Riscos ocupacionais e acidentes de trabalho em um serviço de atendimento móvel de urgência do Rio Grande do Norte

Exploratory, descriptive and quantitative study with prospective data, performed in the Mobile Emergency Care Service in the metropolitan region of Natal/RN, in order to identify the knowledge of the multidisciplinary team about the rules of standard precautions and worker safety, to identify occupational hazards peculiar to the activities of this service; characterize work-related accidents (WRA) and know the procedures adopted after each WRA. The population consisted of 162 professionals and data were collected between the months of November and December 2010. As for personal and professional characteristics, of the 162 professional, 12,96% were physicians; 6,79%, nurses; 33,95%, nursing technicians, 46,29%, conductors; 74,70% were male; 43,21% were between 31 and 40 years old; 69,33% lived in Natal/RN, 50,00% had completed high school; 58,64% were married; 69,75% had children, 46,91% were between 1 and 4 years of training; 61,73% had improvement courses; 59,25% had 3 to 4 years of service; 54,32%, with 1-4 years experience in emergency; 44,44% received 1-2 minimum wages; 78,40% received insalubrity premium; 67,28% worked in Basic Support Unit (BSU); 83,95% had journey on SAMU Metropolitano of 31-40 hours per week; 52,47% had other employments. As for knowledge of rules of standard precautions, safety and occupational hazards, 99,38% knew what it was WRA; 62,96% gave incomplete answers; 74,07% knew the rules of prevent WRA; 46,67% acquired this knowledge in lectures; 53,09% knew Personal Protective Equipment (PPE); 71,60% gave incorrect answers about the importance of standard precautions; 45,06% never received an educational intervention on this issue; 89,51% said that educational interventions in the prevention of WRA are very important; 90,12% pointed out this as a very important issue in the workplace; 27,00% suggested guidance on the topic in the workplace; regarding the physical hazards, 34,57% considered noise as the most important; about chemical hazards, 78,40% chose the gases and smoke; for biological hazards, 48,77% reported contact with the blood; for mechanical hazards, 80,86% said that were transport accidents; about ergonomic risks, 40,12% say it is the tension/stress in the care of critically ill, psychiatric and aggressive patients; and there was an average of 4,5 to the feeling of safety in the workplace. Regarding the data on the WRAs occurred, 31,48% experienced at least one accident event; 72,55% did not notify it; 60,98% answered that there was no routine for notification; 56,86% were performing patient transportation; 49,02% were hurt in the Basic Support Unit/Rescue Unit (BSU/RH); 60,78% occurred during the day; 96,08% of professionals were in normal work schedule (24 hours on duty); 31,37% had contusion; 58.82% had damage to members/pelvic girdle; 43,14% had traffic accidents. About the evolution of the WRA, 62,75% did not have to take time away from work; 76,47% had no sequelae; 88,24% did not require rehabilitation; no professional had a change of occupation. And by means of univariate logistic regression, showed that the nurses and male sex were risk factors for the occurrence of WRA. We conclude that there were gaps in the knowledge of staff regarding WRA, emphasizing the need for continuing education in biosafety in the service.

