Description of Nosocomial Infection Prevention Practices by Anesthesiologists in a University Hospital

Kishi D; Videira RLR Description of Nosocomial Infection Prevention Practices by Anesthesiologists in a University Hospital. Background and objectives: Anesthesiologists play an important role in the prevention of nosocomial infections. In anesthetic practice, physiologic barriers are routinely breached, allowing patient contamination with microorganisms and the consequent development of infection. The lack of adhesion to recommended practices can facilitate transmission of microorganisms. It is important to describe prophylactic practices of anesthesia-related nosocomial infections performed by anesthesiologists. Methods: Structured questionnaires were distributed to be answered voluntarily and anonymously by anesthesiologists. Results: Among 112 anesthesiologists, 75% answered the questionnaire. Surgical mask is used by 95.2% of anesthesiologists, 96.3% wear gloves frequently, 98.9% wear sterile gloves for neuraxial block, 91.3% use sterile technique for central venous puncture, 95.1% wash their hands between cases, 91.6% try to maintain the endotracheal tube sterile, 96.3% discard the prefilled propofol syringe at the end of each anesthesia, 30% clean the vials before using it in the neuraxial blocks, and 19.8% clean the vials before intravenous use. Conclusions: Respondents showed good adhesion to practices of nosocomial infection prophylaxis and to improve them educational multidisciplinary campaigns are necessary.

Climacteric, physically active women ingesting their routine diet oxidize more carbohydrates than lipids

Objective To investigate the influence of a routine Brazilian diet on the rate of oxidation of energy substrates in climacteric, obese women, who came to the outpatient clinic of the Hospital of the School of Medicine of Ribeirao Preto (HCFMRP-USP). Methods Subjects were recruited from outpatients at the Climacteric Clinic of the HCFMRP-USP, who were aged between 39 and 65 years and who voluntarily agreed to participate in this study. They were submitted to anthropometric measurements and indirect calorimetry for resting energy expenditure and substrate oxidation rate determination. Results The carbohydrate oxidation in the group of climacteric, obese women showed a significant positive correlation between energy consumption at rest and ingestion of carbohydrates (in grams); the subjects` rate of lipid intake showed a significant negative correlation with their body mass index, waist circumference, and daily total caloric intake. Conclusion Carbohydrate intake and carbohydrate oxidation rate may contribute to weight gain in climacteric women.

Neural influences on sprint running - Training adaptations and acute responses

Performance in sprint exercise is determined by the ability to accelerate, the magnitude of maximal velocity and the ability to maintain velocity against the onset of fatigue. These factors are strongly influenced by metabolic and anthropometric components. Improved temporal sequencing of muscle activation and/or improved fast twitch fibre recruitment may contribute to superior sprint performance. Speed of impulse transmission along the motor axon may also have implications on sprint performance. Nerve conduction velocity (NCV) has been shown to increase in response to a period of sprint training. However, it is difficult to determine if increased NCV is likely to contribute to improved sprint performance. An increase in motoneuron excitability, as measured by the Hoffman reflex (H-reflex), has been reported to produce a more powerful muscular contraction, hence maximising motoneuron excitability would be expected to benefit sprint performance. Motoneuron excitability can be raised acutely by an appropriate stimulus with obvious implications for sprint performance. However, at rest reflex has been reported to be lower in athletes trained for explosive events compared with endurance-trained athletes. This may be caused by the relatively high, fast twitch fibre percentage and the consequent high activation thresholds of such motor units in power-trained populations. In contrast, stretch reflexes appear to be enhanced in sprint athletes possibly because of increased muscle spindle sensitivity as a result of sprint training. With muscle in a contracted state, however, there is evidence to suggest greater reflex potentiation among both sprint and resistance-trained populations compared with controls. Again this may be indicative of the predominant types of motor units in these populations, but may also mean an enhanced reflex contribution to force production during running in sprint-trained athletes. Fatigue of neural origin both during and following sprint exercise has implications with respect to optimising training frequency and volume. Research suggests athletes are unable to maintain maximal firing frequencies for the full duration of, for example, a 100m sprint. Fatigue after a single training session may also have a neural manifestation with some athletes unable to voluntarily fully activate muscle or experiencing stretch reflex inhibition after heavy training. This may occur in conjunction with muscle damage. Research investigating the neural influences on sprint performance is limited. Further longitudinal research is necessary to improve our understanding of neural factors that contribute to training-induced improvements in sprint performance.

