Evidências de validação de um protocolo para assistência às pessoas com úlceras venosas em serviços de alta complexidade

Venous ulcers are lesions resulting from chronic venous insufficiency, venous valvular abnormalities and venous thrombosis. Its occurrence has been growing with the increase in life expectancy of the world population. Considered as fundamental aspects in the approach to the person with venous ulcer care with the interdisciplinary approach, adoption of protocol-specific knowledge, technical skill, coordination between levels of care complexity of the Health System and active participation of patients and their families, a holistic perspective. The construction of a clinical protocol for people with venous ulcers can help professionals of high complexity services in patient assessment and the establishment of quality care in a systematic way and focused on the factors that interfere with wound healing. Thus, this study aimed to analyze the evidence of validation of a clinical protocol for people with venous ulcers treated at high-complexity services. This is a methodological study with a quantitative approach, developed in three stages: literature review, evidence of content validity and evidence of validation in the clinical context. Approved by the Federal University of Rio Grande do Norte Research Ethics Committee (Opinion: 147.452 and CAAE: 07556312.0.0000.5537). The literature review was conducted in August and September 2012, becoming the basis for the construction of the protocol. Then the evidence of content validity, which included 53 judges (experts) selected by the Lattes platform to evaluate the protocol items was performed. The judges were contacted by e-mail and rated the protocol via Google Docs . After analyzing the ratios obtained in this step, which reported kappa between 0.75 and 0.96 and between 0.80 and 0.98 IVC, and the suggestions of the judges, the protocol was adjusted and subjected to empirical evidence to validate the clinical setting at the University Hospital Onofre Lopes in Natal / RN. Evidence of validation in the clinical setting involved 4 judges who acted in pairs (paired) evaluated 32 patients with venous ulcers in the clinical context of high complexity. In both stages, we used the Kappa Index and Content Validity Index to analyze the responses of the judges. The parameters set as acceptable for these indices were: Kappa ≥ 0.61 and Content Validity Index > 0.80. Any evidence of content validity, as evidence of validation in the clinical context, the protocol items that have not reached Kappa and Content Validity Index established indices were excluded and some items were modified or added after suggestions. The process of content validation evidence and evidence of validation in the clinical setting allowed the improvement of the protocol for the care of people with venous ulcers initially proposed. The initial version of the protocol, built from the literature, contained 15 categories and 108 items; after evidence of content validity, remained the reduction to 15 categories with 91 items; the final version, clinically validated, is composed of the same 15 categories, 76 items. The protocol was validated in its content and in the clinical aspect, so we accepted the alternative hypothesis in the study. This protocol may contribute to the care system, allowing tailor behaviors and promote greater resolution in the treatment of people with venous ulcers in health services of high complexity

Conversor CC/CA de alta freqüência baseado em inversores ressonantes com comutação seqüencial para excitação de uma tocha indutiva a plasma térmico

This work describes the study, the analysis, the project methodology and the constructive details of a high frequency DC/AC resonant series converter using sequential commutation techniques for the excitation of an inductive coupled thermal plasma torch. The aim of this thesis is to show the new modulation technique potentialities and to present a technological option for the high-frequency electronic power converters development. The resonant converter operates at 50 kW output power under a 400 kHz frequency and it is constituted by inverter cells using ultra-fast IGBT devices. In order to minimize the turn-off losses, the inverter cells operates in a ZVS mode referred by a modified PLL loop that maintains this condition stable, despite the load variations. The sequential pulse gating command strategy used it allows to operate the IGBT devices on its maximum power limits using the derating and destressing current scheme, as well as it propitiates a frequency multiplication of the inverters set. The output converter is connected to a series resonant circuit constituted by the applicator ICTP torch, a compensation capacitor and an impedance matching RF transformer. At the final, are presented the experimental results and the many tests achieved in laboratory as form to validate the proposed new technique

Implementação de um algoritmo para a análise de curtos-circuitos de alta impedância baseado no fluxo de carga soma de potências

