Assistência aos portadores de úlceras venosas: proposta de protocolo

Venous ulcers (VU), recurrent chronic wounds resulting from Chronic Venous Insufficiency (CVI), affect different age groups and would severely affect ambulation of patients. The lesions require treatment lasting and complex and are responsible for significant morbidity and mortality. Thus, this study aims to identify the important aspects covered in the scientific literature protocol for assisting patients with venous ulcers, identifying the issues to be proposed by the judges of the study (nurses, doctors and physiotherapists) to the protocol of care provided to patients venous ulcers and present the structure of protocol proposed by the judges of the study to assist patients with venous ulcers treated at a referral hospital of Rio Grande do Norte. This is a descriptive study using a quantitative approach, carried out at the dressings, located in the outpatient surgical clinic of the Hospital University Onofre Lopes (HUOL), located in East Sanitary District, Natal-RN. The sample consisted of 39 professionals, 30 nurses, seven doctors and two physical therapists, team members HUOL surgical clinic and other public and private institutions of Rio Grande do Norte and Jequié/Bahia. These professionals were the judges responsible for selecting the guidelines already proposed in the literature on VU protocols. Approved by the Ethics in Research HUOL (Report n.o 081/07), began the first stage of the study which consisted of reviewing the scientific literature about the relevant aspects to be included in a protocol for assisting patients with VU. These aspects were organized into a proposed questionnaire to the judges of the study. Following examination, held on the content validation with application of the Kappa (K), accepting a score higher than 0.80 and the Likert Scale, whereas rates from 4.0 to 5.0. The data collected were organized in Microsoft Excel and exported into Statistical Package for Social Sciences (SPSS) 15.0. The literature review included national and international scientific articles, thesis, dissertation and institutional protocols. Regarding the characterization of professional nurses predominated (76.1%), between 34 and 45 years (41.0%), female (79.5%), married/consensual union (46.2%), with specialization in VU care (61.5%), working in the hospital network (46.1%), with up to 5 years experience in VU (69.2%) and claiming to feel prepared to care for these injuries (92.3 %). With regard to aspects that had very good agreement (K ≥ 0.81), remained the items found in the literature with some modifications. In the analysis of the proposed evaluation items had very important, ranging from 4.1 (drug treatment) to 4.9 (patient assessment and care of the injury and the injured and perilesional skin). The proposition of the protocol is arranged in eleven items: A) Evaluation of patient and lesion, B) Registration and documentation, C) the wound and perilesional skin, D) an indication of coverage, E) Use of antibiotic and pain treatment, F) Surgical treatment of CVI, G) Drug treatment, H) Improving venous return and prevetion of recurrence, I) Referral of patients, J) Training and K) Reference and counter reference

Estratégia pública de gestão ambiental :uma contribuição para a realização de eventos públicos

The present study is included in the environmental international theme, approaching the search for the environmental conformity in public events. It describes the main environmental impacts, objects of the study Sound Disturbances, implications concerning the increase in the Volume of Traffic and in the volume of Solid Residues generated in the surroundings of the event. The methodology used consists of the report of the case study of the festivity called Carnatal, held in Natal/RN, in December of 2001. As a work method, it was used a quantitative evaluation of the sound intensity level, according to the effective legislation, an electronic count of volume of traffic and an evaluation of the productive performance of the means of production of public urban sanitation company used in the event. The results pinpoint the recognition of the impacts generated by the event and the proposition of a Program of Environmental Management, aiming at, in addition to the establishment of the instruments and goals for the mitigation of the impacts, defining the role of the social actors in the search for the environmental conformity of festivities

Balanced scorecard como ferramenta de gestão aplicada a unidade hospitalar privada

In this study the objective is to implant Balanced Scorecard administration for the development of a Strategic Map, for the support of the electric outlet of decisions in the administration of operations of an unit of attendance doctor-hospitalar. The present work presents a case study developed at a private hospital in the State of Rio Grande do Norte. The collection of data was developed after the analysis of the revision of the literature, and he/she had as critical judgement of evaluation used by the following Unit. The work is concluded in the proposition of a strategic map that elevates the return on investment (financial perspective), in the item profitability and growth. In the search of the customer's satisfaction (customer's perspective), that is nothing else than it already exists inside of the Unit in study, just needing to be organized and aligned with the executive picture and the other collaborators. The requirements competitiveness, information, innovation and technology (perspective of the internal processes), they were indispensable to eliminate the re-work, waste and to improve the automation. It is finally, the investment and development of innovation mechanisms, they enlarge important competitive advantage in the processes for creation of value, through the ability, attitude and knowledge (perspective of the learning and growth). As one of the results of this study a strategic map was developed, looked for in Balanced Scorecard, for support in the electric outlet of decisions of the administration of operations of an Unit Doctor- Healthcare

