Serial measurement of the circulating levels of tumour necrosis factor and its soluble receptors 1 and 2 for monitoring leprosy patients during multidrug treatment

Leprosy is an infectious and contagious spectral disease accompanied by a series of immunological events triggered by the host response to the aetiologic agent, Mycobacterium leprae . The induction and maintenance of the immune/inflammatory response in leprosy are linked to multiple cell interactions and soluble factors, primarily through the action of cytokines. The purpose of the present study was to evaluate the serum levels of tumour necrosis factor (TNF)-α and its soluble receptors (sTNF-R1 and sTNF-R2) in leprosy patients at different stages of multidrug treatment (MDT) in comparison with non-infected individuals and to determine their role as putative biomarkers of the severity of leprosy or the treatment response. ELISA was used to measure the levels of these molecules in 30 healthy controls and 37 leprosy patients at the time of diagnosis and during and after MDT. Our results showed increases in the serum levels of TNF-α and sTNF-R2 in infected individuals in comparison with controls. The levels of TNF-α, but not sTNF-R2, decreased with treatment. The current results corroborate previous reports of elevated serum levels of TNF-α in leprosy and suggest a role for sTNF-R2 in the control of this cytokine during MDT.

Measurement of nurses' workload in an oncology outpatient clinic

The growing demand and the degree of patient care in oncological outpatient services, as well as the complexity of treatment have had an impact on the workload of nurses. This study aimed at measuring the workload and productivity of nurses in an oncological outpatient service. An observational study using a work sampling technique was conducted and included seven nurses working in an oncological outpatient service in the south-eastern region of Brazil. A total of 1,487 intervention or activity samples were obtained. Nurses used 43.2% of their time on indirect care, 33.2% on direct care, 11.6% on associated activities, and 12% on personal activities. Their mean productivity was 88.0%. The findings showed that nurses in this service spend most of their time in indirect care activities. Moreover, the productivity index in this study was above that recommended in the literature.

Warning systems in a computerized nursing process for Intensive Care Units

A hybrid study combining technological production and methodological research aiming to establish associations between the data and information that are part of a Computerized Nursing Process according to the ICNP® Version 1.0, indicators of patient safety and quality of care. Based on the guidelines of the Agency for Healthcare Research and Quality and the American Association of Critical Care Nurses for the expansion of warning systems, five warning systems were developed: potential for iatrogenic pneumothorax, potential for care-related infections, potential for suture dehiscence in patients after abdominal or pelvic surgery, potential for loss of vascular access, and potential for endotracheal extubation. The warning systems are a continuous computerized resource of essential situations that promote patient safety and enable the construction of a way to stimulate clinical reasoning and support clinical decision making of nurses in intensive care.

Adherence To Diabetes Mellitus Treatments In Family Health Strategy Units

This cross-sectional study aimed to analyze the adherence to drug and non-drug treatments in 17 Family Health Strategy units. A total of 423 patients with type 2 diabetes mellitus were selected through stratified random sampling in Family Health Strategy units of a city in the state of Minas Gerais, Brazil, in 2010. The results showed that the prevalence rate of adherence to drug therapy was higher than 60% in the 17 units investigated; in relation to physical activity, adherence was higher than 60% in 58.8% units; and for the diet plan, there was no adherence in 52.9% units. Therefore, we concluded that adherence to drug therapy in most units was high and the practice of physical activity was heterogeneous, and in relation to diet adherence, it was low in all units. We recommend strengthening of institutional guidelines and educational strategies, in line with SUS guidelines, so that, professionals may face the challenges imposed by the lack of adherence.



Management of basic health units in municipalities of different size: profile and management instruments

Objective To identify the characteristics of managers and their use of management instruments in primary care and to analyze differences in these features among municipalities of different sizes. Method The present cross-sectional descriptive study was conducted at 108 basic health units from 21 municipalities in northern Paraná, Brazil. The data were collected using a semi-structured questionnaire during the second half of 2010. Results Most managers had graduate degrees and were female and nurses. The managers from the small municipalities were younger, their payment was lower, and they had less work experience. The use of management instruments was expressive for both the organization and work management; however, the instruments were used less in the small municipalities. Conclusion The managers were committed to their role; it is recommended that policies and guidance should be formulated at the federal and state levels to support small municipalities.

Usability of computerized nursing process from the ICNP® in intensive care units

OBJECTIVE To analyze the usability of Computerized Nursing Process (CNP) from the ICNP® 1.0 in Intensive Care Units in accordance with the criteria established by the standards of the International Organization for Standardization and the Brazilian Association of Technical Standards of systems. METHOD This is a before-and-after semi-experimental quantitative study, with a sample of 34 participants (nurses, professors and systems programmers), carried out in three Intensive Care Units. RESULTS The evaluated criteria (use, content and interface) showed that CNP has usability criteria, as it integrates a logical data structure, clinical assessment, diagnostics and nursing interventions. CONCLUSION The CNP is a source of information and knowledge that provide nurses with new ways of learning in intensive care, for it is a place that provides complete, comprehensive, and detailed content, supported by current and relevant data and scientific research information for Nursing practices.