This work has as main objective to show all the particularities regarding the Three-phase Power Summation Method, used for load flow calculation, in what it says respect to the influence of the magnetic coupling among the phases, as well as to the losses presented in all the existent transformers in the feeder to be analyzed. Besides, its application is detailed in the study of the short-circuits, that happen in the presence of high impedance values, which possess a problem, that is its difficult detection and consequent elimination on the part of common devices of protection. That happens due to the characteristic presented by the current of short¬ circuit, in being generally of the same order of greatness that the load currents. Results of simulations accomplished in several situations will be shown, objectifying a complete analysis of the behavior of the proposed method in several types of short-circuits. Confront of the results obtained by the method with results of another works will be presented to verify its effectiveness

Análise do efeito do tempo da moagem de alta energia no tamanho de cristalito e microdeformação da rede cristalina do WC-Co

Hard metals are the composite developed in 1923 by Karl Schröter, with wide application because high hardness, wear resistance and toughness. It is compound by a brittle phase WC and a ductile phase Co. Mechanical properties of hardmetals are strongly dependent on the microstructure of the WC Co, and additionally affected by the microstructure of WC powders before sintering. An important feature is that the toughness and the hardness increase simultaneously with the refining of WC. Therefore, development of nanostructured WC Co hardmetal has been extensively studied. There are many methods to manufacture WC-Co hard metals, including spraying conversion process, co-precipitation, displacement reaction process, mechanochemical synthesis and high energy ball milling. High energy ball milling is a simple and efficient way of manufacturing the fine powder with nanostructure. In this process, the continuous impacts on the powders promote pronounced changes and the brittle phase is refined until nanometric scale, bring into ductile matrix, and this ductile phase is deformed, re-welded and hardened. The goal of this work was investigate the effects of highenergy milling time in the micro structural changes in the WC-Co particulate composite, particularly in the refinement of the crystallite size and lattice strain. The starting powders were WC (average particle size D50 0.87 μm) supplied by Wolfram, Berglau-u. Hutten - GMBH and Co (average particle size D50 0.93 μm) supplied by H.C.Starck. Mixing 90% WC and 10% Co in planetary ball milling at 2, 10, 20, 50, 70, 100 and 150 hours, BPR 15:1, 400 rpm. The starting powders and the milled particulate composite samples were characterized by X-ray Diffraction (XRD) and Scanning Electron Microscopy (SEM) to identify phases and morphology. The crystallite size and lattice strain were measured by Rietveld s method. This procedure allowed obtaining more precise information about the influence of each one in the microstructure. The results show that high energy milling is efficient manufacturing process of WC-Co composite, and the milling time have great influence in the microstructure of the final particles, crushing and dispersing the finely WC nanometric order in the Co particles

Influência da formação de pozolanas com adição de metacaulim em concreto de alta resistência

The need to build durable structures and resistant to harsh environments enabled the development of high strength concrete, these activities generate a high cement consumption, which implies factor in CO2 emissions. Often the desired strength is not achieved using only the cement composition. This study aims to evaluate the influence of pozzolans with the addition of metakaolin on the physical mechanics of high strength concrete comparing them with the standard formulation. Assays were performed to characterize the aggregates according to NBR 7211, evaluation of cement and coarse aggregate through the trials of petrography (NBR 15577-3/08) and alkali-aggregate reaction (NBR 15577-05/08). Specimens were fabricated according to NBR 5738-1/04 with additions of 0%, 4%, 6%, 8% and 10% of metakaolin for cement mortars CP V in the formulations. For evaluation of the concrete hardened in fresh state and scattering assays were performed and compressive strength in accordance with the NBR 7223/1992 and NBR 5739-8/94 respectively. The results of the characterization of aggregates showed good characteristics regarding size analysis and petrography, as well as potentially innocuous as the alkali-aggregate reaction. As to the test of resistance to compression, all the formulations with the addition of metakaolin showed higher value at 28 days of disruption compared with the standard formulation. These results present an alternative to reduce CO2 emissions, and improvements in the quality and durability of concrete, because the fine particle size of metakaolin provides an optimal compression of the mass directly influencing the strength and rheology of the dough

