Adherence to Heart Rate Training Zones in an Exercise Training Program in Adults with Coronary Artery Disease

Objectives: To investigate the effect of exercise intensity on functional capacity in individuals with coronary artery disease, assess adherence to the heart rate training zone (HRTZ), and determine the relationship between trained intensity and functional capacity. Methods: A retrospective study was conducted on the medical records of 54 outpatients with coronary artery disease in a public hospital. The prescribed intensity started at 50%–60% of the heart rate reserve, increasing monthly to 70%–80% by the third month. Spearman’s test was used to assess the correlation between improvement in distance in the incremental shuttle walk test (ISWT), exercise intensity, and rating of perceived exertion (Borg–RPE). Adherence was classified as ‘below’ when HRTZ was not achieved in any phase of the program, ‘intermediate’ when HR was within the HRTZ for one or two months, and ‘above’ when HR was at or higher than HRTZ ≥ two months. Improvement was tested using t-test and one-way ANOVA. Results: 51.9% of participants had an increase in ISWT of ≥70 m (p < 0.0001). In at least one month, 50.9% trained below HRTZ. The trained intensity did not fall below 8.6% of the prescribed HRTZ minimum threshold. Changes in ISWT were not significantly correlated with exercise intensity (p = 0.87) or Borg–RPE (p = 0.16). Conclusion: While a significant increase in functional capacity was found, considerable heterogeneity in changes were observed. This may, in part, be related to adherence to HRTZ with progressive exercise intensity and to the variability in exercise volume in cardiovascular rehabilitation programs

Análise da viabilidade técnica para implantação de energia fotovoltaica em edifício de um templo religioso na cidade de Porciúncula – RJ / Analysis of the technical feasibility of implementing photovoltaic energy in a religious temple building in the city of Porciúncula – RJ

O contexto energético mundial associado à necessidade do desenvolvimento tecnológico sustentável implica na constante busca por fontes alternativas de energias renováveis. Nesse contexto, a energia solar se apresenta como uma fonte de energia inesgotável, considerando o alto índice de radiação que o sol fornece diariamente à terra. A energia solar fotovoltaica se apresenta como principal sistema de conversão da energia proveniente do sol. A localização estratégica do Brasil confere ao país uma capacidade de geração de energia solar singular. Baseado nessas considerações, o objetivo desse estudo é analisar a implantação de um sistema fotovoltaico na Igreja Cristã Casa de Oração de Porciúncula- RJ. De posse de uma ótima média de radiação anual, entre 4,9 e 5,09 Kwh/m².dia, e com amplo espaço útil nos telhados para instalação do sistema , concluiu-se que há a viabilidade técnica para implementação do projeto

Investigação da transferência de calor em cilindros aquecidos utilizando a dinâmica dos fluidos computacional / Heat transfer investigation in heated cylinders using computational fluid dynamics

Diversos dispositivos presentes na indústria utilizam cilindros aquecidos, onde por meio destes ocorre a troca de calor. O escoamento através desta geometria vem sendo investigado para melhor compreender suas características, no entanto o modelo matemático que descreve o comportamento do escoamento é complexo e na maioria das vezes dados experimentais são a principal fonte de informação. Entretanto, atualmente é possível realizar a predição de tal fenômeno através da ciência conhecida como dinâmica dos fluidos computacional (DFC). Visto isto, o presente trabalho tem como objetivo investigar as características do escoamento ao redor de cilindros aquecidos por meio desta técnica e examinar os resultados obtidos com dados disponíveis na literatura. Para isto, empregou-se diferentes softwares livres, o Gmsh foi utilizado na construção da geometria e malha, o OpenFoam para a solução numérica das equações que descrevem tal fenômeno, o Gnuplot no acompanhamento do resíduo e de parâmetros de interesse, e finalmente o ParaView na visualização do escoamento. Através da simulação observou-se as particularidades transientes do escoamento, visualizando o desprendimento de vórtices e a formação da esteira de von Kármán, no qual este evento foi responsável por induzir oscilações nos coeficientes de arrasto e sustentação. Desta forma, as simulações concordaram com as características previstas na literatura. Tendo em vista estes aspectos, foi possível concluir que a autenticidade da metodologia empregada no presente estudo, através dos softwares mencionados, foi comprovada

