A medicina iluminista e o vitalismo: uma discussão do Nouveaux Éléments de la Science de l‟Homme de Paul-Joseph Barthez (1734-1806).

A dissertação comenta criticamente as interpretações recentes referentes ao vitalismo no século XVIII, dedicando atenção especial aos Nouveuax Éléments de la Science de lHomme (publicado primeiramente em 1778), de Paul-Joseph Barthez (1734-1806). Até a segunda metade do século XX, como é primeiramente argumentado nesta dissertação, intérpretes do iluminismo entendiam a doutrina mecanicista como a herdeira direta da Revolução Científica, bem como a corrente dominante no mundo das ciências da vida ao longo de todo o século XVIII. Assim, na historiografia do século passado, o vitalismo era ou escassamente mencionado, ou visto como uma retrógrada corrente anti-iluminista. Mais recentemente, vários historiadores e pesquisadores da história das ciências no século XVIII (sobretudo Williams e Reill) entendem o iluminismo de um modo mais amplo e plural, considerando o vitalismo iluminista (um termo proposto por Reill) como parte integrante de um conceito mais dinâmico de iluminismo. A seguir, são apresentados a doutrina mecanicista e seus conceitos centrais, bem como as ideias de alguns dos principais representantes do mecanicismo no século XVII e início do XVIII, no caso, mais especificamente, do mecanicismo newtoniano. Em seguida, são expostos e comentados a doutrina vitalista e seus conceitos, no que é dado destaque ao vitalismo na Universidade de Montpellier. Nesse contexto, são comentados conceitos vitalistas, tal como apresentados nos Nouveuax Éléments de la Science de lHomme, no qual Barthez propõe uma nova fisiologia baseada no princípio vital; nisso são apresentados sua metodologia de pesquisa, o conceito de princípio vital, as forças sensitivas e motrizes do princípio da vida, além dos conceitos de simpatia, sinergia e, por fim, o conceito de temperamento. Esses conceitos ou essa terminologia , tal como é mostrado, não são originalmente concebidos por Barthez, mas foram por ele reapropriados e reformulados em debate com o newtonianismo e demais correntes filosóficas médicas desde a Antiguidade até o século XVIII, assim como com observações e experimentos próprios às investigações médico-científicas da época. Como resultado, é alcançada uma compreensão da doutrina vitalista como um esforço intelectual inovador tanto interagindo quanto integrado com o debate científico contemporâneo, ou seja, os médicos vitalistas se viam e, em geral, eram vistos como atuando segundo os padrões de cientificidade exigidos por seus pares.

Impacto social do transplante cardíaco

Pós-graduação em Serviço Social - FCHS

O papel da acupunctura na medicina dentária: uma revisão de literatura

Dissertação para obtenção do grau de Mestre no Instituto Superior de Ciências da Saúde Egas Moniz

Um modelo matemático para estudo de otimização do consumo de energia elétrica

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Identificação das políticas de incentivo ao desenvolvimento da energia eólica no Rio Grande do Norte (RN)

Energy is a vital resource for social and economic development. In the present scenario, the search for alternative energy sources has become fundamental, especially after the oil crises between 1973 and 1979, the Chernobyl nuclear accident in 1986 and the Kyoto Protocol in 1997. The demand for the development of new alternative energy sources aims to complement existing forms allows to meet the demand for energy consumption with greater security. Brazil, with the guideline of not dirtying the energy matrix by the fossil fuels exploitation and the recent energy crisis caused by the lack of rains, directs energy policies for the development of other renewable energy sources, complementing the hydric. This country is one of the countries that stand out for power generation capacity from the winds in several areas, especially Rio Grande do Norte (RN), which is one of the states with highest installed power and great potential to be explored. In this context arises the purpose of this work to identify the incentive to develop policies of wind energy in Rio Grande do Norte. The study was conducted by a qualitative methodology of data analysis called content analysis, oriented for towards message characteristics, its informational value, the words, arguments and ideas expressed in it, constituting a thematic analysis. To collect the data interviews were conducted with managers of major organizations related to wind energy in Brazil and in the state of Rio Grande do Norte. The identification of incentive policies was achieved in three stages: the first seeking incentives policies in national terms, which are applied to all states, the second with the questionnaire application and the third to research and data collection for the development of the installed power of the RN as compared to other states. At the end, the results demonstrated hat in Rio Grande do Norte state there is no incentive policy for the development of wind power set and consolidated, specific actions in order to optimize the bureaucratic issues related to wind farms, especially on environmental issues. The absence of this policy hinders the development of wind energy RN, considering result in reduced competitiveness and performance in recent energy auctions. Among the perceived obstacles include the lack of hand labor sufficient to achieve the reporting and analysis of environmental licenses, the lack of updating the wind Atlas of the state, a shortfall of tax incentives. Added to these difficulties excel barriers in infrastructure and logistics, with the lack of a suitable port for large loads and the need for reform, maintenance and duplication of roads and highways that are still loss-making. It is suggested as future work the relationship of the technology park of energy and the development of wind power in the state, the influence of the technology park to attract businesses and industries in the wind sector to settle in RN and a comparison of incentive policies to development of wind energy in the Brazilian states observing wind development in the same states under study.

