Clinical research monitoring: scenarios and challenges

Clinical research is essential for the development of new drugs, diagnostic tests and new devices. Clinical monitoring is implemented to improve the quality of research and attain high ethical and scientific standards. This review discusses the role of clinical monitors, taking into account the variety of scenarios in which medical research is developed, and highlights the challenges faced by research teams to ensure that patients rights are respected and that the social role of scientific research is preserved. Specific emphasis is given to the ethical dilemmas related to the multiple roles which clinical monitors play in the research framework, mainly those involving the delicate equilibrium between the loyalty to the sponsor and to the research subjects. The essential role of clinical monitoring for research developed in poor healthcare scenarios is highlighted as an approach to get the local infrastructure strengthening needed to achieve an adequate level of good clinical practices.

The results of the Campaign for evaluating sphygmomanometers accuracy and their physical conditions

OBJECTIVE: To evaluate the sphygmomanometers calibration accuracy and the physical conditions of the cuff-bladder, bulb, pump, and valve. METHODS: Sixty hundred and forty five aneroid sphygmomanometers were evaluated, 521 used in private practice and 124 used in hospitals. Aneroid manometers were tested against a properly calibrated mercury manometer and were considered calibrated when the error was <=3mm Hg. The physical conditions of the cuffs-bladder, bulb, pump, and valve were also evaluated. RESULTS: Of the aneroid sphygmomanometers tested, 51% of those used in private practice and 56% of those used in hospitals were found to be not accurately calibrated. Of these, the magnitude of inaccuracy ranged from 4 to 8mm Hg in 70% and 51% of the devices, respectively. The problems found in the cuffs - bladders, bulbs, pumps, and valves of the private practice and hospital devices were bladder damage (34% vs. 21%, respectively), holes/leaks in the bulbs (22% vs. 4%, respectively), and rubber aging (15% vs. 12%, respectively). Of the devices tested, 72% revealed at least one problem interfering with blood pressure measurement accuracy. CONCLUSION: Most of the manometers evaluated, whether used in private practice or in hospitals, were found to be inaccurate and unreliable, and their use may jeopardize the diagnosis and treatment of arterial hypertension.

Identity of care in a Psychosocial Care Center for Children and Adolescents who uses drugs

Objective To associate the territory of identity with the production of care within a PCC focusing on children and adolescents with drug abuse and their institutional identity. Method We used the “ process tracing methodology” in four research categories: focus groups, characterization of professionals, observing the everyday and interviewing two members of emblematic cases of the service. Results territory of identity of the institution, which operates the production of care is crossed by the difficulty of dealing with the complexity brought by the users and the performance of the PCC network. This paper is also permeated by different conceptions of care and small problematization of these issues in collective spaces of service. Conclusion The discussion in focus groups and other devices can be powerful resources to reframe the meaning of care and identity of collective service.

Assessment of tidal volume and thoracoabdominal motion using volume and flow-oriented incentive spirometers in healthy subjects

The objective of the present study was to evaluate incentive spirometers using volume- (Coach and Voldyne) and flow-oriented (Triflo II and Respirex) devices. Sixteen healthy subjects, 24 ± 4 years, 62 ± 12 kg, were studied. Respiratory variables were obtained by respiratory inductive plethysmography, with subjects in a semi-reclined position (45º). Tidal volume, respiratory frequency, minute ventilation, inspiratory duty cycle, mean inspiratory flow, and thoracoabdominal motion were measured. Statistical analysis was performed with Kolmogorov-Smirnov test, t-test and ANOVA. Comparison between the Coach and Voldyne devices showed that larger values of tidal volume (1035 ± 268 vs 947 ± 268 ml, P = 0.02) and minute ventilation (9.07 ± 3.61 vs 7.49 ± 2.58 l/min, P = 0.01) were reached with Voldyne, whereas no significant differences in respiratory frequency were observed (7.85 ± 1.24 vs 8.57 ± 1.89 bpm). Comparison between flow-oriented devices showed larger values of inspiratory duty cycle and lower mean inspiratory flow with Triflo II (0.35 ± 0.05 vs 0.32 ± 0.05 ml/s, P = 0.00, and 531 ± 137 vs 606 ± 167 ml/s, P = 0.00, respectively). Abdominal motion was larger (P < 0.05) during the use of volume-oriented devices compared to flow-oriented devices (52 ± 11% for Coach and 50 ± 9% for Voldyne; 43 ± 13% for Triflo II and 44 ± 14% for Respirex). We observed that significantly higher tidal volume associated with low respiratory frequency was reached with Voldyne, and that there was a larger abdominal displacement with volume-oriented devices.

Câmaras climáticas para o envelhecimento acelerado: ação de microambientes sobre bens culturais

Environmental chambers were designed for the accelerated ageing of materials used in artistic artifacts to study the synergistic action of temperature, humidity, UV and visible radiation and gaseous pollutants. Two inox-steel/PTFE compartments are kept under controlled temperature and relative humidity, whose values are transmitted to a PC, which stores, plots in real time and continuously feedback heating and humidifying devices through logical signals. A borosilicate, or quartz, window allows the irradiation inside the chamber from an external source. A flow of purified air purges the chamber and conveys selected pollutants from an external source. Each independent compartment works under either stationary or cyclic conditions.

