Competências de Comunicação Clínica: Objetivos de Ensino-Aprendizagem para um Currículo Nuclear nas Áreas da Saúde

RESUMO Este ensaio destaca a importância das competências de comunicação clínica (CCC) nas ciências da saúde. Estas competências podem ser ensinadas, aprendidas e avaliadas, e vários estudos evidenciam para as vantagens de uma formação específica nesta área, potenciando a relação que os profissionais da área da saúde estabelecem com os pacientes, cuidadores informais e equipas de saúde, com resultados melhorados nos indicadores de saúde e cuidados mais humanizados. Confrontados com dificuldades na integração de programas específicos de comunicação nos curricula, assim como um défice no processo de avaliação e feedback estruturado, é crucial um investimento na formação pedagógica e no desenvolvimento curricular. Conscientes da escassez de trabalhos sistemáticos que apontam para um consenso sobre as competências e objetivos de ensino-aprendizagem das CCC, o sub-grupo Core Curriculum do comité de ensino (tEACH) da Associação Europeia de Comunicação em Saúde (EACH) desenvolveu e alcançou um consenso para um currículo nuclear nas diferentes áreas da saúde. Neste contexto, surgiu o Health Professions Core Communication Curriculum – HPCCC, que pode servir como referencial flexível de acordo com as necessidades específicas e contribuir para uma maior sistematização das iniciativas de CCC em saúde em língua portuguesa.

Use of nuclear technique in samples for agricultural purposes

The concern related to environment is growing. Due to this, it is needed to determine chemical elements in a large range of concentration. The neutron activation technique (NAA) determines the elemental composition by the measurement of artificial radioactivity in a sample that was submitted to a neutron flux. NAA is a sensitive and accurate technique with low detection limits. An example of application of NAA was the measurement of concentrations of rare earth elements (REE) in waste samples of phosphogypsum (PG) and cerrado soil samples (clayey and sandy soils). Additionally, a soil reference material of the International Atomic Energy Agency (IAEA) was also analyzed. The REE concentration in PG samples was two times higher than those found in national fertilizers, (total of 4,000 mg kg-1 ), 154 times greater than the values found in the sandy soil (26 mg kg-1 ) and 14 times greater than the in clayey soil (280 mg kg-1 ). The experimental results for the reference material were inside the uncertainty of the certified values pointing out the accuracy of the method (95%). The determination of La, Ce, Pr, Nd, Pm, Sm, Eu, Tb, Dy, Ho, Er, Tm, Yb and Lu in the samples and reference material confirmed the versatility of the technique on REE determination in soil and phosphogypsum samples that are matrices for agricultural interest.

Start-up of horizontal anaerobic reactors with sludge blanket and fixed bed for wastewater treatment from coffee processing by wet method

In this study it was evaluated the start-up procedures of anaerobic treatment system with three horizontal anaerobic reactors (R1, R2 and R3), installed in series, with volume of 1.2 L each. R1 had sludge blanket, and R2 and R3 had half supporter of bamboo and coconut fiber, respectively. As an affluent, it was synthesized wastewater from mechanical pulping of the coffee fruit by wet method, with a mean value of total chemical oxygen demand (CODtotal) of 16,003 mg L-1. The hydraulic retention time (HRT) in each reactor was 30 h. The volumetric organic loading (VOL) applied in R1 varied from 8.9 to 25.0 g of CODtotal (L d)-1. The mean removal efficiencies of CODtotal varied from 43 to 97% in the treatment system (R1+R2+R3), stabilizing above 80% after 30 days of operation. The mean content of methane in the biogas were of 70 to 76%, the mean volumetric production was 1.7 L CH4 (L reactor d)-1 in the system, and the higher conversions were around at 0.20 L CH4 (g CODremoved)-1 in R1 and R2. The mean values of pH in the effluents ranged from 6.8 to 8.3 and the mean values of total volatile acids remained below 200 mg L-1 in the effluent of R3. The concentrations of total phenols of the affluent ranged from 45 to 278 mg L-1, and the mean removal efficiency was of 52%. The start-up of the anaerobic treatment system occurred after 30 days of operation as a result of inoculation with anaerobic sludge with active microbiota.

