Effects of continuous versus bolus infusion of enteral nutrition in critical patients

PURPOSE: Enteral alimentation is the preferred modality of support in critical patients who have acceptable digestive function and are unable to eat orally, but the advantages of continuous versus intermittent administration are surrounded by controversy. With the purpose of identifying the benefits and complications of each technique, a prospective controlled study with matched subjects was conducted. PATIENTS AND METHODS: Twenty-eight consecutive candidates for enteral feeding were divided into 2 groups (n = 14 each) that were matched for diagnosis and APACHE II score. A commercial immune-stimulating polymeric diet was administered via nasogastric tube by electronic pump in the proportion of 25 kcal/kg/day, either as a 1-hour bolus every 3 hours (Group I), or continuously for 24 hours (Group II), over a 3-day period. Anthropometrics, biochemical measurements, recording of administered drugs and other therapies, thorax X-ray, measurement of abdominal circumference, monitoring of gastric residue, and clinical and nutritional assessments were performed at least once daily. The principal measured outcomes of this protocol were frequency of abdominal distention and pulmonary aspiration, and efficacy in supplying the desired amount of nutrients. RESULTS: Nearly half of the total population (46.4%) exhibited high gastric residues on at least 1 occasion, but only 1 confirmed episode of pulmonary aspiration occurred (3.6%). Both groups displayed a moderate number of complications, without differences. Food input during the first day was greater in Group II (approximately 20% difference), but by the third day, both groups displayed similarly small deficits in total furnished volume of about 10%, when compared with the prescribed diet. CONCLUSIONS: Both administration modalities permitted practical and effective administration of the diet with frequent registered abnormalities but few clinically significant problems. The two groups were similar in this regard, without statistical differences, probably because of meticulous technique, careful monitoring, strict patient matching, and conservative amounts of diet employed in both situations. Further studies with additional populations, diagnostic groups, and dietetic prescriptions should be performed in order to elucidate the differences between these commonly used feeding modalities.

Proton magnetic resonance spectroscopy of the frontal lobe in schizophrenics: a critical review of the methodology

Schizophrenic patients undergoing proton magnetic resonance spectroscopy show alterations in N-acetyl aspartate levels in several brain regions, indicating neuronal dysfunction. The present review focuses on the main proton magnetic resonance spectroscopy studies in the frontal lobe of schizophrenics. A MEDLINE search, from 1991 to March 2004, was carried out using the key-words spectroscopy and schizophrenia and proton and frontal. In addition, articles cited in the reference list of the studies obtained through MEDLINE were included. As a result, 27 articles were selected. The results were inconsistent, 19 papers reporting changes in the N-acetyl aspartate levels, while 8 reported no change. Methodological analysis led to the conclusion that the discrepancy may be due the following factors: (i) number of participants; (ii) variation in the clinical and demographic characteristics of the groups; (iii) little standardization of the acquisition parameters of spectroscopy. Overall, studies that fulfill strict methodological criteria show N-acetyl aspartate decrease in the frontal lobe of male schizophrenics.

Weimar and the crisis of political legitimacy in Late Modernity : Max Weber, Hans Kelsen and Carl Schmitt

Através da comparação das ideias de três grandes teóricos da política no conturbado contexto da República de Weimar, esta dissertação pretende reconsiderar a crise da legitimidade política na modernidade tardia. Tal crise é concebida tanto em sentido estrito, enquanto crise das democracias liberais perante os efeitos de rápidas mudanças sociais e a emergência da política de massas, como em sentido lato, ou seja, enquanto crise dos alicerces político-intelectuais da era moderna. Nessa medida, veremos como os juízos de Weber, Kelsen e Schmitt não se limitam a veicular veredictos contrastantes sobre a democracia de massas, o parlamentarismo e os partidos políticos, remetendo também para narrativas distintas sobre o destino do homem moderno – narrativas que oscilam entre o optimismo moderado, a ambivalência e a reacção hostil.