Atendimento Pré-hospitalar Móvel. Mapeando Riscos e Prevenindo Erros

The attention with safety of the patients is important in the quality of the nursing and health care. In the pre-hospital care, such care is essential on site with the purpose of avoiding possible consequences to the individual, ensuring a fast and appropriate care, with improvement of the morbidity and reduction of the mortality. This medical attention is equally associated with the significant risks of adverse events and serious mistakes, which can be reduced with the awareness of the professionals, organization and quality management. It is a descriptive, transversal research, of quantitative approach, with the objective of identifying the risks for the safety of the patient during the mobile pre-hospital care under the view of the nurses, in a city of the Brazilian Northeast. The sample was formed by 23 nurses. The inclusion criteria: to have at least two years of experience and accept to participate on the research. The data collection was done in two steps, first photo collection, through the adapted method of photographic analysis, and the second with the application of questionnaire, divide in two parts: socio-professional data and digital photo punctuation instrument of the patient s safety. The majority of the nurses had an average working time in the mobile pre-hospital care of six years and six months, in the age group of 38 to 53 years old (69,56%) and with Lato sensu specialization (73,91%), being (29,41%) emergency and (29,41%) in intensive care. The (74%) have the Advance Cardiac Life Support (ACLS) and (100%) have the Pre-Hospital Trauma Life Support (PHTLS); (91, 30%) know the thematic safety of the patient. On the pictures it was observed a bigger variability of the categories (risks) where 44% of variance emerged on the first picture of the research. The pictures 4 and 9 with the average below 5 were classified as very insecure, while pictures 7 and 3 with an average above 7, very secure. On the results of risks observed for the patient s safety in the mobile pre-hospital care five categories emerged: organization and packaging of the equipment and materials, routines and specificities in the mobile pre-hospital care, risks on the management of medications, for traumas and infections. Starting from the analysis of these risks, it was proposed ten steps for the safety in the mobile pre-hospital care: 1- Identify the patient; 2- Safety related to prevention of infection; 3- Safety in the management of medications; 4- Safety and standardization of the packaging of equipment and materials; 5- Attention to the specificities of the mobile pre-hospital care; 6- Incentive and value the participation of the patient and family; 7- Promote the communication with the central of regulation; 8- Prevention of traumas and falls; 9- Protect the skin from additional injuries; 10- Understand the benefit of all the equipment in the ambulance. The multiple risks and their emerged combinations on the research indicate a variety of actions to be developed and stimulated, like the use of steps for the patient s safety in the mobile pre-hospital care which contributes with the aid and management of risks, reduction of mistakes, disabilities and death

Assistência de enfermagem às urgências e emergências psiquiátricas no serviço de atendimento móvel de urgência em Mossoró-RN

This study aims to identify the concepts of professional nursing team on assistance in urgency and psychiatric emergencies in SAMU in Mossoró/RN, identifying the difficulties in implementing an emergency assistance to the user in psychiatric distress in this service and point strategies in pursuit of consolidation and expansion of comprehensive health care to the public. It is a descriptive research with qualitative and exploratory approach. The subjects were employees of the nursing staff of SAMU of that mentioned municipality. Semi-structured interviews are applied as tool for data collection. It was counted on the consent of the institution where the study was developed and approval by the Ethics Committee in Research of UFRN with CAAE No 17326513.0.0000.5537, besides signing the Informed Free Consent Term by the participants. Data analysis was done by means of thematic analysis proposed by Bardin. Thus , as a result of the research produced the following categories: mechanistic practice; dehumanization of care; need for qualification, barriers to assistance in urgency and psychiatric emergency and strategies in pursuit of comprehensive care, which proceeded in preparing two articles entitled "Nursing care to the emergency room and psychiatric emergencies in the mobile emergency care service" and "Barriers for emergency service and psychiatric emergencies in the mobile emergency care service". In the studied reality it was identified that nursing care offered to users in situations of urgency and psychiatric emergency is made based primarily on the use of chemical and physical restraints, as well as transportation to the general hospital, constantly using the police force support, which meets the guidelines of the Psychiatric Reform and thereby undermining the provision of an effective and humane care. This scenario is worsened by the lack of an organized network of services in mental health, where after the service the user is taken to a general hospital, considering that there is no ready or appropriate psychiatric emergency service as a Center of Psychosocial Care - CAPs III to reference it, thereby precluding the realization of a resolute and comprehensive care. Thus, it is concluded that nursing care is based on biologicist and medicine-centered model advocated by classical psychiatry, and that despite all the advances in psychiatric reform, still guides the mental health care, so the lack of service network organized in hierarchical and mental health, where the user in urgency and emergency service can be watched in full and the guidelines of the psychiatric reform can be realized in practice

