Gasto com a internação de idosos em unidades de terapia intensiva

Introduction: Population aging in Brazil underscores the need to discuss the proper management of the budget allocated in health field, especially in the sectors of high complexity, where coexist costly procedures, limited resources and the need for cost containment. In the other hand, demand is growing in a way directly proportional to the increase in the number of elderly in country. Objective: In this way, this research had as main objective to analyze the costs resulting from the admission of elderly in intensive care units (ICU) and its associated factors. Methods: This is a cross-sectional study with a quantitative approach and featured as a descriptive and exploratory research. Data were collected from medical records of elderly hospitalized in ICU from a brazilian city called Natal-RN, between november first, 2013 and january, 31 of 2014. The variables collected relate to the socio demographic profile, morbidity framework and characterization of hospitalization. The dependent variable was categorized by quartile 75 in high and low expense of hospitalization and submitted to chi-square test with the independent variables of the survey. Associations with p value <0.20 in the bivariate analysis were submitted to the technique of multiple logistic regression. We opted for the construction of three regression models from the above algorithm: general regression model, composed by all 493 hospitalizations in the study, other made with 181 individuals admitted in health public system (SUS) and a third one related to 312 cases from private service in health area. Results: In the general regression model, the variables respiratory diseases, hospitalizations in the private system, disoriented patient and previous stroke were associated with greater probability of high spending in the ICU. In the other hand, in SUS kind of hospitalizations, this probability was associated with disoriented patient, 80 years old or more, sepsis and admission for clinical reason. In the cases from the private network health, the high expenditure was associated with respiratory disease, mechanical ventilation, hospitalization for clinical reason and disoriented patients. Conclusion: The increased expenditure on hospitalization of elderly in intensive care depends on the clinical conditions of individuals. This highlights the importance of avoiding hospitalizations due to diseases sensitive to primary care by health preventive actions and providing comprehensive care to the elderly. In addition, obtaining different explanatory models, according to kind hospital funding, demonstrates the importance of the organization in health services related to composition of costs of hospitalization among the elderly. Another question founded was the need that to improve the funding, we must use rationally the available resources by avoiding unnecessary hospitalizations of elderly people in the extremes of severity. On this kind of precarious funding, ICU hospitalization of elderly non-critical or in a terminal state can compromise the quality of services provided to those who really need intensive care.

Gravidade do olho seco em pacientes internados em unidade de terapia intensiva: análise de conceito e construção de definições

Dry eye syndrome is a multifactorial disease of the tear film, resulting from the instability of the lacrimal functional unit that produces volume change, up or tear distribution. In patients in intensive care the cause is enhanced due to various risk factors, such as mechanical ventilation, sedation, lagophthalmos, low temperatures, among others. The study's purpose is to build an assessment tool of Dry Eye Severity in patients in intensive care units based on the systematization of nursing care and their classification systems. The aim of this study is to build an assessment tool of Dry Eye Severity in hospitalized patients in Care Unit Intensiva.Trata is a methodological study conducted in three stages, namely: context analysis, concept analysis, construction of operational definitions and magnitudes of nursing outcome. For the first step we used the methodological framework for Hinds, Chaves and Cypress (1992). For the second step we used the model of Walker and Avant and an integrative review Whitemore seconds, Knalf (2005). This step enabled the identification of the concept of attributes, background and consequent ground and the construction of the settings for the result of nursing severity of dry eye. For the construction of settings and operational magnitudes, it was used Psicometria proposed by Pasquali (1999). As a result of context analysis, visualized from the reflection that the matter should be discussed and that nursing needs to pay attention to the problem of eye injury, so minimizing strategies are created this event with a high prevalence. With the integrative review were located from the crosses 19 853 titles, selected 215, and from the abstracts 96 articles were read in full. From reading 10 were excluded culminating in the sample of 86 articles that were used to analyze the concept and construction of settings. Selected articles were found in greater numbers in the Scopus database (55.82%), performed in the United States (39.53%), and published mainly in the last five years (48.82). Regarding the concept of analysis were identified as antecedents: age, lagophthalmos, environmental factors, medication use, systemic diseases, mechanical ventilation and ophthalmic surgery. As attributes: TBUT <10s, Schimer I test <5 mm in Schimer II test <10mm, reduced osmolarity. As consequential: the ocular surface damage, ocular discomfort, visual instability. The settings were built and added indicators such as: decreased blink mechanism and eyestrain.

