Trauma em idosos atendidos pelo serviço pré-hospitalar móvel

O The aim of this study was to characterize the occurrence of trauma in the elderly population served by the mobile pre-hospital service, in Natal, Rio Grande do Norte. This is a descriptive, transversal and quantitative approach and whose population consisted of 2,080 trauma victims. The sample, of systematic random type, consisted of 400 elderly people, aged from 60 years old, assisted by the Office of Mobile Emergency in Natal / RN, between January 2011 and December 2012. Data collection began after consent and assent of the institution of a Research Ethics Committee under No. 309 505. It was proceeded to documentary retrospective analysis of records of this service through a form of self-development, validated by expert judges considered reliable (α> 0.75) and valid (CVI = 0.97) in their clarity and relevance. Data were tabulated by the Statistical Package for Social Sciences, version 20.0. The results show that older victims have an average age of 74.19 years old, with a prevalence of female involvement by chronic diseases, especially hypertension, average usage of 2.2 routine medications with vital signs within normal limits. The trauma prevailed during the daytime, in the residence of the victims, north of the city and on weekends. Among the mechanisms of trauma were falls, traffic accidents and physical aggression, whose most common type was brain-cerebral trauma and the main consequences were suture wounds and closed fractures. Basic Support Units were as more driven to pre-hospital care (87.8%) and the main destination place consisted of a referral hospital for emergency of the state (57.5%). Among the most commonly performed procedures by nursing staff immobilization with rigid board and neck collar and the peripheral venipuncture, and the main component used for volume replacement to saline were highlighted. There was a significant relationship between the deaths and the mechanism of injury, mechanism of injury and procedures, except medication administration procedures carried out, except immobilization and unit for service. It is highlighted the prevalence of trauma in the elderly, poor follow-up Pre-Hospital Trauma Life Support protocol and the paucity of records and nursing procedures performed. There is need for a protocol of care specific to elderly trauma victims and education strategies for the prevention of such events

Implementação de rotinas computacionais básicas para cabeça estéreo robótica

O Laboratório de Sistemas Inteligentes do Departamento de Engenharia de Computação e Automação da Universidade Federal do Rio Grande do Norte - UFRN -tem como um de seus projetos de pesquisa -Robosense -a construção de uma plataforma robótica móvel. Trata-se de um robô provido de duas rodas, acionadas de forma diferencial, dois braços, com 5 graus de liberdade cada, um cinturão de sonares e uma cabeça estéreo. Como objetivo principal do projeto Robosense, o robô deverá ser capaz de navegar por todo o prédio do LECA, desviando de obstáculos. O sistema de navegação do robô, responsável pela geração e seguimento de rotas, atuará em malha fechada. Ou seja, sensores serão utilizados pelo sistema com o intuito de informar ao robô a sua pose atual, incluindo localização e a configuração de seus recursos. Encoders (sensores especiais de rotação) foram instalados nas rodas, bem como em todos os motores dos dois braços da cabeça estéreo. Sensores de fim-de-curso foram instalados em todas as juntas da cabeça estéreo para que seja possível sua pré-calibração. Sonares e câmeras também farão parte do grupo de sensores utilizados no projeto. O robô contará com uma plataforma composta por, a princípio, dois computadores ligados a um barramento único para uma operação em tempo real, em paralelo. Um deles será responsável pela parte de controle dos braços e de sua navegação, tomando como base as informações recebidas dos sensores das rodas e dos próximos objetivos do robô. O outro computador processará todas as informações referentes à cabeça estéreo do robô, como as imagens recebidas das câmeras. A utilização de técnicas de imageamento estéreo torna-se necessária, pois a informação de uma única imagem não determina unicamente a posição de um dado ponto correspondente no mundo. Podemos então, através da utilização de duas ou mais câmeras, recuperar a informação de profundidade da cena. A cabeça estéreo proposta nada mais é que um artefato físico que deve dar suporte a duas câmeras de vídeo, movimentá-las seguindo requisições de programas (softwares) apropriados e ser capaz de fornecer sua pose atual. Fatores como velocidade angular de movimentação das câmeras, precisão espacial e acurácia são determinantes para o eficiente resultado dos algoritmos que nesses valores se baseiam

Algoritmos genéricos para otimização de uma arquitetura de controle inteligente híerárquico

