A systematic review of triage-related interventions to improve patient flow in emergency departments

Background Overcrowding in emergency departments is a worldwide problem. A systematic literature review was undertaken to scientifically explore which interventions improve patient flow in emergency departments. Methods A systematic literature search for flow processes in emergency departments was followed by assessment of relevance and methodological quality of each individual study fulfilling the inclusion criteria. Studies were excluded if they did not present data on waiting time, length of stay, patients leaving the emergency department without being seen or other flow parameters based on a nonselected material of patients. Only studies with a control group, either in a randomized controlled trial or in an observational study with historical controls, were included. For each intervention, the level of scientific evidence was rated according to the GRADE system, launched by a WHO-supported working group. Results The interventions were grouped into streaming, fast track, team triage, point-of-care testing (performing laboratory analysis in the emergency department), and nurse-requested x-ray. Thirty-three studies, including over 800,000 patients in total, were included. Scientific evidence on the effect of fast track on waiting time, length of stay, and left without being seen was moderately strong. The effect of team triage on left without being seen was relatively strong, but the evidence for all other interventions was limited or insufficient. Conclusions Introducing fast track for patients with less severe symptoms results in shorter waiting time, shorter length of stay, and fewer patients leaving without being seen. Team triage, with a physician in the team, will probably result in shorter waiting time and shorter length of stay and most likely in fewer patients leaving without being seen. There is only limited scientific evidence that streaming of patients into different tracks, performing laboratory analysis in the emergency department or having nurses to request certain x-rays results in shorter waiting time and length of stay.

Contribuição ao beneficiamento de finos de fosfatos

Foram estudadas as características de floculação da hidro-xiapatita, calcita e quartzo com poliacrilamidas aniônicas. Tanto as suspensões de hidroxiapatita como a calcita foram completamente floculadas enquanto que o quartzo foi refratário a floculação com esses polimeros. Entretanto, observou-se que a floculação da calcita foi impedida com a utilização de um poliacrilato de sódio, enquanto que a hidroxiapatita continuou a ser floculada pela poliacrilamida num intervalo de concentração de O a 1000 g/ton de poliacrilato. Estes resultados permitiram estabelecer condições para a floculação seletiva de hidroxiapatita em misturas sintéticas com quartzo e calcita. Nestes sistemas foram estudados diversos parâmetros operacionais, tais como tipo de separação, efeito do teor da alimentação, e influência da moagem. Onde a separação estagiada apresentou melhor resultado, uma moagem adicional no sistema não favoreceu a seletividade. Por outro lado, o teor de P205 no concentrado é proporcional ao teor presente na alimentação. A hidroxiapatita, em estudo, de alta pureza (de acordo com técnicas de análise química, espectrofotometria de infravermelho e difração de raios X) apresentou um parto de carga zero em pH 6,77 na presença de diversos eletrólitos. A aplicação do sistema de floculação seletiva a fraçoes ultrafinas industriais foi estudada em detalhe e comparada com processos de flotação e floco-flatação. 0s resultados obtidos mostraram que a floculação seletiva somente foi eficiente nos sistemas sintéticos. A flotação, embora o minério apresente uma granulometria muito fina, foi mais eficiente que a floculação seletiva e a floco-flotação nos sistemas reais, em termos de taxa de enriquecimento e percentual de rejeição de massa. Entretanto com a floco-flotação foi possivel obter altas recuperações(-90%) para os minérios de Araxá e Itataia. Para o minério de Tapira, um aumento do teor de P2O5 foi obtido com a flotação da fração seletivamente floculada. As taxas de enriquecimento obtidas foram baixas (entre 1,35 e 2,101 em função das associações entre a apatita do minério com óxido de ferro e argila, o que revelou a caracterização mineralógica. Conclue-se que a concentração de minerios fosfatados de baixo teor é uma operação onerosa, onde o fator predominante é a absorção seletiva de reagentes e atransferência não específica de material de ganga nos respectivos concentrados.