Estudo de simulação de reservatórios para o desenvolvimento de um campo do nordeste brasileiro

In the last 16 years emerged in Brazil a segment of independent producers with focus on onshore basins and shallow waters. Among the challenges of these companies is the development of fields with projects with a low net present value (NPV). The objective of this work was to study the technical-economical best option to develop an oil field in the Brazilian Northeast using reservoir simulation. Real geology, reservoir and production data was used to build the geological and simulation model. Due to not having PVT analysis, distillation method test data known as the true boiling points (TBP) were used to create a fluids model generating the PVT data. After execution of the history match, four development scenarios were simulated: the extrapolation of production without new investments, the conversion of a producing well for immiscible gas injection, the drilling of a vertical well and the drilling of a horizontal well. As a result, from the financial point of view, the gas injection is the alternative with lower added value, but it may be viable if there are environmental or regulatory restrictions to flaring or venting the produced gas into the atmosphere from this field or neighboring accumulations. The recovery factor achieved with the drilling of vertical and horizontal wells is similar, but the horizontal well is a project of production acceleration; therefore, the present incremental cumulative production with a minimum rate of company's attractiveness is higher. Depending on the crude oil Brent price and the drilling cost, this option can be technically and financially viable.

Queilite actínica: expressão imuno-histoquímica da cox-2 e avaliação do diclofenaco sódico gel como uma terapia alternativa

Actinic cheilitis (AC) is a potentially malignant disorder which affects the lip vermilion and results from chronic exposure to sunlight. Currently, it is not possible to predict which cases of AC may progress to squamous cell carcinoma, and therefore, some biomolecular markers have been researched. Cyclooxygenase 2 (COX-2) is an enzyme associated with inflammatory response which is overexpressed in oral cancer; however, little is known about the role of this protein in actinic cheilitis. About the treatment of this lesion, currently available therapeutic modalities to AC may cause cytotoxic effects and deleterious results to patients. Therefore, the aim of this study was to evaluate the immunoexpression of COX-2 in AC of different risks of malignant transformation and analyse, through clinical follow-up, the efficacy of diclofenac sodium 3% gel in the treatment of this condition. Epithelial immunoexpression of COX-2 was analysed semi-quantitatively in 90 cases of AC classified as low risk (n = 55) and high risk (n = 35) of malignant transformation, in which the scores were assigned: (0) 0 to 5% of positive cells - Negative; (1) 6 to 30% of positive cells - Low expression; (2) 31 to 100% of positive cells - High expression. The chi-square test of Pearson was conducted to verify possible associations between immunoexpression of COX-2 and histologic grade of actinic cheilitis. The weighted kappa coefficient denoted a good interobserver agreement (0.677). Nineteen patients diagnosed with AC were instructed to perform topical application of the gel three times a day for a period of 90 days. In each biweekly visit, a follow-up record was accomplished through digital photographs and after treatment was completed, two researchers analysed all the images to assess clinical aspects of the lip. Furthermore, tolerability to the drug and patient satisfaction after treatment were evaluated. COX-2 was overexpressed in 74.4% of AC cases. Both low and high-risk groups revealed predominance of score 3, followed by scores 2 and 1. There was no significant association (p = 0.315) between COX-2 expression and histological grading. Among the total number of participants of this clinical study, ten showed total remission of all clinical features of the lesion and three had partial improvement of these characteristics. One participant presented worsening of the clinical condition. In five cases, the treatment was discontinued due to development of mild adverse effects at the site of gel application. Regarding analysis of satisfaction and tolerability to the drug, most patients were fully satisfied with the therapy (n = 11) and reported that the drug was not irritating to the lips (n = 9). Our study demonstrates that high expression of COX-2 is common in AC; however, this protein was not associated with malignant transformation risk of the analysed cases. Topical application of diclofenac sodium 3% gel provided a convenient and well tolerated approach in most cases, and may be a promising alternative for the treatment of actinic cheilitis.