Determinação de Paraquate em maçãs do tipo Gala, Fuji, Argentina e Verde

Introduction: Brazil is one of the world leaders in consumption of agrochemicals, generating billions of reais/year and this fact is increasing. The herbicide Paraquat has a highly hydrophilic molecule and it is used in the control of weeds in many types of plantations. Objective: To determine the presence and content of Paraquat in apples using the following types from the national market: Gala, Fuji, Argentina and Verde, with or without peel and to analyze the residual Paraquat content according to the Brazilian and European legislation. Method: An adapted methodology (UV/VIS spectrophotometer) was used in apples’ types with or without peel. Results: Considering the studied types of apples, although Paraquat was present in all of them, only the Verde and Gala types would be approved by European regulations. Argentina type would be approved only by the limits stated by Anvisa and Fuji type would not be approved by none of the regulations. Conclusions: There is a need for constant inspection by analyzing the content of pesticides in food as well as legislation that establishes mandatory information about the type of agrochemical used and the corresponding residual limit allowed.Introdução: O Brasil é um dos líderes mundiais no consumo de agrotóxicos, gerando bilhões de reais por ano em valores crescentes. O herbicida Paraquate é uma molécula considerada altamente hidrofílica utilizada em plantações de milho, soja, batata, maçã, entre outros. Objetivo: Determinar a presença e o teor de Paraquate em maçãs do tipo Gala, Fuji, Argentina e Verde, em presença e ausência de casca e discutir seus limites aceitáveis nas legislações vigentes brasileira e europeia. Método: Determinar a quantidade de Paraquate por meio de metodologia adaptada utilizando um espectrofotômetro UV/VIS em amostras de maçãs já mencionadas com e sem casca. Resultados: Dos tipos estudados de maçãs considerando a fruta com a casca, embora o Paraquate estivesse presente em todas, somente os tipos Verde e Gala estariam aprovados pela regulamentação da Comissão Europeia, a Argentina seria aprovada pelos limites da Anvisa e a Fuji seria reprovada pelas duas regulamentações. Conclusões: Há a necessidade de constante fiscalização por meio da análise de teor de agrotóxicos em alimentos, bem como de novas legislações que estabeleçam a obrigatoriedade da informação do tipo de agrotóxico utilizado no produto e o limite residual permitido

Leituras e leitores de Richard Morse: a trajetória de um livro sobre a formação da metrópole paulista

De comunidade à metrópole: a biografia de São Paulo, was first published in 1954 and then re published in 1970 as Formação histórica de São Paulo: de comunidade à metrópole. Written by a young US researcher fascinated by Latin America, this material was originally submitted as his PhD thesis at Columbia University in 1952. Since then, Richard Morse's (1922-2001) work has come a long way and is now considered a primary reference in the history of urban development of São Paulo. This article briefly recovers the reader's response when Morse's research was first published, and how it ensured the book's importance in the Brazilian historiography. The aim is to draw a parallel trajectory of the book and its author - the young researcher at Columbia who became a professor of Latin American History at Yale - and to discuss the meanings regarding its importance in São Paulo's historiography as well as its contribution to a better understanding of the city.O livro De comunidade à metrópole: a biografia de São Paulo, publicado em 1954 e reeditado em 1970 com um novo título, Formação histórica de São Paulo: de comunidade à metrópole, foi escrito por um jovem norte-americano encantado com a América Latina, tendo sido inicialmente apresentado como tese de doutorado na Universidade de Columbia, em 1952. Desde então, essa obra de Richard Morse (1922-2001) percorreu um longo caminho, sendo hoje considerada "um clássico" sobre a evolução urbana da capital paulista. Retoma-se sinteticamente aqui a recepção da publicação, recuperando leitores e leituras que acabaram por garantir ao livro de Morse esse lugar na historiografia paulistana e brasileira. Busca-se, desse modo, traçar um paralelo entra a trajetória do livro e a de seu autor - que de jovem investigador em Columbia torna-se professor de História da América Latina na Universidade de Yale - para discutir o sentido do livro na historiografia e na própria interpretação que o livro fundaria sobre a cidade de São Paulo

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure &lt;= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030