Momento ideal para a endarterectomia de carótida após um AVC recente

Vários estudos prospectivos de escolha aleatória confirmaram a eficácia da endarterectomia de carótida na prevenção de novos acidentes vasculares cerebrais (AVC) em pacientes sintomáticos com estenose grave na carótida. Entretanto, o timing da endarterectomia ainda é controverso. A cirurgia precoce pode estar associada à hemorragia intracerebral e à extensão do infarto inicial. A cirurgia tardia pode expor o paciente à recorrência do AVC e à oclusão da artéria carótida. Os estudos que avaliaram o intervalo de tempo para a endarterectomia são retrospectivos e não randomizados. Na ausência de um estudo prospectivo randomizado comparando endarterectomia precoce e tardia, uma abordagem para se interpretar os resultados das séries cirúrgicas é a comparação destes com a história natural do AVC isquêmico. Os autores descrevem os argumentos em favor da cirurgia precoce, a história natural do AVC isquêmico e os fatores de risco associados ao AVC no perioperatório da endarterectomia.

Traqueostomia percutânea: técnica ideal?

A traqueostomia percutânea tem substituído a traqueostomia convencional em muitas Unidades de Terapia Intensiva, devido à facilidade e segurança do método realizado à beira do leito, dispensando o transporte do paciente da Unidade de Terapia Intensiva para o Centro Cirúrgico. Alguns autores sugerem que a dissecção limitada resulta em menor dano tecidual, diminui o risco de sangramento e infecção de ferida operatória. Esta revisão visa analisar e sintetizar estudos prospectivos e randomizados, revisões sistemáticas e meta-análises, comparando a traqueostomia percutânea e traqueostomia convencional em pacientes adultos em Unidades de Terapia Intensiva.

Frequency of fear of needles and impact of a multidisciplinary educational approach towards pregnant women with diabetes

PURPOSE: To evaluate the frequency of fear of needles and the impact of a multidisciplinary educational program in women with pre-gestational and gestational diabetes taking insulin during pregnancy. METHODS: The short Diabetes Fear of Injecting and Self-testing Questionnaire (D-FISQ), composed by two subscales that access fear of self injection (FSI) and fear of self testing (FST), was administered twice during pregnancy to 65 pregnant women with pre-gestational and gestational diabetes: at the first endocrine consult and within the last two weeks of pregnancy or postpartum. An organized multidisciplinary program provided diabetes education during pregnancy. Statistical analysis was carried out by Wilcoxon and McNemar tests and Spearman correlation. A p<0.05 was considered to be significant. RESULTS: Data from the short D-FISQ questionnaire shows that 43.1% of pregnant women were afraid of needles in the first evaluation. There was a significant reduction in scores for FSI and FST subscales between the first and second assessments (first FSI 38.5% compared with second 12.7%, p=0.001; first FST 27.7% compared with second FST 14.3%, p=0.012). CONCLUSIONS: The fear of needles is common in pregnant women on insulin therapy and an organized multidisciplinary educational diabetes program applied during pregnancy reduces scores of such fear.

Flows of Bingham Materials Through Ideal Porous Media: an Experimental and Theoretical Study

The flow of Bingham liquids through porous media has been studied. Experiments have been performed to determine the flow rate / pressure drop relationship for the flow of a grease of Binghamian rheological behavior through an array of rods of circular cross section. The yield stress and plastic viscosity of the grease have been determined with the aid of a controlled stress rotational rheometer. To investigate a wider range of the flow parameters, the mass and momentum conservation equations have been solved numerically, in conjunction with the generalized Newtonian constitutive law and the bi-viscosity model. The finite volume method has been employed to obtain the numerical solution. These numerical results also yielded a flow rate / pressure drop relationship, which is in very good agreement with the experimental results. A capillaric theory has been developed to determine an analytical relationship between the flow rate and pressure drop for flows of Bingham liquids through porous media. It is shown that the predictions of this theory are in good agreement with the experimental and numerical results.

Analysis of Regular and Irregular Dynamics of a Non Ideal Gear Rattling Problem

This paper presents a study on the dynamics of the rattling problem in gearboxes under non-ideal excitation. The subject has being analyzed by a number of authors such as Karagiannis and Pfeiffer (1991), for the ideal excitation case. An interesting model of the same problem by Moon (1992) has been recently used by Souza and Caldas (1999) to detect chaotic behavior. We consider two spur gears with different diameters and gaps between the teeth. Suppose the motion of one gear to be given while the motion of the other is governed by its dynamics. In the ideal case, the driving wheel is supposed to undergo a sinusoidal motion with given constant amplitude and frequency. In this paper, we consider the motion to be a function of the system response and a limited energy source is adopted. Thus an extra degree of freedom is introduced in the problem. The equations of motion are obtained via a Lagrangian approach with some assumed characteristic torque curves. Next, extensive numerical integration is used to detect some interesting geometrical aspects of regular and irregular motions of the system response.