Performance of UASB reactors in two stages under different HRT and OLR treating residual waters of swine farming

In this study it was evaluated the effects of hydraulic retention time (HRT) and Organic Loading Rate (OLR) on the performance of UASB (Upflow Anaerobic Sludge Blanket) reactors in two stages treating residual waters of swine farming. The system consisted of two UASB reactors in pilot scale, installed in series, with volumes of 908 and 188 L, for the first and second stages (R1 and R2), respectively. The HRT applied in the system of anaerobic treatment in two stages (R1 + R2) was of 19.3, 29.0 and 57.9 h. The OLR applied in the R1 ranged from 5.5 to 40.1 kg CODtotal (m³ d)-1. The average removal efficiencies of chemical oxygen demand (COD) and total suspended solids (TSS) ranged, respectively, from 66.3 to 88.2% and 62.5 to 89.3% in the R1, and from 85.5 to 95.5% and 76.4 to 96.1% in the system (R1 + R2). The volumetric production of methane in the system (R1 + R2) ranged from 0.295 to 0.721 m³CH4 (m³ reactor d)-1. It was found that the OLR applied were not limiting to obtain high efficiencies of CODtotal and TSS removal and methane production. The inclusion of the UASB reactor in the second stage contributed to increase the efficiencies of CODtotal and TSS removal, especially, when the treatment system was submitted to the lowest HRT and the highest OLR.

Anaerobic reactors with biofilter and different diameter-length ratios in cassava starch industry wastewater treatment

The use of anaerobic reactors with media support in the treatment of wastewater from the cassava starch industry has emerged as a viable option because it allows the application of high organic loads and a significant reduction of the HDT needed for the treatment. This research aimed at studying the process of biodigestion in two anaerobic reactors with bamboo support, in the treatment of effluent of cassava starch, by evaluating their performance. The two reactors used present the following diameter: length ratio, 1:6 and 1:3. The organic loads applied to the systems were 0.519, 1.156, 1.471, 3.049, 4.347, 4.708 and 5.601g.L-1.d-1. Regarding the efficiency of removal of COD, TS and TVS, no statistically significant differences were obtained between the reactors. The two systems evaluated showed a stable behavior with respect to the VA/TA (volatile acidity/total alkalinity) for all submitted loads. The reactors tended to the maintenance of biogas production as a function of consumed COD for the last three organic loads applied, indicating an ability to withstand higher organic loads.

Performance of UASB reactors in two stages followed by post-treatment with activated sludge in wastewater batch of wet-processed coffee

In this study it was evaluated the efficiency of the treatment of wet-processed coffee wastewater in upflow anaerobic sludge blanket (UASB) reactors in two stages, in bench scale, followed by post-treatment with activated sludge in batch. The first UASB reactor was submitted to an hydraulic retention time (HRT) of 6.2 d and organic loading rates (OLR) of 2.3 and 4.5g CODtotal (L d)-1, and the second UASB reactor to HRT of 3.1 d with OLR of 0.4 and 1.4g CODtotal (L d)-1. The average values of the affluent CODtotal increased from 13,891 to 27,926mg L-1 and the average efficiencies of removal of the CODtotal decreased from 95 to 91%, respectively, in the UASB reactors in two stages. The volumetric methane production increased from 0.274 to 0.323L CH4 (L reactor d)-1 with increment in the OLR. The average concentrations of total phenols in the affluent were of 48 and 163mg L-1, and the removal efficiencies in the UASB reactors in two stages of 92 and 90%, respectively, and increased to 97% with post-treatment. The average values of the removal efficiencies of total nitrogen and phosphorus were of 57 to 80% and 44 to 60%, respectively, in the UASB reactors in two stages and increased to 91 and 84% with the post-treatment.

