Trabalho noturno em unidades fechadas: estudo com trabalhadores de enfermagem num hospital público

Esta pesquisa tem como objetivo geral avaliar as situações que envolvem o trabalho noturno em unidades fechadas, sob a percepção dos profissionais de enfermagem de um hospital público. Trata-se de um estudo descritivo com abordagem quantitativa, utilizando um questionário semiestruturado com perguntas fechadas. O instrumento abrange as condições de trabalho, as condições de saúde, o ambiente de trabalho, as relações com os colegas e com a chefia, a motivação e a percepção do profissional de enfermagem no que se refere à valorização profissional que a sociedade e os outros profissionais atribuem ao seu trabalho. Foi utilizada uma população amostral de noventa sujeitos distribuídos em quatro clínicas fechadas. Os dados foram analisados através do programa Statistical Package for the Social Sciences (SPSS). Os resultados permitiram estabelecer uma relação desses dados com a atuação dos profissionais no que se refere à satisfação na execução dos procedimentos. Os trabalhadores de enfermagem do serviço noturno em unidades fechadas são representados, majoritariamente, por mulheres entre 41 e 50 anos de idade, casadas e com filhos sob sua guarda, 60% apresentam dois vínculos empregatícios com carga horária de trabalho superior a 60 horas semanais, encontram-se satisfeitas por atuarem em unidades fechadas e insatisfeitas com o serviço noturno, apresentando-se, portanto, estressadas e desmotivadas, com ganho de peso e índice elevado de afastamento por motivo de saúde. Os resultados apontam, ainda, que 90% dos participantes nunca receberam incentivos para a realização de cursos de atualização, 63,3% expressaram insatisfação com o dimensionamento de pessoal, o que se traduz em sobrecarga de atividades para os profissionais. Mais de 50% dos participantes da pesquisa sentem-se desvalorizados profissionalmente perante a sociedade e encontram-se insatisfeitos com os salários e benefícios oferecidos pela instituição. No que se refere à exposição a riscos, 86,6% dos profissionais se declararam insatisfeitos e muito insatisfeitos com os riscos ergonômicos. Já os riscos químicos, biológicos, psicossociais e mecânicos apresentaram 50% de índice de insatisfação, seguido pelos riscos físicos com 40%. Os dados desse estudo levam a concluir que existe uma grande complexidade de fatores, cuja interação interfere direta e indiretamente na qualidade do desempenho profissional de enfermagem e contribui para a falta de segurança e insatisfação no trabalho noturno.

Cumulative inbreeding rate in hatchery-reared indian major carps of Karnataka and Maharashtra states

The state fisheries department hatcheries are the major suppliers of seed to the farmers in Karnataka and Maharashtra. The brood stocks of these hatcheries are genetically closed units. In the present study, effective population size and cumulative inbreeding rates were estimated. The cumulative inbreeding rates ranged from 2.69 to 13.75, 8.63 to 15.21 and 3.02 to 5.88 per cent for catla, mrigal and rohu, respectively, in Karnataka state hatcheries. In Maharashtra, the cumulative inbreeding rates for catla ranged from 7.81 to 39.34 per cent and it was 5.84 to 14.09 and 2.46 to 10.20 per cent for mrigal and rohu, respectively. To estimate the inbreeding rates in future generations, predictive models were developed using linear regression, and polynomial and power equations separately for each hatchery. Their multiple correlation and standard errors suggested that simple linear regression can predict the future inbreeding rate efficiently.