Obtenção de Propriedades Físico-Químicas de Misturas de Hidrocarbonetos em Baixa e Alta Pressão Visando a Caracterização e a Modelagem

The composition of petroleum may change from well to well and its resulting characteristics influence significantly the refine products. Therefore, it is important to characterize the oil in order to know its properties and send it adequately for processing. Since petroleum is a multicomponent mixture, the use of synthetic mixtures that are representative of oil fractions provides a better understand of the real mixture behavior. One way for characterization is usually obtained through correlation of physico-chemical properties of easy measurement, such as density, specific gravity, viscosity, and refractive index. In this work new measurements were obtained for density, specific gravity, viscosity, and refractive index of the following binary mixtures: n-heptane + hexadecane, cyclohexane + hexadecane, and benzene + hexadecane. These measurements were accomplished at low pressure and temperatures in the range 288.15 K to 310.95 K. These data were applied in the development of a new method of oil characterization. Furthermore, a series of measurements of density at high pressure and temperature of the binary mixture cyclohexane + n-hexadecane were performed. The ranges of pressure and temperature were 6.895 to 62.053 MPa and 318.15 to 413.15 K, respectively. Based on these experimental data of compressed liquid mixtures, a thermodynamic modeling was proposed using the Peng-Robinson equation of state (EOS). The EOS was modified with scaling of volume and a relatively reduced number of parameters were employed. The results were satisfactory demonstrating accuracy not only for density data, but also for isobaric thermal expansion and isothermal compressibility coefficients. This thesis aims to contribute in a scientific manner to the technological problem of refining heavy fractions of oil. This problem was treated in two steps, i.e., characterization and search of the processes that can produce streams with economical interest, such as solvent extraction at high pressure and temperature. In order to determine phase equilibrium data in these conditions, conceptual projects of two new experimental apparatus were developed. These devices consist of cells of variable volume together with a analytical static device. Therefore, this thesis contributed with the subject of characterization of hydrocarbons mixtures and with development of equilibrium cells operating at high pressure and temperature. These contributions are focused on the technological problem of refining heavy oil fractions

Morfologia em alta resolução espacial de estrelas de tipo Mira e R Corenae Borealis

Mira and R Coronae Borealis (R CrB) variable stars are evolved objects surrounded by circumstellar envelopes (CSE) composed of the ejected stellar material. We present a detailed high-spatial resolution morfological study of the CSE of three stars: IRC+10216, the closest and more studied Carbon-Rich Mira; o Ceti, the prototype of the Mira class; and RY Sagitarii (RY Sgr), the brightest R CrB variable of the south hemisphere. JHKL near-infrared adaptive optics images of IRC+10216 with high dynamic range and Vband images with high angular resolution and high depth, collected with the VLT/NACO and VLT/FORS1 instruments, were analyzed. NACO images of o Ceti were also analyzed. Interferometric observations of RY Sgr collected with the VLTI/MIDI instrument allowed us to explore its CSE innermost regions (»20 40 mas). The CSE of IRC+10216 exhibit, in near-infrared, clumps with more complex relative displacements than proposed in previous studies. In V-band, the majority of the non-concentric shells, located in the outer CSE layers, seem to be composed of thinner elongated shells. In a global view, the morphological connection between the shells and the bipolar core of the nebulae, located in the outer layers, together with the clumps, located in the innermost regions, has a difficult interpretation. In the CSE of o Ceti, preliminar results would be indicating the presence of possible clumps. In the innermost regions (.110 UA) of the CSE of RY Sgr, two clouds were detected in different epochs, embedded in a variable gaussian envelope. Based on a rigorous verification, the first cloud was located at »100 R¤ (or »30 AU) from the centre, toward the east-north-east direction (modulo 180o) and the second one was almost at a perpendicular direction, having aproximately 2£ the distance of the first cloud. This study introduces new constraints to the mass-loss history of these kind of variables and to the morphology of their innermost CSE regions

