A problemática do dimensionamento da informalidade na economia brasileira

Small businesses have frequently been subject of debates in the contexts of economy as well as public policies. On the other hand, the intermingling between these and the informal economy is undeniable. In this context, the current paper aims to present and analyze the different forms of conceptualization and the results obtained in the many attempts of measuring the informal economy in Brazil. It also seeks to evince that there is not well defined dividing line between what is formal and informal; these realities articulate and complement each other in semiformality. Throughout this study, the difficulties in measuring the real size of informal economy become evident. Nonetheless, all of the existing estimates point to a significant participation of this segment in the national economy as a whole. The many existent initiatives in the country that are aimed at decreasing informality are also examined. However, it is clear that, despite the fact that they have achieved a small decrease in the participation of informality in the whole of the economy through the 21st Century, it is still expanding in absolute numbers

Therapeutic Hypothermia for Traumatic Brain Injury

Experimental evidence demonstrates that therapeutic temperature modulation with the use of mild induced hypothermia (MIH, defined as the maintenance of body temperature at 32-35°C) exerts significant neuroprotection and attenuates secondary cerebral insults after traumatic brain injury (TBI). In adult TBI patients, MIH has been used during the acute "early” phase as prophylactic neuroprotectant and in the sub-acute "late” phase to control brain edema. When used to control brain edema, MIH is effective in reducing elevated intracranial pressure (ICP), and is a valid therapy of refractory intracranial hypertension in TBI patients. Based on the available evidence, we recommend: applying standardized algorithms for the management of induced cooling; paying attention to limit potential side effects (shivering, infections, electrolyte disorders, arrhythmias, reduced cardiac output); and using controlled, slow (0.1-0.2°C/h) rewarming, to avoid rebound ICP. The optimal temperature target should be titrated to maintain ICP <20mmHg and to avoid temperatures <35°C. The duration of cooling should be individualized until the resolution of brain edema, and may be longer than 48h. Patients with refractory elevated ICP following focal TBI (e.g. hemorrhagic contusions) may respond better to MIH than those with diffuse injury. Randomized controlled trials are underway to evaluate the impact of MIH on neurological outcome in adult TBI patients with elevated ICP. The use of MIH as prophylactic neuroprotectant in the early phase of adult TBI is not supported by clinical evidence and is not recommende

Too cold may not be so cool: spontaneous hypothermia as a marker of poor outcome after cardiac arrest

In a recent issue of Critical Care, den Hartog and colleagues show an association between spontaneous hypothermia, defined by an admission body temperature <35°C, and poor outcome in patients with coma after cardiac arrest (CA) treated with therapeutic hypothermia (TH). Given that TH alters neurological prognostication, studies aiming to identify early markers of injury severity and outcome are welcome, since they may contribute overall to optimize the management of comatose CA patients. This study provides an important message to clinicians involved in post-resuscitation care and raises important questions that need to be taken into account in future studies

Uma reflexão sobre a problemática da baixa produtividade do trabalho na economia brasileira: O desafio das empresas de pequeno porte

Since the threshold of the 21st century, the issue of productivity began to occupy a central role in economic debate. From that point, many studies concerning the Brazilian economy have been made, and the unanimous conclusion was that the country has been unable to increase the average productivity of its economy in order to approaches the ones of central countries of the global economy. The resulting diagnostic is that this is a major hindrance for Brazil to overcome its deep social inequality. This study assumes that the average labor productivity of the national economy is so low mainly due to its structural heterogeneity and tries to identify which strata of its productive structure are those with the lowest productivity and responsible for the reduction in the average. It then goes on to identify, both through the analysis of these strata composition and based in international comparisons, that the segment of micro and small businesses is the main responsible for this phenomenon in the country. From that, it analyses the possible trajectories through which this problem could be overcame and assumes that the elevation of the productivity of these firms, instead of a structural change, would be the best course for a process of inclusive development. It also suggests that this trajectory would be the only one able to establish an economic environment in which the overflow of technical progress is absorbed. Finally, it proposes that development policies - particularly the ones of incentive to innovation - should focus on the improvement and modernization of productive and management processes of small businesses

Management of mechanical ventilation in acute severe asthma: practical aspects

Background: Acute severe asthma induces marked alterations in respiratory mechanics, characterized by acritical limitation of expiratory flow and aheterogeneous and reversible increase in airway resistance, resulting in premature airway closure, lung, and chest wall dynamic hyperinflation and high intrinsic PEEP. Discussion: These abnormalities increase the work of breathing and can lead to respiratory muscle fatigue and life-threatening respiratory failure, in which case mechanical ventilation is life-saving. When instituting mechanical ventilation in this setting, amajor concern is the risk of worsening lung hyperinflation (thereby provoking barotrauma) and inducing or aggravating hemodynamic instability. Guidelines for mechanical ventilation in acute severe asthma are not supported by strong clinical evidence. Controlled hypoventilation with permissive hypercapnia may reduce morbidity and mortality compared to conventional normocapnic ventilation. Profound pathological alterations in respiratory mechanics occur during acute severe asthma, which clinicians should keep in mind when caring for ventilated asthmatics. Conclusion: We focus on the practical management of controlled hypoventilation. Particular attention must be paid to ventilator settings, monitoring of lung hyperinflation, the role of extrinsic PEEP, and administering inhaled bronchodilators. We also underline the importance of deep sedation with respiratory drive-suppressing opioids to maintain patient-ventilator synchrony while avoiding as much as can be muscle paralysis and the ensuing risk of myopathy. Finally, the role of noninvasive positive pressure ventilation for the treatment of respiratory failure during severe asthma is discusse

Monitoring of Brain and Systemic Oxygenation in Neurocritical Care Patients

Maintenance of adequate oxygenation is a mainstay of intensive care, however, recommendations on the safety, accuracy, and the potential clinical utility of invasive and non-invasive tools to monitor brain and systemic oxygenation in neurocritical care are lacking. A literature search was conducted for English language articles describing bedside brain and systemic oxygen monitoring in neurocritical care patients from 1980 to August 2013. Imaging techniques e.g., PET are not considered. A total of 281 studies were included, the majority described patients with traumatic brain injury (TBI). All tools for oxygen monitoring are safe. Parenchymal brain oxygen (PbtO2) monitoring is accurate to detect brain hypoxia, and it is recommended to titrate individual targets of cerebral perfusion pressure (CPP), ventilator parameters (PaCO2, PaO2), and transfusion, and to manage intracranial hypertension, in combination with ICP monitoring. SjvO2 is less accurate than PbtO2. Given limited data, NIRS is not recommended at present for adult patients who require neurocritical care. Systemic monitoring of oxygen (PaO2, SaO2, SpO2) and CO2 (PaCO2, end-tidal CO2) is recommended in patients who require neurocritical care

Neural detection of complex sound sequences in the absence of consciousness

Neural responses to violations of global regularities are thought to require consciousness. However, Tzovara et al. show that some comatose patients can also detect deviations in sequences composed of repeated groups of sounds, suggesting that the unconscious brain has a greater capacity to track sensory inputs than previously believe