Aspectos fundamentais da experiência da vida

A tese que de seguida se esboça assenta sobre uma inquietação fundamental: o facto de cada um dar por si atirado na vida, de, quando cada um dá por si, dar por si a ser vida, etc. Acontece que, logo que se tenta focar mais precisamente de que é de que se trata quando se trata da “vida”, nota-se que esse fenómeno tem habitualmente a forma de um acontecimento anónimo: não se sabe bem a que é que corresponde, que conteúdos tem, que estruturas fundamentais a suportam, etc. Isto é: somos levados pela vida (passamos pela vida, atravessamo-la, estamos expostos a ela, etc.) sem saber exactamente a que é que estamos expostos, o que é que nos leva, sobre que pilares assenta a nossa vivência e a nossa compreensão dela, etc. A tese que se segue não tem a pretensão de deixar definitivamente respondidas estas perguntas; tudo o que faz, na verdade, é meramente proceder a um breve levantamento ou a um registo de algumas das estruturas fundamentais da vida a partir do ângulo da experiência da vida. E, como se espera deixar claro, procurar a resposta a partir do ângulo da experiência (do ângulo da experiência da vida) não é algo acidental ou fortuito. O que se procurará apurar é se não haverá tais laços de afinidade entre “vida” e “experiência” que todas as operações próprias da experiência têm lugar numa vinculação e estão subordinadas às estruturas fundamentais da vida (estruturas que ultrapassam o âmbito da “experiência”) e que, assim também, a vida tenha, de raiz, no modo como nela somos levados e conduzidos, a estrutura ou a forma da “experiência”.

Cumprimento de ordens, obediência hierárquica e disciplina militar versus perpetração (in)voluntária de crimes

Following orders, hierarchical obedience and military discipline are essential values for the survival of the armed forces. Without them, it is not possible to conceive the armed forces as an essential pillar of a democratic state of law and a guarantor of national independence. As issuing orders as well as receiving and following them are inextricably linked to military discipline, and as such injunctions entail the workings of a particular obedience regime within the specific kind of organized power framework which is the Armed Forces, only by analysing the importance of such orders within this microcosm – with its strict hierarchical structure – will it be possible to understand which criminal judicial qualification to ascribe to the individual at the rear by reference to the role of the front line individual (i.e. the one who issues an order vs the one who executes it). That is, of course, when we are faced with the practice of unlawful acts, keeping in mind the organizational framework and its influence over the will of the executor. One thing we take as read, if the orders can be described as unlawful, the boundary line of the duty of obedience, which cannot be overstepped, both because of a legal as well as a constitutional imperative, will have been crossed. And the military have sworn an oath of obedience to the fundamental law. The topic of hierarchical obedience cannot be separated from the analysis of current legislation which pertains to the topic within military institutions. With that in mind, it appeared relevant to address the major norms which regulate the matter within the Portuguese military legal system, and, whenever necessary and required by the reality under analysis, to relate that to civilian law or legal doctrine.

Quantitative Centromere Epigenetics

A PhD is like a box of chocolates, …… and in this thesis I will present what I got. My work has been focused on a cellular structure that is essential for accurate genome inheritance: the centromere. Centromeres are chromosomal domains that do not rely on the presence of any specific DNA sequence. Rather, they are determined by the presence of a histone variant called CENP-A. Stable transmission of CENP-A containing chromatin is accomplished through 1) an unusually high level of protein stability, 2) selfdirected recruitment of nascent CENP-A near existing molecules, and 3) strict cell cycle regulation of assembly. Together, these features lead to a self-sustaining loop that allows for epigenetic maintenance of centromeres.(...)

Dependable decentralized storage management for cloud computing

The MAP-i Doctoral Program of the Universities of Minho, Aveiro and Porto.

As agências europeias no Direito Administrativo Europeu

Dissertação de mestrado em Direito Administrativo

A narrativa da liderança escolar: os alunos como agentes de revelação

Publicado em "Educação, territórios e desenvolvimento humano: atas do I Seminário Internacional, Vol. I – conferências e intervenções". ISBN 978-989-96186-9-5

Aplicação de técnicas e procedimentos Lean Production numa empresa da indústria automóvel

Dissertação de mestrado integrado em Engenharia e Gestão Industrial

Column-based databases: estudo exploratório no âmbito das bases de dados NoSQL

Dissertação de mestrado integrado em Engenharia e Gestão de Sistemas de Informação

Study to determine the cardiovascular risk ofthe population of Guimarães/Vizela, includingthe prevalence of arterial stiffness and early vascular aging syndrome

Tese de Doutoramento em Medicina.

O papel dos livros informativos para a infância na conformação de uma educação histórica

Relatório de estágio de mestrado em Educação Pré-Escolar e Ensino do 1ºCiclo do Ensino Básico

Current situation on the occurrence of mycotoxins and toxigenic fungi in Portugal

Mycotoxins are secondary metabolites produced by filamentous fungi that are toxic for humans and animals in small amounts and that are found worldwide in a large number of agricultural commodities. They are usually ingested involuntarily, when contaminated plant products are consumed, and represent a great risk for public health. Therefore, governments throughout the world have imposed strict legal limits for their levels in food and feed products in order to reduce potential health risks for consumers. Despite of its ubiquity, the mycotoxin problem is mainly dependent on regional factors, such as the mycotoxigenic characteristics of the local mycoflora, the local climate conditions, and the local agricultural practices. For this reason, a constant vigilance from local governmental food safety agencies and from the local researcher community is needed. This communication will review the current situation on the occurrence of mycotoxigenic fungi in some Portuguese cultures, such as wine grapes, corn and dried fruits. Particular attention will be given to the incidence of mycotoxigenic Aspergillus strains in those cultures and to the levels of ochratoxin A, aflatoxins, cyclopiazonic acid and fumonisin B2 produced. Data will be discussed taking into account the geographical origin of the isolates and the particular climate conditions of each sampling region. An updated review on the levels of the main mycotoxins found in local products and in imported commodities will also be presented.