Determinação de recomendações bioclimáticas para habitação de interesse social de quatro climas do Rio Grande do Norte

Recomendações projetuais baseadas no clima são fontes importantes de diretrizes para os arquitetos. Uma das formas de obtenção dessas recomendações é por meio de normas, como a NBR 15220 (ABNT, 2005), que agrupa as cidades em zonas homogêneas quanto as estratégias sugeridas. O zoneamento bioclimático brasileiro divide o território do Rio Grande do Norte em duas zonas, a ZB 7 e ZB 8, que possuem algumas recomendações distintas, como aberturas grandes e vedações leves para a região litorânea contra aberturas pequenas e vedações pesadas para a região semiárida. Entretanto, outras configurações climáticas estão presentes no RN e não possuem clara recomendação. Este é o caso das regiões serranas e das regiões intermediárias entre o litoral e a região semiárida. Em virtude disso, este estudo visa encontrar recomendações bioclimáticas para habitações de interesse social nessas quatro condições climáticas. Para tanto, utilizou-se ferramenta computacional para realização de simulações das condições térmicas de três tipos de habitações populares - alongada, ramificada e compacta - e das seguintes estratégias: presença ou ausência de ventilação natural e sombreamento, massa térmica leve ou pesada, e Fator de Calor Solar alto ou baixo. Essas simulações foram realizadas para quatro condições climáticas do estado. Foram analisados os desempenhos de cada caso para identificar as estratégias e tipos de habitação recomendados para cada clima. De maneira geral, nos climas deNatal, Mossoró e Caicó viu-se que habitações com FCS baixo e com presença de ventilação natural possuem os melhores desempenhos. No clima de Areia, a ausência de ventilação aliada ao baixo FCS é que produziu os melhores desempenhos. O sombreamento melhora o desempenho nas cidades de clima quente, mas aumenta as horas com desconforto ao frio em Areia. A massa térmica varia de acordo com as demais estratégias, tendo casos em que habitações com massa térmica alta possuem melhores desempenhos que outros casos com massa térmica baixa. Por fim, viu-se que as estratégias para Natal, Caicó e Mossoró são bem semelhantes, com a recomendação de ventilação natural, FCS baixo nas vedações e sombreamento. Para Areia, a recomendação é não ventilar, ter FCS baixo e massa térmica alta.

Determinação de recomendações bioclimáticas para habitação de interesse social de quatro climas do Rio Grande do Norte

Recomendações projetuais baseadas no clima são fontes importantes de diretrizes para os arquitetos. Uma das formas de obtenção dessas recomendações é por meio de normas, como a NBR 15220 (ABNT, 2005), que agrupa as cidades em zonas homogêneas quanto as estratégias sugeridas. O zoneamento bioclimático brasileiro divide o território do Rio Grande do Norte em duas zonas, a ZB 7 e ZB 8, que possuem algumas recomendações distintas, como aberturas grandes e vedações leves para a região litorânea contra aberturas pequenas e vedações pesadas para a região semiárida. Entretanto, outras configurações climáticas estão presentes no RN e não possuem clara recomendação. Este é o caso das regiões serranas e das regiões intermediárias entre o litoral e a região semiárida. Em virtude disso, este estudo visa encontrar recomendações bioclimáticas para habitações de interesse social nessas quatro condições climáticas. Para tanto, utilizou-se ferramenta computacional para realização de simulações das condições térmicas de três tipos de habitações populares - alongada, ramificada e compacta - e das seguintes estratégias: presença ou ausência de ventilação natural e sombreamento, massa térmica leve ou pesada, e Fator de Calor Solar alto ou baixo. Essas simulações foram realizadas para quatro condições climáticas do estado. Foram analisados os desempenhos de cada caso para identificar as estratégias e tipos de habitação recomendados para cada clima. De maneira geral, nos climas deNatal, Mossoró e Caicó viu-se que habitações com FCS baixo e com presença de ventilação natural possuem os melhores desempenhos. No clima de Areia, a ausência de ventilação aliada ao baixo FCS é que produziu os melhores desempenhos. O sombreamento melhora o desempenho nas cidades de clima quente, mas aumenta as horas com desconforto ao frio em Areia. A massa térmica varia de acordo com as demais estratégias, tendo casos em que habitações com massa térmica alta possuem melhores desempenhos que outros casos com massa térmica baixa. Por fim, viu-se que as estratégias para Natal, Caicó e Mossoró são bem semelhantes, com a recomendação de ventilação natural, FCS baixo nas vedações e sombreamento. Para Areia, a recomendação é não ventilar, ter FCS baixo e massa térmica alta.

