Clinical relationships and ethical problems in primary care, Sao Paulo, SP, Brazil

Objectives: Main Objective: to identify ethical problems in primary care according to nurses` and doctors` perceptions. Secondary Objective: to know ethical issues of patient-professional relationships in primary care. Design: Synthesis to integrate and reinterpret primary results of qualitative studies. Setting: Primary healthcare centers, Sao Paulo, SP, Brazil. Participants and/or context: Incidental sample of 34 nurses and 36 medical doctors working in primary healthcare centers selected by convenience. Methods: Individual, semi-structured interviews to identity situations considered as sources of ethical problems. The sample is socially representative of primary care health centers and professionals. Data collection assured discourse saturation. Hermeneutic-dialectical discourse analysis was used to study the results. Results: Patient-professional relationships and team work were the main sources of ethical problems. The most important problems were patient information, privacy, confidentiality, interpersonal relationship, linkage and patient autonomy. These issues reflect the recent changes in clinical relation ships and show the peculiarities of primary care with its continuous care which lasts a long time. Healthcare involves multiprofessional team work in the midst of the patient claims for autonomy. Good care of patients needs requires a relationship based on communication and cooperation, and includes feelings and values, with communication skills. Conclusions: Ethical problems in primary care are common situations. For quality and humane primary care the relationship should consist of dialogue, trust and cooperation. (C) 2009 Elsevier Espana, S.L. All rights reserved.

Propofol-induced sleep: Polysomnographic evaluation of patients with obstructive sleep apnea and controls

OBJECTIVE: The localization of upper airway obstruction in patients with obstructive sleep apnea (OSA) may optimize treatment. Nasoendoscopy during propofol sedation allows such an evaluation, but the effect of this drug on respiratory patterns and muscle relaxation is unknown. The objective of the present study was to determine through polysomnography whether propofol would change sleep parameters. STUDY DESIGN: Prospective study of subjects submitted to polysomnography under sedation with propofol. SETTING: Tertiary referral center. SUBJECTS AND METHODS: Fifteen non-obese subjects (4 controls/11 OSA patients) were submitted to two diurnal polysomnograms (90-120 minutes of sleep), with and without the use of propofol. The parameters presence of snoring, apnea-hypopnea index (AHI), oxygen desaturation, and sleep architecture were compared. RESULTS: The use of propofol did not induce snoring in the control subjects, whereas 100 percent of the OSA patients snored. AHI and mean oxygen saturation (SaO(2)) did not differ significantly between examinations with and without sedation. However, minimum SaO(2) differed significantly (P < 0.05) with sedation, being lower during propofol sedation. Propofol also significantly changed the sleep architecture, with a significant increase in N3 sleep (P < 0.005) and total abolishment of rapid eye movement sleep (P < 0.0005) during propofol sedation. CONCLUSIONS: These preliminary results allow us to infer that sedation with propofol changes sleep architecture but permits respiratory evaluation, because the main respiratory parameters evaluated in OSA are maintained. These preliminary results support the view that nasoendoscopy under propofol sedation is a promising examination for management of this disease. (C) 2010 American Academy of Otolaryngology-Head and Neck Surgery Foundation. All rights reserved.

Aerobic exercise is safe and effective in systemic sclerosis

Several studies have established that systemic sclerosis patients have a reduced exercise capacity when compared to healthy individuals. It is relevant to evaluate whether aerobic exercise in systemic sclerosis patients is a safe and effective intervention to improve aerobic capacity. Seven patients without pulmonary impairment and seven healthy controls were enrolled in an 8-week program consisting of moderate intensity aerobic exercise. Patients and controls had a significant improvement in peak oxygen consumption (19.72 +/- 3.51 vs. 22.27 +/- 2.53 and 22.94 +/- 4.70 vs. 24.55 +/- 3.00, respectively, p = 0.006), but difference between groups was not statistically significant (p = 0.149). This finding was reinforced by the fact that at the end of the study both groups were able to perform a significantly higher exercise intensity when compared to baseline, as measured by peak blood lactate (1.43 +/- 0.51 vs. 1.84 +/- 0.33 and 1.11 +/- 0.45 vs. 1.59 +/- 0.25, respectively, p = 0.01). Patients improved the peak exercise oxygen saturation comparing to the baseline (84.14 +/- 9.86 vs. 90.29 +/- 5.09, p = 0.048). Rodnan score was similar before and after the intervention(15.84 +/- 7.84 vs. 12.71 +/- 4.31, p = 0.0855). Digital ulcers and Raynaud`s phenomenon remained stable. Our data support the notion that improving aerobic capacity is a feasible goal in systemic sclerosis management. The long term benefit of this intervention needs to be determined in large prospective studies.