Prácticas comunicativas forenses: Las relaciones intertextuales en el examen de testigos. Forensic communicative practices: intertextual relations in examination of witnesses.

Inscripto en el análisis del discurso interaccional de tradición angloamericana y optando por un abordaje metodológico etnográfico, este proyecto plantea investigar las relaciones entre textos orales y entre textos orales y escritos vinculados en cadenas textuales en un acontecimiento comunicativo institucional en el que tales relaciones tienen consecuencias directas en la confiabilidad de la información e intervienen en la construcción del conocimiento oficial. La situación comunicativa elegida es el examen y el contraexamen de testigos comunes durante procesos penales orales, de formato común no abreviado, en la jurisdicción de Córdoba capital. En las interacciones verbales con litigantes y jueces en las que emerge el testimonio se ponen en juego otros textos orales (en forma de citas de lo dicho antes por el mismo testigo u otras personas, referencias a rumores u opiniones colectivas, etc.) y textos escritos (actas de secuestro, informes periciales, actas de las declaraciones testimoniales en la etapa de instrucción, etc.). El foco de atención son las prácticas asociadas a la intertextualidad puesto que condicionan el carácter de la prueba testimonial producida ante el juzgador. Postulamos que los litigantes despliegan tácticas locales y estrategias globales reconocibles y recurrentes vinculadas al tratamiento de diversas categorías de textos previos. Además, planteamos averiguar si la participación de los jueces en interacción con los testigos es de suficiente injerencia como para ser un modo importante de generación de prueba testimonial. El enfoque metodológico general es etnográfico y analíticodiscursivo. Se seleccionará una causa por delito grave, se presenciará el debate en la cámara y se registrará el audio de todas las audiencias. Los datos a analizar serán los segmentos en las interacciones en los que se incorpora la lectura o se cita las actas de las declaraciones indagatorias o testimoniales anteriores, y los segmentos en los que se requiere, en calidad de prueba testimonial, la reproducción de dichos. Se procederá a partir de los detalles de la superficie textual y la pragmática de los intercambios y aprovechando el valor heurístico del concepto de voz, buscando identificar patrones recurrentes y los mecanismos generales que los rigen. Sobre esa base, se considerarán los intercambios verbales como interacción social que emerge moldeada por condiciones situacionales e institucionales y otros factores, tales como la incidencia de la pertenencia a grupos sociales o profesionales. Con el estudio se obtendrá una visión de prácticas cotidianas asociadas a la intertextualidad que son de crucial importancia para el carácter de la prueba testimonial producida ante el juzgador. Este paso nos acercará a conocer cómo se lleva a cabo efectivamente la administración de justicia penal y permitirá valorar los patrones de conducta a la luz de las normas procesales. In line with the Anglo-American tradition of situated discourse analysis, this project aims at tracing the links between oral texts and between oral and written texts related in textual chains which are present in an institutional event in which such relations have a direct consequence on the reliability of the information given and have an impact on the construction of what counts as official knowledge. The communicative situation under study is that of the direct and cross-examination of lay witnesses during a criminal trial in the city of Córdoba. During the face-to-face interactions between trial lawyers and judges in which the testimony takes place, other oral texts and written texts get incorporated. The focus of this research is centered on practices of intertextuality as they condition the nature of the oral evidence produced. It is argued that trial lawyers use recurrent local tactics and global strategies that are related to the treatment given to different categories of previous texts. Another aim of this study is to examine if judge’s interventions have an impact on the generation of the oral evidence. The data will come from a criminal trial that will be audio-taped in its entirety. Ethnographic observations of a criminal trial will be made. The focus of analysis will be on segments of interactions in which previous texts are read aloud or incorporated as quotes. After carrying out a detailed analysis of the surface of texts and the pragmatics of the exchanges, recurrent patterns and the general mechanisms that condition their emergence will be described. In this way, verbal exchanges will be considered social interactions that unfold conditioned by situational, institutional and social factors. This study will examine the relationship between intertextuality and the institutional practice of providing oral evidence. This will help understand how justice is actually administered and how patterns of behavior are valued according to institutional norms.