Genetic evidence for the vital function of osterix in cementogenesis

To date, attempts to regenerate a complete tooth, including the critical periodontal tissues associated with the tooth root, have not been successful. Controversy still exists regarding the origin of the cell source for cellular cementum (epithelial or mesenchymal). This disagreement may be partially due to a lack of understanding of the events leading to the initiation and development of the tooth roots and supportive tissues, such as the cementum. Osterix (OSX) is a transcriptional factor essential for osteogenesis, but its role in cementogenesis has not been addressed. In the present study, we first documented a close relationship between the temporal- and spatial-expression pattern of OSX and the formation of cellular cementum. We then generated 3.6 Col 1-OSX transgenic mice, which displayed accelerated cementum formation vs. WT controls. Importantly, the conditional deletion of OSX in the mesenchymal cells with two different Cre systems (the 2.3 kb Col 1 and an inducible CAG-CreER) led to a sharp reduction in cellular cementum formation (including the cementum mass and mineral deposition rate) and gene expression of dentin matrix protein 1 (DMP1) by cementocytes. However, the deletion of the OSX gene after cellular cementum formed did not alter the properties of the mature cementum as evaluated by backscattered SEM and resin-cast SEM. Transient transfection of Osx in the cementoblasts in vitro significantly inhibited cell proliferation and increased cell differentiation and mineralization. Taken together, these data support 1) the mesenchymal origin of cellular cementum (from PDL progenitor cells); 2) the vital role of OSX in controlling the formation of cellular cementum; and 3) the limited remodeling of cellular cementum in adult mice.

The effect of implementing a modified early warning scoring (MEWS) system on the adequacy of vital sign documentation

Introduction and objectives Early recognition of deteriorating patients results in better patient outcomes. Modified early warning scores (MEWS) attempt to identify deteriorating patients early so timely interventions can occur thus reducing serious adverse events. We compared frequencies of vital sign recording 24 h post-ICU discharge and 24 h preceding unplanned ICU admission before and after a new observation chart using MEWS and an associated educational programme was implemented into an Australian Tertiary referral hospital in Brisbane. Design Prospective before-and-after intervention study, using a convenience sample of ICU patients who have been discharged to the hospital wards, and in patients with an unplanned ICU admission, during November 2009 (before implementation; n = 69) and February 2010 (after implementation; n = 70). Main outcome measures Any change in a full set or individual vital sign frequency before-and-after the new MEWS observation chart and associated education programme was implemented. A full set of vital signs included Blood pressure (BP), heart rate (HR), temperature (T°), oxygen saturation (SaO2) respiratory rate (RR) and urine output (UO). Results After the MEWS observation chart implementation, we identified a statistically significant increase (210%) in overall frequency of full vital sign set documentation during the first 24 h post-ICU discharge (95% CI 148, 288%, p value <0.001). Frequency of all individual vital sign recordings increased after the MEWS observation chart was implemented. In particular, T° recordings increased by 26% (95% CI 8, 46%, p value = 0.003). An increased frequency of full vital sign set recordings for unplanned ICU admissions were found (44%, 95% CI 2, 102%, p value = 0.035). The only statistically significant improvement in individual vital sign recordings was urine output, demonstrating a 27% increase (95% CI 3, 57%, p value = 0.029). Conclusions The implementation of a new MEWS observation chart plus a supporting educational programme was associated with statistically significant increases in frequency of combined and individual vital sign set recordings during the first 24 h post-ICU discharge. There were no significant changes to frequency of individual vital sign recordings in unplanned admissions to ICU after the MEWS observation chart was implemented, except for urine output. Overall increases in the frequency of full vital sign sets were seen.

