Brazilian registered nurses` perceptions and attitudes towards adverse events in nursing care: a phenomenological study

Aim To describe the perceptions and attitudes of registered nurses (RNs) towards adverse events (AEs) in nursing care. Background The professionals` subjective perspectives should be taken into account for the prevention of AEs in care settings. Method Schutz`s social phenomenology was developed. Interviews were conducted with nine Intensive Care Unit RNs. Results The following five descriptive categories emerged: (1) the occurrence of AEs is inherent to the human condition but provokes a feeling of insecurity, (2) the occurrence of AEs indicates the existence of failures in health care systematization, (3) the professionals` attitudes towards AEs should be permeated by ethical principles; (4) the priority regarding AEs should be the mitigation of harm to patients, and (5) decisions regarding the communication of AEs were determined by the severity of the error. Conclusions The various subjective perspectives related to the occurrence of AEs requires a health care systematization with a focus on prevention. Ethical behaviour is essential for the patients` safety. Implications for nursing management Activities aimed at the prevention of AEs should be integrated jointly with both the professionals and the health care institution. A culture of safety, not punishment, and improvement in the quality of care provided to patients should be priorities.

Specification of Supervisory Control Systems for Ventricular Assist Devices

One of the most important recent improvements in cardiology is the use of ventricular assist devices (VADs) to help patients with severe heart diseases, especially when they are indicated to heart transplantation. The Institute Dante Pazzanese of Cardiology has been developing an implantable centrifugal blood pump that will be able to help a sick human heart to keep blood flow and pressure at physiological levels. This device will be used as a totally or partially implantable VAD. Therefore, an improvement on device performance is important for the betterment of the level of interaction with patient`s behavior or conditions. But some failures may occur if the device`s pumping control does not follow the changes in patient`s behavior or conditions. The VAD control system must consider tolerance to faults and have a dynamic adaptation according to patient`s cardiovascular system changes, and also must attend to changes in patient conditions, behavior, or comportments. This work proposes an application of the mechatronic approach to this class of devices based on advanced techniques for control, instrumentation, and automation to define a method for developing a hierarchical supervisory control system that is able to perform VAD control dynamically, automatically, and securely. For this methodology, we used concepts based on Bayesian network for patients` diagnoses, Petri nets to generate a VAD control algorithm, and Safety Instrumented Systems to ensure VAD system security. Applying these concepts, a VAD control system is being built for method effectiveness confirmation.

Comparison Between Voltage Control Structures of Synchronous Machines

This paper compares the behaviour of two different control structures of automatic voltage regulators of synchronous machines equipped with static excitation systems. These systems have a fully controlled thyristor bridge that supplies DC current to the rotor winding. The rectifier bridge is fed by the stator terminals through a step-down transformer. The first control structure, named ""Direct Control"", has a single proportional-integral (PI) regulator that compares stator voltage setpoint with measured voltage and acts directly on the thyristor bridge`s firing angle. This control structure is usually employed in commercial excitation systems for hydrogenerators. The second structure, named ""Cascade Control"", was inspired on control loops of commercial DC motor drives. Such drives employ two PIs in a cascade arrangement, the external PI deals with the motor speed while the internal one regulates the armature current. In the adaptation proposed, the external PI compares setpoint with the actual stator voltage and produces the setpoint to the internal PI-loop which controls the field current.

Unsaturated Infinite Slope Stability Considering Surface Flux Conditions

A slope stability model is derived for an infinite slope subjected to unsaturated infiltration flow above a phreatic surface. Closed form steady state solutions are derived for the matric suction and degree of saturation profiles. Soil unit weight, consistent with the degree of saturation profile, is also directly calculated and introduced into the analyzes, resulting in closed-form solutions for typical soil parameters and an infinite series solution for arbitrary soil parameters. The solutions are coupled with the infinite slope stability equations to establish a fully realized safety factor function. In general, consideration of soil suction results in higher factor of safety. The increase in shear strength due to the inclusion of soil suction is analogous to making an addition to the cohesion, which, of course, increases the factor of safety against sliding. However, for cohesive soils, the results show lower safety factors for slip surfaces approaching the phreatic surface compared to those produced by common safety factor calculations. The lower factor of safety is due to the increased soil unit weight considered in the matric suction model but not usually accounted for in practice wherein the soil is treated as dry above the phreatic surface. The developed model is verified with a published case study, correctly predicting stability under dry conditions and correctly predicting failure for a particular storm.