Factors influencing Intensive Care Units nurses in end-of-life decisions

OBJECTIVETo identify the factors that influence the Intensive Care Unit nurse in the decision-making process in end-of-life situations.METHODEthnographic case study, which used the theoretical framework of medical anthropology. Data were collected through semi-structured interviews with 10 nurses.RESULTSThe inductive thematic analysis enabled us to identify four themes:The cultural context of the Intensive Care Unit: decision-making in situations of end-of-life; Beliefs and subjectivity of care in end-of-life situations; Professional experience and context characteristics of end-of-life care situations; and Humanization practices in end-of-life situations: the patient and family centered care.CONCLUSIONProfessional maturity, the ability to transmit information and the ability to negotiate are directly related to the inclusion of nurses in the decision-making process.

Factors affecting the quality of cardiopulmonary resuscitation in inpatient units: perception of nurses

Abstract OBJECTIVE To identify, in the perception of nurses, the factors that affect the quality of cardiopulmonary resuscitation (CPR) in adult inpatient units, and investigate the influence of both work shifts and professional experience length of time in the perception of these factors. METHOD A descriptive, exploratory study conducted at a hospital specialized in cardiology and pneumology with the application of a questionnaire to 49 nurses working in inpatient units. RESULTS The majority of nurses reported that the high number of professionals in the scenario (75.5%), the lack of harmony (77.6%) or stress of any member of staff (67.3%), lack of material and/or equipment failure (57.1%), lack of familiarity with the emergency trolleys (98.0%) and presence of family members at the beginning of the cardiopulmonary arrest assistance (57.1%) are factors that adversely affect the quality of care provided during CPR. Professional experience length of time and the shift of nurses did not influence the perception of these factors. CONCLUSION The identification of factors that affect the quality of CPR in the perception of nurses serves as parameter to implement improvements and training of the staff working in inpatient units.

Runoff measurement and prediction for a watershed under natural vegetation in central Brazil

This work aimed to measure and analyze total rainfall (P), rainfall intensity and five-day antecedent rainfall effects on runoff (R); to compare measured and simulated R values using the Soil Conservation Service Curve Number method (CN) for each rainfall event; and to establish average R/P ratios for observed R values. A one-year (07/01/96 to 06/30/97) rainfall-runoff data study was carried out in the Capetinga watershed (962.4 ha), located at the Federal District of Brazil, 47° 52' longitude West and 15° 52' latitude South. Soils of the watershed were predominantly covered by natural vegetation. Total rainfall and runoff for the period were 1,744 and 52.5 mm, respectively, providing R/P of 3% and suggesting that watershed physical characteristics favored water infiltration into the soil. A multivariate regression analysis for 31 main rainfall-runoff events totaling 781.9 and 51.0 mm, respectively, indicated that the amount of runoff was only dependent upon rainfall volume. Simulated values of total runoff were underestimated about 15% when using CN method and an area-weighted average of the CN based on published values. On the other hand, when average values of CN were calculated for the watershed, total runoff was overestimated about 39%, suggesting that CN method shoud be used with care in areas under natural vegetation.

Sample size for measurement of root traits on common bean by image analysis

Evaluation of root traits may be facilitated if they are assessed on samples of the root system. The objective of this work was to determine the sample size of the root system in order to estimate root traits of common bean (Phaseolus vulgaris L.) cultivars by digital image analysis. One plant was grown per pot and harvested at pod setting, with 64 and 16 pots corresponding to two and four cultivars in the first and second experiments, respectively. Root samples were scanned up to the completeness of the root system and the root area and length were estimated. Scanning a root sample demanded 21 minutes, and scanning the entire root system demanded 4 hours and 53 minutes. In the first experiment, root area and length estimated with two samples showed, respectively, a correlation of 0.977 and 0.860, with these traits measured in the entire root. In the second experiment, the correlation was 0.889 and 0.915. The increase in the correlation with more than two samples was negligible. The two samples corresponded to 13.4% and 16.9% of total root mass (excluding taproot and nodules) in the first and second experiments. Taproot stands for a high proportion of root mass and must be deducted on root trait estimations. Samples with nearly 15% of total root mass produce reliable root trait estimates.

