Successful treatment of vancomycin-resistant enterococcus ventriculitis in a child

Enterococci are an uncommon cause of CNS infection. A 20 month-old boy, diagnosed with hydrocephalus with ventriculoperitoneal shunt and history of lengthy hospitalization and use of wide spectrum antibiotics, was admitted to the pediatric intensive care unit diagnosed with ventriculitis. On the 14th day of empirical antibiotic therapy (vancomycin and meropenem) the child presented fever while the CSF sample culture evidenced vancomycin-resistant Enterococcus faecium. The patient received intravenous linezolid achieving cerebrospinal fluid sterilization. Conclusion: Intravenous linezolid appears to be a safe and effective therapy for vancomycin-resistant enterococcus ventriculoperitoneal shunt infection.Federal University of São Paulo State Hospital of Diadema Department of PediatricsUNIFESP, State Hospital of Diadema Department of PediatricsSciEL

Avaliação da eficiência técnica de clones de eucalipto em escala comercial: uma abordagem empregando Data Envelopment Analysis (DEA)

This study aims to identify which clones present technical efficiency improvements regarding their cutting age, helping the decision-making as to their best cutting ages and which clones shall be either excluded or maintained in the next production cycles. The data envelopment analysis (DEA) methodology is discussed to determine and to compare the technical efficiency of eucalyptus clones of the genuses Eucaplyptus urophylla and Eucalyptus grandis in commercial scale. They were produced between 2016 and 2017, with cutting ages equal to five and seven years. Their plantation occurred in areas of sandy soils, and warm, temperate climate in order to produce cellulose and paper. The plantation belongs to a company located in the state of São Paulo. The calculation of the technical efficiency and its current values, clearances, targets and benchmarks throughout the years are determined by the variables total cost, individual volume, and produced volume. The DEA BCC-O model was employed due to the little proportionality of some input-output pairs. Clones CL02, CL03, CL05, and CL08 seemed to be efficient in both cutting ages. This indicated that they were likely benchmarks for the inefficient clones. However, clone CL04 was the only one which exclusion of the clone list to be used in the next plantation cycles was suggested since it presented a reduction in its individual volume and basic density, when an improvement in its cutting age occurs. We concluded that the DEA methodology is a good choice for helping the decision-making regarding which eucalyptus clones shall be used, reduced, and/or eliminated from the next cycle, determining which ones are the most efficient ones, verifying their evolution about their cutting ages.O presente artigo refere-se à utilização da metodologia de análise de envoltória de dados (DEA) para determinar e comparar a eficiência técnica de clones de eucalipto dos gêneros Eucaliptus urophylla e Eucaliptus grandis, em escala comercial, produzidos no período de 2016 e 2017 e com idades de corte entre 5 e 7 anos. O plantio desses clones ocorreu em locais com solos arenosos, clima quente e temperado, destinados à produção de celulose e papel, pertencentes a uma empresa situada no interior do estado de São Paulo. Este estudo visa  identificar quais clones apresentam ou não melhorias de eficiência técnica relacionadas a sua idade de corte, podendo auxiliar na tomada de decisão das melhores idades de corte e também quais clones deverão ser excluídos ou mantidos nos próximos ciclos produtivos. O cálculo da eficiência técnica e de seus valores atuais, folgas, alvos e benchmarks ao longo dos anos são determinados através das variáveis custo total; volume individual e volume produzido, sendo utilizado o modelo DEA BCC-O, em função da existência de pouca proporcionalidade de alguns pares input-output. Os clones CL02, CL03, CL05 e CL08 mostraram-se eficientes em ambas as idades de corte, caracterizando-os como possíveis benchmarks para os clones ineficientes. Já o clone CL04 foi o único cuja eliminação da lista de clones a serem utilizados nos próximos ciclos de plantio foi sugerida, apresentando diminuição de seu volume individual e densidade básica, quando ocorre o aumento de sua idade de corte. Conclui-se que a metodologia DEA é uma opção para o auxílio da tomada de decisão de quais clones de eucalipto devem ser utilizados, reduzidos e/ou eliminados de seu próximo ciclo, determinando quais são mais eficientes, verificando sua evolução em relação a sua idade de corte