Application of the center manifold theory to the study of slewing flexible Non-ideal structures with nonlinear curvature: a case study

In this paper is Analyzed the local dynamical behavior of a slewing flexible structure considering nonlinear curvature. The dynamics of the original (nonlinear) governing equations of motion are reduced to the center manifold in the neighborhood of an equilibrium solution with the purpose of locally study the stability of the system. In this critical point, a Hopf bifurcation occurs. In this region, one can find values for the control parameter (structural damping coefficient) where the system is unstable and values where the system stability is assured (periodic motion). This local analysis of the system reduced to the center manifold assures the stable / unstable behavior of the original system around a known solution.

On non-ideal and non-linear portal frame dynamics analysis using bogoliubov averaging method

We apply the Bogoliubov Averaging Method to the study of the vibrations of an elastic foundation, forced by a Non-ideal energy source. The considered model consists of a portal plane frame with quadratic nonlinearities, with internal resonance 1:2, supporting a direct current motor with limited power. The non-ideal excitation is in primary resonance in the order of one-half with the second mode frequency. The results of the averaging method, plotted in time evolution curve and phase diagrams are compared to those obtained by numerically integrating of the original differential equations. The presence of the saturation phenomenon is verified by analytical procedures.

Prevalence of metabolic syndrome and its association with educational inequalities among Brazilian adults: a population-based study

The present study estimated the prevalence of metabolic syndrome (MS) according to the criteria established by the National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATPIII) and the International Diabetes Federation (IDF) and analyzed the contribution of social factors in an adult urban population in the Southeastern region of Brazil. The sample plan was based on multistage probability sampling according to family head income and educational level. A random sample of 1116 subjects aged 30 to 79 years was studied. Participants answered a questionnaire about socio-demographic variables and medical history. Fasting capillary glucose (FCG), total cholesterol, high-density lipoprotein cholesterol (HDL-C), and triglycerides were determined and all non-diabetic subjects were submitted to the 75-g oral glucose tolerance test. Body mass index (BMI, kg/m²), waist circumference and blood pressure (BP) were determined. Age- and gender-adjusted prevalence of MS was 35.9 and 43.2% according to NCEP-ATPIII and IDF criteria, respectively. Substantial agreement was found between NCEP-ATPIII and IDF definitions. Low HDL-C levels and high BP were the most prevalent MS components according to NCEP-ATPIII criteria (76.3 and 59.2%, respectively). Considering the diagnostic criteria adopted, 13.5% of the subjects had diabetes and 9.7% had FCG ≥100 mg/dL. MS prevalence was significantly associated with age, skin color, BMI, and educational level. This cross-sectional population-based study in the Southeastern region of Brazil indicates that MS is highly prevalent and associated with an important social indicator, i.e., educational level. This result suggests that in developing countries health policy planning to reduce the risk of MS, in particular, should consider improvement in education.

Ideal sweetness of mixed juices from Amazon fruits

Ready-to-drink fruit juices represent a large share of the market and are an important target for product development. The mixture of fruits can bring about improvements to nutritional and sensory aspects of these beverages while making used of the wide variety of exotic fruits from the Amazon region. Therefore, it is necessary to select mixed fruits and determine their ideal sweetness according to consumer acceptance. Consumers in the city of Belém (Brazil) evaluated five different concentrations of sugar using the just-about-right scale in two blends selected by preference ranking. For the cupuassu-acerola-açai blend, the optimum concentration of sugar was 9.5 g/100 mL, and for the soursop-camucamu-yellow mombin blend, it was 10.7 g/100 mL.

Development of pitanga nectar with different sweeteners by sensory analysis: ideal pulp dilution, ideal sweetness, and sweetness equivalence

The objective of this study was to develop pitanga nectar formulations in which sucrose was replaced with different sweeteners. Consumer tests were conducted with 50 fruit juice consumers, and a just-about-right scale was used to determine the ideal pulp dilution and ideal sweetness with sucrose. Furthermore, the adequate concentrations of six sweeteners were determined to obtain the equivalent sweetness of sucrose using relative to these concentrations the magnitude estimation model with 19 selected assessors. The ideal dilution test resulted in 25% pulp, and the ideal sweetness test, 10% sucrose. Sweetener concentrations to replace sucrose were 0.0160%, 0.0541%, 0.1000%, 0.0999%, 0.0017%, and 0.0360%, respectively, for sucralose, aspartame, stevia 40% rebaudioside A, stevia 95% rebaudioside A, neotame, and a 2:1 cyclamate/saccharin blend. These results can be used to prepare pitanga nectar with different sweeteners and obtain the same sweetness intensity in less caloric products than that of nectar prepared with sucrose.