Microstructural characterization of rapidly solidified and heat-treated Ti(92)B(8) eutectic alloy

In this work, Ti(92)B(8) alloy was processed via rapid solidification (splat-cooling) and then heat-treated at 700 degrees C and 1000 degrees C. A careful microstructural characterization indicated that, after rapid solidification, a very fine two-phase microstructure was produced with no significant saturation of B in alpha/beta Ti. There was no indication of amorphous formation in the rapidly solidified splats. Both alpha Ti and TiB were observed in the microstructures of the splats after heat-treatment at 700 degrees C and 1000 degrees C, confirming the stability of the alpha Ti+TiB two-phase region in this temperature range. (C) 2008 Elsevier Inc. All rights reserved.

Kinetics of the xylitol crystallization in hydro-alcoholic solution

Nyvlt method Was used to determine the kinetic parameters of commercial xylitol in ethanol:water (50:50 %w/w) Solution by batch cooling crystallization. The kinetic exponents (n, g and in) and the system kinetic constant (B(N)) were determined. Model experiments were carried Out in order to verify the combined effects of saturation temperatures (40, 50 and 60 degrees C) and cooling rates (0.10, 0.25 and 0.50 degrees C/min) on these parameters. The fitting between experimental and Calculated crystal sizes has 11.30% mean deviation. (C) 2007 Elsevier B.V. All rights reserved.

Magnetic characterization of Mn(5)SiB(2) and Mn(5)Si(3) phases

In this work the Mn(5)Si(3) and Mn(5)SiB(2) phases were produced via arc melting and heat treatment at 1000 degrees C for 50 h under argon. A detailed microstructure characterization indicated the formation of single-phase Mn(5)Si(3) and near single-phase Mn(5)SiB(2) microstructures. The magnetic behavior of the Mn(5)Si(3) phase was investigated and the results are in agreement with previous data from the literature, which indicates the existence of two anti-ferromagnetic structures for temperatures below 98 K. The Mn(5)SiB(2) phase shows a ferromagnetic behavior presenting a saturation magnetization M(s) of about 5.35 x 10(5) A/m (0.67 T) at room temperature and an estimated Curie temperature between 470 and 490 K. In addition, AC susceptibility data indicates no evidence of any other magnetic ordering in 4-300 K temperature range. The magnetization values are smaller than that calculated using the magnetic moment from previous literature NMR results. This result suggests a probable ferrimagnetic arrangement of the Mn moments. (C) 2009 Elsevier B. V. All rights reserved.

Near zero magnetostriction of Fe-Ti alloys

Fe(100-x)Ti(x) alloys (x = 10, 15, 20) were studied with respect to their microstructure and magnetostriction. Depending on heat treatment temperature and composition, the sample retained either the alpha-phase (A2 structure) or the alpha-phase plus the TiFe(2) Laves phase (C14 structure). The saturation magnetostriction measured at 238K is negative, about -11 ppm. However, for fields up to 0.4 T the magnetostriction is barely zero, a very interesting result. High values of magnetostriction are of interest for applications mainly in sensors and actuators, but zero magnetostriction is also a remarkable property, desirable for many applications such as electric transformers and fluxgate sensor cores. Therefore, the Fe(100-x)Ti(x) (x < 20 at%) are an attractive option to be considered for these applications.

Magnetostriction of Fe-Sn polycrystalline alloys

In the present work we study the magnetostriction of Fe(91)Sn(9) and Fe(80)Sn(20) polycrystalline samples produced by arc melting and heat treated at temperatures of 1153 K for 6 h and 1023 K for 24 h, looking for high values of magnetostriction as in Fe-Ga alloys. Magnetostriction, as well as saturation magnetization measurements, was carried out at temperatures close to 203 K in the magnetic field interval 0 to 1.5 T. Results of magnetostriction on sample Fe(91)Sn(9), which has almost pure alpha-phase, show magnitude and behavior similar to pure Fe. The two additional Fe(80)Sn(20) samples have a combination of alpha-phase plus either Fe(5)Sn(3) or Fe(3)Sn(2) and show a peculiar behavior of the magnetostriction for mu(0)H < 0.3 T the magnetostriction grows from zero to saturation of the alpha-phase. Following, for mu(0)H > 0.3 T, the magnetostriction starts again to grow linearly with the field, but saturation was not observed up to 5 T. This behavior was attributed to the presence of Fe(5)Sn(3) or Fe(3)Sn(2) phases in these samples that are also ferromagnetic as the alpha-phase is. (c) 2008 Elsevier B.V. All rights reserved.