Utilização do Balanced Scorecard na gestão pública : um estudo de caso na Polícia Militar do Estado do Rio Grande do Norte

This dissertation deals with the use of the Balanced Scorecard (BSC) in the Military Police of Rio Grande do Norte (PMRN), an organization of service delivery in the area of public safety. For this purpose we sought refuge in the company's own documents, which presented the mission, vision and strategic objectives, which are items essential to the development of the instrument and its prospects. With the general objective of developing the BSC to PMRN, fitting into the methodology in a single case study, that from the desk study and according to their development, we established the classification of goals to the generic models and the BSC then adjusted according to public understanding of the corporation presented by professionals in the process of collection and in-depth interviews. Thus emerged the strategy map PMRN, based on the presentation of the causes and effects between the strategic objectives of each perspective, the value proposition to customers, internal processes needed to meet this value proposition and intangible assets, which are the basis to execute these processes

Desenvolvimento de metodologia para avaliação de desempenho ambiental em edifícios adaptada à realidade do Nordeste brasileiro

This research refers to the production of green buildings, defined, mainly, based on the use of sources of alternative energies, smaller emission of pollutant, use of recyclable materials, systems of recycling of the waters, maximization of the natural illumination, preservation of green areas or native, and appropriate quality of the internal air. From the conception of those buildings, it appears the needs of evaluating them, creating the methodologies for the evaluation of environmental performance of buildings. In that way, this work can be divided in two moments: the first one when it identifies the methodologies for the evaluation of environmental performance for buildings existents in the literature, defining their categories, criteria and sub-criteria to be appropriate to the reality of the Brazilian Northeast; and the second one when starting from the analysis of the systems of existent evaluation. It defines a methodological base and it generates a new evaluation system, denominated MEDACNE (Methodology of Evaluation of Environmental Acting for Construction in the Northeast). In that moment, the process of framing of the section of the building site is verified under the maintainable optics, stimulated mainly by the pressures of the society - conferences, protocols and agreements. Finally, the proposed methodology was applied in a case study, a residential building, called Maria José Gurgel , located in Natal-RN, Brazil, for its validation. This methodological proposition should increase the patterns environmental places for the production of new buildings, and it will be a reference guide for architects, engineers and planners to develop their constructions considering the criteria of the sustainability. This study made use of bibliographical research in books and specialized magazines and the analysis of the data was realized in an interpretative way

Otimizações da transmissão de imagens em redes de sensores visuais sem fio explorando a relevância de monitoramento dos nós fontes e codificação DWT

The development of wireless sensor networks for control and monitoring functions has created a vibrant investigation scenario, covering since communication aspects to issues related with energy efficiency. When source sensors are endowed with cameras for visual monitoring, a new scope of challenges is raised, as transmission and monitoring requirements are considerably changed. Particularly, visual sensors collect data following a directional sensing model, altering the meaning of concepts as vicinity and redundancy but allowing the differentiation of source nodes by their sensing relevancies for the application. In such context, we propose the combined use of two differentiation strategies as a novel QoS parameter, exploring the sensing relevancies of source nodes and DWT image coding. This innovative approach supports a new scope of optimizations to improve the performance of visual sensor networks at the cost of a small reduction on the overall monitoring quality of the application. Besides definition of a new concept of relevance and the proposition of mechanisms to support its practical exploitation, we propose five different optimizations in the way images are transmitted in wireless visual sensor networks, aiming at energy saving, transmission with low delay and error recovery. Putting all these together, the proposed innovative differentiation strategies and the related optimizations open a relevant research trend, where the application monitoring requirements are used to guide a more efficient operation of sensor networks

Enumeração de espectro de distâncias de esquemas de modulação codificada em treliça empregando codificação turbo

