Comparison of Predictive Equations for Resting Energy Expenditure in Overweight and Obese Adults

Objective. To compare values from predictive equations of resting energy expenditure (REE) with indirect calorimetry (IC) in overweight and obese adults. Methods. Eighty-two participants aged 30 to 60 years old were retrospectively analyzed. The persons had a body mass index ≥25 kg/m2. REE was estimated by IC and other five equations of the literature (Harris and Benedict, WHO1, WHO2, Owen, Mifflin). Results. All equations had different values when compared to those of IC. The best values were found by Harris and Benedict, WHO1, and WHO2, with high values of intraclass correlation coefficient and low values of mean difference. Furthermore, WHO1 and WHO2 showed lower systematic error and random. Conclusion. No predictive equations had the same values of REE as compared to those of indirect calorimetry, and those which least underestimated REE were the equations of WHO1, WHO2, and Harris and Benedict. The next step would be to validate the new equation proposed

Dietary factors associated with metabolic syndrome in Brazilian adults

<p>Abstract</p> <p>Background</p> <p>Metabolic Syndrome (MS) is defined as the association of numerous factors that increase cardiovascular risk and diet is one of the main factors related to increase the MS in the population. This study aimed to evaluate the association of diet on the presence of MS in an adult population sample.</p> <p>Methodology</p> <p>305 adults were clinically screened to participate in a lifestyle modification program. Anthropometric assessments included waist circumference (WC), body fat and calculated BMI (kg/m²) and muscle-mass index (MMI kg/m²). Dietary intake was estimated by 24 h dietary recall. Fasting blood was used for biochemical analysis. MS was diagnosed using NCEP-ATPIII (2001) criteria with adaptation for glucose (≥ 100 mg/dL). Logistic regression (Odds ratio) was performed in order to determine the odds ratio for developing MS according to dietary intake.</p> <p>Results</p> <p>An adequate intake of fruits, OR = 0.52 (CI:0.28-0.98), and an intake of more than 8 different items in the diet (variety), OR = 0.31 (CI:0.12-0.79) showed to be a protective factor against a diagnosis of MS. Saturated fat intake greater than 10% of total caloric value represented a risk for MS diagnosis, OR = 2.0 (1.04-3.84).</p> <p>Conclusion</p> <p>Regarding the dietary aspect, a risk factor for MS was higher intake of saturated fat, and protective factors were high diet variety and adequate fruit intake.</p

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

DETC2009-87187 MULTIPLE SYNCHRONOUS STATES IN STATIC DELAY-FREE OSCILLATOR NETWORKS

ABSTRACT Oscillator

Architectures, stability and optimization for clock distribution networks

Synchronous telecommunication networks, distributed control systems and integrated circuits have its accuracy of operation dependent on the existence of a reliable time basis signal extracted from the line data stream and acquirable to each node. In this sense, the existence of a sub-network (inside the main network) dedicated to the distribution of the clock signals is crucially important. There are different solutions for the architecture of the time distribution sub-network and choosing one of them depends on cost, precision, reliability and operational security. In this work we expose: (i) the possible time distribution networks and their usual topologies and arrangements. (ii) How parameters of the network nodes can affect the reachability and stability of the synchronous state of a network. (iii) Optimizations methods for synchronous networks which can provide low cost architectures with operational precision, reliability and security. (C) 2011 Elsevier B. V. All rights reserved

<b> Impact of exercising muscles to exhaustion on blood markers in weight-training </b>

Metabolic markers of physical exhaustion were evaluated in venous blood drawn from 8 men (20-30 years old) with at least 3 years’ experience in weight-lifting training. They were submitted, in the morning, to an overload (exhaustion) test starting at 80% of 1 RM (one repetition maximum) on 8 muscle groups. Heart rate (HR) was measured and samples of venous blood were collected before and immediately after the exhaustion test (ET) and sent to a laboratory for blood gas analysis (pH, lactate, pO2, pCO2 and HCO-3) and measurement of electrolytes (Na+, Cl-, K+ and Ca++) and glycemia. The HR/kg ratios observed were in the following sequence of descending order: arm and hamstrings > shoulder and back > chest > quadriceps > calf. Results for NH4, pH, lactate and HCO-3 levels were changed in all 8 muscle groups, whereas Ca++, K+, Na+, Cl-, and uric acid did not change significantly after the ET. The muscle groups: back, biceps, triceps, chest, and hamstrings exhibited changes in seven to nine indicators while only 4 to 6 biochemical indicators changed in response to shoulder, calf, and quadriceps exercises. Thus, blood markers indicating acidosis, hemoconcentration and hyperglycemia were sensitive markers although with low specificity for the eight muscle groups. Calf and quadriceps had the highest tolerance for weight loading along with the smallest HR increase and lowest number of biochemical indicators changed. Therefore, it appears possible to reach muscle exhaustion with systemic responses in the blood by working out the arm muscles and hamstrings with lighter weights than for quadriceps and calf muscles.ResumoO impacto da exaustão (com pesos) de grupos musculares, sobre indicadores sanguíneos de acidose e de hemoconcentração foi estudado em 8 jovens (20-30 anos) treinados em musculação. Todos foram submetidos a sobrecarga inicial de 80% de 1RM, até a exaustão (TE), em 8 exercícios distintos, com coleta de sangue e registro da freqüência cardíaca (FC) antes (At) e imediatamente após (Ap) o TE para a determinação da glicemia, indicadores hemogasimétricos: pH, lactato (lac), NH4+, pO2, pCO2, HCO-3 e ácido úrico (AU) e hemoconcentração: hematócrito, hemoglobina, sódio (Na+) e cloreto (Cl-). O efeito da exaustão (At/Ap) sobre cada variável foi testado pelo teste t (Student) e a comparação entre os exercícios pela ANOVA (one way) para α=0,05. A elevação da FC por kg levantado ocorreu de forma decrescente: rosca direta, triceps pulley e mesa flexora, maiores (p < 0,05) que elevação lateral, puxador alto, supino, Hack e flexão plantar do tornozelo em pé na máquina. Com o TE observou-se, nos 8 exercícios, redução significativa do pH e HCO-3 e elevações do lac e NH4 +. Os exercícios com maior número de variáveis alteradas (7 a 9) foram: rosca direta, puxador alto, supino e mesa flexora e com menor número de alterações os exercícios flexão plantar do tornozelo em pé na máquina e Hack. Estes últimos foram discriminados por NH4 +, lac, e HCO-3. Assim o estado de exaustão, com repercussões sanguíneas sistêmicas foi atingido mais rapidamente com exercícios rosca direta e mesa fl exora do que os exercícios Hack e flexão plantar do tornozelo