Adaptable Strut-and-Tie Model for Design and Verification of Four-Pile Caps

A large percentage of pile caps support only one column, and the pile caps in turn are supported by only a few piles. These are typically short and deep members with overall span-depth ratios of less than 1.5. Codes of practice do not provide uniform treatment for the design of these types of pile caps. These members have traditionally been designed as beams spanning between piles with the depth selected to avoid shear failures and the amount of longitudinal reinforcement selected to provide sufficient flexural capacity as calculated by the engineering beam theory. More recently, the strut-and-tie method has been used for the design of pile caps (disturbed or D-region) in which the load path is envisaged to be a three-dimensional truss, with compressive forces being supported by concrete compressive struts between the column and piles and tensile forces being carried by reinforcing steel located between piles. Both of these models have not provided uniform factors of safety against failure or been able to predict whether failure will occur by flexure (ductile mode) or shear (fragile mode). In this paper, an analytical model based on the strut-and-tie approach is presented. The proposed model has been calibrated using an extensive experimental database of pile caps subjected to compression and evaluated analytically for more complex loading conditions. It has been proven to be applicable across a broad range of test data and can predict the failures modes, cracking, yielding, and failure loads of four-pile caps with reasonable accuracy.

Reliability Analysis in Reciprocating Compressors for Refrigeration Systems

The most-used refrigeration system is the vapor-compression system. In this cycle, the compressor is the most complex and expensive component, especially the reciprocating semihermetic type, which is often used in food product conservation. This component is very sensitive to variations in its operating conditions. If these conditions reach unacceptable levels, failures are practically inevitable. Therefore, maintenance actions should be taken in order to maintain good performance of such compressors and to avoid undesirable stops of the system. To achieve such a goal, one has to evaluate the reliability of the system and/or the components. In this case, reliability means the probability that some equipment cannot perform their requested functions for an established time period, under defined operating conditions. One of the tools used to improve component reliability is the failure mode and effect analysis (FMEA). This paper proposes that the methodology of FMEA be used as a tool to evaluate the main failures found in semihermetic reciprocating compressors used in refrigeration systems. Based on the results, some suggestions for maintenance are addressed.

Flow Visualization in Arteriovenous Fistula and Aneurysm Using Computational Fluid Dynamics

The arteriovenous fistula (AVF) is characterized by enhanced blood flow and is the most widely used vascular access for chronic haemodialysis (Sivanesan et al., 1998). A large proportion of the AVF late failures are related to local haemodynamics (Sivanesan et al., 1999a). As in AVF, blood flow dynamics plays an important role in growth, rupture, and surgical treatment of aneurysm. Several techniques have been used to study the flow patterns in simplified models of vascular anastomose and aneurysm. In the present investigation, Computational Fluid Dynamics (CFD) is used to analyze the flow patterns in AVF and aneurysm through the velocity waveform obtained from experimental surgeries in dogs (Galego et al., 2000), as well as intra-operative blood flow recordings of patients with radiocephalic AVF ( Sivanesan et al., 1999b) and physiological pulses (Aires, 1991), respectively. The flow patterns in AVF for dog and patient surgeries data are qualitatively similar. Perturbation, recirculation and separation zones appeared during cardiac cycle, and these were intensified in the diastole phase for the AVF and aneurysm models. The values of wall shear stress presented in this investigation of AVF and aneurysm models oscillated in the range that can both cause damage to endothelial cells and develop atherosclerosis.