Implementação de classificador de tarefas mentais baseado em EEG

BARBOSA, André F. ; SOUZA, Bryan C. ; PEREIRA JUNIOR, Antônio ; MEDEIROS, Adelardo A. D.de, . Implementação de Classificador de Tarefas Mentais Baseado em EEG. In: CONGRESSO BRASILEIRO DE REDES NEURAIS, 9., 2009, Ouro Preto, MG. Anais... Ouro Preto, MG, 2009

Recomendações para o desenvolvimento de uma ferramenta de suporte às primeiras decisões projetuais visando ao desempenho energético de edificações de escritório em clima quente

PEDRINI, Aldomar; SZOKOLAY, Steven. Recomendações para o desenvolvimento de uma ferramenta de suporte às primeiras decisões projetuais visando ao desempenho energético de edificações de escritório em clima quente. Ambiente Construído, Porto Alegre, v. 5, n. 1, p.39-54, jan./mar. 2005. Trimestral. Disponível em: . Acesso em: 04 out. 2010.

Diagnóstico, estadiamento e tratamento cirúrgico do adenocarcinoma de pâncreas

O adenocarcinoma pancreático é um dos tumores sólidos de pior prognóstico, sendo o tratamento cirúrgico o único potencialmente curativo. Na grande maioria dos pacientes o tumor é diagnosticado em fase avançada, comumente na presença de doença metastática. A introdução de modernos métodos diagnósticos associados ao aperfeiçoamento dos já existentes tem gerado controvérsia quanto à melhor maneira de se estabelecer o diagnóstico e estadiamento do tumor. Da mesma forma, o papel da cirurgia na paliação e aspectos técnicos da ressecção de lesões localizadas estão longe de alcançarem consenso na prática. Método - Revisão da literatura sobre os aspectos controversos relacionados ao tema e um algoritmo para a abordagem dos pacientes com suspeita de tumor de pâncreas são apresentados. Foram utilizados os descritores: “adenocarcinoma” e “pâncreas” para pesquisa no PubMed (www.pubmed.com) e na Bireme (www.bireme.br) e a seguir selecionadas as publicações pertinentes a cada tópico escolhido com atenção especial para metanálises, estudos clínicos controlados, revisões sitemáticas e ainda publicações de grandes centros especializados em doenças pancreáticas. Conclusões - Na suspeita de adenocarcinoma de pâncreas é possível realizar estadiamento muito próximo do real sem a necessidade da exploração cirúrgica sistemática em virtude da disponibilidade na prática de exames modernos e eficientes. Isso permite que paliação menos invasiva seja praticada na maioria dos pacientes com lesões avançadas e incuráveis. Nos em que a cura é possível, a operação deve ser realizada objetivando-se, essencialmente, a remoção da lesão com margens livres e com aceitáveis índices de morbi-mortalidade