El Plan Bonet, 1961-64. La condición del paisaje en la ordenación del desarrollo turístico de La Manga del Mar Menor

En el contexto rural de Murcia, la recepción de la modernidad fue un fenómeno episódico y tardío. Hacia 1960 se produjo, sin embargo, un breve e ilusionante periodo cuando algunos maestros de la arquitectura española llegaron para trabajar en el desarrollo turístico de un litoral virgen y lleno de oportunidades. Entre ellos, Antoni Bonet recibió el encargo de urbanizar La Manga, una estrecha franja de tierra de 24km que separa el Mediterráneo del Mar Menor. El Plan retomaba los planteamientos urbanos de Le Corbusier para reelaborar algunas ideas preparatorias: autonomía y jerarquía de los núcleos habitados, eje vertebrador, centro cívico al borde del mar, tratamiento del frente marítimo con islas artificiales. Minimizando su impacto en el ecosistema dunar con una carretera elevada puntualmente para favorecer el aporte de arena, el Plan concentraba la edificación alrededor de torres de 16 plantas, generando unidades compactas de viviendas y equipamientos repetidas cada 2km. Inspirándose en la lectura del territorio de Le Corbusier en Buenos Aires (1929), Bonet respondía a la horizontalidad del plano del mar por contraste topológico, subrayando la presencia vertical de las torres como hitos paisajísticos que, desde la orilla opuesta, marcaban la posición de cada núcleo.

End-expiratory lung volume recovers more slowly after closed endotracheal suctioning than after open suctioning : a randomized crossover study

Purpose Endotracheal suctioning causes significant lung derecruitment. Closed suction (CS) minimizes lung volume loss during suction, and therefore, volumes are presumed to recover more quickly postsuctioning. Conflicting evidence exists regarding this. We examined the effects of open suction (OS) and CS on lung volume loss during suctioning, and recovery of end-expiratory lung volume (EELV) up to 30 minutes postsuction. Material and Methods Randomized crossover study examining 20 patients postcardiac surgery. CS and OS were performed in random order, 30 minutes apart. Lung impedance was measured during suction, and end-expiratory lung impedance was measured at baseline and postsuctioning using electrical impedance tomography. Oximetry, partial pressure of oxygen in the alveoli/fraction of inspired oxygen ratio and compliance were collected. Results Reductions in lung impedance during suctioning were less for CS than for OS (mean difference, − 905 impedance units; 95% confidence interval [CI], − 1234 to –587; P < .001). However, at all points postsuctioning, EELV recovered more slowly after CS than after OS. There were no statistically significant differences in the other respiratory parameters. Conclusions Closed suctioning minimized lung volume loss during suctioning but, counterintuitively, resulted in slower recovery of EELV postsuction compared with OS. Therefore, the use of CS cannot be assumed to be protective of lung volumes postsuctioning. Consideration should be given to restoring EELV after either suction method via a recruitment maneuver.

The implausibility of ‘usual care’ in an open system: sedation and weaning practices in Paediatric Intensive Care Units (PICUs) in the United Kingdom (UK).

Background
The power of the randomised controlled trial depends upon its capacity to operate in a closed system whereby the intervention is the only causal force acting upon the experimental group and absent in the control group, permitting a valid assessment of intervention efficacy. Conversely, clinical arenas are open systems where factors relating to context, resources, interpretation and actions of individuals will affect implementation and effectiveness of interventions. Consequently, the comparator (usual care) can be difficult to define and variable in multi-centre trials. Hence outcomes cannot be understood without considering usual care and factors that may affect implementation and impact on the intervention.

Methods
Using a fieldwork approach, we describe PICU context, ‘usual’ practice in sedation and weaning from mechanical ventilation, and factors affecting implementation prior to designing a trial involving a sedation and ventilation weaning intervention. We collected data from 23 UK PICUs between June and November 2014 using observation, individual and multi-disciplinary group interviews with staff.

Results
Pain and sedation practices were broadly similar in terms of drug usage and assessment tools. Sedation protocols linking assessment to appropriate titration of sedatives and sedation holds were rarely used (9 % and 4 % of PICUs respectively). Ventilator weaning was primarily a medical-led process with 39 % of PICUs engaging senior nurses in the process: weaning protocols were rarely used (9 % of PICUs). Weaning methods were variably based on clinician preference. No formal criteria or use of spontaneous breathing trials were used to test weaning readiness. Seventeen PICUs (74 %) had prior engagement in multi-centre trials, but limited research nurse availability. Barriers to previous trial implementation were intervention complexity, lack of belief in the evidence and inadequate training. Facilitating factors were senior staff buy-in and dedicated research nurse provision.

