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

Integridade tissular de pacientes com úlceras venosas: um estudo baseado na Classificação dos Resultados de Enfermagem

The venous ulcer is an epidemiological problem of high prevalence, causing disability and dependence. Assess the tissue impairment level of patients with venous lesions, within a nursing referential, is relevant for the implementation of a directed assistance to specific clientele. Thus, this work aims to characterize the health status regarding the integrity the lower limbs skin of patients with venous ulcers, according to the of tissue integrity outcome indicators from the Nursing Outcomes Classification. A cross-sectional study conducted in a university hospital in Natal - Rio Grande do Norte. The sample consisted of 50 participants, selected through consecutive sampling. Data collection occurred through a interview and physical examination form and a operational definitions tool for indicators of the nursing Tissue Integrity outcome directed to patients with venous ulcer, applied from February to June 2012. Data analysis was done by descriptive statistics and nonparametric tests (Spearman, Kruskal-Wallis and Mann-Whitney tests). The project was approved by the Research Ethics Committee with protocol 608/11 and Presentation Certificate to Ethical Consideration No. 0038.0.294.000-11. The results were presented using three scientific articles derivatives of research. It was found that the indicators show moderate impairment, light and not impaired, as the median. The respondents had an average of 59.72 years, 66% female, 50% were retired, 60% with a partner, 44% had arterial hypertension, 26% allergies, 20% diabetes mellitus, 96% were sedentary, 14% drank alcohol and 6% were smokers. There was a statistically significant correlation of low intensity between age and hydration (p=0.032; rs=-0.304) and skin desquamation (p=0.026; rs=-0.316), family income and necrosis (p=0.012; rs=-0.353); Ankle Brachial Index and tissue perfusion (p=0,044; rs=-0,329); Diabetes Mellitus and texture (p=0.015) and tissue perfusion (p=0.026); allergy and texture (p=0.034), physical activity and hydration (p=0.034), smoking and thickness (p=0.018), and alcohol consumption and exudate (p=0.045). We conclude that the patients had light to moderate impairment, indicating a good state of health on the integrity of the skin of the lower limbs, according to the indicators of the outcome of tissue integrity Classification Nursing Outcomes valued in the present study. It is believed that the evaluation of impairment tissue using a self-nursing system and its relation with socioeconomic, clinical and risk factors are unique tools in the care planning and in the wound healing

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

Desenho e Construção de um protótipo gerador de jato de plasma frio a pressão atmosférica para aplicações biomédicas

Research for better performance materials in biomedical applications are constants. Thus recent studies aimed at the development of new techniques for modification of surfaces. The low pressure plasma has been highlighted for its versatility and for being environmentally friendly, achieving good results in the modification of physic chemical properties of materials. However, it is requires an expensive vacuum system and cannot able to generate superficial changes in specific regions. Furthermore, it is limits their use in polymeric materials and sensitive terms due to high process temperatures. Therefore, new techniques capable of generating cold plasma at atmospheric pressure (APPJ) were created. In order to perform surface treatments on biomaterials in specific regions was built a prototype capable of generating a cold plasma jet. The prototype plasma generator consists of a high voltage source, a support arm, sample port and a nozzle through which the ionized argon. The device was formed to a dielectric tube and two electrodes. This work was varied some parameters such as position between electrodes, voltage and electrical frequency to verify the behavior of glow discharges. The disc of titanium was polished and there was a surface modification. The power consumed, length, intensity and surface modifications of titanium were analyzed. The energy consumed during the discharges was observed by the Lissajous figure method. To check the length of the jets was realized with Image Pro Plus software. The modifications of the titanium surfaces were observed by optical microscopy (OM ) and atomic force microscopy (AFM ). The study showed that variations of the parameters such as voltage, frequency and geometric position between the electrodes influence the formation of the plasma jet. It was concluded that the plasma jet near room temperature and atmospheric pressure was able to cause modifications in titanium surface

Desenvolvimento de um reator fotoquímico aplicável no tratamento de efluentes fenólicos presentes na indústria do petróleo

With water pollution increment at the last years, so many progresses in researches about treatment of contaminated waters have been developed. In wastewaters containing highly toxic organic compounds, which the biological treatment cannot be applied, the Advanced Oxidation Processes (AOP) is an alternative for degradation of nonbiodegradable and toxic organic substances, because theses processes are generation of hydroxyl radical based on, a highly reactivate substance, with ability to degradate practically all classes of organic compounds. In general, the AOP request use of special ultraviolet (UV) lamps into the reactors. These lamps present a high electric power demand, consisting one of the largest problems for the application of these processes in industrial scale. This work involves the development of a new photochemistry reactor composed of 12 low cost black light fluorescent lamps (SYLVANIA, black light, 40 W) as UV radiation source. The studied process was the photo-Fenton system, a combination of ferrous ions, hydrogen peroxide, and UV radiation, it has been employed for the degradation of a synthetic wastewater containing phenol as pollutant model, one of the main pollutants in the petroleum industry. Preliminary experiments were carrier on to estimate operational conditions of the reactor, besides the effects of the intensity of radiation source and lamp distribution into the reactor. Samples were collected during the experiments and analyzed for determining to dissolved organic carbon (DOC) content, using a TOC analyzer Shimadzu 5000A. The High Performance Liquid Chromatography (HPLC) was also used for identification of the cathecol and hydroquinone formed during the degradation process of the phenol. The actinometry indicated 9,06⋅1018 foton⋅s-1 of photons flow, for 12 actived lamps. A factorial experimental design was elaborated which it was possible to evaluate the influence of the reactants concentration (Fe2+ and H2O2) and to determine the most favorable experimental conditions ([Fe2+] = 1,6 mM and [H2O2] = 150,5 mM). It was verified the increase of ferrous ions concentration is favorable to process until reaching a limit when the increase of ferrous ions presents a negative effect. The H2O2 exhibited a positive effect, however, in high concentrations, reaching a maximum ratio degradation. The mathematical modeling of the process was accomplished using the artificial neural network technique