Impaired postural compensation for respiration in people with recurrent low back pain

This study evaluated the degree to which the disturbance to posture from respiration is compensated for in healthy normals and whether this is different in people with recurrent low back pain (LBP), and to compare the changes when respiratory demand is increased. Angular displacement of the lumbar spine and hips, and motion of the centre of pressure (COP), were recorded with high resolution and respiratory phase was recorded from ribcage motion. With subjects standing in a relaxed posture, recordings were made during quiet breathing, while breathing with increased dead-space to induce hypercapnoea, and while subjects voluntarily increased their respiration to match ribcage expansion that was induced in the hypercapnoea condition. The relationship between respiration and the movement parameters was measured from the coherence between breathing and COP and angular motion at the frequency of respiration, and from averages triggered from the respiratory data. Small angular changes in the lumbopelvic and hip angles were evident at the frequency of respiration in both groups. However, in quiet standing, the LBP subjects had a greater displacement of their COP that was associated with respiration than the control subjects. The LBP group had a trend for less hip motion. There were no changes in the movement parameters when respiratory demand increased involuntarily via hypercapnoea, but when respiration increased voluntarily, the amplitude of motion and the displacement of the COP increased in both groups. The present data suggest that the postural compensation to respiration counteracts at least part of the disturbance to posture caused by respiration and that this compensation may be less effective in people with LBP.

Prevalência e fatores associados à infecção pelo M. tuberculosis entre agentes comunitários de saúde

Introdução: A tuberculose é uma doença milenar e que, ainda hoje, constitui grave problema de saúde pública em todo o mundo. Objetivo: Estimar a prevalência e os fatores associados à infecção latente pelo MTB entre Agentes Comunitários de Saúde atuantes na rede básica de saúde de Municípios prioritários para o controle de TB – Cuiabá/MT, Manaus/AM, Salvador/BA e Vitória/ES. Métodos: Estudo de corte transversal no qual os dados foram coletados através de questionário, composto de questões abertas e fechadas sobre características pessoais; informações a respeito da tuberculose; utilização de medidas preventivas, etc. Aplicou-se prova tuberculínica, com leitura após 48-72h por enfermeiros treinados, considerando como ponte de corte positivo 5 e 10 mm de enduração. A análise múltipla foi feita por meio de regressão logística hierarquica. Foram incluídas no modelo as variáveis que mostraram associação com desfecho com p<0,1. Permaneceram no modelo as variáveis independentes que mantiveram associação com desfecho após ajuste (p<0,05). Este estudo obteve aprovação do Comitê de Ética em Pesquisa com seres humanos do Centro de Ciências da Saúde da Universidade Federal do Espírito Santo, n° de registro CEP-07/2010 e das Secretarias Municipais de Saúde, por meio de uma Carta de Apresentação. Resultados: 322 Agentes Comunitários de Saúde (ACS) aceitaram participar voluntariamente do estudo por meio da assinatura do Termo de Consentimento Livre e Esclarecido. Destes, 10 não compareceram para leitura, sendo estes considerados como perdas, além do que um indivíduo foi excluído pelo fato do teste rápido para HIV ter resultado positivo, perfazendo uma amostra final de 311 participantes. Ainda em relação aos ACS triados, a positividade a Prova Tuberculínica, levando-se em consideração o ponto de corte ao teste de 10 mm e de 5 mm de enduração, foi de 37,30% (IC95%: 0,31-0,42) e de 57,88% (IC95%: 0,52-0,63), respectivamente.Conclusões: Faz-se necessário um programa de realização de Prova Tuberculínica, de rotina, combinado com intervenções para reduzir o risco de transmissão nosocomial, bem como a realização de outros estudos para avaliar a eficácia de novos testes para detecção de tuberculose latente.