Comparison between the Comfort and Hartwig sedation scales in pediatric patients undergoing mechanical lung ventilation

CONTEXT: A high number of hospitalized children do not receive adequate sedation due to inadequate evaluation and use of such agents. With the increase in knowledge of sedation and analgesia in recent years, concern has also risen, such that it is now not acceptable that incorrect evaluations of the state of children's pain and anxiety are made. OBJECTIVE: A comparison between the Comfort and Hartwig sedation scales in pediatric patients undergoing mechanical lung ventilation.DESIGN: Prospective cohort study. SETTING: A pediatric intensive care unit with three beds at an urban teaching hospital. PATIENTS: Thirty simultaneous and independent observations were conducted by specialists on 18 patients studied. DIAGNOSTIC TEST: Comfort and Hartwig scales were applied, after 3 minutes of observation. MAIN MEASUREMENTS: Agreement rate (kappa). RESULTS: On the Comfort scale, the averages for adequately sedated, insufficiently sedated, and over-sedated were 20.28 (SD 2.78), 27.5 (SD 0.70), and 15.1 (SD 1.10), respectively, whereas on the Hartwig scale, the averages for adequately sedated, insufficiently sedated, and over-sedated were 16.35 (SD 0.77), 20.85 (SD 1.57), and 13.0 (SD 0.89), respectively. The observed agreement rate was 63% (p = 0.006) and the expected agreement rate was 44% with a Kappa coefficient of 0.345238 (z = 2.49). CONCLUSIONS: In our study there was no statistically significant difference whether the more complex Comfort scale was applied (8 physiological and behavioral parameters) or the less complex Hartwig scale (5 behavioral parameters) was applied to assess the sedation of mechanically ventilated pediatric patients.CONTEXTO: É elevado o número de crianças hospitalizadas que não recebem uma sedação adequada, devido a avaliação e ao uso inadequado desses agentes. Nos últimos anos aumentou a preocupação e os conhecimentos a respeito da sedação e analgesia, de tal modo que é inaceitável hoje em dia termos uma criança sem correta avaliação de seu estado de dor e ansiedade. OBJETIVO: Comparar o uso de duas escalas de sedação (COMFORT e HARTWIG) em pacientes pediátricos em ventilação pulmonar mecânica. TIPO DE ESTUDO: Estudo prospectivo. LOCAL: Unidade de cuidados intensivos pediátricos de hospital terciário. PARTICIPANTES: Realizadas 30 observações, simultâneas e independentes, em 18 pacientes, por médicos especializados. TESTE DIAGNÓSTICO: Após observação de três minutos, aplicou-se critérios objetivos (escalas de COMFORT e HARTWIG) para avaliar a sedação. VARIÁVEL ESTUDADA: Taxa de concordância (Coeficiente Kappa) onde p < 0,01 foi considerado significante. RESULTADOS: Escala COMFORT (média e desvio padrão) para adequadamente sedado, inadequadamente sedado e muito sedado foi 20,28 ± 2,78, 27,5 ± 0,70 e 15,1 ± 1,10 respectivamente. Para a escala de HARTWIG: 16,35 ± 0,77, 20,85 ± 1,57 e 13,0 ± 0,89. Taxa de concordância observada 63% (p = 0,006), esperada de 44% com o coeficiente kappa = 0,345238 (z = 2,49). CONCLUSÕES: Em nosso estudo, não houve diferença significativa na aplicabilidade entre as escalas de COMFORT e HARTWIG em assegurar o nível de sedação em crianças submetidas a ventilação pulmonar mecânica.Universidade Federal de São Paulo (UNIFESP)Escola Paulista de MedicinaHospital do Servidor Público Municipal de São PauloUNIFESP, EPMSciEL