Eficácia da fisioterapia respiratória em pacientes pediátricos hospitalizados com pneumonia adquirida na comunidade : um ensaio clínico randomizado

Objetivo: Avaliar a eficácia da fisioterapia respiratória como tratamento adjuvante em pacientes pediátricos com pneumonia adquirida na comunidade. Delineamento: Ensaio clínico randomizado Local do estudo: Hospital da Criança Santo Antônio – Complexo Hospitalar Santa Casa, Porto Alegre, Brasil. Participantes e métodos: Foram arroladas crianças com idade entre 1 e 12 anos, com diagnóstico clínico e radiológico confirmado de pneumonia, hospitalizadas no período de setembro de 2001 a setembro de 2002. Os pacientes que preencheram os critérios de inclusão foram randomizados para receber fisioterapia respiratória três vezes ao dia (grupo intervenção) ou para receber, uma vez ao dia, orientações para respirar profundamente, expectorar a secreção e manter preferencialmente o decúbito lateral (grupo controle). As variáveis analisadas na linha de base, no primeiro e no segundo períodos de seguimento e no dia da alta hospitalar foram: escore de gravidade (composto pela freqüência respiratória anormal para a idade, tiragem supra-esternal, intercostal, e subcostal, febre, saturação de oxigênio da hemoglobina e raio-x de tórax), duração da hospitalização, freqüência respiratória, temperatura e saturação do oxigênio. Resultados: Setenta e dois pacientes foram randomizados para os grupos intervenção ou controle. Destes, sete foram retirados devido a complicações como atelectasia ou drenagem pleural. Dentre os 65 pacientes estudados no primeiro seguimento (terceiro dia), a febre foi mais prevalente no grupo intervenção (34,4%) do que no grupo controle (12,5%), bem como o escore de gravidade 9,63 ± 1,62 e 8,71 ± 0,86 pontos, respectivamente. No segundo seguimento, entre o quarto e sexto dia, a diferença entre os grupos teve tendência à significância apenas para febre, 31,6% no grupo intervenção e 6,7% no grupo controle (P= 0,07). A duração média da hospitalização foi de 7,41 ± 6,58 dias para o grupo intervenção e 4,52 ± 2,21 dias para o controle. Conclusão: Neste ensaio clínico, a fisioterapia prolongou a hospitalização e a duração da febre nos pacientes pediátricos com pneumonia adquirida na comunidade. Nestes pacientes, a fisioterapia é prejudicial e não deveria ser prescrita até que evidências de benefício estejam disponíveis.

Desenvolvimento de bloco de vedação com barita na composição de partida para blindagem de radiação X

This work main objective is to study the use of bricks in barium X-rays rooms in order to contribute to the optimization of shielding rooms diagnosis. The work was based on experimental measurements of X-ray attenuation (40 to 150 kV), using ceramic seal bearing the incorporation of barium sulfat (BaSO4). Different formulations were studied in three different firing temperatures and evaluated for incorporation in the ceramic body. The composition of 20% of barite processed at a temperature of 950 ° C showed better physical and mechanical properties, is considered the most suitable for the purpose of this work. Were produced bricks sealing composition formulated based on that presented the best technological features. These blocks were tested physically as a building material and wall protective barrier. Properties such as visual, deviation from the square, face flatness, water absorption and compressive strength were evaluated for all the blocks produced. The behavior of this material as attenuator for X-rays was investigated by experimental results which take into account mortar manufacturers barium through the different strains and compared with the reference material (Pb). The simulation results indicated that the ceramic block barium shows excellent properties of attenuation equivalence lead taking into account the energy used in diagnostic X-ray

Síntese e caracterização de cerâmicas nanométricas para produção de gás de síntese

In this work, ceramic powders belonging to the system Nd2-xSrxNiO4 (x = 0, 0.4, 0.8, 1.2 and 1.6) were synthesized for their use as catalysts to syngas production partial. It was used a synthesis route, relatively new, which makes use of gelatin as organic precursor. The powders were analyzed at several temperatures in order to obtain the perovskite phase and characterized by several techniques such as thermal analysis, X-rays diffraction, Rietveld refinement method, specific surface area, scanning electron microscopy, energy dispersive spectroscopy of X-rays and temperature programmed reduction. The results obtained using these techniques confirmed the feasibility of the synthesis method employed to obtain nanosized particles. The powders were tested in differential catalytic conditions for dry reforming of methane (DRM) and partial oxidation of methane (POM), then, some systems were chosen for catalytic integrals test for (POM) indicating that the system Nd2-xSrxNiO4 for x = 0, 0.4 and 1.2 calcined at 900 °C exhibit catalytic activity on the investigated experimental conditions in this work without showing signs of deactivation

Desempenho dos serviços de atenção primária do município de Natal/RN para o diagnóstico e controle da tuberculose