A hierarchical fuzzy control scheme is applied to improve vibration suppression by using an electro-mechanical system based on the lever principle. The hierarchical intelligent controller consists of a hierarchical fuzzy supervisor, one fuzzy controller and one robust controller. The supervisor combines controllers output signal to generate the control signal that will be applied on the plant. The objective is to improve the performance of the electromechanical system, considering that the supervisor could take advantage of the different techniques based controllers. The robust controller design is based on a linear mathematical model. Genetic algorithms are used on the fuzzy controller and the supervisor tuning, which are based on non-linear mathematical model. In order to attest the efficiency of the hierarchical fuzzy control scheme, digital simulations were employed. Some comparisons involving the optimized hierarchical controller and the non-optimized hierarchical controller will be made to prove the efficiency of the genetic algorithms and the advantages of its use

Avaliação da potencialidade de argilas de queima clara como matérias-primas para o desenvolvimento de novos produtos cerâmicos

The industries of structural ceramics are among the most important production chains in the state of Rio Grande do Norte. The industry and other interest groups to target the replacement of firewood by natural gas. Studies accordingly concluded that simple change does not guarantee products of superior quality, and that the increase in spending on fuel can economically cripple the use of gas for burning the majority of products manufactured by that action. However some proposals of innovations in terms of process and product are being studied in an attempt to justify the use of natural gas in industry, structural ceramics. One of the aspects investigated is the development of ceramic products differentiated, with new designs and greater value added. Inserted in that context, this paper aims to investigate the potential use of clay-firing clear fabrication of the "bricks of apparent joins drought", a new ceramic product with an innovative way. The development of the work was done in three stages. In the initial stage was held the characterization of raw materials, sought information on physical, chemical, mineralogical and mechanical samples. In the second stage five bodies were made using two of the nine ceramic clay characterized the first step. The masses were analyzed and compared with respect to the size distribution, plasticity and technological properties. In the last part of this work was carried out tests on massive bricks manufactured on an industrial scale. The results show that the nine clays can be used in the manufacture of new ceramic products, is the only constituent of mass ceramic or by mixing with other(s) clay(s

Parâmetros físico-químicos de estrelas nos campos de exoplanetas do satélite corot

A rotação estelar é um dos mais importantes observáveis da evolução estelar. Neste sentido, o satélite CoRoT representa uma oportunidade única de medir os períodos rotacionais para uma amostra de estrelas estatisticamente robusta, oferecendo dados absolutamente necessários para o estudo da rotação e seu papel na evolução estelar. Para conseguir isto, um passo fundamental é a caracterização física e química das estrelas observadas pelo CoRoT, especificamente devido ao fato de que o cálculo de períodos rotacionais confiáveis é um trabalho difícil sem a ajuda dos parâmetros estelares. Desta forma, foi elaborado um importante seguimento observacional das estrelas nos campos do CoRoT do anticentro LRa01 e do centro LRc01, permitindo a correta identificação dos períodos que reflitam a modulação rotacional. Nesta tese de doutorado são apresentados os resultados de tal seguimento. Parâmetros físicos e químicos, tais como temperatura efetiva Teff , gravidade superficial log(g), velocidade de microturbulência Vmic, abundância de ferro [Fe/H], velocidade de rotação projetada Vsin(i), e abundância de lítio A(Li) são apresentados para uma amostra de 116 estrelas dos campos CoRoT. Elas se encontram em diferentes estágios evolutivos, desde a sequência principal (SP) até o ramo das gigantes vermelhas (GV). As observações foram feitas utilizando os espectrógrafos UVES (VLT) e HYDRA (CTIO). Para a derivação de tais parâmetros foram utilizados o programa TurboSpectrum e os modelos de atmosfera de MARCS. Paralelamente, velocidades rotacionais Vsin(i) foram obtidas a partir do ajuste dos perfis observados e sintéticos das linhas de ferro e por meio de uma calibração de função de correlação cruzada (CCF). Períodos rotacionais Prot para 77 estrelas da amostra foram obtidos a partir das curvas de luz do satélite CoRoT. Extensas tabelas destes parâmetros e seus respectivos erros são apresentadas. Foram encontradas diferenças nas distribuições de Teff , [Fe/H] e estágios evolutivos entre os diferentes campos do CoRoT, indicando possíveis efeitos de seleção na amostra, assim como a existência de diferentes populações estelares do disco Galáctico. Por outro lado, o comportamento rotacional e as abundâncias de lítio não apresentam diferenças entre estrelas de parâmetros físicos similares, mas que pertencem a diferentes campos do CoRoT. A partir da análise de temperaturas, foi encontrada uma maior extinção por avermelhamento para estrelas do CoRoT localizadas no campo LRc01, assim como um gradiente deste valor em função da distância. Os resultados mostram que as abundâncias de lítio, as velocidades de rotação e os períodos rotacionais apresentam o mesmo comportamento descrito na literatura. Por outro lado, é apresentada pela primeira vez a relação que existe entre o lítio e o período de rotação em diferentes estágios evolutivos, mostrando, tal como era esperado, que ambas as grandezas possuem uma anticorrelação. Também é apresentada a evolução simultânea da rotação e do lítio, e foram calculadas relações que permitem obter valores médios de A(Li) como função da temperatura efetiva e do período rotacional. Os dados apresentados nesta tese de doutorado representam um importante ponto de partida para serem utilizados como uma amostra de calibração para diferentes programas no contexto da missão do satélite CoRoT, uma vez que a lista de estrelas aqui analisadas são parte das mais brilhantes que compõem o campo Exo do CoRoT