In this work, a performance analysis of transmission schemes employing turbo trellis coded modulation. In general, the performance analysis of such schemes is guided by evaluating the error probability of these schemes. The exact evaluation of this probability is very complex and inefficient from the computational point of view, a widely used alternative is the use of union bound of error probability, because of its easy implementation and computational produce bounds that converge quickly. Since it is the union bound, it should use to expurge some elements of distance spectrum to obtain a tight bound. The main contribution of this work is that the listing proposal is carried out from the puncturing at the level of symbol rather than bit-level as in most works of literature. The main reason for using the symbol level puncturing lies in the fact that the enummerating function of the turbo scheme is obtained directly from complex sequences of signals through the trellis and not indirectly from the binary sequences that require further binary to complex mapping, as proposed by previous works. Thus, algorithms can be applied through matrix from the adjacency matrix, which is obtained by calculating the distances of the complex sequences of the trellis. This work also presents two matrix algorithms for state reduction and the evaluation of the transfer function of this. The results presented in comparisons of the bounds obtained using the proposed technique with some turbo codes of the literature corroborate the proposition of this paper that the expurgated bounds obtained are quite tight and matrix algorithms are easily implemented in any programming software language

Proposta de zoneamento ambiental visando a proteção dos recursos hídricos de uma bacia hidrográfica

One of the most important natural resources for sustaining human life, water, has been losing the basic requirements of quality and quantity sufficient enough to attend the population due to water contamination'problems, often caused by human beings themselves. Because of this, the sources of this resource are often located in remote places of the natural environment to ensure the quality of the water. However, when urban expansion began to occupy these areas, which were once regarded as distant, environmental pollution problems began to occur due to occupation of the land without planning. Based on this occurrence, this study aims to propose environmental zoning for the Maxaranguape river watershed in order to protect its water resources. This is important because this river can serve as a source of supply for the metropolitan area of Natal, the capital of Rio Grande do Norte. In accordance to this proposition, the model of natural soil loss vulnerability (CREPANI et al., 2001), the model of aquifer pollution vulnerability (FOSTER et al., 2006), and the legal incompatibility map (CREPANI et al., 2001) were used to delimit the zones. All this was done with Geographic Information System (GIS) and also created a geographic database update of the basin. The results of the first model mentioned indicated that 63.67% of the basin was classified as moderately stable / vulnerable, 35.66% as moderately vulnerable, and 0.67% as vulnerable. The areas with high vulnerability degree correspond with sand dunes and river channels areas. The second model indicated that 2.84% of the basin has low vulnerability, 70.27%) has median vulnerability, and 26.76% and 0.13% has high vulnerability and extreme vulnerability, respectively. The areas with the highest vulnerability values also refer to part of the sand dunes and river channels besides other areas such as Pureza urban area. The legal incompatibility map indicated that the basin has 85.02 km2 of Permanent Protection Area (PPA) and 14.62% of this area has some incongruity of use. Based on these results it was possible to draw three main zones: Protection and Sustainable Use Zone (PSUZ), Protection and Environmental Restoration Zone (PERZ) and Environmental Control Zone, which are divided into A, B and C. The PSUZ refer to the coastal areas of the basin, where the sand dunes are located. These sites should be areas of environmental protection and of sustainable urban expansion. The ZPRA refer to river channels, which are in high need of rehabilitation. The third zone corresponds to the rest of the basin which should have, in general, the mapping of possible sources of contamination for further control on the use and occupation of the river