Tuberculosis (TB) is one of the most important health problems being faced worldwide. In Brazil, the responsibility for the actions of to diagnosis and control of this disease was transferred to the municipalities within the Primary Health Care (PHC), aiming at improvement in epidemiological indicators, requiring reorientation of the practice of family health teams and requiring methodologies to analyze the extent to which components of the PHC are being achieved. Thus, this study aims to analyze the performance of primary care services in the city of Natal-RN for the diagnosis and control of TB, from the perspective of health professionals (doctors and nurses). The study is descriptive, cross-sectional and quantitative. Data collection was conducted from March to July 2011 and involved 121 health professionals working in 52 health units (family health unit, basic health unit and mixed units). The instrument is structured based on the Primary Care Assessment Tool (PCAT), validated and adapted to assess attention to TB in Brazil, and includes questions regarding the Structure and Process components of health services. For quantitative analysis, it was constructed indicators, whose response patterns are followed according to the Likert scale between one and five, which meant the degree of preference relation (or agreement) of the claims. Values between 1 and 3 were considered unsatisfactory for the indicator, between 3 and less than 4, regular, and between 4 and 5, satisfactory. With regard to inputs and equipment, the units had satisfactory condition for form (  = 4.26), consultation (  = 4.02) and basic basket (  = 4.24); regular condition to pot (  = 3.56) and unsatisfactory conditions for transportation tickets (  = 1.50) and sputum smear microscopy (  = 2.42) and X-rays (  = 1.07). In relation to actions, there was satisfactory development for those focused on the individual patient. Actions aimed at the collective level, as the search for respiratory symptoms (RS), monitoring of contacts and guidelines for the community ranged from regular to unsatisfactory (  = 3.16 -  = 1.34). With regard to training, 94,2% received training to identify RS. As regards the time for diagnosis, the median time elapsed between the identification of RS and the beginning of treatment it was 22 days. In relation to the difficulties faced by professionals in the diagnosis of TB, 56,2% reported that they are related only to health services, especially for the failure in the rearguard laboratory and in the specialized services reference, the lack of human and material resources and low performing an active search. The professionals perceive the performance of diagnosis and control of TB, permeated with limitations and barriers to organizational and operational character of various sizes, emerging the need for effective coordination of various sectors and key stakeholders of TB care, to adoption of a new intersectoral strategies that aim to increase the responsiveness of the PHC, providing the best performance in service delivery to the user, family and community, and ensuring effective action and resolving the needs of this population group.

Application of X-ray technique in nondestructive evaluation of eucalypt wood

X-rays were initially used for the inspection of special-purpose wood pieces for quantitative evaluation properties of different species. X-ray densitometry has had its use expanded ill dendroclimatology of Picea engelmannii trees. Subsequent laboratories developed applications of X-ray densitometry for environmental, wood science and technology, and related areas. This paper describes the basic methodology of X-ray densitometry applied to the eucalypt wood analysis, as well its presenting the results of applications in three areas: (i) evaluation of wood biodegradation by white rot fungi, (ii) detection of sapwood and heartwood, and (iii) determination of the effect of management oil wood properties. The wood decayed by white rot fungi was detected by X-ray densitometry with it decreasing wood density due to the biodegradation of cell wall components. The sapwood and heartwood of eucalypts were separated in response to the attenuation of X-rays, reflected by the wood anatomical structure and chemical composition. Also, Ill eucalypt trees after the application of irrigation and i characteristic wood density profiles were detected. Ill addition, the significant potential of X-ray densitometry for eucalypt wood research and analysis is discussed.

Utilização do teste de raios - x na avaliação dos efeitos da dessecação e infestação em diásporos de Canela-Batalha - Cryptocarya aschersoniana Mez (Lauraceae)

No presente trabalho, objetivou-se avaliar os efeitos da dessecação e identificar lesões por predação por insetos, em diásporos de canela-batalha (Cryptocarya aschersoniana Mez.), utilizando-se testes de raios X. Os danos provocados pela dessecação foram dimensionados nas imagens e associados à formação de plântulas. Diásporos recém-beneficiados (45 % de umidade e 37 % de germinação) foram colocados para secar em sala climatizada (20 ºC e 60 % UR), dentro de bandejas plásticas em camada única. Posteriormente, com o intuito de acelerar o processo de secagem, foram colocados em caixas de secagem com solução saturada de hidróxido de sódio (28 % UR) e amostrados com 45, 37, 35, 31 e 26 % de umidade. Para as radiografias, utilizou-se a intensidade de radiação de 40 kVp e tempo de exposição de 1,5 minutos. Posteriormente, as radiografias foram fotografadas e as imagens analisadas em computador, sendo medido o afastamento entre o endocarpo e a semente. As sementes foram classificadas em sementes intactas, sementes com afastamento parcial, sementes com afastamento total e sementes predadas. Os testes de germinação foram realizados sobre areia, em germinadores tipo Mangelsdorf a 25 ºC e luz branca constante. Pelos resultados, observa-se que a germinação é comprometida quando o teor de água das sementes fica abaixo de 26 %. Nesse ponto, o afastamento entre o endocarpo e a semente é de 0,65 mm. Houve uma correlação positiva entre a viabilidade das sementes, avaliada pelo teste de germinação, e o afastamento entre o endocarpo e a semente observado nas radiografias. A análise radiográfica possibilita identificar danos provocados por predação após infestação por insetos.