Comparative analysis of the ground reaction forces, during the support phase, in a group of pregnant women on their 3rd trimester of pregnancy and in a group of not pregnant women

PURPOSE: To analyze and compare the Ground Reaction Forces (GRF), during the stance phase of walking in pregnant women in the 3rd trimester of pregnancy, and non pregnant women. METHODS: 20 women, 10 pregnant and 10 non pregnant, voluntarily took part in this study. GRF were measured (1000 Hz) using a force platform (BERTEC 4060-15), an amplifier (BERTEC AM 6300) and an analogical-digital converter of 16 Bits (Biopac). RESULTS: The study showed that there were significant differences among the two groups concerning absolute values of time of the stance phase. In what concerns to the normalized values the most significant differences were verified in the maximums values of vertical force (Fz3, Fz1) and in the impulse of the antero-posterior force (Fy2), taxes of growth of the vertical force, and in the period of time for the antero-posterior force (Fy) be null. CONCLUSIONS: It is easier for the pregnant to continue forward movement (push-off phase). O smaller growth rates in what concerns to the maximum of the vertical force (Fz1) for the pregnant, can be associated with a slower speed of gait, as an adaptation strategy to maintain the balance, to compensate the alterations in the position of her center of gravity due to the load increase. The data related to the antero-posterior component of the force (Fy), shows that there is a significant difference between the pregnant woman’s left foot and right foot, which accuses a different functional behavior in each one of the feet, during the propulsion phase (TS).

Avaliação da satisfação e a importância atribuída pelos utentes aos serviços prestados na área de colheitas de sangue

Com o objectivo de avaliar a satisfação e importância atribuída pelos utentes aos serviços prestados no Serviço de Colheitas, realizou-se um estudo observacional descritivo transversal. A amostra foi constituída pelos 107 utentes deste Serviço do Hospital de São João, que aceitaram voluntariamente participar no estudo através do preenchimento do QSUSC. Da análise conjugada das variáveis satisfação e importância concluiu-se que o tempo de espera para a colheita de sangue é uma área que requer acções de melhoria de grande prioridade. Na análise bivariada entre a satisfação e variáveis independentes os resultados apontam que existe associação apenas com o estado civil.

Ethical dilemmas in scientific publication: pitfalls and solutions for editors

Editors of scientific journals need to be conversant with the mechanisms by which scientific misconduct is amplified by publication practices. This paper provides definitions, ways to document the extent of the problem, and examples of editorial attempts to counter fraud. Fabrication, falsification, duplication, ghost authorship, gift authorship, lack of ethics approval, non-disclosure, 'salami' publication, conflicts of interest, auto-citation, duplicate submission, duplicate publications, and plagiarism are common problems. Editorial misconduct includes failure to observe due process, undue delay in reaching decisions and communicating these to authors, inappropriate review procedures, and confounding a journal's content with its advertising or promotional potential. Editors also can be admonished by their peers for failure to investigate suspected misconduct, failure to retract when indicated, and failure to abide voluntarily by the six main sources of relevant international guidelines on research, its reporting and editorial practice. Editors are in a good position to promulgate reasonable standards of practice, and can start by using consensus guidelines on publication ethics to state explicitly how their journals function. Reviewers, editors, authors and readers all then have a better chance to understand, and abide by, the rules of publishing.