Anaerobic-aerobic treatment of swine wastewater in uasb and batch reactors in series

In this work it was evaluated the performance of two systems of swine wastewater treatment consisting of two-stage upflow anaerobic sludge blanket (UASB) reactors, with and without post-treatment in sequencing batch reactor (SBR), fed continuously, with aerobic phase. The UASB reactors in the first stage had 908 L in the sets I and II, and in the second stage 350 and 188 L, respectively. In the set II the post-treatment was performed in a SBR of 3,000 L. The hydraulic detention times in the anaerobic treatment systems were 100, 75 and 58 h in the set I; 87, 65 and 51 h in the set II; and 240 and 180 h in the SBR. The volumetric organic load applied in the first stage UASB reactors ranged from 6.9 to 12.6 g total COD (L d)-1 in the set I and 7.5 to 9.8 g total COD (L d)-1 in the set II. The average removal efficiencies of total COD, total phosphorus (Ptotal), and Kjeldahl and organic nitrogen (KN and Norg) in the anaerobic treatment systems were similar and reached maximum values of 97%, 64%, 68%, and 98%. In the SBR, the removal efficiencies of total COD and thermotolerant coliforms were up to 62 and 92% resulting, respectively, in effluent concentrations of 135 mg L-1 and 2x10(4)MPN (100 mL)-1. For Ptotal, total nitrogen (TN) and Norg, the average removal efficiencies in the SBR were up to 58, 25 and 73%, respectively.

COD, TSS, nutrients and coliforms removals in UASB reactors in two stages treating swine wastewater

The performance of two upflow anaerobic sludge blanket (UASB) reactors was evaluated in pilot scale (908 and 188 L), installed in series (R1 and R2), fed with swine wastewater with TSS around 5 and 13 g L-1. The UASB reactors were submitted to HDT of 36 and 18 h with VOL of 5.5 to 34.4 g COD (L d)-1 in the R1 and HDT of 7.5 e 3.7 h with VOL from 5.1 to 45.2 g COD (L d)-1 in the R2. The average removal efficiencies of COD ranged from 55 to 85% in the R1 and from 43 to 57% in the R2, resulting in values from 82 to 93% in the UASB reactors in two stage. Methane concentrations in the biogas were 69 to 74% with specific production from 0.05 to 0.27 L CH4 (g removedCOD)-1 in the R1 and of 0.10 to 0.12 L CH4 (g removedCOD)-1 in the R2. The average removal efficiencies were 61 to 75% for totalP, 39 to 69% for KN, 82 to 93% for orgN and 20 to 94% for Fe, Zn, Cu and Mn. The amN concentration were not reduced indicating the need to post-treatment for effluent disposal into water bodies. There were reductions of total coliforms from 99.8123 to 99.9989% and of thermotolerant coliforms from 99.9725 to 99.9999%. The conditions imposed to the UASB reactors in two stage provided high conversions of removedCOD into methane (up to 77%) and reductions of organic an inorganic pollution loads from swine wastewater.

Start-up of anaerobic reactors for slaughterhouse wastewater treatment

This study aimed to evaluate the start-up of a horizontal anaerobic fixed bed reactor (HAFBR) followed by an upflow anaerobic sludge blanket (UASB) for the slaughterhouse wastewater treatment. HAFBR was filled with bamboo rings and had 1.2 m in length, 0.10 m in diameter and volume of 7.5 L. The UASB had the volume of 15 L. The HAFBR and UASB operated at organic loading rate and hydraulic retention time average of 8.46 and 3.77 kg m-3 d-1 of COD and 0.53 and 0.98 days, respectively. During 150 days of monitoring system it was found pH 6.8, relatively high values of bicarbonate alkalinity (> 1000 mg L-1) and reduced values of volatile acids (70 to 150 mg L-1), which afforded average removal efficiencies of COD total and total suspended solids of the order of 31 and 23% in HAFBR and 79% and 63% in UASB. It can be concluded that the generation and consumption of bicarbonate alkalinity and total volatile acids, thereby maintaining the pH during the study indicated stable operation of the reactors. The COD removal in the reactors was satisfactory especially when it considers that the assessment was conducted in a period of adaptation of organisms to the effluent and also the high organic load applied during this period.