Conclusions
We examined and identified contextual and organisational factors that may impact on the implementation of our intervention. We found usual practice relating to sedation, analgesia and ventilator weaning broadly similar, yet distinctively different from our proposed intervention, providing assurance in our ability to evaluate intervention effects. The data will enable us to develop an implementation plan; considering these factors we can more fully understand their impact on study outcomes.

Pairwise assembly of organopalladium(II) units with cyanurato(3-) and trithiocyanurato(3-) ligands: formation of chiral Pd12, Pd10 and Pd9 cage-molecules

The o-palladated, chloro-bridged dimers [Pd{2-phenylpyridine(-H)}-μ-Cl]2 and [Pd{N,N-dimethylbenzylamine(-H)}-μ-Cl]2 react with cyanuric acid in the presence of base to afford closed, chiral cage-molecules in which twelve organo-Pd(II) centers, located in pairs at the vertices of an octahedron, are linked by four tetrahedrally-arranged cyanurato(3-) ligands. Incomplete (Pd10) cages, having structures derived from the corresponding Pd12 cages by replacing one pair of organopalladium centers with two protons, have also been isolated. Reaction of [Pd{2-phenylpyridine(-H)}-μ-Cl]2 with trithiocyanuric acid gives an entirely different and more open type of cage-complex, comprising only nine organopalladium centers and three thiocyanurato(3-) ligands: cage-closure in this latter system appears to be inhibited by steric crowding of the thiocarbonyl groups.

(Table 1) Summary of basalt unit thickness, vesicularity, number of flow units, and average porosity at ODP Site 135-839

An inflatable drill-string packer was used at Site 839 to measure the bulk in-situ permeability within basalts cored in Hole 839B. The packer was inflated at two depths, 398.2 and 326.9 mbsf; all on-board information indicated that the packer mechanically closed off the borehole, although apparently the packer hydraulically sealed the borehole only at 398.2 mbsf. Two pulse tests were run at each depth, two constant-rate injection tests were run at the first set, and four were run at the second. Of these, only the constant-rate injection tests at the first set yielded a permeability, calculated as ranging from 1 to 5 * 10**-12 m**2. Pulse tests and constant-rate injection tests for the second set did not yield valid data. The measured permeability is an upper limit; if the packer leaked during the experiments, the basalt would be less permeable. In comparison, permeabilities measured at other Deep Sea Drilling Project and Ocean Drilling Program sites in pillow basalts and flows similar to those measured in Hole 839B are mainly about 10**-13 to 10**-14 m**2. Thus, if our results are valid, the basalts at Site 839 are more permeable than ocean-floor basalts investigated elsewhere. Based on other supporting evidence, we consider these results to be a valid measure of the permeability of the basalts. Temperature data and the geochemical and geotechnical properties of the drilled sediments all indicate that the site is strongly affected by fluid flow. The heat flow is very much less than expected in young oceanic basalts, probably a result of rapid fluid circulation through the crust. The geochemistry of pore fluids is similar to that of seawater, indicating seawater flow through the sediments, and sediments are uniformly underconsolidated for their burial depth, again indicating probable fluid flow. The basalts are highly vesicular. However, the vesicularity can only account for part of the average porosity measured on the neutron porosity well log; the remainder of the measured porosity is likely present as voids and fractures within and between thin-bedded basalts. Core samples, together with porosity, density, and resistivity well-log data show locations where the basalt section is thin bedded and probably has from 15% to 35% void and fracture porosity. Thus, the measured permeability seems reasonable with respect to the high measured porosity. Much of the fluid flow at Site 839 could be directed through highly porous and permeable zones within and between the basalt flows and in the sediment layer just above the basalt. Thus, the permeability measurements give an indication of where and how fluid flow may occur within the oceanic crust of the Lau Basin.