Interface entre arquitetura bioclimática e decisões projetuais

This research has as its object study focus bioclimatic in architecture and its conection with projects decisions, on what regards to environmental comfort for single-family dwelling. From the analysis of five architectural projects inserted in Natal/RN, warm-moist weather, this research gather informations regarding architectural features guided by shape and space arrengement, which embody important elements for the project design development. Computer simulations assisted as foundation to verify the efficiency grade for these projects strategies from shading analysis. Related strategies for the demands of natural ventilation circulation and thermal mass for refrigeration were analysed as well. Results show that there is an hierarchizing of priorities for the decisions made when it comes to shape and space disposition variables, as well as the way these variables will consider the bioclimatic demands. The analysis, even, show that there is no single way to respond to specific bioclimatic demands, as it points out the value of examination of the projectual solutions throughtout the conception process, in order to achieve an efficient project performance for the envimonment comfort

Adequação bioclimática para os espaços urbanos abertos do centro de Fortaleza, CE

This research presents a study investigating the correlation between the environmental-physycal charcateristics of cities and the formation of its micro-climates. The study was conducted in the central area of Fortaleza characterized as a stable and consolidated area, where the city originated and currently faces serious problems in its urban dynamics. The points of measurements were determined by the elaboration and analysis of topography maps, height of buildings, land use, type of surface coating and vegetation, following the methodology of Katzschner (1997). A zoning map was then determined, according to common morphological characteristics of the 12 measurement points, which were based on a set of Romero s (2001) bioclimatic criteria. Air measurements, temperature, humidity, intensity and direction of winds were made in transect form in two different circuits in the study area, with six points of data collection in each area, in three different times: 6:00 am, 1:00pm and 7:00pm, during two periods of the year: August 2008 and March 2009. The results verified the influence of different environmental-physical types in the behavior of the climatic variables that were collected. A verticalização tão condenada em algumas situações se bem equilibrada e controlada pode reduzir as temperaturas do ar através do sombreamento dos espaços urbanos e possibilidade de maior permeabilidade a ventilação natural. The highest average air temperature and lower humidity were recorded at the point I at all times. This situation may have been in result of the high density, poor vegetation and extended paving of the ground. According to the results, it s clear the positive influence vegetation has on easing air temperature. Another indicator observed that areas with a greater variation in building heights tend to present decreased average air temperature. High rise structure, planned in accordance to urban air quality parameters, can reduce air temperatures by the shading of urban spaces and the possibility of greater penetration of natural ventilation

Por uma moradia termicamente confortável: proposta de habitação de interesse social com ênfase no conforto térmico

This research covers the topic of social housing and its relation to thermal comfort, so applied to an architectural and urban intervention in land situated in central urban area of Macaíba/RN, Brazil. Reflecting on the role of design and use of alternative building materials in the search for better performance is one of its main goals. The hypothesis is that by changing design parameters and choice of materials, it is possible to achieve better thermal performance results. Thus, we performed computer simulations of thermal performance and natural ventilation using computational fluid dynamics or CFD (Computational Fluid Dynamics). The presentation of the thermal simulation followed the methodology proposed in the dissertation Negreiros (2010), which aims to find the percentage of the amount of hours of comfort obtained throughout the year, while data analysis was made of natural ventilation from images generated by the images extracted from the CFD. From model building designed, was fitted an analytical framework that results in a comparison between three different proposals for dwellings housing model, which is evaluated the question of the thermal performance of buildings, and also deals with the spatial variables design, construction materials and costs. It is concluded that the final report confirmed the general hypotheses set at the start of the study, it was possible to quantify the results and identify the importance of design and construction materials are equivalent, and that, if combined, lead to gains in thermal performance potential.