O estado da arte da síntese de semicondutores nanocristalinos coloidais

Colloidal semiconductor nanocrystals, also known as quantum dots, have attracted great attention since they have interesting size-dependent properties due to the quantum confinement effect. These nanoparticles are highly luminescent and have potential applications in different technological areas, including biological labeling, light-emitting diodes and photovoltaic devices. The synthetic methods of semiconductor nanocrystals have progressed in the last 30 years, and several protocols were developed to synthesize monodisperse nanocrystals with good optical properties, different compositions and morphologies. This review describes the main methods used to synthesize nanocrystals in the II-VI and III-V systems, and the recent approaches in this field of research.

Oligômeros e polímeros derivados do tiofeno: síntese e aplicações

In this review we summarize recent synthetic investigations about the preparation of oligothiophenes and polythiophenes, the most important π-conjugated organic materials for applications in electrochromic and electroluminescent devices. It is showed that many interesting and novel functionalized oligothiophenes have been synthesized by convenient coupling strategies (Heck, Kumada, Negishi, Suzuki, Stille and Ullmann) and oxidative coupling methods. Synthesis of polythiophenes are also presented and described according to chemical and electrochemical polymerization methodologies. The description of these noteworthy synthetic methods illustrates how important and promising are the interdisciplinary approaches in the obtaining of oligothiophenes and polythiophenes.

Filtros digitais por transformadas de Fourier aplicados em eletroquímica

The electrochemical properties of micro and nano-electrodes are widely investigated due to their low faradaic and capacitive currents, leading to a new generation of smart and implantable devices. However, the current signals obtained in low-dimensional devices are strongly influenced by noise sources. In this paper, we show the evaluation of filters based on Fast Fourier Transform (FFT) and their implementation in a graphical user interface (GUI) in MATLAB®. As a case study, we evaluated an electrochemical reaction process of charge transfer via outer-sphere. Results showed successful removal of most of the noise in signals, thus proving a promising tool for low-scale measurement.

Processamento de placas de circuito impresso de equipamentos eletroeletrônicos de pequeno porte

A hydrometallurgical process applicable to printed circuit boards of small electrical and electronic devices was developed. This involved three leaching steps (60 ºC, 2 h): 6 mol L-1 NaOH, 6 mol L-1 HCl and aqua regia. NaOH removed the resin and flame retardant that covered the circuit boards. HCl dissolved the most electropositive metals and a small amount of copper (~0.3 wt%). Aqua regia dissolved the noble metals. Silver precipitated as AgCl. Gold and platinum were quantitatively extracted with pure methyl-isobutylketone and Alamine 336 (10 % vol. in kerosene), respectively. Slow evaporation of the raffinate crystallized CuCl2.4H2O (89% yield).

PREPARO DE AMOSTRAS ASSISTIDO POR CAMPO ELÉTRICO: FUNDAMENTOS, AVANÇOS, APLICAÇÕES E TENDÊNCIAS

Sample preparation is commonly considered a key step to achieve selective, sensitive, and reliable chemical analyses, particularly those involving complex matrices. Although the application of electric fields to improve the speed and efficiency of sample preparation methods has been proven, this approach is still considered to be state-of-the-art; hence, further development is necessary to improve future applications. This review describes the fundamentals, advances, applications, and perspectives of using electric fields to enhance sample preparation techniques such as liquid-liquid and solid-liquid extractions in conventional and microscale devices.

Ba-DOPED ZnO MATERIALS: A DFT SIMULATION TO INVESTIGATE THE DOPING EFFECT ON FERROELECTRICITY

ZnO is a semiconductor material largely employed in the development of several electronic and optical devices due to its unique electronic, optical, piezo-, ferroelectric and structural properties. This study evaluates the properties of Ba-doped wurtzite-ZnO using quantum mechanical simulations based on the Density Functional Theory (DFT) allied to hybrid functional B3LYP. The Ba-doping caused increase in lattice parameters and slight distortions at the unit cell angle in a wurtzite structure. In addition, the doping process presented decrease in the band-gap (Eg) at low percentages suggesting band-gap engineering. For low doping amounts, the wavelength characteristic was observed in the visible range; whereas, for middle and high doping amounts, the wavelength belongs to the Ultraviolet range. The Ba atoms also influence the ferroelectric property, which is improved linearly with the doping amount, except for doping at 100% or wurtzite-BaO. The ferroelectric results indicate the ZnO:Ba is an strong option to replace perovskite materials in ferroelectric and flash-type memory devices.

