Assessment of the teaching-learning process in students of the health area: cardiopulmonary resuscitation maneuvers

OBJECTIVETo evaluate the skills and knowledge of undergraduate students in the health area on cardiopulmonary resuscitation maneuvers with the use of an automatic external defibrillator.METHODThe evaluation was performed in three different stages of the teaching-learning process. A theoretical and practical course was taught and the theoretical classes included demonstration. The evaluation was performed in three different stages of the teaching-learning process. Two instruments were applied to evaluate the skills (30-items checklist) and knowledge (40-questions written test). The sample comprised 84 students.RESULTSAfter the theoretical and practical course, an increase was observed in the number of correct answers in the 30-items checklist and 40-questions written test.CONCLUSIONAfter the theoretical class (including demonstration), only one of the 30-items checklist for skills achieved an index ≥ 90% of correct answers. On the other hand, an index of correct answers greater than 90% was achieved in 26 (86.7%) of the 30 items after a practical training simulation, evidencing the importance of this training in the defibrillation procedure.

The sheeping technique or how to avoid exchange maneuvers.

INTRODUCTION: The arteries of bifurcation aneurysms are sometimes so angulated or tortuous that an exchange maneuver is necessary to catheterize them with a balloon or stent delivery catheter. Because of the risk of distal wire perforation associated with exchange maneuvers, we sought to find an alternative technique. METHODS: Our experience shows that a microcatheter tends to preferentially follow a previously placed microcatheter, even if the initial catheterization might be challenging. Accessing an artery with two microcatheters simultaneously may thus be an alternative to an exchange maneuver. Because of this tendency for catheters to behave like sheep following one another, we named this method the sheeping technique (ST). The ST consists of (a) first placing a 1.7 French microcatheter into the division branch requiring balloon or stent protection to straighten the course of the arteries in order to facilitate and (b) positioning in the same artery of a larger and stiffer balloon or stent microcatheter. Once the second balloon or stent microcatheter is in place, the first microcatheter can be pulled back and used to coil the aneurysm. RESULTS: Between January 2009 and December 2012, The ST was successfully used in 208/246 procedures (85 %). Conversion to an exchange maneuver was necessary in 38/246 (15 %). There were no arterial perforations or ischemic events related to the handling of both microcatheters. CONCLUSION: The sheeping technique may improve safety by replacing the need for an exchange maneuver during difficult balloon- or stent-assisted coiling.

Correlação entre a pressão de perda à manobra de Valsalva e a pressão máxima de fechamento uretral com a história clínica em mulheres com incontinência urinária de esforço

Objetivo: analisar a relação entre a pressão de perda com manobra de Valsalva e a pressão máxima de fechamento uretral com a queixa clínica em mulheres com incontinência urinária de esforço. Métodos: estudo retrospectivo no qual foram incluídas 164 pacientes com diagnóstico de incontinência urinária de esforço ou mista atendidas no setor de Uroginecologia e Cirurgia Vaginal do Departamento de Ginecologia da UNIFESP/EPM. As pacientes submeteram-se à anamnese padronizada, exame físico e estudo urodinâmico. A pressão de perda foi mensurada sob manobra de Valsalva (Valsalva leak point pressure - VLPP), com volume vesical de 200 mL. O perfil uretral foi realizado utilizando-se cateter de fluxo número 8, sendo medida a pressão máxima de fechamento uretral (PMFU). As pacientes foram agrupadas conforme a queixa clínica de perda urinária aos esforços e realizou-se análise estatística por meio do teste de chi² para verificar a proporção entre as variáveis. Utilizou-se, a seguir, a análise de variância (ANOVA) para verificar diferenças entre VLPP e PMFU com relação à gravidade subjetiva da incontinência. Resultados: a média de idade foi de 51,2 anos (19-82), sendo que 79 encontravam-se no menacme (48,2%) e 85 (51,8%) na pós-menopausa. A paridade média foi de 4,0 filhos (0-18). Houve correlação entre o número de pacientes com VLPP inferior a 60 cmH2O e a queixa clínica (p<0,0001), sendo que o grupo com perda urinária aos mínimos esforços teve média de 69,1 cmH2O na pressão de perda, o grupo com perda urinária aos moderados esforços teve média de 84,6 cmH2O e o grupo com perda urinária aos grandes esforços teve média de 90,6 cmH2O. Conclusões: VLPP correlacionou-se com a queixa clínica, sendo menor no grupo com perda aos mínimos esforços. Não houve correlação entre a PMFU e a queixa clínica.