Understanding dementia is vital in all health care staff

As the Australian population continues to age, health care staff will come into contact with and care for increasing numbers of people with dementia. A basic understanding of dementia is important to the quality of these interactions. This article summarises recently published research on levels of knowledge of Alzheimer’s disease among health care staff in an Australian regional health district (Smyth, Fielding, Beattie, Gardiner, Moyle, Franklin, Hines & MacAndrew, 2013).

Putting vital stains in context

While vital staining remains a cornerstone in the diagnosis of ocular disease and contact lens complications, there are many misconceptions regarding the properties of commonly used dyes by eye-care practitioners and what is and what is not corneal staining after instillation of sodium fluorescein. Similarly, the proper use and diagnostic utility of rose Bengal and lissamine green B, the other two ophthalmic dyes commonly used for assessing ocular complications, have similarly remained unclear. Due to the limitations of vital stains for definitive diagnosis, concomitant signs and symptoms in addition to a complete patient history are required. Over the past decade, there have been many reports of a type of corneal staining—often referred to as solution-induced corneal staining (SICS)—that is observed with the use of multipurpose solutions in combination with soft lenses, more specifically silicone hydrogel lenses. Some authors believe that SICS is a sign of lens/solution incompatibility; however, new research shows that SICS may be neither a measure of lens/solution biocompatibility nor ‘true’ corneal staining, as that observed in pathological situations. A large component of SICS may be a benign phenomenon, known as preservative-associated transient hyperfluorescence (PATH). There is a lack of correlated signs and/or symptoms with SICS/PATH. Several properties of SICS/PATH, such as appearance and duration, differentiate it from pathological corneal staining. This paper reviews the properties of vital stains, their use and limitations in assessment of the ocular surface, the aetiology of corneal staining, characteristics of SICS/PATH that differentiate it from pathological corneal staining and what the SICS/PATH phenomenon means for contact lens-wearing patients.

Response to re : putting vital stains in context

A response to: "Re: Putting vital stains in context" by Eric Papas & Lyndon Jones, published in the same issue of this journal. "There has been considerable discussion in recent times about the origins of solution-induced corneal staining (SICS) and I welcome this opportunity to further clarify some points raised in my paper1 in relation to certain issues highlighted by Drs Papas and Jones.2 Part of the difficulty in understanding these phenomena relates to the imprecise terminology used. For example, Drs Papas and Jones state ‘. . . SICS..."

Response to re : putting vital stains in context

A response to "Re: Putting vital stains in context" by Charles W McMonnies, published in the same issue of this journal. "I thank Professor McMonnies for his thoughtful comments,1 which rightly forcemeto more directly address the clinical ramifications of solution-induced corneal staining (SICS). I concur with his observation that determining whether the staining can be attributed to preservative-associated transient hyperfluorescence (PATH) or true pathology can be difficult in a typical clinical situation, perhaps requiring two visits in a single day. There is no easy answer to this dilemma..."

Vital role of journalism underlined

Book Review of 'Tragedy at Pike River Mine: How and why 29 men died', by Rebecca Macie. Wellington: AWA Press, 2013, 224 pp. ISBN 9781877551901

The primacy of vital signs – Acute care nurses’ and midwives’ use of physical assessment skills: A cross sectional study