Layout, conforto e satisfação dos usuários em escritórios: uma avaliação pós-ocupação no edifício da sede administrativa do INPE-CRN

This research aimed to identify the link between the layout of workspaces in offices and the design strategies for environmental comfort. Strategies surveyed were focused on the thermal, visual and luminic comfort. In this research, visual comfort is related to issues of visual integration within and between the interior and exterior of the building. This is a case study conducted at the administrative headquarters of Centro Regional Nordeste do Instituto de Pesquisas Espaciais (INPE-CRN), located in Natal/RN. The methodological strategy used was the Post-Occupancy Evaluation, which combined the survey data on the building (layout of workspaces, bioclimatic strategies adopted in the design, use of these strategies) with some techniques aimed at acquiring qualitative information related to users. The workspace layout is primordial to satisfaction and productivity of workers. Issues such as concentration, communication, privacy, personal identity, density and space efficiency, barriers (access, visual and even ventilation and lighting), among others, are associated with the layout. The environmental comfort is one of the essential elements to maintaining life quality in workplace. Moreover, it is an important factor in user`s perception of the space in which he or she are inserted. Both layout and environmental comfort issues should be collected and analyzed in the establishment phase of the programming step. That way, it is possible to get adequate answers to these questions in subsequent project phases. It was found that changes in the program that occurred over time, especially concerning persons (number and characteristics), resulted in changes in layout, generating high density and inflexible environments. It turns difficult to adjust the furniture to the occupants` requirement, including comfort needs. However, the presence of strategies for environmental quality provides comfort to spaces, ensuring that, even in situations not considered optimal, users perceive the environment in a positive way. It was found that the relationship between environmental comfort and layout takes the following forms: in changing the perception of comfort, depending on the layout of the arrangements; adjustments in layout, due to needs for comfort; and the elevation of user satisfaction and environmental quality due to the presence of strategies comfort even in situations of inadequate layout

Simulação computacional como ferramenta de auxílio ao projeto: aplicação em edifícios naturalmente ventilados no clima de Natal/RN

Natural air ventilation is the most import passive strategy to provide thermal comfort in hot and humid climates and a significant low energy strategy. However, the natural ventilated building requires more attention with the architectural design than a conventional building with air conditioning systems, and the results are less reliable. Therefore, this thesis focuses on softwares and methods to predict the natural ventilation performance from the point of view of the architect, with limited resource and knowledge of fluid mechanics. A typical prefabricated building was modelled due to its simplified geometry, low cost and occurrence at the local campus. Firstly, the study emphasized the use of computational fluid dynamics (CFD) software, to simulate the air flow outside and inside the building. A series of approaches were developed to make the simulations possible, compromising the results fidelity. Secondly, the results of CFD simulations were used as the input of an energy tool, to simulate the thermal performance under different rates of air renew. Thirdly, the results of temperature were assessed in terms of thermal comfort. Complementary simulations were carried out to detail the analyses. The results show the potentialities of these tools. However the discussions concerning the simplifications of the approaches, the limitations of the tools and the level of knowledge of the average architect are the major contribution of this study

Padronização e flexibilidade: proposta de um edifício tipo para uma escola técnica profissionalizante

Nowadays the acquisition of sustainable elements and concepts in construction has been increasingly discussed, improved and incorporated to buildings, since the sector directly interferes in the urban space and environment, representing environmental impact. In order to make a sustainable building (Green Building) it is vital to incorporate less damaging constructive practice, starting from the project until the operation of the enterprise, that means to consider an integrated process of conception, implementation, construction and operation. The more effective sustainable principles participation in architecture happens at the projecting step through minimal environment impact solutions. Among the issues varieties that goes with sustainability proposal of the buildings project, there were added to this work the elements that are directly attached to bioclimatic architecture, more specifically the climate variation, ventilation, lighting and sunlight, that directly affect the project conception. It is important to put in evidence that architecture role goes far beyond the simple activity of building spaces; it is the sequence of political, economic, social and cultural elements, having the users as the main apparatus to its materialization. Thereby this professional dissertation consists of an architecture draft for a professional and technological school in the Rio Grande do Norte State, this dissertation is based on the analysis of previous experience and the bioclimatic principles that implicate in building on hot and dry, hot and humid climates, and the use of strategic solutions that aim the optimization of natural light and ventilation