition and biological activities of EOs from different species of Eucalyptus. Among the 900 species and subspecies of the Eucalyptus genus, we examined 68 species. The studies associated with these species were conducted in 27 countries. We have focused on the antimicrobial, acaricidal, insecticidal and herbicidal activities, hoping that such information will contribute to the development of research in this field. It is also intended that the information described in this study can be useful in the rationalization of the use of Eucalyptus EOs as components for pharmaceutical and agrochemical applications as well as food preservatives and flavorants. View Full-Tex