Heart rate changes during the Valsalva maneuver in patients with isolated aortic insufficiency

To determine the possible relationship between left ventricular dilatation and heart rate changes provoked by the Valsalva maneuver (Valsalva ratio), we studied 9 patients with isolated chronic aortic insufficiency. Left ventricular systolic function was assessed by two-dimensional echocardiography and cardiac catheterization. All patients were asymptomatic (functional class I of the New York Heart Association). The left ventricular internal diameters and volumes were significantly increased in all patients. The asymptomatic patients had either normal or slightly depressed ejection fraction (EF>0.40). The Valsalva ratio of these asymptomatic patients showed no significant correlation with the left ventricular volumes or with the left ventricular ejection fraction. In other words, parasympathetic heart rate control, as expressed by the Valsalva ratio, was normal in the asymptomatic patients with left ventricular dilatation and preserved left ventricular ejection fraction. Therefore, left ventricular dilatation may not be the major mechanism responsible for the abnormal parasympathetic heart rate control of patients with acquired heart disease

Passive Dynamics in the Control of Gymnastic Maneuvers

The control of aerial gymnastic maneuvers is challenging because these maneuvers frequently involve complex rotational motion and because the performer has limited control of the maneuver during flight. A performer can influence a maneuver using a sequence of limb movements during flight. However, the same sequence may not produce reliable performances in the presence of off-nominal conditions. How do people compensate for variations in performance to reliably produce aerial maneuvers? In this report I explore the role that passive dynamic stability may play in making the performance of aerial maneuvers simple and reliable. I present a control strategy comprised of active and passive components for performing robot front somersaults in the laboratory. I show that passive dynamics can neutrally stabilize the layout somersault which involves an "inherently unstable" rotation about the intermediate principal axis. And I show that a strategy that uses open loop joint torques plus passive dynamics leads to more reliable 1 1/2 twisting front somersaults in simulation than a strategy that uses prescribed limb motion. Results are presented from laboratory experiments on gymnastic robots, from dynamic simulation of humans and robots, and from linear stability analyses of these systems.

Analysis of the alveolar recruitment maneuvers applied at seven intensive care units

Introduction: During the past years, alveolar recruitment maneuvers (RM) have produced growing interest due to their beneficial potential in pulmonary protection, and have been introduced in clinical practice. Objective: To describe and analyze the knowledge of MR and its application at seven intensive care units in the city of Cali, Colombia. Methods and materials: Descriptive Cross-Sectional Study with an intentional sample of 64 professionals working in seven intensive care units and who apply MR. The self-completed survey was made up of thirteen questions, and the application period was two months. Results: Out of 64 professionals surveyed, 77.8% of them follow a protocol guide; 54.7% employes during RM the ideal Positive end-expiratory pressure (PEEP), which maintains a saturation > 90% and a PaO2 > 60 mmHg; 42.1% tolerates airway pressures between 35 and 50 cmH2O; 48.4% perform RM with a progressive increase of the PEEP and a low tidal volume. Conclusions: Regarding the knowledge related to RM, heterogeneity was found in the answers. There is currently no consensus about which is the most effective and secure way to implement an MR. This study can be the starting point to create awareness towards the revision of knowledge, capacities and abilities that are required to perform RM.

Evasive Maneuvers in Space Debris Environment and Technological Parameters

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Sub-Optimal Orbital Maneuvers for Artificial Satellites

The determination of a specific orbit and the procedure to calculate orbital maneuvers of artificial satellites are problems of extreme importance in the study of orbital mechanics. Therefore, the transferring problem of a spaceship from one orbit to another, and the attention due to this subject has in increased during the last years. Many applications can be found in several space activities, for example, to put a satellite in a geostationary orbit, to change the position of a spaceship, to maintain a specific satellite's orbit, in the design of an interplanetary mission, and others. The Brazilian Satellite SCD-1 (Data Collecting Satellite) will be used as example in this paper. It is the first satellite developed entirely in Brazil, and it remains in operation to this date. SCD-1 was designed, developed, built, and tested by Brazilian scientists, engineers, and technicians working at INPE (National Institute for Space Research, and in Brazilian Industries. During the lifetime, it might be necessary do some complementary maneuvers, being this one either an orbital transferring, or just to make periodical corrections. The purpose of transferring problem is to change the position, velocity and the satellite's mass to a new pre determined state. This transfer can be totally linked (in the case of "Rendezvous") or partially free (free time, free final velocity, etc). In the global case, the direction, the orientation and the magnitude of the thrust to be applied must be chosen, respecting the equipment's limit. In order to make this transferring, either sub-optimal or optimal maneuvers may be used. In the present study, only the sub-optimal will be shown. Hence, this method will simplify the direction of thrust application, to allow a fast calculation that may be used in real time, with a very fast processing. The thrust application direction to be applied will be assumed small and constant, and the purpose of this paper is to find the time interval that the thrust is applied. This paper is basically divided into three parts: during the first one the sub-optimal maneuver is explained and detailed, the second presents the Satellite SCD-1, and finally the last part shows the results using the sub-optimal maneuver applied to the Brazilian Satellite.

Orbital maneuvers using gravitational capture times

Artificial satellites around the Earth can be temporarily captured by the Moon via gravitational mechanisms., How long the capture remains depends on the phase space region where the trajectory is located. This interval of time (capture time) ranges from less than one day (a single passage), up to 500 days, or even more. Orbits of longer times might be very useful for certain types of missions. The advantage of the ballistic capture is to save fuel consumption in an orbit transference from around the Earth to around the Moon. Some of the impulse needed in the transference is saved by the use of the gravitational forces involved. However, the time needed for the transference is elongated from days to months. In the present work we have mapped a significant part of the phase space of the Earth-Moon system, determining the length of the capture times and the origin of the trajectory, if it comes from the Earth direction, or from the opposite direction. Using such map we present a set of missions considering the utilization of the long capture times. (C) 2003 COSPAR. Published by Elsevier B.V. Ltd. All rights reserved.