Stand-alone posterior ressection of lumbar hemivertebrae: case report

Background: In this case report we presented the stand-alone posterior approach for hemivertebra resection with unilateral laminar hooks.Case report: The patient was male and five years old. The coronal and sagital X-Rays images showed a failure of vertebral formation, segmented hemivertebra of third lumbar vertebra. The segmented hemivertebra caused a thoracolumbar scoliosis from T12 to L4 (rightside convexity), of 30 degrees (Cobb angle). The patient was submitted to a hemivertebra resection from posterior approach with two unilateral laminars hooks stabilization (superior lamina in L2 and inferior lamina of L4) in association to a compression system and autologus bone graft. The coronal X-Ray image after surgery showed a partial improvement to 25 degrees (Cobb angle) between L2 and L4. After three years of follow up it was not observed system failure (hook pull-out), maintance of curve (25 degrees of Cobb angle) and correction of trunk inbalance.Conclusion: The hemivertebra resection with posterior approach is safe, with satisfactory correction of scoliosis curve, which means is a good choice for congenital scoliosis surgical treatment.

Sobre a natureza dos processos físicos de aquecimento da atmosfera de estrelas do tipo solar

In the present work, we have studied the nature of the physical processes of the coronal heating, considering as basis significant samples of single and binary evolved stars, that have been achieved with the ROSAT satellite. In a total of 191 simple stars were studied, classified in the literature as giants with spectral type F, G and K. The results were compared with those obtained from 106 evolved stars of spectral type F, G and K, which belong to the spectroscopic binary systems. Accurate measurements on rotation and information about binarity were obtained from De Medeiros s catalog. We have analysed the behavior of the coronal activity in function of diverse stellar parameters. With the purpose to better clarify the profile of the stars evolution, the HR diagram was built for the two samples of stars, the single and the binary ones. The evolved traces added in the diagram were obtained from the Toulouse-Geneve code, Nascimento et al. (2000). The stars were segregated in this diagram not only in range of rotational speed but also in range of X-ray flux. Our analysis shows clearly that the single stars and the binary ones have coronal activity controlled by physical process independent on the rotation. Non magnetic processes seem to be strongly influencing the coronal heating. For the binary stars, we have also studied the behavior of the coronal emission as a function of orbital parameters, such as period and eccentricity, in which it was revealed the existence of a discontinuity in the emission of X-rays around an orbital period of 100 days. The study helped to conclude that circular orbits of the binary stars are presented as a necessary property for the existence of a higher level ofX-rays emission, suggesting that the effect of the gravitational tide has an important role in the coronal activity level. When applied the Kolmogorov-Smirnov test (KS test ) for the Vsini and FX parameters to the samples of single and binary stars, we could evidence very relevant aspects for the understanding of the mechanisms inherent to the coronal activity. For the Vsini parameter, the differences between the single stars and the binary ones for rotation over 6.3 km/s were really remarkable. We believe, therefore, that the existence of gravitational tide is, at least, one of the factors that most contribute for this behavior. About the X-rays flux, the KS test showed that the behavior of the single and the binary stars, regarding the coronal activity, comes from the same origin

Deposição de A/N por sputtering não reativo

In this work we deposit via non-reactive magnetron sputtering of radio-frequency nanofilmes of nitreto of aluminum(AlN). The nanofilms aluminum nitride are semiconductors materials with high thermal conductivity, high melting point, piezoelectricity and wide band gap (6, 2 eV) with hexagonal wurtzite crystal structure, belonging to the group of new materials called III-V nitrides in which together with the gallium nitride and indium nitride have attracted much interest because they have physical and chemical properties relevant to new technological applications, mainly in microelectronic and optoelectronic devices. Three groups were deposited with thicknesses nanofilms time dependent on two substrates (glass and silicon) at a temperature of 25 ° C. The nanofilms AlN were characterized using three techniques, X-ray diffraction, Raman spectroscopy and atomic force microscopy (AFM), examined the morphology of these. Through the analysis of X-rays get the thickness of each sample with its corresponding deposition rate. The analysis of X-rays also revealed that nanofilms are not crystalline, showing the amorphous character of the samples. The results obtained by the technique, atomic force microscopy (AFM) agree with those obtained using the technique of X-rays. Characterization by Raman spectroscopy revealed the existence of active modes characteristic of AlN in the samples