A modalização como estratégia argumentativa em textos de vestibulandos

In this work, the argumentative strategies construction in university entrance examinations texts is analyzed. The study intended to present, through the analyzed occurrences in the corpus, the discursive strategies use for the argumentation construction, observing the different lexicalization forms and the effects that these strategies produced for the intended meaning construction. Aiming to analyze the modalization via texts written by candidates for the UFRN entrance examination, the relations between this category and the resources used for the argumentative guidance of the text were highlighted. Conceived as a speaker argumentative strategy to express his/her relationship with the proposition content which enunciates, the modalization is, thus, one of the linguistic expression form used for the attainment of intended meaning effects in the argumentation construction. In order to substantiate the research, the theoretical assumptions adopted were the propositions which deal with this linguistic category, guiding it to a pragmatic-semantic perspective as well as a discursive-semantic one. Hence, Neves ( 1996, 2006), Koch ( 2000, 2002), Cervoni ( 1989), Bronkart (1999) and Castilho; Morais de Castilho (1996) studies, among others founded this work. Afterwards, a contextualized analysis of the modalized statements, taking into account all the set of elements implied on the argumentation construction, was carried out. The research, which had a strict qualitative character, revealed that the candidates make use of modalization to express commitment or dissociation as regards the statement which they produce; to obtain credibility and provide more authority to their arguments, thus avoiding them of being contested; to impose their arguments as real ones and acquire acceptance of the interlocutor; to lessen the proposition content and disguise the knowledge source; to comment the enunciation and attribute the discourse to another sender; to establish a dialogic relation with the interlocutor. In addition to offering support for new investigations, the research also aims to contribute for the mother tongue teaching, emphasizing the need of a focus which provides special attention to the written language functioning and its application diversity. In this work, the argumentative strategies construction in university entrance examinations texts is analyzed. The study intended to present, through the analyzed occurrences in the corpus, the discursive strategies use for the argumentation construction, observing the different lexicalization forms and the effects that these strategies produced for the intended meaning construction. Aiming to analyze the modalization via texts written by candidates for the UFRN entrance examination, the relations between this category and the resources used for the argumentative guidance of the text were highlighted. Conceived as a speaker argumentative strategy to express his/her relationship with the proposition content which enunciates, the modalization is, thus, one of the linguistic expression form used for the attainment of intended meaning effects in the argumentation construction. In order to substantiate the research, the theoretical assumptions adopted were the propositions which deal with this linguistic category, guiding it to a pragmatic-semantic perspective as well as a discursive-semantic one. Hence, Neves ( 1996, 2006), Koch ( 2000, 2002), Cervoni ( 1989), Bronkart (1999) and Castilho; Morais de Castilho (1996) studies, among others founded this work. Afterwards, a contextualized analysis of the modalized statements, taking into account all the set of elements implied on the argumentation construction, was carried out. The research, which had a strict qualitative character, revealed that the candidates make use of modalization to express commitment or dissociation as regards the statement which they produce; to obtain credibility and provide more authority to their arguments, thus avoiding them of being contested; to impose their arguments as real ones and acquire acceptance of the interlocutor; to lessen the proposition content and disguise the knowledge source; to comment the enunciation and attribute the discourse to another sender; to establish a dialogic relation with the interlocutor. In addition to offering support for new investigations, the research also aims to contribute for the mother tongue teaching, emphasizing the need of a focus which provides special attention to the written language functioning and its application diversity

A construção de posicionamento valorativo no cronotopo do PSV- 2008 da UFRN

Située dans le domaine de la Linguistique Appliquée (CELANI, 1998; MOITA LOPES, 2004, 2006, 2009), cette recherche documentaire fait partie d‟une approche qualitative-interprétative qui privilégie une perspective socio-historique (FREITAS, 2002, 2007; ROJO, 2006). Le but principal de ce travail est d‟analyser comment l‟interlocution a lieu dans les lettres argumentatives produites par 10 sujets-énonciateurs ayant participé au processus de sélection du «vestibular» d‟UFRN, appelé ici le chronotope du PSV-2008. Pour cela, les objectifs spécifiques qui guident cette recherche consistent à analyser les modes d‟assimilation du discours de l‟autre par le candidat, à identifier les positions axiologiques résultant des formes du processus interlocutif, et à construire une vision du sujet-énonciateur sur la base des choix de valeurs de l‟énonciateur et des relations espace-temps qui constituent l‟énonciateur et l‟interlocuteur. Quant à la théorie, la recherche est fondée principalement sur la notion de chronotope de Bakhtin une catégorie qui découle de la théorie du roman et problématisée par Amorim (2004) en articulation avec les réflexions théoriques de Geraldi (1997, 1999, 2006), Britto (2006) et Antunes (2005, 2006) sur le processus d‟écriture les relations dialogiques, la responsivité et les voix sociales (BAKHTIN, 1990, 2003, 2008; BAKHTIN/VOLOCHINOV, 2006) qui sont traversées par la conception dialogique du langage. L‟analyse nous a permis d‟identifier, principalement, deux débats dialogiques, dont le premier confronte le candidat à la dissertation et le second, à des interlocuteurs mentionnés dans la proposition. Les sujets ont formulé leurs énoncés sur un ton d‟indignation, en critiquant ce que l‟interlocuteur avait exprimé. Les candidats ont fait appel à la formation d‟un scénario d‟espoir, de crédulité, de respect et d‟éthique, conforme à la dignité de l‟être humain. Ces résultats mettent en évidence la façon dont des sujets multiples et hétérogènes, insérés dans la dimension de la vie, prennent position à l‟intérieur des pratiques discursives, face aux coordonnées d‟espace et de temps