Processos de aquecimento na alta atmosfera estelar: emissão coronal em raio-x e emissão cromosférica em CaII

In the present work we study the processes of heating in the high stellar atmosphere, with base in an analysis of behavior of the cromospheric and coronal emission for a sample of single stars classified as giant in the literature. The evolutionary status of the stars of the sample was determined from HIPPARCOS satellite trigonometric parallax measurements and from the Toulouse Genéve code. In this study we show the form of behavior of the CaII emission flux in spectral lines H and K F(CaII) and the X-ray emission flux in function of the rotation, number of Rossby Ro and depth in mass of the convective envelope. In this analysis we show that while the cromospheric activity is dominated clearly by a physical process of heating associated with the rotation, like a magnetic field produced by dynamo effect, the coronal activity seems to be influenced for a mechanism independent of the rotation. We show also that the effective role of the depth in massa of the convective envelope on the stellar activity has an important effect in the responsible physical process for the behavior of the activity in the atmosphere of the stars.

Análise dos fatores responsáveis pela alta salinidade do aqüífero fissural da microbacia da Riacho do Feijão - Pedro Avelino/RN

The fissures aquifer northeast semi-arid Brazilian, present high text frequently of leave, with of low a hídric availability. The research has as objective main to analyze the components that inside influence in the salinity of the waterbearing fissures of an evaluation physicist-chemistry of the water, leading in consideration the physical interventions of the environment. One used techniques of interpretation of image of Landsat satellite -1999 and delimitation of the micro basin through the topographical map SUDENE. One identified waters of the NaCl type with Ca++ and Mg++ in secondary concentrations. The analyzed wells (15), had presented an average salinity of 5.147 mg/L of STD and a well only supplies drinking waters with 319 mg/L of STD. The recharge of the aquifer one if carries through for infiltration in the open fracture of ortognaisse it migmatization. The type and directions of the fracture do not control the STD. Relations between salinity and out let do not exist. The quality of the well of low salinity is identical the superficial waters (aquifer dam and alluvial). The studies of the meteoric erosion processes had evidenced that in the transformations of the rock in ground, the Ca++ and Na+ are taken for superficial waters. The treatment of the data chemical showed that the grade of Na+, Ca++, Mg++ and Cl-are controlled for the evaporation process, from only water that would have the qualities of superficial waters or the well of low salinity. Already the HCO3-grade is controlled for the precipitation of the dolomite. The STD of this aquifer one would be consequence of the high tax of evaporation of dams constructed in regions of plain topography. You leave them precipitated in deep argillaceous ones dry dams are led for the aquifer in first rains. The research suggests some recommendations for the use and exploitation of the water salinity in piscicultura, carcinicultura, culture of the grass-salt (Atriplex sp), among others

Interferindo com oscilações de alta frequência no hipocampo epiléptico: consequências para as crises espontâneas

Conselho Nacional de Desenvolvimento Científico e Tecnológico

Revisitando o eletrocorticograma intra-operatório na epilepsia mesial do lobo temporal: relevância das oscilações de alta frequência