INITIAL GROWTH OF Citharexyllum myrianthum plants UNDER PLANTING FERTILIZATION

The objective of this work was to evaluate the initial growth of Citharexyllum myrianthum under the influence of three sources of planting fertilizers, in conditions of 18 L pots. The treatments used were, as follows: absolute control; 5 L of biosolid/pot; 300 g of natural rock phosphate (NRP), and 200 grams of NPK 06-29-06. The seedlings were grown in pots in full sun, supplemented with Dystrophic Red Yellow Latosol. At 150 days after transplanting, the plants were measured, obtaining the height of the aerial part and the diameter of the stem. Then, the increment of these two variables was calculated. Subsequently, the leaves were removed to determine the leaf area (LA), separating the aerial part from the root system, and then packed in a paper bag and placed in an oven at 65ºC, for drying until reaching constant weight. After weighing this material to obtain the dry matter of the aerial part (APDM) and root (RDM). The leaves were ground to determine the foliar contents of N, P, K, Ca, and Mg. To evaluate the effect of treatments on the soil, samples were taken from the pots to determine the levels of macronutrients, organic matter, and CEC(t). It was found that the LA and APDM of plants fertilized with NPK showed significantly higher values when compared to plants cultivated in the control treatment. It is recommended to fertilize Citharexyllum myrianthum plants with 200 grams of N-P-K 06-29-06/hole or with 5 L of biosolid

Evaluation of Fully Biodegradable PLA/PHB Blend Filled with Microcrystalline Celluloses

In this work, biodegradable biocomposites were developed using PLA/PHB blend as matrix and two types of microcrystalline cellulose as filler at three different contents. The biocomposites were evaluated regarding their thermal and morphological characteristics and molecular dynamic behavior. It was seen that cellulose addition did not promote significant changes in the Tm, Tc and Tcc in the matrix. On the other hand, XRD and TGA revealed that the addition of the highest content (7 wt%) of cellulose fillers resulted in a more significant decrease in crystallinity and thermal stability of the PLA/PHB matrix, suggesting a formation of filler aggregates. This indication was confirmed by TD-NMR, whose results pointed to a greater heterogeneity molecular in the samples containing higher cellulose contents. Therefore, this technique proved to be a relevant and complementary tool for the characterization of composites materials, contributing to determinate the most appropriate filler content introduced in a polymer matrix

Application of heijunka leveling in a medical devices company

One of the great challenges for companies is to satisfy their customers by delivering products on the dates and quantities required, while keeping low inventories levels as well as reduced lead times. In order to achieve this goal, the Lean Manufacturing with heijunka as a foundation, based on capacity leveling according to demand and is expected to reduce inventories and lead-time levels. In this sense, the objective of this work was to study the application of the heijunka leveling tool in a small medical devices company, characterized by low volume production and unstable demand. This study was based on an exploratory bibliographical survey with the objective of identifying existing studies on the subject; Carried out a case study with application of the tool and described its application in this company as well as its consequences. The results show the need to adapt it to the situation of each company, which involves determining an ideal level of leveling, so that it is possible to obtain the advantages that this tool provides