Avaliação muscular respiratória: adaptação do mano vacuômetro nacional para a avaliação da pressão inspiratória nasal e nível de intensidade da ventilação voluntária máxima em sujeitos saudáveis

The clinical importance of evaluating the respiratory muscles with a variety of tests has been proposed by several studies, once that the combination of several tests would allow a better diagnosis and therefore, a better clinical follow of disorders of the respiratory muscles. This study aimed to evaluate the feasibility of adapting a national electronic manovacuometer to measure the nasal inspiratory pressure (study 1) and analyze the level of load intensity of maximum voluntary ventilation, as well as the variables that may influence this maneuver in healthy subjects (study 2). We studied 20 healthy subjects by a random evaluation of two measures of SNIP in different equipments: a national and an imported. In study 2 it was analyzed the intensity of the load of MVV test, change in pressure developed during the maneuver, the possible differences between genders, and the correlations between the flow developed in the test and the result of MVV. In study 1 it was found the average for both measures of nasal inspiratory pressures: 125 ± 42.4 cmH2O for the imported equipment and 131.7 ± 28.7 cmH2O for the national one. Pearson analysis showed a significant correlation between the average, with a coefficient r = 0.63. The average values showed no significant differences evaluated by paired t test (p> 0.05). In the Bland-Altman analysis it was found a BIAS = 7 cmH2O, SD 32.9 and a confidence interval of - 57.5 cmH2O up to 71.5 cmH2O. In the second study it was found significant differences between the genders in the air volume moved, being higher in males 150.9 ± 13.1 l / min vs 118.5 ± 15.7 L / min for (p = 0.0002, 95% CI 44.85 to 20:05). Regarding the inspiratory and expiratory loading, they were significantly higher in men than in women, peak inspiratory pressure (34.7 ± 5.3 cmH2O vs 19.5 ± 4.2 cmH2O, 95% CI - 18.0 to -12.3, p <0.0001), peak expiratory (33.8 vs. 23.1 ± 5.9 cmH2O ± 5.4 cmH2O, 95% CI -17.1 to - 4.6, p <0.0001), and the delta pressure (59.7 ± 10 cmH2O vs 36.8 ± 8.3 cmH2O, 95% CI 14.5 to 31.2, p <0.0002). The Pearson correlation showed that the flow generated by the maneuver is strongly correlated with the delta-expiratory pressure / inspiratory (r2= 0.83,R = 0.91, 95%IC 0.72 a 0.97 e p< 0.0001).Through these results we suggest that the national electronic manovacuometer is feasible and safe to perform the sniff test in healthy subjects. For the MVV, there are differences between the genders in the intensity of pressure developed during the maneuver. We found a load intensity considered low during the MVV, and found a strong correlation between the flow generated in the test and the delta pressure expiratory / inspiratory

Efeitos da perda de peso induzida pela cirurgia bariátrica sobre a função respiratória