Epilepsies are neurological disorders characterized by recurrent and spontaneous seizures due to an abnormal electric activity in a brain network. The mesial temporal lobe epilepsy (MTLE) is the most prevalent type of epilepsy in adulthood, and it occurs frequently in association with hippocampal sclerosis. Unfortunately, not all patients benefit from pharmacological treatment (drug-resistant patients), and therefore become candidates for surgery, a procedure of high complexity and cost. Nowadays, the most common surgery is the anterior temporal lobectomy with selective amygdalohippocampectomy, a procedure standardized by anatomical markers. However, part of patients still present seizure after the procedure. Then, to increase the efficiency of this kind of procedure, it is fundamental to know the epileptic human brain in order to create new tools for auxiliary an individualized surgery procedure. The aim of this work was to identify and quantify the occurrence of epilepticform activity -such as interictal spikes (IS) and high frequency oscillations (HFO) - in electrocorticographic (ECoG) signals acutely recorded during the surgery procedure in drug-resistant patients with MTLE. The ECoG recording (32 channels at sample rate of 1 kHz) was performed in the surface of temporal lobe in three moments: without any cortical resection, after anterior temporal lobectomy and after amygdalohippocampectomy (mean duration of each record: 10 min; N = 17 patients; ethic approval #1038/03 in Research Ethic Committee of Federal University of São Paulo). The occurrence of IS and HFO was quantified automatically by MATLAB routines and validated manually. The events rate (number of events/channels) in each recording time was correlated with seizure control outcome. In 8 hours and 40 minutes of record, we identified 36,858 IS and 1.756 HFO. We observed that seizure-free outcome patients had more HFO rate before the resection than non-seizure free, however do not differentiate in relation of frequency, morphology and distribution of IS. The HFO rate in the first record was better than IS rate on prediction of seizure-free patients (IS: AUC = 57%, Sens = 70%, Spec = 71% vs HFO: AUC = 77%, Sens = 100%, Spec = 70%). We observed the same for the difference of the rate of pre and post-resection (IS: AUC = 54%, Sens = 60%, Spec = 71%; vs HFO: AUC = 84%, Sens = 100%, Spec = 80%). In this case, the algorithm identifies all seizure-free patients (N = 7) with two false positives. To conclude, we observed that the IS and HFO can be found in intra-operative ECoG record, despite the anesthesia and the short time of record. The possibility to classify the patients before any cortical resection suggest that ECoG can be important to decide the use of adjuvant pharmacological treatment or to change for tailored resection procedure. The mechanism responsible for this effect is still unknown, thus more studies are necessary to clarify the processes related to it

O dispositivo alta nos Centros de Atenção Psicossocial/CAPS : loucura, vida cotidiana e organização social

The present paper proposes an analysis about the Brazilian Psychiatric Reform as a public policy and deriving from a research developed with the workers of a Psychosocial Attention Centre III (CAPS III) and the managers of the Psychosocial Attention Web (REAP) in Aracaju. This analysis is developed as an investigation of the discharge at those services, understood not as a procedure, but as a dispositive from which different elements can be articulated: users, knowledge, technical procedures, police measures, juridical decisions, laws, services edifying. This, form the background of the articulation between mental alienation and the subject of right alienation, in the ways through which this articulation develops to the relations between madness,citizenship, internment and substitutive practices. Our investigation about the discharge as a dispositive was built with some narrative constructions, as a discourse analysis inspired by Michel Foucault s method, from the perspective of some of the main dispositive operators: workers and managers. The main aspect observed were: the articulations built by the discharge as a dispositive based on two discursive grate, the Reform as a new treatment substituting internship, and the Reform as juridical insertion and users rights practice; the exercise of these discursive grades based on the workers and managers perspective; the transference of limitations and contradictions of these grades to the competence of the dispositive operators, emerged in an outstanding way, as sometimes those operators are liable for the emergent limitations and difficulties, and some other times they are restrained by their institutional role, which is to maintain the domination relations articulated by the dispositive; finally, some aspects extracted which the dispositive operators - when they were expected to act in a way to maintain certain power relations - were capable to resist, managing other power relations from the dispositive, that we call, as Agamben, dispositive profanity