Evaluation of flow patterns and elongated bubble characteristics during the flow boiling of halocarbon refrigerants in a micro-scale channel

In the present study, quasi-diabatic two-phase flow pattern visualizations and measurements of elongated bubble velocity, frequency and length were performed. The tests were run for R134a and R245fa evaporating in a stainless steel tube with diameter of 2.32 mm, mass velocities ranging from 50 to 600 kg/m(2) s and saturation temperatures of 22 degrees C, 31 degrees C and 41 degrees C. The tube was heated by applying a direct DC current to its surface. Images from a high-speed video-camera (8000 frames/s) obtained through a transparent tube just downstream the heated sections were used to identify the following flow patterns: bubbly, elongated bubbles, churn and annular flows. The visualized flow patterns were compared against the predictions provided by Barnea et al. (1983) [1], Felcar et al. (2007) [10], Revellin and Thome (2007) [3] and Ong and Thome (2009) [11]. From this comparison, it was found that the methods proposed by Felcar et al. (2007) [10] and Ong and Thome (2009) [1] predicted relatively well the present database. Additionally, elongated bubble velocities, frequencies and lengths were determined based on the analysis of high-speed videos. Results suggested that the elongated bubble velocity depends on mass velocity, vapor quality and saturation temperature. The bubble velocity increases with increasing mass velocity and vapor quality and decreases with increasing saturation temperature. Additionally, bubble velocity was correlated as linear functions of the two-phase superficial velocity. (C) 2010 Elsevier Inc. All rights reserved.

Flow boiling heat transfer of R134a and R245fa in a 2.3 mm tube

This paper presents new experimental flow boiling heat transfer results in micro-scale tubes. The experimental data were obtained in a horizontal 2.3 mm I.D stainless steel tube with heating length of 464 mm, R134a and R245fa as working fluids, mass velocities ranging from 50 to 700 kg m(-2) s(-1), heat flux from 5 to 55 kW m(-2), exit saturation temperatures of 22, 31 and 41 degrees C, and vapor qualities ranging from 0.05 to 0.99. Flow pattern characterization was also performed from images obtained by high-speed filming. Heat transfer coefficient results from 1 to 14 kW m(-2) K(-1) were measured. It was found that the heat transfer coefficient is a strong function of heat flux, mass velocity and vapor quality. The experimental data were compared against ten flow boiling predictive methods from the literature. Liu and Winterton [3], Zhang et al. [5] and Saitoh et al. [6] worked best for both fluids, capturing most of the experimental heat transfer trends. (C) 2010 Elsevier Ltd. All rights reserved.

Collapse behavior of soil in a Brazilian region affected by a rising water table

Collapsible soils are usually nonsaturated, low density, and metastable-structured soils that are known to exhibit a volume reduction following an episode of moisture increase or suction reduction. This paper describes the collapsible behavior of clayey sand based on controlled soil suction tests carried out on undisturbed samples from the city of Pereira Barreto, in the State of Sao Paulo, Brazil. Foundation settlements due to soil collapse are common in this region and occurred during the filling of the reservoir of the Tres Irmaos Dam, which induced the elevation of the groundwater table in different parts of Pereira Barreto. This paper shows that collapse strains depend on the stress and soil suction acting in the sample and that saturation is not necessary for a collapse to occur. The influence of soil suction, gradual wetting, and the wetting and drying cycle on the collapsible behavior of the soil is also shown and discussed.

New prediction methods for CO2 evaporation inside tubes: Part I - A two-phase flow pattern map and a flow pattern based phenomenological model for two-phase flow frictional pressure drops

An updated flow pattern map was developed for CO2 on the basis of the previous Cheng-Ribatski-Wojtan-Thome CO2 flow pattern map [1,2] to extend the flow pattern map to a wider range of conditions. A new annular flow to dryout transition (A-D) and a new dryout to mist flow transition (D-M) were proposed here. In addition, a bubbly flow region which generally occurs at high mass velocities and low vapor qualities was added to the updated flow pattern map. The updated flow pattern map is applicable to a much wider range of conditions: tube diameters from 0.6 to 10 mm, mass velocities from 50 to 1500 kg/m(2) s, heat fluxes from 1.8 to 46 kW/m(2) and saturation temperatures from -28 to +25 degrees C (reduced pressures from 0.21 to 0.87). The updated flow pattern map was compared to independent experimental data of flow patterns for CO2 in the literature and it predicts the flow patterns well. Then, a database of CO2 two-phase flow pressure drop results from the literature was set up and the database was compared to the leading empirical pressure drop models: the correlations by Chisholm [3], Friedel [4], Gronnerud [5] and Muller-Steinhagen and Heck [6], a modified Chisholm correlation by Yoon et al. [7] and the flow pattern based model of Moreno Quiben and Thome [8-10]. None of these models was able to predict the CO2 pressure drop data well. Therefore, a new flow pattern based phenomenological model of two-phase flow frictional pressure drop for CO2 was developed by modifying the model of Moreno Quiben and Thome using the updated flow pattern map in this study and it predicts the CO2 pressure drop database quite well overall. (C) 2007 Elsevier Ltd. All rights reserved.