Use of the heat dissipation method for sap flow measurement in citrus nursery trees1

Sap flow could be used as physiological parameter to assist irrigation of screen house citrus nursery trees by continuous water consumption estimation. Herein we report a first set of results indicating the potential use of the heat dissipation method for sap flow measurement in containerized citrus nursery trees. 'Valencia' sweet orange [Citrus sinensis (L.) Osbeck] budded on 'Rangpur' lime (Citrus limonia Osbeck) was evaluated for 30 days during summer. Heat dissipation probes and thermocouple sensors were constructed with low-cost and easily available materials in order to improve accessibility of the method. Sap flow showed high correlation to air temperature inside the screen house. However, errors due to natural thermal gradient and plant tissue injuries affected measurement precision. Transpiration estimated by sap flow measurement was four times higher than gravimetric measurement. Improved micro-probes, adequate method calibration, and non-toxic insulating materials should be further investigated.

The role of ultrasonography in the measurement of subcutaneous and visceral fat and its correlation with hepatic steatosis

Objective To evaluate the sonographic measurement of subcutaneous and visceral fat in correlation with the grade of hepatic steatosis. Materials and Methods In the period from October 2012 to January 2013, 365 patients were evaluated. The subcutaneous and visceral fat thicknesses were measured with a convex, 3–4 MHz transducer transversely placed 1 cm above the umbilical scar. The distance between the internal aspect of the abdominal rectus muscle and the posterior aortic wall in the abdominal midline was considered for measurement of the visceral fat. Increased liver echogenicity, blurring of vascular margins and increased acoustic attenuation were the parameters considered in the quantification of hepatic steatosis. Results Steatosis was found in 38% of the study sample. In the detection of moderate to severe steatosis, the area under the ROC curve was 0.96 for women and 0.99 for men, indicating cut-off values for visceral fat thickness of 9 cm and 10 cm, respectively. Conclusion The present study evidenced the correlation between steatosis and visceral fat thickness and suggested values for visceral fat thickness to allow the differentiation of normality from risk for steatohepatitis.

Measurement and simulation of solar radiation availability in relation to the growth of coffee plants in an agroforestry system with rubber trees

Solar radiation is an important factor for plant growth, being its availability to understory crops strongly modified by trees in an Agroforestry System (AFS). Coffee trees (Coffea arabica - cv. Obatã IAC 1669-20) were planted at a 3.4 x 0.9 m spacing inside and aside rows of monocrops of 12 year-old rubber trees (Hevea spp.), in Piracicaba-SP, Brazil (22º42'30" S, 47º38'00" W - altitude: 546m). One-year-old coffee plants exposed to 25; 30; 35; 40; 45; 80; 90; 95 and 100% of the total solar radiation were evaluated according to its biophysical parameters of solar radiation interception and capture. The Goudriaan (1977) adapted by Bernardes et al. (1998) model for radiation attenuation fit well to the measured data. Coffee plants tolerate a decrease in solar radiation availability to 50% without undergoing a reduction on growth and LAI, which was approximately 2m².m-2 under this condition. Further reductions on the availability of solar radiation caused a reduction in LAI (1.5m².m-2), thus poor land cover and solar radiation interception, resulting in growth reduction.

Test of a microlysimeter for measurement of soil evaporation

Quantifying soil evaporation is required on studies of soil water balance and applications aiming to improve water use efficiency by crops. The performance of a microlysimeter (ML) to measure soil evaporation under irrigation and non-irrigation was evaluated. The MLs were constructed using PVC tubes, with dimensions of 100 mm inner diameter, 150 mm depth and 2.5 mm wall thickness. Four MLs were uniformly distributed on the soil surface of two weighing lysimeters conducted under bare soil, previously installed at Iapar, in Londrina, PR, Brazil. The lysimeters had 1.4 m width, 1.9 m length and 1.3 m depth and were conducted with and without irrigation. Evaporation measurements by MLs (E ML) were compared with measurements by lysimeters (E L) during four different periods in the year. Differences between E ML and E L were small either for low or high atmospheric demand and also for either irrigated or non-irrigated conditions, which indicates that the ML tested here is suitable for measurement of soil evaporation.

Measurement systems of soil water matric potential and evaluation of soil moisture under different irrigation depths

The development of new methodologies and tools that enable to determine the water content in soil is of fundamental importance to the practice of irrigation. The objective of this study was to evaluate soil matric potential using mercury tensiometer and puncture digital tensiometer, and to compare the gravimetric soil moisture values obtained by tensiometric system with gravimetric soil moisture obtained by neutron attenuation technique. Four experimental plots were maintained with different soil moisture by irrigation. Three repetitions of each type of tensiometer were installed at 0.20 m depth. Based on the soil matric potential and the soil water retention curve, the corresponding gravimetric soil moisture was determined. The data was then compared to those obtained by neutron attenuation technique. The results showed that both tensiometric methods showed no difference under soil matric potential higher than -40 kPa. However, under drier soil, when the water was replaced by irrigation, the soil matric potential of the puncture digital tensiometer was less than those of the mercury tensiometer.