Risk-based decision making method for maintenance policy selection of thermal power plant equipment

This study presents a decision-making method for maintenance policy selection of power plants equipment. The method is based on risk analysis concepts. The method first step consists in identifying critical equipment both for power plant operational performance and availability based on risk concepts. The second step involves the proposal of a potential maintenance policy that could be applied to critical equipment in order to increase its availability. The costs associated with each potential maintenance policy must be estimated, including the maintenance costs and the cost of failure that measures the critical equipment failure consequences for the power plant operation. Once the failure probabilities and the costs of failures are estimated, a decision-making procedure is applied to select the best maintenance policy. The decision criterion is to minimize the equipment cost of failure, considering the costs and likelihood of occurrence of failure scenarios. The method is applied to the analysis of a lubrication oil system used in gas turbines journal bearings. The turbine has more than 150 MW nominal output, installed in an open cycle thermoelectric power plant. A design modification with the installation of a redundant oil pump is proposed for lubricating oil system availability improvement. (C) 2009 Elsevier Ltd. All rights reserved.

Availability analysis of heat recovery steam generators used in thermal power plants

The combined-cycle gas and steam turbine power plant presents three main pieces of equipment: gas turbines, steam turbines and heat recovery steam generator (HRSG). In case of HRSG failure the steam cycle is shut down, reducing the power plant output. Considering that the technology for design, construction and operation of high capacity HRSGs is quite recent its availability should be carefully evaluated in order to foresee the performance of the power plant. This study presents a method for reliability and availability evaluation of HRSGs installed in combined-cycle power plant. The method`s first step consists in the elaboration of the steam generator functional tree and development of failure mode and effects analysis. The next step involves a reliability and availability analysis based on the time to failure and time to repair data recorded during the steam generator operation. The third step, aiming at availability improvement, recommends the fault-tree analysis development to identify components the failure (or combination of failures) of which can cause the HRSG shutdown. Those components maintenance policy can be improved through the use of reliability centered maintenance (RCM) concepts. The method is applied on the analysis of two HRSGs installed in a 500 MW combined-cycle power plant. (C) 2010 Elsevier Ltd. All rights reserved.

Comparison of adsorbent films obtained by plasma polymerization of oxygenated organic compounds

Thin films obtained by plasma polymerization of ethyl ether, methyl or ethyl acetate, acetaldehyde, acetone and 2-propanol were compared. Infrared spectroscopy (FFIR), resistance to chemicals, contact angle measurements, X-ray photoelectron spectroscopy (XPS), optical and scanning electron microscopy (SEM), and quartz crystal microbalance (QCM) were carried out. For all films FTIR showed high intensity for polar bonds yet the films are not resistant to polar solvents. Contact angle measurements revealed hydrophilic and organophilic surfaces and XPS pointed out a high proportion of oxygenated bonds. All films showed good step coverage and peeling was significant only with acetone and 2-propanol. All films are adsorbent for organic compounds in a large scale of polarity but acetaldehyde and 2-propanol act like a selective membrane. Also, deposition of these films on hydrophobic substrates leads to island formation. A possible model to explain the results must consider the hydrogen bridge formation on 2-propanol and acetaldehyde films. Ethyl ether, ethyl and methyl acetate showed good characteristics for development of sensor and sample pretreatment using miniaturized devices. (C) 2007 Elsevier B.V. All rights reserved.

Measuring Dynamic Oscillations of a Small Span Cable-Stayed Footbridge: Case Study Using L1 GPS Receivers

Highly redundant or statically undetermined structures, such as a cable-stayed bridge, have been of particular concern to the engineering community nowadays because of the complex parameters that must be taken into account for healthy monitoring. The purpose of this study was to verify the reliability and practicability of using GPS to characterize dynamic oscillations of small span bridges. The test was carried out on a cable-stayed wood footbridge at Escola de Engenharia de Sao Carlos-Universidade de Sao Paulo, Brazil. Initially a static load trial was carried out to get an idea of the deck amplitude and oscillation frequency. After that, a calibration trial was carried out by applying a well known oscillation on the rover antenna to check the environment detectable limits for the method used. Finally, a dynamic load trial was carried out by using GPS and a displacement transducer to measure the deck oscillation. The displacement transducer was used just to confirm the results obtained by the GPS. The results have shown that the frequencies and amplitude displacements obtained by the GPS are in good agreement with the displacement transducer responses. GPS can be used as a reliable tool to characterize the dynamic behavior of large structures such as cable-stayed footbridges undergoing dynamic loads.