Atuação dos profissionais de saúde no atendimento à criança vítima de violência

This study had the purpose of identifying the health professional performance during the care of children victimized by violence. Its objectives were the evaluation of how health professionals diagnose violence on the hospitalized child during the care process; the identification, according to the experience of each health professional, of the types of violence on the hospitalized child, the child's aggressors and the most frequent1y injured area in the body and the analysis of conducts adopted by health professionals upon the recognition of a violence case on a hospitalized child. The study was of the descriptive-exploratory type, using a quantitative approach, performed on Hospital da Criança Santo Antônio (HCSA) in Boa Vista - RR. The population consisted of 235 health professionals, with data collected from June to August 2006. The results show a clear predominance of the female gender, (76,17%); aged 31 to 35 (26,81%); married (45,96%). As for professional formation, 63,9% were nursing auxiliaries and technicians,16,2% physicians, 14,8% nurses, 3,9% social assistants and 2,1% psychologists; 45,96% had completed middle-level education, 51,06% of which coming from private education establishments and 48,94% from public education institutions.; 97,66 % have specialization or improvement courses on their area; 32,77% among 05 to 09 years of work time; 32,06(10 worked on pediatric infirmaries; 75,74% state they have experience with children victimized by violence; 96,22% consider themselves capable of identifying the types of violence suffered by children; 29,00% consider physical violence the most common kind; 91,57% sought to identify the aggressors; 27,72% consider the mother to be the child's main aggressor, 26,36% the father, and 22,28% the stepfather; 26,55% consider the limbs and pelvic waist to be the body region most affected by violence; 26,91% take the attitude of reporting to the nurse and 20,13% to the social service; 70,79% state that the conducts were performed as a team; 26,25% of the professionals consider that the social assistants helped the most on deciding which conduct to adopt; 76,40% state there was no one opposed to the performing of these conducts; but 23,60% that stated there was no one opposed to the performing of these conducts, 77,08% reveal that the family members were against the conducts taken by the team. We conclude that, the hea1th professionals who were part of the study, apparently are not adequate prepared to diagnose and report the violence on child. The results were more drastic when we related the physicians and the nurses' answers, considering that they give directed assistance to these victims social assistants and psychologists are the ones best prepared to conduct cases of child mistreatment. However, we are conscious of our responsibility with professional education not only in upper grade institution but also on the middle-level. We believe also, that a continued education program can help to improve the professional knowledge and improve the quality of care

Algoritmos para o problema de localização de uma facilidade com distâncias limitadas e restrições de atendimento

The objective in the facility location problem with limited distances is to minimize the sum of distance functions from the facility to the customers, but with a limit on each distance, after which the corresponding function becomes constant. The problem has applications in situations where the service provided by the facility is insensitive after a given threshold distance (eg. fire station location). In this work, we propose a global optimization algorithm for the case in which there are lower and upper limits on the numbers of customers that can be served

Desenvolvimento de um modelo computacional para a ampliação do atendimento do Programa de Acessibilidade Especial Porta a Porta - PRAE

Worldwide, the demand for transportation services for persons with disabilities, the elderly, and persons with reduced mobility have increased in recent years. The population is aging, governments need to adapt to this reality, and this fact could mean business opportunities for companies. Within this context is inserted the Programa de Acessibilidade Especial porta a porta PRAE, a door to door public transportation service from the city of Natal-RN in Brazil. The research presented in this dissertation seeks to develop a programming model which can assist the process of decision making of managers of the shuttle. To that end, it was created an algorithm based on methods of generating approximate solutions known as heuristics. The purpose of the model is to increase the number of people served by the PRAE, given the available fleet, generating optimized schedules routes. The PRAE is a problem of vehicle routing and scheduling of dial-a-ride - DARP, the most complex type among the routing problems. The validation of the method of resolution was made by comparing the results derived by the model and the currently programming method. It is expected that the model is able to increase the current capacity of the service requests of transport

Uma Aplicação de Redes Neurais Auto-Organizaveis à Reconstrução Tridimensional de Superfícies

We propose a multi-resolution approach for surface reconstruction from clouds of unorganized points representing an object surface in 3D space. The proposed method uses a set of mesh operators and simple rules for selective mesh refinement, with a strategy based on Kohonen s self-organizing map. Basically, a self-adaptive scheme is used for iteratively moving vertices of an initial simple mesh in the direction of the set of points, ideally the object boundary. Successive refinement and motion of vertices are applied leading to a more detailed surface, in a multi-resolution, iterative scheme. Reconstruction was experimented with several point sets, induding different shapes and sizes. Results show generated meshes very dose to object final shapes. We include measures of performance and discuss robustness.