Influência da intensidade de aeração na formação do floco de lodo ativado e na eficiência de remoção de matéria orgânica

In wastewater treatment, activated sludge systems have been a technology widely applied as secondary treatment. During this step, which has a strong biological aspect, it is necessary to introduce oxygen supply for the maintenance of metabolic activity of the bacteria through the aerators. Aeration devices are responsible for most of the energy consumption in this stage. In this background, the influence of three aeration intensities (atmospheric air flow 3.5, 7.0 and 10.5 L.min-1) and the concentration of dissolved oxygen (DO) on the dimension of activated sludge flocs as well as on the efficiency of organic matter removal were assessed using a traditional activated sludge system which was fed with synthetic domestic wastewater. Samples were taken weekly from the three units that make up the system feed, aeration and storage tank in order to verify the Chemical Oxygen Demand (COD). It was established the process efficiency through a comparison between the initial and final COD. Besides the parameters already mentioned, this monitoring work on activated sludge batch system was also observed by Mixed Liquor Suspend Solids (MLSS), Volatile Suspend Solids (VSS), pH and temperature measures. The results have showed a maximum removal efficiency around 75% in the first aeration sequence and approximately 85% for the second and third one. For the first aeration, the DO concentration remained higher than 3.0 mg.L-1 and a diameter range from 10 to 60 μm was observed. In the second e third sequence, the DO concentration remained higher than 4.0 mg.L-1 with a diameter range of 10 until 200 μm. Although the sequence 1 and 2 have presented similar performances for organic matter removal, the sequence 2 promoted a regular floc size distribution and with lower values of Sludge Volumetric Index (SVI) meaning a better flocculating ability. In addition, the results reaffirmed what the literature has reported: higher DO concentrations produce flocs with greater dimensions

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

Uma leitura dos exercícios dos excursos n Os Lusíadas

The Lusiads is an epic poem, written by Luís de Camões, about the adventure of Vasco da Gama s trip and the history of Portugal. It's based on traditionals epics from the Greek and Roman poets, Homero and Virgílio. Camões followes especially their structures. However, the poet insert modifications that divert his poem from parameters established by Aristóteles for the classic epic poems. These deviations are centered mainly on the narrative subject and in the point of view. We intend to show an analysis focused on digressions from The Lusiads, in which the author, himself or by tellers characters, narrates the story in order to make his complaints, reflections and exhortations. Besides, we present general aspects of Maneirismo predominant in these digressions how evidences of modernity of the poem; as one brief outlook about the poem's projection in time and around the world. These points are importants elements of consolidation of a universal permanence of The Lusiads. That's why they have had to read and to study by the centuries, according the vision of the epoch's spirit

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

Multicamadas Ferromagnéticas Nanométricas Periódicas e Quasiperiódicas

We present a study of nanostructured magnetic multilayer systems in order to syn- thesize and analyze the properties of periodic and quasiperiodic structures. This work evolved from the deployment and improvement of the sputtering technique in our labora- tories, through development of a methodology to synthesize single crystal ultrathin Fe (100) films, to the final goal of growing periodic and quasiperiodic Fe/Cr multilayers and investi- gating bilinear and biquadratic exchange coupling between ferromagnetic layer dependence for each generation. Initially we systematically studied the related effects between deposition parameters and the magnetic properties of ultrathin Fe films, grown by DC magnetron sput- tering on MgO(100) substrates. We modified deposition temperature and film thickness, in order to improve production and reproduction of nanostructured monocrystalline Fe films. For this set of samples we measured MOKE, FMR, AFM and XPS, with the aim of investi- gating their magnocrystalline and structural properties. From the magnetic viewpoint, the MOKE and FMR results showed an increase in magnetocrystalline anisotropy due to in- creased temperature. AFM measurements provided information about thickness and surface roughness, whereas XPS results were used to analyze film purity. The best set of parame- ters was used in the next stage: investigation of the structural effect on magnetic multilayer properties. In this stage multilayers composed of interspersed Fe and Cr films are deposited, following the Fibonacci periodic and quasiperiodic growth sequence on MgO (100) substrates. The behavior of MOKE and FMR curves exhibit bilinear and biquadratic exchange coupling between the ferromagnetic layers. By computationally adjusting magnetization curves, it was possible to determine the nature and intensity of the interaction between adjacent Fe layers. After finding the global minimum of magnetic energy, we used the equilibrium an- gles to obtain magnetization and magnetoresistance curves. The results observed over the course of this study demonstrate the efficiency and versatility of the sputtering technique in the synthesis of ultrathin films and high-quality multilayers. This allows the deposition of magnetic nanostructures with well-defined magnetization and magnetoresistance parameters and possible technological applications

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.

Sobre a relação entre rotação, atividade crosmosférica e abundância de lítio em estrelas subgigantes

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