Adult-population incidence of severe sepsis in Australian and New Zealand intensive care units

Objective. To determine the population incidence and outcome of severe sepsis occurring in adult patients treated in Australian and New Zealand intensive care units (ICUs), and compare with recent retrospective estimates from the USA and UK. Design. Inception cohort study. Setting. Twenty-three closed multi-disciplinary ICUs of 21 hospitals (16 tertiary and 5 university affiliated) in Australia and New Zealand. Patients. A total of 5878 consecutive ICU admission episodes. Measurements and results. Main outcome measures were population-based incidence of severe sepsis, mortality at ICU discharge, mortality at 28 days after onset of severe sepsis, and mortality at hospital discharge. A total of 691 patients, 11.8 (95% confidence intervals 10.9-12.6) per 100 ICU admissions, were diagnosed with 752 episodes of severe sepsis. Site of infection was pulmonary in 50.3% of episodes and abdominal in 19.3% of episodes. The calculated incidence of severe sepsis in adults treated in Australian and New Zealand ICUs is 0.77 (0.76-0.79) per 1000 of population. 26.5% of patients with severe sepsis died in ICU, 32.4% died within 28 days of the diagnosis of severe sepsis and 37.5% died in hospital. Conclusion. In this prospective study, 11.8 patients per 100 ICU admissions were diagnosed with severe sepsis and the calculated annual incidence of severe sepsis in adult patients treated in Australian and New Zealand ICUs is 0.77 per 1000 of population. This figure for the population incidence falls in the lower range of recent estimates from retrospective studies in the U.S. and the U.K.

Motor unit synchronization of the vasti muscles in closed and open chain tasks

Objectives: To investigate motor unit synchronization between medial and lateral vasti and whether such synchronization differs in closed and open chain tasks. Design: Electromyographic recordings of single motor unit action potentials were made from the vastus medialis obliquus (VMO) and multiunit recordings from vastus lateralis during isometric contractions at 30 degrees of knee flexion in closed and open chain conditions. Setting: Laboratory. Participants: Five volunteers with no history of knee pain (age, 30 +/- 3.32y). Interventions: Not applicable. Main Outcome Measure: The degree of synchronization between motor unit firing was evaluated by identifying peaks in the electromyographic averages of the vastus lateralis, triggered from motor unit action potentials in the VMO, and the proportion of power in the power spectral density of the triggered average at the firing frequency of the reference motor unit. The proportion of cases in which there was significant power and peaks in the triggered averages was calculated. Results: The proportion of trials with peaks in the triggered averages of the vastus lateralis electromyographic activity was greater than 61.5% in all tasks, and there was a significantly greater proportion of cases where power in the spectrum was greater than 7.5% (P = .01) for the closed chain condition. Conclusions: There was a high proportion of synchronized motor units between the 2 muscles during isometric contractions, with evidence for greater common drive between the VMO and vastus lateralis in closed chain tasks. This has implications for rehabilitation because it suggests that closed chain tasks may generate better coordination between the vasti muscles.

The Behavior of Hydroxyl Units of Synthetic Goethite and its Dehydroxylated Product Hematite

The behavior of the hydroxyl units of synthetic goethite and its dehydroxylated product hematite was characterized using a combination of Fourier transform infrared (FTIR) spectroscopy and X-ray diffraction (XRD) during the thermal transformation over a temperature range of 180-270 degrees C. Hematite was detected at temperatures above 200 degrees C by XRD while goethite was not observed above 230 degrees C. Five intense OH vibrations at 3212-3194, 1687-1674, 1643-1640, 888-884 and 800-798 cm(-1), and a H2O vibration at 3450-3445 cm(-1) were observed for goethite. The intensity of hydroxyl stretching and bending vibrations decreased with the extent of dehydroxylation of goethite. Infrared absorption bands clearly show the phase transformation between goethite and hematite: in particular. the migration of excess hydroxyl units from goethite to hematite. Two bands at 536-533 and 454-452 cm(-1) are the low wavenumber vibrations of Fe-O in the hematite structure. Band component analysis data of FTIR spectra support the fact that the hydroxyl units mainly affect the a plane in goethite and the equivalent c plane in hematite.