A hipotética linguagem ideal de Platão

Para que um discurso sobre o espetáculo do mundo transcendente seja acolhido como totalidade inteligível e coerente, urge desvencilhar-se da arbitrariedade do domínio de trêmulos contornos do sensível, esfera de opiniões apenas. É o que propõe Platão, na esteira das reflexões dos primeiros pensadores: para suprir deficiências que causam a elisão da realidade e transformar a linguagem num veículo de intelecção autêntica dos conceitos essenciais de um pensar filosófico, ele a coloca no centro de uma especulação rigorosa. Tal como seus antecessores Heráclito e Parmênides, Platão revela logofilia ao empenhar-se na construção de uma nova estrutura discursiva, diferente daquela do homem comum, desencadeando no campo da Filosofia uma revolução que se tornara indispensável: elabora um modelo fundador - princípio de uma ordem permanente propedêutica à construção de uma linguagem formal e abstrata - referente a entes que os homens, na maioria, por si mesmos não conseguem visualizar. Somente nela poderá reverberar a verdade universal das Formas que, ao emprestarem seus nomes à infindável série dos particulares sensíveis, os clarifica e lhes confere significação. Com as teorias que a partir das Formas desenvolve e expõe nos Diálogos, o filósofo visa induzir o leitor a preparar-se para operar, metodicamente, a conversão de sua alma ao plano desses seres ideais, supra-sensíveis, e apreender, assim, a realidade que tudo fundamenta e torna cognoscível.

O ideal de Baudelaire por Walter Benjamin

O artigo examina a interpretação feita por Walter Benjamin dos poemas de Charles Baudelaire marcados pela noção de ideal, a qual se opõe ao spleen. Benjamin encontra aí o esforço de rememoração de uma experiência plena, a qual constituiria, por sua vez, um elemento essencial à compreensão da modernidade como impossibilidade desta forma de experiência. Com as noções de beleza e de aura, o artigo busca ainda salientar a importância da categoria da distância para a configuração desta forma de experiência.

La felicidad como ideal de la imaginación

En este artículo intentamos desarrollar mínimamente los cinco discursos sobre la felicidad que hemos encontrado en la obra de Kant. Los hemos encontrado con dificultad, porque no se trata de discursos ordenados ni continuados a lo largo de sus páginas, sino más bien de sugerencias que van apareciendo de vez en cuando al hilo de otras reflexiones. La felicidad se dibuja como totalidad, como un concepto indeterminado, como el polo opuesto a la cultura, como sentimiento y como bien. Aunque no se trate de discursos bien enlazados, es posible seguirles la pista a lo largo de los textos. No obstante, hay otra sugerencia que Kant nos proporciona y que él mismo no desarrolla en absoluto: según ella la felicidad sería el ideal de la imaginación. Este sexto discurso no pronunciado tal vez pudiera suministrar la clave que nos sirva para encontrar la coherencia de los demás.

Mundo Real e Mundo Ideal em Rousseau: da Necessidade da Ficção para Pensar o Político

RESUMO:A hipótese desenvolvida nos leva a confrontar três textos do corpusrousseauísta: o Segundo Discurso, Júlia ou A Nova Heloísa e o extrato do Primeiro Diálogo, em que há a ficção do mundo ideal, textos que, apesar do seu estatuto genérico diferente, estão em coerência e convergência teórica. Desejamos evidenciar um aspecto da unidade problemática do pensamento de Rousseau concernente à abordagem crítica da sociedade de seus contemporâneos e sua concepção do papel das Letras e dos Espetáculos. A preocupação do filósofo é de refundar a natureza humana, a fim de lançar as bases de uma nova organização social. Nessa empreitada, a ficção desempenha um papel crucial, o prefácio do Segundo Discurso o comprova: para bem conhecer o homem atual, deve-se supor o que ele não é mais. O homem do estado de natureza, ser de ficção, cujas paixões são retas e naturais, é o modelo teórico que reativa a sociedade dos seres ideais de Júlia. Dessa forma, a ficção é chamada a desempenhar um papel referencial fundamental para o pensamento social e político de Rousseau, aparecendo como um poderoso meio de ação sobre o público. O romance pode reeducar os povos corrompidos, pois, assim como o teatro, como denuncia a Carta a d’Alembert, possui os meios para perverter uma sociedade tida como virtuosa.