Alterações na expressão do antígeno nuclear de proliferação celular e dos receptores de estrogênio e de progesterona provocadas pela quimioterapia primária no carcinoma de mama

OBJETIVO: averiguar as alterações induzidas pela quimioterapia primária no fenótipo celular. MÉTODOS: avaliamos a expressão do antígeno nuclear de proliferação celular (PCNA) e dos receptores de estrogênio (RE) e de progesterona (RP) em 17 tumores de mama no estádio clínico II, obtidos antes e após a terapia antiblástica, por método imuno-histoquímico. Os valores foram relacionados com o estado menstrual, com a resposta clínica tumoral e com o comprometimento axilar. RESULTADOS: houve redução significante na porcentagem de células coradas pelo anti-PCNA antes (tempo A) e após (tempo B) a quimioterapia (p=0,041). Observamos também resultados significantes ao compararmos os índices médios de PCNA com o grau histológico GII/GIII [tempo A=63,1 e tempo B=38,7 (p=0,049)] e nos casos em que houve resposta clínica [tempo A=53,1 e tempo B=34,4 (p=0,011)]. Não observamos relação significante entre os índices de PCNA com o estado menstrual e o axilar. Houve redução significante do RE após a quimioterapia nas pacientes pré-menopausadas [tempo A=60,3 e tempo B=24,1 (p=0,027)] e naquelas que apresentaram resposta clínica ao tratamento [tempo A=59,1 e tempo B=37,9 (p=0,030)]. Observamos aumento significante do RP após a quimioterapia nas pacientes pós-menopausadas [tempo A=35,3 e tempo B=58,3 (p=0,023)]. Não encontramos relação entre os receptores hormonais e o comprometimento axilar. CONCLUSÕES: a diminuição dos índices de PCNA nos tumores de alto grau histológico, do RE nas pacientes pré-menopausadas e de ambos, PCNA e RE, nos tumores com redução clínica após a quimioterapia nos mostra que ela atuou sobre as células em proliferação e que o PCNA pode ser utilizado como parâmetro de resposta a este tratamento.

Carcinoma ductal in situ associado a carcinoma invasivo na mesma mama: análise do grau nuclear e da expressão das proteínas p53 e C-erbB-2 e dos receptores de estrógeno

OBJETIVOS: avaliar a variação do grau nuclear e da expressão das proteínas p53 e c-erbB-2 e dos receptores de estrógeno (RE) no carcinoma ductal in situ (CDIS) e no carcinoma invasivo, presentes na mesma mama. MÉTODOS: estudo descritivo retrospectivo com 38 mulheres com CDIS associado a carcinoma invasivo da mama. Foi avaliado o grau nuclear e o realizado estudo imunohistoquímico para expressão das proteínas p53 e c-erbB-2 e para os RE. Os casos considerados positivos para a expressão das proteínas e dos RE foram aqueles com contagem de células positivas igual ou superior a 10%. A concordância entre estas variáveis no componente in situ e invasivo foi avaliada pelo coeficiente kappa (k), interpretado de acordo com os critérios de Landis e Koch. O teste de MacNemar foi usado para testar diferenças entre os dois grupos. RESULTADOS: a concordância entre o grau nuclear e a expressão dos RE nos componentes in situ e invasivo foi de 0,89 para ambos, quase perfeita. A concordância para a expressão da proteína c-erbB-2 também foi considerada quase perfeita, com coeficiente de 0,84. Já a concordância entre a expressão da proteína p53 no componente in situ e no invasivo foi de 1,0, considerada perfeita. Não houve diferenças significativas entre o grau nuclear e as expressões das proteínas e dos RE nos componentes in situ e invasivo na mesma mama. CONCLUSÕES: existe concordância alta do grau nuclear e da expressão das proteínas p53 e c-erbB-2 no CDIS e no carcinoma invasivo presentes na mesma mama.