A responsabilidade social e as PME: as práticas de SER das microempresas

Mestrado em Contabilidade e Gestão das Instituições Financeiras

Digital storytelling: student ID in higher education

Identity achievement is related to personality, as well as cognitive and interpersonal development. In tandem with the deep structural changes that have taken place in society, education must also shift towards a teaching approach focused on learning and the overall development of the student. The integration of technology may be the drive to foster the needed changes. We draw on the literature of multiple subject areas as basis for our work, namely: identity construction and self-representation, within a psychological and social standpoint; Higher Education (HE) in Portugal after Bologna, college student development and other intrinsic relationships, namely the role of emotions and interpersonal relationships in the learning process; the technological evolution of storytelling towards Digital Storytelling (DS) – the Californian model – and its connections to identity and education. Ultimately we propose DS as the aggregator capable of humanizing HE while developing essential skills and competences. Grounded on an interpretative/constructivist paradigm, we implemented a qualitative case study to explore DS in HE. In three attempts to collect student data, we gathered detailed observation notes from two Story Circles; twelve student written reflections; fourteen Digital Stories and detailed observation notes from one Story Show. We carried out three focus groups with teachers where we discussed their perceptions of each student prior to and after watching the Digital Stories, in addition to their opinion on DS in HE as a teaching and learning method and its influence on interpersonal relationships. We sought understandings of the integration of DS to analyze student selfperception and self-representation in HE contexts and intersected our findings with teachers’ perceptions of their students. We compared teachers’ and students’ perspectives, through the analysis of data collected throughout the DS process – Story Circle, Story Creation and Story Show – and triangulated that information with the students’ personal reflections and teacher perceptions. Finally we questioned if and how DS may influence teachers’ perceptions of students. We found participants to be the ultimate gatekeepers in our study. Very few students and teachers voluntarily came forth to take part in the study, confirming the challenge remains in getting participants to see the value and understand the academic rigor of DS. Despite this reluctance, DS proved to be an asset for teachers and students directly and indirectly involved in the study. DS challenges HE contexts, namely teacher established perception of students; student’s own expectations regarding learning in HE; the emotional realm, the private vs. public dichotomy and the shift in educational roles.

Auditoria Energética a Instalação Comercial

O setor da indústria destaca-se como um dos maiores consumidores de energia final em Portugal, representando cerca de 30% do consumo. Para fazer face a esta situação e no âmbito da Estratégia Nacional para a Energia foi criado, pelo Decreto-Lei n.º 71/2008, o Sistema de Gestão dos Consumos Intensivos de Energia (SGCIE), regulamento que classifica como Consumidoras Intensivas de Energia (CIE) as indústrias com um consumo anual superior aos 500 tep. Prevendo a elaboração de Planos de Racionalização dos Consumos de Energia (PREn), estabelecendo-se acordos de racionalização dos consumos com a Direção Geral de Energia e Geologia (DGEG) [1]. Atuando ao nível da eficiência energética o consumo de energia na indústria pode diminuir significativamente, para tal é necessário proceder-se à execução de auditorias energéticas e determinar as soluções mais adequadas de forma a reduzir os desperdícios e custos associados ao consumo de energia. Nesta dissertação apresenta-se a realização de uma auditoria energética a uma instalação comercial, que assenta essencialmente em quatro etapas, nomeadamente: planeamento da intervenção, trabalho de campo, tratamento e análise da informação recolhida, elaboração do relatório da auditoria. A aplicação desta metodologia constitui uma grande ajuda na realização de auditorias energéticas conferindo uma maior qualidade à sua execução. De forma a validar a metodologia utilizada nas auditorias energéticas foi realizado o estudo a uma instalação comercial que registou no ano 2013, um consumo energético inferior a 500 tep, contudo aderiu de forma voluntária ao Sistema de Gestão dos Consumos Intensivos de Energia (SGCIE), sendo obrigado a racionalizar o seu consumo de energia de acordo com as metas estabelecidas no SGCIE.