Algoritmos inteligentes para auto-correção, auto-verificação e auto-validação de medidas em sensores

This work presents a set of intelligent algorithms with the purpose of correcting calibration errors in sensors and reducting the periodicity of their calibrations. Such algorithms were designed using Artificial Neural Networks due to its great capacity of learning, adaptation and function approximation. Two approaches willbe shown, the firstone uses Multilayer Perceptron Networks to approximate the many shapes of the calibration curve of a sensor which discalibrates in different time points. This approach requires the knowledge of the sensor s functioning time, but this information is not always available. To overcome this need, another approach using Recurrent Neural Networks was proposed. The Recurrent Neural Networks have a great capacity of learning the dynamics of a system to which it was trained, so they can learn the dynamics of a sensor s discalibration. Knowingthe sensor s functioning time or its discalibration dynamics, it is possible to determine how much a sensor is discalibrated and correct its measured value, providing then, a more exact measurement. The algorithms proposed in this work can be implemented in a Foundation Fieldbus industrial network environment, which has a good capacity of device programming through its function blocks, making it possible to have them applied to the measurement process

Análise de antenas utilizando substrato cerâmico, zpt, produzido por síntese auto propagante para aplicações em sistemas de micro-ondas

Ceramic substrates have been investigated by researchers around the world and has achieved a high interest in the scientific community, because they had high dielectric constants and excellent performance in the structures employed. Such ceramics result in miniaturized structures with dimensions well reduced and high radiation efficiency. In this work, we have used a new ceramic material called lead zinc titanate in the form of Zn0,8Pb0,2TiO3, capable of being used as a dielectric substrate in the construction of various structures of antennas. The method used in constructing the ceramic combustion synthesis was Self- Sustained High Temperature (SHS - "Self-Propagating High-Temperature Synthesis") which is defined as a process that uses highly exothermic reactions to produce various materials. Once initiated the reaction area in the reaction mixture, the heat generated is sufficient to become self-sustaining combustion in the form of a wave that propagates converting the reaction mixture into the product of interest. Were analyzed aspects of the formation of the composite Zn0,8Pb0,2TiO3 by SHS powders and characterized. The analysis consisted of determining the parameters of the reaction for the formation of the composite, as the ignition temperature and reaction mechanisms. The production of composite Zn0,8Pb0,2TiO3 by SHS performed in the laboratory, was the result of a total control of combustion temperature and after obtaining the powder began the development of ceramics. The product was obtained in the form of regular, alternating layers of porous ceramics and was obtained by uniaxial pressing. 10 The product was characterized by analysis of dilatometry, X-ray diffraction analysis and scanning electron microscopy. One of the contributions typically defined in this work is the development of a new dielectric material, nevertheless presented previously in the literature. Therefore, the structures of the antennas presented in this work consisted of new dielectric ceramics based Zn0,8Pb0,2TiO3 usually used as dielectric substrate. The materials produced were characterized in the microwave range. These are dielectrics with high relative permittivity and low loss tangent. The Ansoft HFSS, commercial program employee, using the finite element method, and was used for analysis of antennas studied in this work