Ana Cristina Cesar: um corpo de crítica

La présente thèse est une approche critique de la production littéraire de l écrivain carioca Ana Cristina Cesar. Aussi bien dans la poésie que dans son oeuvre critique, Ana Cristina Cesar a mis en évidence la question de l écriture comme le principal dilème de son projet comme écrivain. En face d autant de registres, soit en forme de poèmes, texte critique ou lettres, la question de l écriture est, dans l ensemble de son oeuvre, formulée à partir d une interpénétration entre la littérature et la vie. Considérant le problème de l écriture comme partie d un projet de l être écrivain pour Ana Cristina Cesar, nous affirmons que l intérêt de notre recherche se dirige vers l analyse des manières selon lesquelles ce problème parcourt son écriture et dévient une question métalinguistique dans sa création. Nous partons de la réflexion sur l écriture dans son oeuvre pour relever la question principale de notre proposition de travail avec son texte: Qu est-ce que c est, après tout, écrire pour Ana Cristina Cesar et comment cela se formule-t-il dans la production des rôles qu elle exerce en tant que poète, critique et professeur? Parmi les principaux objectifs qui guident cette recherche sont: promouvoir un dialogue avec les textes de l auteur, où se présente le problème de l écrire, à travers une réflexion sur le parcours de son activité intellectuelle, pour elle imprégné de questions sur l écriture féminine et la production marginale; et enquêter les manières dont cette réflexion s articule dans les fonctions qu elle développe comme poète, critique et professeur et les rélations qu elle établi avec la littérature de son époque. En outre, nous discuterons l importance de son oeuvre dans la littérature marginale, ce qui possibilite aussi une évaluation de cette production dans la littérature brésilienne

Sloterdijk e o lugar do homem no humanismo pós-metafísico

This work starts from the principle that the word humanism has been currently used to advocate certain behaviors or ways of acting which had been constituted for more than 2500 years, mainly in what refers to the most basic human values, which are clearly validated without any questioning. Humanism has been seen continually as a stone of civility touch. Thus, in 1999, the philosopher Peter Sloterdijk presented a conference in Baviera entitled Rules for the Human Zoo, whose subtitle was clear that it dealt with an answer to Martin Heidegger s text Letter on Humanism, basically showing that civility is necessarily bound to human domestication. So, the present work is split in three chapters. The first one aims to set the cultural and metaphysical bases of humanism. The second one will adopt an approach about what we will call epistolary humanism and its corollaries. Besides, in the third chapter, we will compose theoretical statements to the Heideggerian criticism against humanism and the post humanist contemporary proposition, as well as about the anthropotechnics. We can state that these two elements are considered as anthropological fundamentals of humanism and post humanism, and by understanding their mentioned historical relationship from their biological and ontological assumptions. Therefore, this work, which has been presented here, when it tries to map humanism under the theoretical influence of Sloterdijk, it distinguishes itself precisely by realizing the coherence with which he aims at diagnosing the directions of the contemporary humanism

O princípio metafísico da poética de Aristóteles

Aristotle's definition of tragedy indicates a metaphysical project insinuated by a notion of kátharsis. The reconstruction of Aristotle's method of definition is inspired in the concepts of enérgeia and dýnamis taken from Physics, understanding cause as substance. The Doctrine of the Four Causes is the theoretical basis of the definition of tragedy, placing tragedy in the genre of imitation and distinguishing its species: language (material cause), noble and complete action (formal cause), actors (efficient cause) and kátharsis (temporarily identified with the final cause). Nevertheless, there is no final cause in the definition of tragedy. The kátharsis of passions is experienced by the spectator when he witnesses tragedy, which is the imitation of a noble action, executed by actors and not narrated. Aristotle justifies hid proposition in favor of mimesis by assuming that imitation is natural to man since infancy and the view of objects allows whoever contemplates them to identify and learn the originals. As a metaphysical principle, kátharsis is projected to beyond definition of tragedy, where it is manifested cathartically, in the spectator. Research about the spectator brings one back to the definition of tragedy, where the imitation is an imperfect copy which evokes in the spectator the presence of the originals of the imitated sentiments, thus realizing the kátharsis of these emotions. In this way kátharsis reveals itself as selfknowledge and approach of divine truth and perfections.