APORTE DE SERAPILHEIRA EM PLANTIO DE RECOMPOSIÇÃO FLORESTAL EM DIFERENTES ESPAÇAMENTOS

http://dx.doi.org/10.5902/1980509817439This study aimed to evaluate the deposition of litter, during one year period, in forest restoration plantation, deployed at different spacings. The planting took place in November 2004, at the Thermoelectric Plant ‘Barbosa Lima Sobrinho’, in Seropédica, Rio de Janeiro state. In December 2007, nine circular collectors were installed, tied to trees with nylon, in the four studied spacings: 1 x 1 m; 1.5 x 1.5 m; 2 x 2 m; and 3 x 2 m. The collections were done monthly, until December 2008. The material was taken to the laboratory, separated into leaves, branches, reproductive and miscellaneous and after being dried in stove at 65 °C for 48 hours, it was weighed. The values found for the total deposition of litter were, from the more to the less dense spacing: 6.93; 4.48; 5.12; and 3.71 Mg ha-1. The spacing which produced a greater quantity of litter was the 1 x 1 m. The litter deposition was higher in the dry season. The seasonal pattern was similar in the different spacings. The leaf fraction was predominant in all the spacings. The litter deposition, in general, was positively correlated with canopy cover index and was not correlated with the basal area of the stand. The obtained values of the litter production in this study can be considered similar to those found in secondary forest near the study area.http://dx.doi.org/10.5902/1980509817439O trabalho tem por objetivo avaliar o aporte de serapilheira, durante o período de um ano, em plantio derecomposição florestal implantado em diferentes espaçamentos. O plantio foi realizado em novembrode 2004, na Usina Termoelétrica Barbosa Lima Sobrinho, Seropédica – RJ. Em dezembro de 200 7 foram instalados nove coletores circulares, que foram presos às árvores com fio de nylon, nos quatrodiferentes espaçamentos: 1 x 1 m; 1,5 x 1,5 m; 2 x 2 m e 3 x 2 m. As coletas foram feitas mensalmenteaté dezembro de 2008. O material foi levado ao laboratório, separado em folhas, galhos, reprodutivose miscelânea e após ser seco em estufa a 65ºC por 48 horas, foi pesado. Os valores encontrados paradeposição total de serapilheira foram, do mais ao menos denso espaçamento: 6,93; 4,48; 5,12; e 3,71Mg ha-1. O espaçamento que produziu maior quantidade de serapilheira foi o 1 x 1 m. A deposição deserapilheira foi maior na estação seca, sendo o padrão sazonal do aporte semelhante nos diferentesespaçamentos. A fração folhas foi predominante em todos os espaçamentos. A deposição de serapilheira,de modo geral, correlacionou-se de forma positiva com a cobertura de copa e não apresentou correlaçãocom a área basal do povoamento. Os valores de produção de serapilheira verificados neste trabalhopodem ser considerados semelhantes aos encontrados em matas secundárias próximas à área de estudo.

MORPHOPHYSIOLOGICAL CHARACTERISTICS OF ARABIC COFFEE

The understanding of the behavior of each cultivar under adverse climatic conditions is important in the choice of plants that best fit the region to be inserted. Due to the large number of cultivars available on the market it makes it difficult for producers to choose which material to plant. In view of the above, this study aimed to know the morphophysiological characteristics of coffee. The experimental design was in randomized blocks with 10 treatments, that is, arabic coffee varieties: Catuai IAC62; Catuai IAC99; Ouro IAC4397; Tupi RN IAC1669-13; Obatã IAC1669-20; Mundo Novo IAC379-24; Mundo Novo IAC 388-17-2; Mundo Novo SH3 Faz São José; Bourbon IACJ15 and Icatu IAC 2944-11 and with four replications totaling 40 plots, where each plot was composed of seven plants. The Mundo Novo IAC 388-17-2 coffee variety shows higher yield in the seventh year of cultivation. Variety of Bourbon IACJ15 coffee presented water use efficiency (EUW) which did not reflect in higher productivity. The Catuai V IAC99 arabica coffee variety stood out in the internal morphology of the leaves. The thickness of the adaxial and abaxial epidermis (TADE and TABE) and the CO2 assimilation rate (A) showed negative correlations with the productivity of processed coffee bags. Keywords: Coffea arabica; plant morphology; plant physiology; varieties.ABSTRACT: The understanding of the behavior of each cultivar under adverse climatic conditions is important in the choice of plants that best fit the region to be inserted. Due to the large number of cultivars available on the market it makes it difficult for producers to choose which material to plant. In view of the above, this study aimed to know the morphophysiological characteristics of coffee. The experimental design was in randomized blocks with 10 treatments, that is, arabic coffee varieties: Catuai IAC62; Catuai IAC99; Ouro IAC4397; Tupi RN IAC1669-13; Obatã IAC1669-20; Mundo Novo IAC379-24; Mundo Novo IAC 388-17-2; Mundo Novo SH3 Faz São José; Bourbon IACJ15 and Icatu IAC 2944-11 and with four replications totaling 40 plots, where each plot was composed of seven plants. The Mundo Novo IAC 388-17-2 coffee variety shows higher yield in the seventh year of cultivation. Variety of Bourbon IACJ15 coffee presented water use efficiency (EUW) which did not reflect in higher productivity. The Catuai V IAC99 arabica coffee variety stood out in the internal morphology of the leaves. The thickness of the adaxial and abaxial epidermis (TADE and TABE) and the CO2 assimilation rate (A) showed negative correlations with the productivity of processed coffee bags. Keywords: Coffea arabica; plant morphology; plant physiology; varieties.   Características morfofisiológicas do café arábico   RESUMO: O entendimento do comportamento de cada cultivar sob condições climáticas adversas é importante na escolha das plantas que melhor se adaptam à região a ser inserida. Devido ao grande número de cultivares disponíveis no mercado, torna-se difícil para o produtor escolher qual material plantar. Diante do exposto, este estudo teve como objetivo conhecer as características morfofisiológicas do café. O delineamento experimental foi em blocos casualizados com 10 tratamentos, ou seja, variedades de café arábico: Catuai IAC62; Catuai IAC99; Ouro IAC4397; Tupi RN IAC1669-13; Obatã IAC1669-20; Mundo Novo IAC379-24; Mundo Novo IAC 388-17-2; Mundo Novo SH3 Faz São José; Bourbon IACJ15 e Icatu IAC 2944-11 e com quatro repetições totalizando 40 parcelas, sendo cada parcela composta por sete plantas. A variedade de café Mundo Novo IAC 388-17-2 apresenta maior produtividade no sétimo ano de cultivo. A variedade de café Bourbon IACJ15 apresentou eficiência no uso de água (EUW) o que não refletiu em maior produtividade. A variedade de café arábica Catuai V IAC99 se destacou na morfologia interna das folhas. A espessura da epiderme adaxial e abaxial (TADE e TABE) e a taxa de assimilação de CO2 (A) apresentaram correlações negativas com a produtividade das sacas de café beneficiado. Keywords: Coffea arabica; morfologia vegetal; fisiologia vegetal; variedades