Background: Obesity leads to alteration of lung volumes and capacities due to accumulation of fat in the chest wall and abdomen. Few studies have shown that weight loss induced by surgery improves lung function. Our objective was to evaluate the anthropometric development, pulmonary function, respiratory muscle, strength and endurance after weight loss induced by bariatric surgery. Methods: We evaluated in pre and post operative period variables of weight, BMI, NC, WHR and spirometric and respiratory pressure. Results: 39 subjects were evaluated, with age mean 35.9 ± 10.9 years, predominantly by women (76.3%). The weight mean decreased from 124.8 ± 17.5 kg to 88.8 ± 14.28 kg in post operative. The mean BMI ranged from 47,9 ± 5,6 Kg/m² to 34,3 ± 4,75 Kg/m². There was a significant increase in FVC from 3,63 ± 0,94 to 4,01±1,03, FEV1 from 3,03 ± 0,72 to 3,39 ± 0,85, FEF 25-75% from 3,41 ± 0,72 to 3,82 ± 0,94, PEF from 6,56 ± 1,47 to 7,81 ± 1,69, ERV from 0,35 ± 0,39 to 0,66 ± 0,38, MVV ranged from 103,43 ± 22,21 to 137,27 ± 29,84, all of them to p<0,01. The MIP and MEP showed no significant difference in pre and post operative. It was noted that for every centimeter reduced in neck circumference, an increase of 0.06 in FVC and 5.98 in MVV is observed. This is also observed in weight and BMI. Conclusion: We conclude that weight loss induced by bariatric surgery in obese provides a significant improvement in lung function and reduction of fat around the neck is more important in the generation of lung volume than the reduction of BMI

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

Valor prognóstico de células TCD8+ E natural killer em carcinoma epidermóide oral e orofaringeano tratado com radioterapia e quimioterapia

The most common malignant neoplasm of the oral cavity and oropharynx are squamous cell carcinoma. Injuries to the same stage and subjected to the same treatment protocol have sometimes different evolutionary courses. The scope of this study was to investigate, through a retrospective cohort, associations between the number of CD8 + T cells and natural killer, identified immunohistochemically in the inflammatory infiltrate in a series of cases of oral squamous cell carcinoma and orofaringeano, and the level of tumor response to radiotherapy and chemotherapy, overall survival and relapse-free survival of patients. We identified 54 patients with unresectable disease were treated exclusively with radiotherapy and chemotherapy. The median follow-up was 22 months. The sample was characterized by the predominance of male subjects, median age 60 years, all were smokers. The most frequent site was the tongue and 81.5% were in stage IV. Patients with disease in the oral cavity had a worse response to treatment (p = 0.006), worse relapse-free survival (p = 0.007), worse overall survival (p = 0.007). The advanced T stage was shown a negative prognostic factor (p= 0.006) for the clinical treatment response made. Immunohistochemistry was performed to select CD8 + cells (anti-CD8) and NK cells (anti-CD57). Lymphocytes positive and negative markings were counted using the program ImageJ ®. Two groups were created for each marking evaluated: Group I patients with more than 50% cells positive, Group II: less than 50% of labeled cells. For CD8 + cells detected in 38 (70.3%) of Group I were CD8 + and 16 (29.7%) Group II CD8 +. For NK cells, 26 (48.15%) Group I NK and 28 (51.85%) Group II NK. Regarding the clinical response to treatment, we observed that 39% of patients achieved a complete response and 25.9% remained without recurrence at the end of follow-up. These results were better in Group I CD8 + (p = 0.2). Identified that 72.2% of patients progressed to death, this finding had no association with the immunohistochemical data. There was no statistically significant differences between the number of CD8 + and NK cells and the ability of tumor response to radiotherapy and chemotherapy, or with overall survival and relapse-free survival of patients. However, especially in relation to a learned response, we found that this group of patients with advanced disease have a low count of CD8 + T cells active. Believing in the role that the immune response plays in the local fight against neoplastic cells, however, our results do not support the use of quantitative analysis of CD8 + T cells and NK cells as a prognostic factors for oral squamous cell carcinoma and oropharynx

Elaboração e avaliação de indicadores comportamentais de aderência ao tratamento hemodialítico