Orbital evolution of the mu and nu dust ring particles of Uranus

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Adsorption of CuX2 (X = Cl-, Br-, and ClO4-) on a silica gel surface chemically modified with thiazolidine-2-thione from acetone and ethanol solutions

The isotherms of adsorption of CuX2 (X = Cl-, Br, ClO4-,) by silica gel chemically modified with thiazolidine-2-thione were studied in acetone (ac) and ethanol (eth) solutions at 25 degrees C. The following equilibrium constants (in 1 mol(-1)) were determined: a) CuCl2, 1.9 x 10(3) (ac), 1.6 x 10(3) (eth); b) CuBr2, 1.7 x 10(3) (ac), 1.2 x 10(3) (eth); c) Cu(ClO4)(2), 1.1 x 10(3) (ac), 1.0 x 10(3) (eth). The electron spin resonance spectra of the surface complexes indicate a tetragonal distorted structure in the case of lower degrees of metal loading on the chemically modified surface. The d-d electronic transition spectra show that for the ClO4- complex, the peak of absorption did not change for any degree of metal loading, and for Cl- and Br complexes, the peak maxima shift to higher energy with lower metal loading.

Avaliação ortopantomográfica das angulações mesiodistais de caninos, pré-molares e molares inferiores com e sem a presença dos terceiros molares

OBJETIVOS: comparar os valores médios normais das angulações mesiodistais dentárias, propostos por Ursi, em 1989, com as angulações mesiodistais de caninos, pré-molares e molares inferiores em indivíduos com e sem a presença dos terceiros molares inferiores e idades entre 18 e 25 anos. Além disso, foram comparados os valores das angulações mesiodistais desses dentes nessas duas situações. MÉTODOS: foram utilizadas 40 radiografias ortopantomográficas de indivíduos, de ambos os gêneros, que não receberam tratamento ortodôntico, divididos em dois grupos: Grupo I, constituído por 20 radiografias que não apresentavam os terceiros molares inferiores; e Grupo II, formado por 20 radiografias com os terceiros molares inferiores presentes. RESULTADOS E CONCLUSÕES: a análise dos resultados e a análise estatística permitiram concluir que ambos os grupos exibiram pré-molares e molares inferiores mais angulados em sentido mesial, quando comparados à oclusão normal. Por outro lado, a angulação mesiodistal de caninos inferiores mostrou-se semelhante àquela apresentada em casos de oclusão normal. Os dois grupos, quando comparados entre si, exibiram semelhantes valores angulares dos caninos, pré-molares e molares inferiores, de modo que a presença dos terceiros molares não exerceu influência sobre essas angulações mesiodistais dentárias.

Analysis of failed commercially pure titanium dental implants: A scanning electron microscopy and energy-dispersive spectrometer X-ray study

Background: the failure of osseointegration in oral rehabilitation has gained importance in current literature and in clinical practice. The integration of titanium dental implants in alveolar bone has been partly ascribed to the biocompatibility of the implant surface oxide layer. The aim of this investigation was to analyze the surface topography and composition of failed titanium dental implants in order to determine possible causes of failure.Methods: Twenty-one commercially pure titanium (cpTi) implants were retrieved from 16 patients (mean age of 50.33 +/- 11.81 years). Fourteen implants were retrieved before loading (early failures), six after loading (late failures), and one because of mandibular canal damage. The failure criterion was lack of osseointegration characterized as dental implant mobility. Two unused implants were used as a control group. All implant surfaces were examined by scanning electron microscopy (SEM) and energy-dispersive spectrometer x-ray (EDS) to element analysis. Evaluations were performed on several locations of the same implant.Results: SEM showed that the surface of all retrieved implants consisted of different degrees of organic residues, appearing mainly as dark stains. The surface topography presented as grooves and ridges along the machined surface similar to control group. Overall, foreign elements such as carbon, oxygen, sodium, calcium, silicon, and aluminum were detected in failed implants. The implants from control group presented no macroscopic contamination and clear signs of titanium.Conclusion: These preliminary results do not suggest any material-related cause for implant failures, although different element composition was assessed between failed implants and control implants.