Compressão auto-adaptativa de imagens coloridas

Image compress consists in represent by small amount of data, without loss a visual quality. Data compression is important when large images are used, for example satellite image. Full color digital images typically use 24 bits to specify the color of each pixel of the Images with 8 bits for each of the primary components, red, green and blue (RGB). Compress an image with three or more bands (multispectral) is fundamental to reduce the transmission time, process time and record time. Because many applications need images, that compression image data is important: medical image, satellite image, sensor etc. In this work a new compression color images method is proposed. This method is based in measure of information of each band. This technique is called by Self-Adaptive Compression (S.A.C.) and each band of image is compressed with a different threshold, for preserve information with better result. SAC do a large compression in large redundancy bands, that is, lower information and soft compression to bands with bigger amount of information. Two image transforms are used in this technique: Discrete Cosine Transform (DCT) and Principal Component Analysis (PCA). Primary step is convert data to new bands without relationship, with PCA. Later Apply DCT in each band. Data Loss is doing when a threshold discarding any coefficients. This threshold is calculated with two elements: PCA result and a parameter user. Parameters user define a compression tax. The system produce three different thresholds, one to each band of image, that is proportional of amount information. For image reconstruction is realized DCT and PCA inverse. SAC was compared with JPEG (Joint Photographic Experts Group) standard and YIQ compression and better results are obtain, in MSE (Mean Square Root). Tests shown that SAC has better quality in hard compressions. With two advantages: (a) like is adaptive is sensible to image type, that is, presents good results to divers images kinds (synthetic, landscapes, people etc., and, (b) it need only one parameters user, that is, just letter human intervention is required

Estudo avaliativo de um algoritmo genético auto-organizável e multiobjetivo utilizando aprendizado de máquina para aplicações de telecomunicações

This paper presents an evaluative study about the effects of using a machine learning technique on the main features of a self-organizing and multiobjective genetic algorithm (GA). A typical GA can be seen as a search technique which is usually applied in problems involving no polynomial complexity. Originally, these algorithms were designed to create methods that seek acceptable solutions to problems where the global optimum is inaccessible or difficult to obtain. At first, the GAs considered only one evaluation function and a single objective optimization. Today, however, implementations that consider several optimization objectives simultaneously (multiobjective algorithms) are common, besides allowing the change of many components of the algorithm dynamically (self-organizing algorithms). At the same time, they are also common combinations of GAs with machine learning techniques to improve some of its characteristics of performance and use. In this work, a GA with a machine learning technique was analyzed and applied in a antenna design. We used a variant of bicubic interpolation technique, called 2D Spline, as machine learning technique to estimate the behavior of a dynamic fitness function, based on the knowledge obtained from a set of laboratory experiments. This fitness function is also called evaluation function and, it is responsible for determining the fitness degree of a candidate solution (individual), in relation to others in the same population. The algorithm can be applied in many areas, including in the field of telecommunications, as projects of antennas and frequency selective surfaces. In this particular work, the presented algorithm was developed to optimize the design of a microstrip antenna, usually used in wireless communication systems for application in Ultra-Wideband (UWB). The algorithm allowed the optimization of two variables of geometry antenna - the length (Ls) and width (Ws) a slit in the ground plane with respect to three objectives: radiated signal bandwidth, return loss and central frequency deviation. These two dimensions (Ws and Ls) are used as variables in three different interpolation functions, one Spline for each optimization objective, to compose a multiobjective and aggregate fitness function. The final result proposed by the algorithm was compared with the simulation program result and the measured result of a physical prototype of the antenna built in the laboratory. In the present study, the algorithm was analyzed with respect to their success degree in relation to four important characteristics of a self-organizing multiobjective GA: performance, flexibility, scalability and accuracy. At the end of the study, it was observed a time increase in algorithm execution in comparison to a common GA, due to the time required for the machine learning process. On the plus side, we notice a sensitive gain with respect to flexibility and accuracy of results, and a prosperous path that indicates directions to the algorithm to allow the optimization problems with "η" variables

Contribuições a técnicas de agrupamento e visualização de dados multivariados utilizando mapas auto-organizáveis