Introduction: This work intents to characterize behavioral indicators of tack to the hemodialysis treatment in a sample of carrying patients of chronic kidney failure (CKF) in the great Natal/RN. The therapeutical adherence represents the agreement degree between the patient behavior and the health team lapsings. The CKF is the gradual and irreversible loss of the renal function, being the hemodialysis treatment an important alternative to assist or to substitute the kidneys. Method: The sample consisted in 80 chronic kidney patients in hemodialysis treatment in two located clinical centers in the region of the great Natal, RN. It was used as instruments (a) a protocol of clinical data collection, (b) the Millon Index of Personality Styles (MIPS) and (c) a script of halfstructuralized interview. Results: The results show a balance between the genders (51% of female and 48.8% of the male sex), average age and equal average time of dialysis respectively to the 43,4 years (±13,25 years) and 22,04 years (±4,24 years). The marital status of half of the sample is married, predominating basic education (43.6%) and a familiar income until a minimum wage (43.8%). It had been defined six physicianlaboratorial indicators to evaluate the therapeutical adherence, further the use of the evaluation of the health team and the patient themselves. Thus, there was an average adherence around 55.97% of the sample ±18.37%). However only between selfassessment of the patients about the adherence and the assessment made by blood pressure post-dialysis indicated a significant association (p=0,029, qui-square test). On the other hand, there was a significant association (p <0.05, chi-square test) among the criteria for treatment adherence and issues investigated in the interview - the perception on the quality of the health services provided to patients, the difficulties following the prescribed diet, the characterization of the days between dialysis sessions and the perception of patients about the dialysis sessions. It was also noted a significant association (p <0.05, Levene test) between adherence to therapy and scales that constitute the MIPS. The health team characterized the patients more adherent behavior as an attitude of acceptance of the treatment, looking actively for their implementation, for more information and knowledge, and establishing a positive communication with the team and with other patients. Similar results were confirmed by the MIPS evaluation. According to that assessment the more compliant patients adopt a more optimistic attitude, trying to act or adapt themselves to their environment, processing cognitively both concrete and objective information, such as more speculative and symbolic information. In addition they establish a gregarious, cooperative, submissive and flexibly pattern of interpersonal relationships to social demands. These characteristics managed to explain 55.7% of the adherence variation according the health team and 23.3% of the variation according the CaxP laboratory indicator. Conclusions: The MIPS shown to be able to identify the most and least adherent to therapy patients. The use of different adherence indicators is important for an evaluation covering the different facets of this process. The adhesion levels are observed within registered by the relevant literature. There is need for further studies with a larger sample to deepen the data findings in this work

A reafirmação do bairro:um estudo geo-histórico do bairro do Alecrim na cidade de Natal-RN

By the end of the 21st Century, economy globalization trends to show a velocity process through which market being expanded characterized by an intense going on of the internationalization of finance, after that marginalizing the periphery of the social spaces. It is clear to see that this process occurred in those less developed countries happens in an accentuated way just because income distribution that is so regressive and also because the insufficient enclosing of the social programs, we find this situation in a big part of Brazilian cities. The marginalizing social economical process observed in Natal, a city located in the east coast part of Northeast region in Brazil and that owns a population upper to 778 thousand in habitants is nearly linked to the extension of goods and services commerce. The installation of new urban activities in the city pointed out tourist activity as the greater impulsive thing in the phenomenon promotion, most of them aiming to promote Natal to the national and international scenery. It privilege strongly in the South zone with economical implementations such as shopping s centers, supermarkets, and home buildings condominiums leading to a loss of functionality of some traditional district located in central areas of the city. Notwithstanding, some spaces, for instance Alecrim district officially created in 1911, has notably resisted to the expansion of the urban process pointed out in Natal in the last years. So that this put Alecrim District as a district with originally characteristics reaffirmed along the historical process form old times. The predominance of some residential characteristics such as the incidence of some villages and a concentration of a big and confuse popular commerce distributed along streets puts Alecrim District as a resistant space in Natal. The same way analyze Alecrim District under the prism of Historic Geography because we understand this way it accomplishes a fundamental role in the theoretical methodological development of our work, just when we analyze the time as a variant in our object of study. It is still inside this theoretical field that we carry out a brief reviewing about quarter/district definition, under the optic from several registered and scientific resources taken into account along this work, because we understand that it was necessary to think this important spatial unit especially to know exactly what we are referring to as a district and so we can reaffirm Alecrim as an important and traditional district to Natal and it has been resisting to spatial transformation verified in the last years in Natal city. To give support to our reflection we used methodological tools related to inhabitants lifestyles knowledge and also the study of Alecrim District as a space that promote a certain centrality in Natal as some indicators to keep original characteristics in the district in Natal