GRSUS: Gerenciamento De Recursos De Sa\'ude, Um Estudo Sob A \'Otica Da Portaria GM/MS 1631/2015 No Estado do Par\'a

Investments in public health had an increase of about R$ 20 bi in recent years. Even with the dynamism of the Unique Health System (SUS), only after 13 years the criteria and parameters for the planning and programming of health services have been updated. The calculations for health resources division are complex due to the nature of the SUS administrative organization, which has three administrative levels. Despite providing the criteria and parameters for the calculations, it was not provided any information system that would automate this process and provide reliable information for decision making. In order to fill such gap, this paper presents a system for health resource management from the perspective of GM/MS 1631/2015 ordinance. The tool has been validated using as case studies two municipalities in the interior of the state of Par\'a. The results were promising, with latent market potential, being possible to simulate various scenarios for a medium and long-term predictions.Comment: Paper presented at the 15th International Conference On Information Systems & Technology Management - Contecsi - 201

DESENVOLVIMENTO INICIAL DO AMENDOINZEIRO SOB DIFERENTES DENSIDADES DE MATOCOMPETIÇÃO COM Urochloa

Gramíneas e leguminosas competem nos sistemas produtivos, sendo que esta competição depende de suas habilidades específicas para a sua sobrevivência. O objetivo desse trabalho foi avaliar o desenvolvimento inicial de amendoinzeiro sob diferentes densidades de matocompetição com Urochloa. Foi realizado um experimento com delineamento inteiramente casualizado, em esquema fatorial 4 x 5. O primeiro fator foi composto por quatro tipos de gramíneas, ou seja, Urochloa brizantha cv. Paiaguás, Marandu, Piatã e Urochloa ruziziensis; o segundo, por cinco densidades de matocompetição e cinco repetições, totalizando 100 parcelas ou vasos. Após 30 dias da semeadura, foram determinados os seguintes parâmetros: ISPADA – índice spad do amendoim; CEA – condutância estomática do amendoim; DCA – diâmetro de caule do amendoim; APA e APG – altura de planta do amendoim e gramínea; MSPAA e MSPAG – massa seca da parte aérea do amendoim e gramínea; e MSRA e MSRG – massa seca de raiz do amendoim e gramínea. O amendoinzeiro responde de maneira negativa quando submetido a altas densidades de matocompetição com gramíneas do gênero Urochloa. A Urochloa ruziziensis apresentou uma maior matocompetição no desenvolvimento inicial do amendoinzeiro