Qualidade de Vida, Saúde Geral e Ansiedade em pacientes com diferentes tipos e níveis de disfunção temporomandibular

Some studies reported in the literature that emotional factors and quality of life may be involved both in aetiology, as in the progression of Temporomandibular disorders (TMD). Proposition: The purpose of this study is to observe a possible association between different forms of anxiety, quality of life and general health of patients diagnosed as carriers of various types and levels of Temporomandibular Dysfunction. Methodology: The sample consisted of 60 patients diagnosed as carriers of TMJD origin of muscle, joint, or both, with different levels of severity (mild TMD, moderate and severe). The patients were diagnosed with TMD-RDC (Research Diagnostic Criteria) to assess the type of dysfunction (muscle or joint) and by the Protocol of Fonseca to verify the degree of dysfunction (mild, moderate or severe). To evaluate the psychosocial aspects were used three self-applied, with the purpose of obtaining information about the general health (General Health Questionnaire - GHQ), the type of anxiety (Trait Anxiety Inventory-State - STAI) and quality of life (World Health Organization Quality Of Life Short WHOQOL-brief). Results: There was a correlation between all indicators studied in several forms of TMD with varying degrees of commitment. Quality of life appeared linked to the type and the level of TMD: Muscular and Articular TMD (p = 0,037), Disk Displacement With Reduction (p = 0.01) and Mild TMD (p = 0.042). The General Health showed association with the level of TMD, with the exception of the stress factor (p = 0.78). For the analysis of the types and levels to Severe Muscular TMD had a statistically significant indicator of the quality of life (p = 0049). The anxiety only showed association with the level of TMD (p = 0,047 for anxiety-trait). Conclusion: Besides the limitations of the study, it was concluded that anxiety, quality of life and general health are important psychosocial indicators, which are linked to several forms of TMD in different levels of severity

Avaliação dos níveis de proteína C-reativa ultra-sensível em pacientes com periodontite crônica severa generalizada e sem periodontite

INTRODUCTION: The high sensitivity C-reactive protein (hsCRP) constitutes an inflammatory mediator used as predictor of cardiovascular risk that comes being researched as indicative relation factor between cardiovascular and periodontal diseases. PROPOSITION: To compare serumals levels of C-reactive protein between patients with and without generalized severe chronic periodontitis. METHODOLOGY: A seccional study was realized using a sample with 62 patients, being 31 participants carriers of periodontal diseases (Group I) and 31 without periodontal diseases (Group II), grouped to the pairs by age and sex. As inclusion criterio were selected patients with diagnosis of generalized severe chronic periodontitis, being preculeds, individuals which presented systemic disease, recent infection history, historical of CVA or stroke, smokers, pregnants and lactants. The research consisted of two stages, a clinc and other biochemist. The clinical stage is constituted of periodontal examination and the biochemist stage, of the peripheral blood collection for determination hsCRP levels and a hemogram to inquire any panel which could suggest infectious and/or inflammatory process. RESULTS: Periodontal disease group presented a average of 0,36mg/dL, while the group without disease presented 0,17 mg/dL, do not existing significant difference statistically between the averages (p = 0,061). The cardiovascular risk for the group I was classified high for 27,6% of participants and low for 72,4% of them. In the group II, 6,45% presented high risk e 93,5% low risk, being this significant relation statistically gotten for Fisher s Test (p = 0,042) presenting OR = 5,33; IC = 95% (1,02 27,4). The independets variables reseacred do not presented significant association statistically with the levels of hsCRP. CONCLUSION: The study indicated that despite of carriers patients of periodontal diseases do not present differents serumals levels of hsCRP from the other group, the periodontal disease was considered as risk factor for hsCRP plasmatic levels elevation