Causas e consequências do progressivo aumento no consumo de metilfenidato (ritalina) no Brasil

O metilfenidato (MPH, Ritalina®) é um fármaco utilizado para o tratamento de indivíduos com transtornos hipercinéticos1. Entretanto, o uso de estimulantes tem sido cada vez mais procurado pela população saudável, com intuito de aprimorar suas habilidades cognitivas, promover a melhora da atenção e memória

Educomunicação, Transformação Social e Desenvolvimento Sustentável

Esta publicação apresenta os principais trabalhos dos GTs do II Congresso Internacional de Comunicação e Educação nos temas Transformação social, com os artigos que abordam principalmente Educomunicação e/ou Mídia-Educação, no contexto de políticas de diversidade, inclusão e equidade; e, em Desenvolvimento Sustentável os artigos que abordam os avanços da relação comunicação/educação no contexto da educação ambiental e desenvolvimento sustentável

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 <= 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

Perdas de grãos e distribuição de palha na colheita mecanizada de soja

Considerando que a colheita é a etapa final de um processo produtivo e que as perdas devem ser mantidas dentro de padrões aceitáveis, as regulagens das colhedoras e as características agronômicas da cultura deverão permitir menores perdas quantitativas para que possa atingir o máximo nível de qualidade e maior sustentabilidade do sistema produtivo. Este trabalho teve como objetivo determinar as perdas quantitativas, distribuição de palha e características operacionais da colhedora por meio do controle estatístico de processo, bem como verificar a qualidade da operação de colheita. O trabalho foi realizado no município de Santa Juliana (MG), com as coordenadas geográficas de referência 19º 18'Se 47º 31'O. A área amostrada constou de 40 pontos distribuídos em malha retangular, equidistantes de 50 m, definidos sequencialmente a partir do momento de início da colheita. em cada ponto foi determinado o teor de água dos grãos, número de vagens por planta, altura de inserção de primeira vagem, altura de plantas, produtividade, distribuição de palha e características operacionais da colhedora. A perda de grãos ocasionada pela colhedora esteve fora dos limites de controle, porém dentro dos padrões aceitáveis de perdas para cultura da soja. A qualidade da operação de colheita e as regulagens da colhedora foram dependentes da velocidade de deslocamento. A distribuição de palha esteve próxima do desejável para o sistema de semeadura direta. A utilização das cartas de controle foi eficiente na identificação dos pontos fora de controle e na avaliação da qualidade do processo de colheita.Considering that the harvest is the final step of a productive process and the losses should be kept within acceptable standards, the settings of harvesters should reduce quantitative losses and warrant high quality and sustainability of the productive system. This study aimed to determine the quantitative losses, straw distribution and operational characteristics of the harvester through the statistical process control, and to verify the quality of the harvesting operation. The study was conducted in Santa Juliana, State of Minas Gerais, Brazil (19º18' S and 47º31' W). The area sampled consisted in 40 points distributed in rectangular grid, equidistant from 50 m, defined sequentially after harvest starting. At each point, we evaluated the water content of the grains, number of pods per plant; insertion height of first pod; plant of height; productivity; straw distribution and operational characteristics of the harvester. The grain loss caused by the harvester was outside the control limits, but within the acceptable standards of losses for soybean crop. The quality of the harvesting operation and adjustments of the harvester were dependent on the speed displacement. The straw distribution proved to be near of the desirable for no-tillage system. The use of control charts was efficient for identifying the points out of control and assessing the quality of harvesting process.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP

Desgaste das facas do corte basal na qualidade da colheita mecanizada de cana-de-açúcar

During the sugarcane mechanized harvester process, the wear of base cutting knives is directly correlated to the quality of the cut made by the machines, and the use of quality control tools important in monitoring this process. Thus, the present study in Ribeirão Preto region aimed to assess the knives cut baseline and damage caused to wear brass knuckles in mechanized harvesting of cane raw sugar, from the viewpoint of statistical quality control (SQC). The wear of the knives was quantified by mass loss and its dimensions, while cutting quality was assessed by cutting height and damage to stumps visually classified according to the level of damage caused. The results showed that the wear of the knives was more pronounced in certain periods of use, but still within control standards. The cutting height was not affected by the wear of the knives, keeping within the limits of desirable quality for operation. Eventually damage the stumps ranged among themselves depending on each face of the cutting knives evaluated, and the predominance of certain classes of damage in each cutting face, but always remained in statistical control.Durante o processo de colheita mecanizada de cana-de-açúcar, o desgaste das facas do mecanismo de corte basal é fator diretamente relacionado com a qualidade do corte realizado pelas máquinas, sendo o emprego de ferramentas de controle de qualidade importantes no monitoramento deste processo. Assim, o presente trabalho, desenvolvido na região de Ribeirão Preto, teve por objetivo avaliar o desgaste das facas do corte basal e os danos causados às soqueiras na colheita mecanizada de cana-de-açúcar, sob a ótica do controle estatístico de qualidade (CEQ). O desgaste das facas foi quantificado por meio da perda de massa e de suas dimensões, enquanto a qualidade do corte foi avaliada pela altura e pelos danos às soqueiras, classificados visualmente em função do nível de dano causado. Os resultados obtidos mostraram que o desgaste das facas ocorreu de maneira mais acentuada em determinados períodos de utilização, porém mantendo-se dentro de padrões de controle. A altura de corte não foi afetada pelo desgaste das facas, mantendo-se dentro dos limites de qualidade desejáveis para a operação. Finalmente, os danos causados às soqueiras variaram entre si em função de cada face de corte das facas avaliadas, havendo predominância de determinadas classes de danos em cada face de corte, porém sempre se mantendo dentro dos padrões aceitáveis pelo controle estatístico

Inflammatory Bowel Disease: An Overview of Immune Mechanisms and Biological Treatments

Inflammatory bowel diseases (IBD) are characterized by chronic inflammation of the intestinal tract associated with an imbalance of the intestinal microbiota. Crohn’s disease (CD) and ulcerative colitis (UC) are the most widely known types of IBD and have been the focus of attention due to their increasing incidence. Recent studies have pointed out genes associated with IBD susceptibility that, together with environment factors, may contribute to the outcome of the disease. In ulcerative colitis, there are several therapies available, depending on the stage of the disease. Aminosalicylates, corticosteroids, and cyclosporine are used to treat mild, moderate, and severe disease, respectively. In Crohn’s disease, drug choices are dependent on both location and behavior of the disease. Nowadays, advances in treatments for IBD have included biological therapies, based mainly on monoclonal antibodies or fusion proteins, such as anti-TNF drugs. Notwithstanding the high cost involved, these biological therapies show a high index of remission, enabling a significant reduction in cases of surgery and hospitalization. Furthermore, migration inhibitors and new cytokine blockers are also a promising alternative for treating patients with IBD. In this review, an analysis of literature data on biological treatments for IBD is approached, with the main focus on therapies based on emerging recombinant biomolecules