Degradação catalítica de polietileno de alta densidade sobre a zeólita HZSM

In last years it has talked a lot about the environment and the plastic waste produced and discarded. In last decades, the increasing development of research to obtain fuel from plastic material, by catalytic degradation, it has become a very attractive looking, as these tailings are discarded to millions worldwide. These materials take a long time to degrade themselves by ways said natural and burning it has not demonstrated a viable alternative due to the toxic products produced during combustion. Such products could bring serious consequences to public health and environment. Therefore, the technique of chemical recycling is presented as a suitable alternative, especially since could be obtain fractions of liquid fuels that can be intended to the petrochemical industry. This work aims to propose alternatives to the use of plastic waste in the production of light petrochemical. Zeolites has been widely used in the study of this process due to its peculiar structural properties and its high acidity. In this work was studied the reaction of catalytic degradation of high-density polyethylene (HDPE) in the presence HZSM-12 zeolites with different acid sites concentrations by thermogravimetry and pyrolysis coupled with GC-MS. The samples of the catalysts were mixed with HDPE in the proportion of 50% in mass and submitted to thermogravimetric analyses in several heating rates. The addition of solids with different acid sites concentrations to HDPE, produced a decrease in the temperature of degradation of the polymer proportional the acidity of the catalyst. These qualitative results were complemented by the data of activation energy obtained through the non-isothermal kinetics model proposed by Vyazovkin. The values of Ea when correlated to the data of surface acidity of the catalysts indicated that there is a exponential decrease of the energy of activation in the reaction of catalytic degradation of HDPE, in function of the concentration of acid sites of the materials. These results indicate that the acidity of the catalyst added to the system is one of the most important properties in the reaction of catalytic degradation of polyethylene

Otimização em braquiterapia de alta taxa de dose com algoritmo transgenético

Este trabalho aborda o problema de otimização em braquiterapia de alta taxa de dose no tratamento de pacientes com câncer, com vistas à definição do conjunto de tempos de parada. A técnica de solução adotada foi a Transgenética Computacional apoiada pelo método L-BFGS. O algoritmo desenvolvido foi empregado para gerar soluções não denominadas cujas distribuições de dose fossem capazes de eiminar o câncer e ao mesmo tempo preservar as regiões normais

Aquisição, processamento e análise de dados de sísmica de alta resolução na plataforma continental norte do Rio Grande do Norte: Vale inciso do rio açu

On the modern Continental Shelf to the north of Rio Grande do Norte state (NE Brazil) is located a paleo-valley, submerged during the last glacial sea-level lowstand, that marks continuation of the most important river of this area (Açu River). Despite the high level of exploration activity of oil industry, there is few information about shallow stratigraphy. Aiming to fill this gap, situated on the Neogene, was worked a marine seismic investigation, the development of a processing flow for high resolution data seismic, and the recognition of the main feature morphology of the study area: the incised valley of the River Açu. The acquisition of shallow seismic data was undertaken in conjunction with the laboratory of Marine Geology/Geophysics and Environmental Monitoring - GGEMMA of Federal University of Rio Grande do Norte UFRN, in SISPLAT project, where the geomorphological structure of the Rio paleovale Açu was the target of the investigation survey. The acquisition of geophysical data has been over the longitudinal and transverse sections, which were subsequently submitted to the processing, hitherto little-used and / or few addressed in the literature, which provided a much higher quality result with the raw data. Once proposed for the flow data was developed and applied to the data of X-Star (acoustic sensor), using available resources of the program ReflexW 4.5 A surface fluvial architecture has been constructed from the bathymetric data and remote sensing image fused and draped over Digital Elevation Models to create three-dimensional (3D) perspective views that are used to analyze the 3D geometry geological features and provide the mapping morphologically defined. The results are expressed in the analysis of seismic sections that extend over the region of the continental shelf and upper slope from mouth of the Açu River to the shelf edge, providing the identification / quantification of geometrical features such as depth, thickness, horizons and units seismic stratigraphyc area, with emphasis has been placed on the palaeoenvironmental interpretation of discordance limit and fill sediment of the incised valley, control by structural elements, and marked by the influence of changes in the sea level. The interpretation of the evolution of this river is worth can bring information to enable more precise descriptions and interpretations, which describes the palaeoenvironmental controls influencing incised valley evolution and preservation to provide a better comprehensive understanding of this reservoir analog system