Gender and other factors associated with the use of hearing protection devices at work

OBJECTIVE To analyze whether sociodemographic, occupational, and health-related data are associated with the use of hearing protection devices at work, according to gender. METHODS A cross-sectional study was conducted in 2006, using a random sample of 2,429 workers, aged between 18 and 65 years old, from residential sub-areas in Salvador, BA, Northeastern Brazil. Questionnaires were used to obtain sociodemographic, occupational, and health-related data. Workers who reported that they worked in places where they needed to shout in order to be heard were considered to be exposed to noise. Exposed workers were asked whether they used hearing protection devices, and if so, how frequently. Analyses were conducted according to gender, with estimates made about prevalence of the use of hearing protection devices, prevalence ratios, and their respective 95% confidence intervals. RESULTS Twelve percent (12.3%) of study subjects reported that they were exposed to noise while working. Prevalence of the use of hearing protection devices was 59.3% for men and 21.4% for women. Men from higher socioeconomic levels (PR = 1.47; 95%CI 1.14;1.90) and who had previous audiometric tests (PR = 1.47; 95%CI 1.15;1.88) were more likely to use hearing protection devices. For women, greater perceived safety was associated with the use of protection devices (PR = 2.92; 95%CI 1.34;6.34). This perception was specifically related to the presence of supervisors committed to safety (PR = 2.09; 95%CI 1.04;4.21), the existence of clear rules to prevent workplace injuries (PR = 2.81; 95%CI 1.41;5.59), and whether they were informed about workplace safety (PR = 2.42; 95%CI 1.23;4.76). CONCLUSIONS There is a gender bias regarding the use of hearing protection devices that is less favorable to women. The use of such devices among women is positively influenced by their perception of a safe workplace, suggesting that gender should be considered as a factor in hearing conservation programs.

Devices and Techniques for Blood Pressure Measurement and Criteria for Hypertension Adopted by Brazilian Physicians: Exploratory Study

OBJECTIVE: To determine technical procedures and criteria used by Brazilian physicians for measuring blood pressure and diagnosing hypertension. METHODS: A questionnaire with 5 questions about practices and behaviors regarding blood pressure measurement and the diagnosis of hypertension was sent to 25,606 physicians in all Brazilian regions through a mailing list. The responses were compared with the recommendations of a specific consensus and descriptive analysis. RESULTS: Of the 3,621 (14.1%) responses obtained, 57% were from the southeastern region of Brazil. The following items were reported: use of an aneroid device by 67.8%; use of a mercury column device by 14.6%; 11.9% of the participants never calibrated the devices; 35.7% calibrated the devices at intervals < 1 year; 85.8% measured blood pressure in 100% of the medical visits; 86.9% measured blood pressure more than once and on more than one occasion. For hypertension diagnosis, 55.7% considered the patient's age, and only 1/3 relied on consensus statements. CONCLUSION: Despite the adequate frequency of both practices, it was far from that expected, and some contradictions between the diagnostic criterion for hypertension and the number of blood pressure measurements were found. The results suggest that, to include the great majority of the medical professionals, disclosure of consensus statements and techniques for blood pressure measurement should go beyond the boundaries of medical events and specialized journals.

Patient safety and the prevention of skin and mucosal lesions associated with airway invasive devices

AbstractOBJECTIVETo analyze the care implemented by the nursing team to promote the safety of adult patients and prevention of skin and mucosal lesions associated with the presence of lower airways invasive devices.METHODStudy with qualitative and quantitative approach, descriptive and exploratory type, whose investigative scenarios were adult inpatient units of a hospital in the West Frontier of Rio Grande do Sul. The study subjects consisted of nurses, nursing technicians and nursing assistants.RESULTSA total of 118 professionals were interviewed. We highlight the observed specific care with endotracheal tube and tracheostomy, management and assessment of the cuff and the criteria used to secretion aspiration.CONCLUSIONThere is a superficial nursing work in the patient direct care and a differentiation in relation to the perception of nurse technicians, especially those working in the intensive care unit, who presented major property and view of the patient's clinical status.

Continued Compliance and Degree of Satisfaction in Nulligravida and Parous Women with Intrauterine Contraceptive Devices

Purpose To evaluate the compliance and degree of satisfaction of nulligravida (has not given birth) and parous (had already given birth) women who are using intrauterine devices (IUDs). Methods A cross-sectional cohort study was conducted comparing nulligravida and parous women who had had an IUD inserted between July 2009 and November 2011. A total of 84 nulligravida women and 73 parous women were included. Interviews were conducted with women who agreed to participate through telephone contact. Statistical analysis was performed with Student s t-test and Mann-Whitney test for numeric variables; Pearson s chi-square test to test associations; and, whenever pertinent, Fisher s exact test for categorical variables. A survival curve was constructed to estimate the likelihood of each woman continuing the use of the IUD. A significance level of 5% was established. Results When compared with parous women, nulligravida women had a higher education level (median: 12 vs. 10 years). No statistically significant differences were found between the nulligravida and parous women with respect to information on the use of the IUD, prior use of other contraceptive methods, the reason for having chosen the IUD as the current contraceptive method, reasons for discontinuing the use and adverse effects, compliance, and degree of satisfaction. The two groups did not show any difference in terms of continued use of the IUD (p = 0.4). Conclusion There was no difference in compliance or the degree of satisfaction or continued use of IUDs between nulligravida and parous women, suggesting that IUD use may be recommended for women who have never been pregnant.