An analytical and numerical study of plane change maneuvers using aerodynamic force

The goal of the present work is to analyze space missions that use the terrestrial atmosphere to accomplish orbital maneuvers that involve a plane change. A set of analytical solutions is presented for the variation of the orbital elements due to a single passage through the atmosphere, assuming that the interval the spacecraft travels through the atmosphere is not too large. The study considers both the lift influence on the spacecraft orbit as well as drag. The final equations are tested with numerical integration and can be considered in accordance with the numerical results whenever the perigee height is larger than a critical value. Next, a numerical study of the ratio between the velocity increment required to correct the semimajor axis decay due to the atmospheric passage and the velocity variation required to obtain the change in the inclination is also presented. This analysis can be used to decide if a maneuver passing through the atmosphere can decrease the fuel consumption of the mission and, in the cases where this technique can be used, if a multiple passage is more efficient than a single passage.

TIME-OPTIMAL GEOMAGNETIC ATTITUDE MANEUVERS OF AN AXISYMMETRICAL SPINNING SATELLITE

A formulation used to determine the time-optimal geomagnetic attitude maneuvers subject to dynamic and geometric constraints is proposed in this paper. This was obtained by a direct search procedure based on a control function parametrization method, using linear programming to obtain numerical suboptimal solutions by linear perturbation. Due to its characteristics it can be used in small computers and to generate computer programs of general application. The dynamic modeling, the magnetic torque model and the suboptimal control procedure are presented. Simulation runs have verified the feasibility of the formulation thus derived and have shown a notable improvement in performance.

An interplanetary mission to Neptune system: Gravitational capture and maneuvers around triton

The gravitational capture was initially used to understand the capture of planetary satellites. However, in the 90's decade, this phenomenon was applied in spacecraft trajectories. Belbruno and Miller studied missions in the Earth-Moon system that uses this technique to save fuel during the insertion of the spacecraft in its final orbit around the Moon. Using a parameter defined as twice the two-body energy of the planet-particle system, Yamakawa also studied the gravitational capture in the Earth-Moon system. In the present paper, this technique is used to study a mission that goes to the Neptune system and perform a gravitational capture in the satellite Triton. The results show direct and retrograde trajectories, for different values of the initial conditions.

Determination of onboard coplanar orbital maneuvers with orbits determined using GPS

In the present paper a study is made in order to find an algorithm that can calculate coplanar orbital maneuvers for an artificial satellite. The idea is to find a method that is fast enough to be combined with onboard orbit determination using GPS data collected from a receiver that is located in the satellite. After a search in the literature, three algorithms are selected to be tested. Preliminary studies show that one of them (the so called Minimum Delta-V Lambert Problem) has several advantages over the two others, both in terms of accuracy and time required for processing. So, this algorithm is implemented and tested numerically combined with the orbit determination procedure. Some adjustments are performed in this algorithm in the present paper to allow its use in real-time onboard applications. Considering the whole maneuver, first of all a simplified and compact algorithm is used to estimate in real-time and onboard the artificial satellite orbit using the GPS measurements. By using the estimated orbit as the initial one and the information of the final desired orbit (from the specification of the mission) as the final one, a coplanar bi-impulsive maneuver is calculated. This maneuver searches for the minimum fuel consumption. Two kinds of maneuvers are performed, one varying only the semi major axis and the other varying the semi major axis and the eccentricity of the orbit, simultaneously. The possibilities of restrictions in the locations to apply the impulses are included, as well as the possibility to control the relation between the processing time and the solution accuracy. Those are the two main reasons to recommend this method for use in the proposed application.

Effects of the Eccentricity of a Perturbing Third Body on the Orbital Correction Maneuvers of a Spacecraft

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Processing optimized for symmetry in the problem of evasive maneuvers

The increasing number of space debris in operating regions around the earth constitutes a real threat to space missions. The goal of the research is to establish appropriate scientific-technological conditions to prevent the destruction and/or impracticability of spacecraft in imminent collision in these regions. A definitive solution to this problem has not yet been reached with the degree of precision that the dynamics of spatial objects (vehicle and debris) requires mainly due to the fact that collisions occur in chains and fragmentation of these objects in the space environment. This fact threatens the space missions on time and with no prospects for a solution in the near future. We present an optimization process in finding the initial conditions (CIC) to collisions, considering the symmetry of the distributions of maximum relative positions between spatial objects with respect to the spherical angles. For this, we used the equations of the dynamics on the Clohessy-Witshire, representing a limit of validation that is highly computationally costly. We simulate different maximum relative positions values of the corresponding initial conditions given in terms of spherical angles. Our results showed that there are symmetries that significantly reduce operating costs, such that the search of the CIC is advantageously carried out up to 4 times the initial processing routine. Knowledge of CIC allows the propulsion system operating vehicle implement evasive maneuvers before impending collisions with space debris.