BACKGROUND: Registered nurses and midwives play an essential role in detecting patients at risk of deterioration through ongoing assessment and action in response to changing health status. Yet, evidence suggests that clinical deterioration frequently goes unnoticed in hospitalised patients. While much attention has been paid to early warning and rapid response systems, little research has examined factors related to physical assessment skills. OBJECTIVES: To determine a minimum data set of core skills used during nursing assessment of hospitalised patients and identify nurse and workplace predictors of the use of physical assessment to detect patient deterioration. DESIGN: The study used a single-centre, cross-sectional survey design. SETTING and PARTICIPANTS: The study included 434 registered nurses and midwives (Grades 5-7) involved in clinical care of patients on acute care wards, including medicine, surgery, oncology, mental health and maternity service areas, at a 929-bed tertiary referral teaching hospital in Southeast Queensland, Australia. METHODS: We conducted a hospital-wide survey of registered nurses and midwives using the 133-item Physical Assessment Skills Inventory and the 58-item Barriers to Registered Nurses’ Use of Physical Assessment scale. Median frequency for each physical assessment skill was calculated to determine core skills. To explore predictors of core skill utilisation, backward stepwise general linear modelling was conducted. Means and regression coefficients are reported with 95% confidence intervals. A p value < .05 was considered significant for all analyses. RESULTS: Core skills used by most nurses every time they worked included assessment of temperature, oxygen saturation, blood pressure, breathing effort, skin, wound and mental status. Reliance on others and technology (F = 35.77, p < .001), lack of confidence (F = 5.52, p = .02), work area (F = 3.79, p = .002), and clinical role (F = 44.24, p < .001) were significant predictors of the extent of physical assessment skill use. CONCLUSIONS: The increasing acuity of the acute care patient plausibly warrants more than vital signs assessment; however, our study confirms nurses’ physical assessment core skill set is mainly comprised of vital signs. The focus on these endpoints of deterioration as dictated by early warning and rapid response systems may divert attention from and devalue comprehensive nursing assessment that could detect subtle changes in health status earlier in the patient's hospitalisation.

Biomassan energia-arvon nostaminen sekundäärilämmöllä kuivaamalla

Viime aikoina ilmastonmuutos, fossiilisten polttoaineiden väheneminen ja niiden hinnan nousu ovat lisänneet merkittävästi maailmanlaajuista kiinnostusta uusiutuviin energiavaroihin. Suomessa uusiutuvien energialähteiden käytössä on jo pitkään panostettu metsäteollisuuden sivutuotevirtana tuottamaan puuperäiseen biomassaan, jota metsäteollisuus käyttää energiantuotantoonsa. Metsäteollisuuden jätevesien käsittelyssä syntyy erilaisia lietteitä, jotka joko uusiokäytetään tai hävitetään polttamalla tai sijoittamalla kaatopaikalle. Erityisesti biolietteiden uusiokäyttö on hankalaa ja kaatopaikkasijoitus tulevaisuudessa mahdotonta tai ainakin kustannuksiltaan kohtuutonta. Käytännössä liete hävitetään polttamalla ja kuivaamalla siitä tulee polttoaine. Lietteiden energiakäyttö on järkevin tapa hävittää jäteliete. Lietteiden korkean vesipitoisuuden vuoksi ne tulee kuitenkin kuivata ennen polttoa. Lietteen kuivaaminen sekundäärienergiavirralla eli metsäteollisuusprosesseissa sivutuotteena muodostuvalla ns. hukkalämmöllä lisää lietteen poltosta saatavaa energiamäärää ja korvaa fossiilisten polttoaineiden käyttöä. Tutkimuksen tavoitteena oli selvittää lietteen kuivaukseen optimaalisin kuoren ja lietteen seossuhde eri kuivausparametrejä vaihdellen. Kokeellinen työ aloitettiin rakentamalla energiatekniikan koehalliin laboratoriokokoluokan kiintopetikuivuri, jossa kuivumista tutkittiin puhaltamalla polttoainepedin läpi lämmitettyä ilmaa. Kuivattavina polttoaineina olivat kuoren ja lietteen seos tai pelkkä kuori ja liete erilaisilla massoilla ja erilaisilla prosenttisilla suhteilla ja erilaisissa lämpötiloissa. Kuivumiskäyrien määritys perustui massanmuutokseen. Koelaitteessa olivat anturit lämpötilan mittausta varten, jotta lämpötila saatiin säädettyä ja seurattua kokeen edellyttämällä tavalla. Lämpötilat ja painonmuutokset tallentuivat koetta tehdessä tietokoneelle. Kuivauskokeet osoittivat, että liete-kuori seos kuivuu hyvin kiintopedissä kun lietteen massaosuus seoksessa on korkeintaan 50 %. Lietteen massaosuuden ollessa tätä suurempi kuivaaminen ei enää ole tehokasta, mikä johtuu luultavasti ilman suuresta kanavoitumisesta kuivauspedissä. Kuorta kuivatessa lämpötilan nosto 50 °C:stä 70 °C:een oli huomattavasti tehokkaampaa kuin 70 °C:stä 90 °C:een, ajallisesti ero oli noin kaksinkertainen.