Administração de anti-infecciosos orais por sonda de nutrição entérica

Com o crescente recurso à nutrição entérica surgem novos desafios, designadamente pela utilização crescente do mesmo dispositivo de acesso na administração da terapêutica farmacológica (Magnuson, Clifford, Hoskins & Bernard, 2005). Desta situação resulta uma necessidade por parte dos profissionais de saúde de conhecer o potencial de complicações e limitações associadas e este método (Williams, 2008), agravada por estudos que têm vindo a revelar técnicas inapropriadas na administração de formulações orais por sonda de nutrição (Belknap, Seiferd & Petermann, 1997) (Hanssens, Woods, Alsulaiti, Adheir, Al-Meer & Obaidan, 2006) (Seifert & Jonhston, 2005). Entre essas complicações encontramos as interacções fármaco-nutriente, que podem conduzir ao compromisso do estado nutricional do doente ou dos objectivos terapêuticos (August, et al., 2002), podendo resultar em obstrução da sonda, alteração da libertação ou biodisponibilidade do fármaco ou nutriente ou alteração da função gastrointestinal (Robin, Boulatta, Brantley, Corkins, Guenter, & et al, 2009). Considerando os riscos associados ao inadequado cumprimento da terapêutica com anti-infecciosos, o presente trabalho pretende conhecer a viabilidade de administração por sonda dos anti-infecciosos disponíveis para prescrição no Centro Hospitalar de São João, EPE (CHSJ,EPE).

Competência cultural: análise do conceito segundo a metodologia tradicional de Walker e Avant

Este estudo teve como objetivo: explorar o significado do conceito de competência cultural, a fim de clarificá-lo na prática de enfermagem. Foi utilizada a metodologia tradicional de análise de conceito proposto por Walker e Avant, nos 15 textos selecionados da EBSCOhost e da Biblioteca Virtual da Saúde. Concluiu-se que a associação entre as características ético-humanitárias pessoais e profissionais, a habilidade cultural com foco na comunicação e o conhecimento cultural são identificadas como as principais características para a existência do conceito.

Derivative-free nonlinear optimization filter simplex

The filter method is a technique for solving nonlinear programming problems. The filter algorithm has two phases in each iteration. The first one reduces a measure of infeasibility, while in the second the objective function value is reduced. In real optimization problems, usually the objective function is not differentiable or its derivatives are unknown. In these cases it becomes essential to use optimization methods where the calculation of the derivatives or the verification of their existence is not necessary: direct search methods or derivative-free methods are examples of such techniques. In this work we present a new direct search method, based on simplex methods, for general constrained optimization that combines the features of simplex and filter methods. This method neither computes nor approximates derivatives, penalty constants or Lagrange multipliers.

Telling stories of culture through literature

Grounded on Raymond Williams‘s definition of knowable community as a cultural tool to analyse literary texts, the essay reads the texts D.H.Lawrence wrote while travelling in the Mediterranean (Twilight in Italy, Sea and Sardinia and Etruscan Places) as knowable communities, bringing to the discussion the wide importance of literature not only as an object for aesthetic or textual readings, but also as a signifying practice which tells stories of culture. Departing from some considerations regarding the historical development of the relationship between literature and culture, the essay analyses the ways D. H. Lawrence constructed maps of meaning, where the readers, in a dynamic relation with the texts, apprehend experiences, structures and feelings; putting into perspective Williams‘s theory of culture as a whole way of life, it also analyses the ways the author communicates and organizes these experiences, creating a space of communication and operating at different levels of reality: on the one hand, the reality of the whole way of Italian life, and, on the other hand, the reality of the reader who aspires to make sense and to create an interpretative context where all the information is put, and, also, the reality of the writer in the poetic act of writing. To read these travel writings as knowable communities is to understand them as a form that invents a community with no other existence but that of the literary text. The cultural construction we find in these texts is the result of the selection, and interpretation done by D.H.Lawrence, as well as the product of the author‘s enunciative positions, and of his epistemological and ontological filigrees of existence, structured by the conditions of possibility. In the rearticulation of the text, of the writer and of the reader, in a dynamic and shared process of discursive alliances, we understand that Lawrence tells stories of the Mediterranean through his literary art.

Mercury, cadmium, lead and arsenic levels in three pelagic fish species from the Atlantic Ocean: intra- and inter-specific variability and human health risks for consumption

Three commonly consumed and commercially valuable fish species (sardine, chub and horse mackerel) were collected from the Northeast and Eastern Central Atlantic Ocean in Portuguese waters during one year. Mercury, cadmium, lead and arsenic amounts were determined in muscles using graphite furnace and cold vapour atomic absorption spectrometry. Maximum mean levels of mercury (0.1715 ± 0.0857 mg/kg, ww) and arsenic (1.139 ± 0.350 mg/kg, ww) were detected in horse mackerel. The higher mean amounts of cadmium (0.0084 ± 0.0036 mg/kg, ww) and lead (0.0379 ± 0.0303 mg/kg, ww) were determined in chub mackerel and in sardine, respectively. Intra- and inter-specific variability of metals bioaccumulation was statistically assessed and species and length revealed to be the major influencing biometric factors, in particular for mercury and arsenic. Muscles present metal concentrations below the tolerable limits considered by European Commission Regulation and Food and Agriculture Organization of the United Nations/World Health Organization (FAO/WHO). However, estimation of non-carcinogenic and carcinogenic health risks by the target hazard quotient and target carcinogenic risk, established by the US Environmental Protection Agency, suggests that these species must be eaten in moderation due to possible hazard and carcinogenic risks derived from arsenic (in all analyzed species) and mercury ingestion (in horse and chub mackerel species).