Magnetic suspension of the rotor of a ventricular assist device of mixed flow type

This work presents results of preliminary studies concerning application of magnetic bearing in a ventricular assist device (VAD) being developed by Dante Pazzanese Institute of Cardiology-IDPC (Sao Paulo, Brazil). The VAD-IDPC has a novel architecture that distinguishes from other known VADs. In this, the rotor has a conical geometry with spiral impellers, showing characteristics that are intermediate between a centrifugal VAD and an axial VAD. The effectiveness of this new type of blood pumping principle was showed by tests and by using it in heart surgery for external blood circulation. However, the developed VAD uses a combination of ball bearings and mechanical seals, limiting the life for some 10 h, making impossible its long-term use or its use as an implantable VAD. As a part of development of an implantable VAD, this work aims at the replacement of ball bearings by a magnetic bearing. The most important magnetic bearing principles are studied and the magnetic bearing developed by Escola Politecnica of Sao Paulo University (EPUSP-MB) is elected because of its very simple architecture. Besides presenting the principle of the EPUSP-MB, this work presents one possible alternative for applying the EPUSP-MB in the IDPC-VAD.

Modeling technique for honeycomb FRP deck bridges via finite elements

Honeycomb structures have been used in different engineering fields. In civil engineering, honeycomb fiber-reinforced polymer (FRP) structures have been used as bridge decks to rehabilitate highway bridges in the United States. In this work, a simplified finite-element modeling technique for honeycomb FRP bridge decks is presented. The motivation is the combination of the complex geometry of honeycomb FRP decks and computational limits, which may prevent modeling of these decks in detail. The results from static and modal analyses indicate that the proposed modeling technique provides a viable tool for modeling the complex geometry of honeycomb FRP bridge decks. The modeling of other bridge components (e.g., steel girders, steel guardrails, deck-to-girder connections, and pier supports) is also presented in this work.

Numerical study of tensile tests conducted on systems with elastic-plastic films deposited onto elastic-plastic substrates

In this work, a series of two-dimensional plane-strain finite element analyses was conducted to further understand the stress distribution during tensile tests on coated systems. Besides the film and the substrate, the finite element model also considered a number of cracks perpendicular to the film/substrate interface. Different from analyses commonly found in the literature, the mechanical behavior of both film and substrate was considered elastic-perfectly plastic in part of the analyses. Together with the film yield stress and the number of film cracks, other variables that were considered were crack tip geometry, the distance between two consecutive cracks and the presence of an interlayer. The analysis was based on the normal stresses parallel to the loading axis (sigma(xx)), which are responsible for cohesive failures that are observed in the film during this type of test. Results indicated that some configurations studied in this work have significantly reduced the value of sigma(xx) at the film/substrate interface and close to the pre-defined crack tips. Furthermore, in all the cases studied the values of sigma(xx) were systematically larger at the film/substrate interface than at the film surface. (C) 2010 Elsevier B.V. All rights reserved.

Particle-Image Velocimetry Study of a Pediatric Ventricular Assist Device

Particle-image velocimetry (PIV) was used to visualize the flow within an optically transparent pediatric ventricular assist device (PVAD) under development in our laboratory The device studied is a diaphragm type pulsatile pump with an ejection volume of 30 ml per beating cycle intended for temporary cardiac assistance as a bridge to transplantation or recovery in children. Of particular interest was the identification of flow patterns, including regions of stagnation and/or strong turbulence that often promote thrombus formation and hemolysis, which can degrade the usefulness of such devices. For this purpose, phase-locked PIV measurements were performed in planes parallel to the diaphram that drives the flow in the device. The test fluid was seeded with 10 Am polystyrene spheres, and the motion of these particles was used to determine the instantaneous flow velocity distribution in the illumination plane. These measurements revealed that flow velocities up to 1.0 m/s can occur within the PVAD. Phase-averaged velocity fields revealed the fixed vortices that drive the bulk flow within the device, though significant cycle-to-cycle variability was also quite apparent in the instantaneous velocity distributions, most notably during the filling phase. This cycle-to-cycle variability can generate strong turbulence that may contribute to greater hemolysis. Stagnation regions have also been observed between the input and output branches of the prototype, which can increase the likelihood of thrombus formation. [DOI: 10.1115/1.4001252]