New prediction methods for CO2 evaporation inside tubes: Part II - An updated general flow boiling heat transfer model based on flow patterns

Corresponding to the updated flow pattern map presented in Part I of this study, an updated general flow pattern based flow boiling heat transfer model was developed for CO2 using the Cheng-Ribatski-Wojtan-Thome [L. Cheng, G. Ribatski, L. Wojtan, J.R. Thome, New flow boiling heat transfer model and flow pattern map for carbon dioxide evaporating inside horizontal tubes, Int. J. Heat Mass Transfer 49 (2006) 4082-4094; L. Cheng, G. Ribatski, L. Wojtan, J.R. Thome, Erratum to: ""New flow boiling heat transfer model and flow pattern map for carbon dioxide evaporating inside tubes"" [Heat Mass Transfer 49 (21-22) (2006) 4082-4094], Int. J. Heat Mass Transfer 50 (2007) 391] flow boiling heat transfer model as the starting basis. The flow boiling heat transfer correlation in the dryout region was updated. In addition, a new mist flow heat transfer correlation for CO2 was developed based on the CO2 data and a heat transfer method for bubbly flow was proposed for completeness sake. The updated general flow boiling heat transfer model for CO2 covers all flow regimes and is applicable to a wider range of conditions for horizontal tubes: tube diameters from 0.6 to 10 mm, mass velocities from 50 to 1500 kg/m(2) s, heat fluxes from 1.8 to 46 kW/m(2) and saturation temperatures from -28 to 25 degrees C (reduced pressures from 0.21 to 0.87). The updated general flow boiling heat transfer model was compared to a new experimental database which contains 1124 data points (790 more than that in the previous model [Cheng et al., 2006, 2007]) in this study. Good agreement between the predicted and experimental data was found in general with 71.4% of the entire database and 83.2% of the database without the dryout and mist flow data predicted within +/-30%. However, the predictions for the dryout and mist flow regions were less satisfactory due to the limited number of data points, the higher inaccuracy in such data, scatter in some data sets ranging up to 40%, significant discrepancies from one experimental study to another and the difficulties associated with predicting the inception and completion of dryout around the perimeter of the horizontal tubes. (C) 2007 Elsevier Ltd. All rights reserved.

The influence of moisture on the deformability of cement-polymer adhesive mortar

Adhesive mortars are widely used to set porcelain stoneware tiles on buildings because their bond strength and flexibility properties increase the cladding serviceability. However, their long-term performance is not well understood, mainly the degradation of the polymeric matrix. The influence of moisture content on the flexibility of six adhesive mortars is investigated, based on standard EN 12002. Four of them have defined formulations and the other two are commercial and are widely used to set porcelain stoneware tiles on building facades in Brazil. The results show that moisture content above 6% is sufficient to reduce 50% of the mortar deformability, but that the drying process allows it to recover to a value similar to that prior to saturation; a logarithmic function best fits the correlation between moisture content and flexibility; water immersion increases matrix rigidity. It is suggested that standards should consider flexibility tests on both dried and wet samples as a requirement for polymer-modified mortars. (C) 2010 Elsevier Ltd. All rights reserved.

Power Factor Calculation by the Finite Element Method

The use of finite element analysis (FEA) to design electrical motors has increased significantly in the past few years due the increasingly better performance of modern computers. Even though the analytical software remains the most used tool, the FEA is widely used to refine the analysis and gives the final design to be prototyped. The power factor, a standard data of motor manufactures data sheet is important because it shows how much reactive power is consumed by the motor. This data becomes important when the motor is connected to network. However, the calculation of power factor is not an easy task. Due to the saturation phenomena the input motor current has a high level of harmonics that cannot be neglected. In this work the FEA is used to evaluate a proposed (not limitative) methodology to estimate the power factor or displacement factor of a small single-phase induction motor. Results of simulations and test are compared.