Self-organizing maps (SOM) are artificial neural networks widely used in the data mining field, mainly because they constitute a dimensionality reduction technique given the fixed grid of neurons associated with the network. In order to properly the partition and visualize the SOM network, the various methods available in the literature must be applied in a post-processing stage, that consists of inferring, through its neurons, relevant characteristics of the data set. In general, such processing applied to the network neurons, instead of the entire database, reduces the computational costs due to vector quantization. This work proposes a post-processing of the SOM neurons in the input and output spaces, combining visualization techniques with algorithms based on gravitational forces and the search for the shortest path with the greatest reward. Such methods take into account the connection strength between neighbouring neurons and characteristics of pattern density and distances among neurons, both associated with the position that the neurons occupy in the data space after training the network. Thus, the goal consists of defining more clearly the arrangement of the clusters present in the data. Experiments were carried out so as to evaluate the proposed methods using various artificially generated data sets, as well as real world data sets. The results obtained were compared with those from a number of well-known methods existent in the literature

O auto da morte e da vida : a escrita barroca de João Cabral de Melo Neto

This dissertation, entitled O Auto da Morte e da Vida: A escrita barroca de João Cabral de Melo Neto, has the aim of analising, interpreting, in a baroque perspective, Cabral s writing in the poem/play Morte e vida severina Auto de Natal Pernambucano, taking as basis the theories of Eugênio D´Ors, Severo Sarduy, Omar Calabrase, Lezama Lima, Afonso Ávila, Affonso Romano de Sant´Anna and others cited in the body of this work. During the analisys we feature confluences, relations, similarities, identification between the Baroque of the counter reformation and the modern Baroque or Neobaroque. We seek to comprehend the baroque which is new in the XX century and Cabral s poetry as an element of the contemporaneity, by updating the concept of the Baroque in the 1600s, when it is detected in its purest characteristic in human relation (the life of the Northwestern brazilian) through an intangible reality (the death). The Baroque as a cultural summary of a period of instability and transformation, with the power of dismantling an already established poetry. The fight between words and things, language and reality

O Aleph e seus duplos: mimesis e auto-reflexividade na obra de Jorge Luis Borges

This study approach the Jorge Luis Borges s prose of fiction under the perspective of mimesis and the self-reflexivity. The hypothesis is that the Aleph is a central symbol of the Borges s fictional universe. The rewriting and the retake of this symbol along of his work entail to a reflection about the possibilities and the limits of mimesis. This study is divided in three parts which contain two chapters. The first part Bibliographic revision and conceptual fundaments of inquiry discuss the critical fortune of author (Chapter 1) and the concepts that will give sustentation to the inquiry (Chapter 2). The second part About the Borges s aesthetic project sketch out the literary project defended by Borges that is his conception of the literature and his ideological matrix (Chapter 3) beside his anti-psychologism and his nostalgia of epos (Chapter 4). The third and last part is entitled The Aleph and his doubles. In the chapter 5 this study analyses the short story El Aleph and consider its centrality on the Borges s work. The argument that is on this short story Borges elaborates a reflection about mimesis. In the chapter 6, on the same hand, four short stories will be analysed: Funes el memorioso ; El Libro de Arena ; El evangelio según Marcos and Del rigor en la ciencia . The conclusion that is the Borges s literature is self-awake of its process as such demonstrate its parodic sense and its bookish origin. Hence, the Borges s literature overlapping the mimetic crisis of language and challenge the limits between fiction and reality. However, it doesn t surrender to the nihilist perspective that is closing of literature to the world

Modelos auto-similares para rádio fontes extragalácticas.

This work is a detailed study of self-similar models for the expansion of extragalactic radio sources. A review is made of the definitions of AGN, the unified model is discussed and the main characteristics of double radio sources are examined. Three classification schemes are outlined and the self-similar models found in the literature are studied in detail. A self-similar model is proposed that represents a generalization of the models found in the literature. In this model, the area of the head of the jet varies with the size of the jet with a power law with an exponent γ. The atmosphere has a variable density that may or may not be spherically symmetric and it is taken into account the time variation of the cinematic luminosity of the jet according to a power law with an exponent h. It is possible to show that models Type I, II and III are particular cases of the general model and one also discusses the evolution of the sources radio luminosity. One compares the evolutionary curves of the general model with the particular cases and with the observational data in a P-D diagram. The results show that the model allows a better agreement with the observations depending on the appropriate choice of the model parameters.