Proposta de implementação da responsabilidade social numa empresa de engenharia e construção

Este estudo tem como finalidade analisar a possibilidade de implementação e integração do sistema de gestão da responsabilidade social numa empresa de engenharia e construção, de acordo com a norma NP 4469-1 (2008). Um dos objetivos deste trabalho é explorar uma das atividades fundamentais para o crescimento da economia: a construção. Esta funciona como barómetro da economia nacional, ou seja, movimenta vários setores importantes na sua cadeia de produção, contribuindo na criação de riqueza como também de emprego. Como consequência das mudanças na economia nos últimos anos, o comércio nacional transformou-se em comércio globalizado, tendo como mercado não só um país mas o mundo inteiro. As empresas veem isso como um desafio, independentemente da sua dimensão. A redução de custos e a diferenciação não podem ser a única fonte de competitividade. A recente situação de instabilidade económica mundial impulsiona as empresas a inovarem na sua imagem para com os stakeholders e, assim, garantir o seu desenvolvimento e sustentabilidade financeira. A temática da Responsabilidade Social Empresarial (RSE) surgiu da necessidade de existir um espírito empresarial responsável, ao encontro do conceito de desenvolvimento sustentável (Baylis e Smith, 2005). Apesar da ampla divulgação da noção de responsabilidade social das empresas, não se verifica, no entanto, uma definição exata da mesma, pois o tema tem sido abordado de diversas formas e tem dividido opiniões ao longo dos anos. A responsabilidade social é, assim, um fruto da gestão das organizações e das profundas críticas sociais, legais, éticas e económicas, inspiradas nos parâmetros da obtenção de valor social (Parra, 2003). A sustentabilidade revela uma mudança de paradigma do mundo empresarial, na medida em que as empresas devem adotar práticas socialmente responsáveis, que integrem de forma voluntária as preocupações ambientais, sociais e económicas no desenvolvimento das suas atividades operacionais e das suas interações com as partes interessadas.

Interface Humana Músculo-Facial

Esta dissertação tem como principal objetivo a criação de uma interface humana, baseada na eletromiografia dos músculos orbicular do olho e frontalis. O algoritmo de programação do microcontrolador ATmega2560 deteta o piscar de olhos voluntário, conta o número de vezes que este acontece e verifica se preenche os requisitos necessários à execução de um comando. Para este efeito foram utilizados elétrodos para a captação do sinal eletromiográfico. O sinal analógico é condicionado pela Shield ECG/EMG da Olimex sendo enviado para o arduíno ATmega2560. Este microcontrolador administra todos os atuadores, dos quais o mais importante é um painel de comandos (quatro comandos diferentes), no qual existe um ponteiro motorizado que indica qual a ação a realizar. O código de execução é extremamente simples:  se o utilizador piscar os olhos três vezes, o ponteiro movimenta-se para a secção do painel imediatamente à direita; e  se o utilizador piscar os olhos quatro vezes, o ponteiro movimenta-se para a secção do painel imediatamente à esquerda. Os testes realizados com este dispositivo indicam que os utilizadores demoram menos de 10 minutos a aprender a utilizar e executar todos os comandos do painel. Apenas num dos testes realizados o dispositivo não funcionou. Dos utilizadores que realizaram o teste:  vários usam óculos;  um idoso com graves problemas auditivos, cegueira parcial e dificuldades locomotoras;  nenhum foi incapaz de piscar, pelo menos, um dos olhos voluntariamente; e  a maioria referiu que, com alguma concentração e principalmente se ouvirem o bip sonoro, a aprendizagem de utilização torna-se muito fácil. Apesar dos limites impostos à concretização de um projeto deste tipo (dos quais se evidenciam as dificuldades em conseguir voluntários com paralisia medular, bem como os limites orçamentais), pode-se afirmar que este dispositivo é eficaz e seria uma mais valia quando implementado num cenário de paralisia medular (total ou parcial). A melhoria de qualidade de vida de um utilizador com estes problemas físicos, ou outros que lhe comprometam a locomoção é garantida. O cenário em que vivem é tremendamente limitado sendo urgente criar soluções para tornar estas vidas mais cómodas. Com os devidos aplicativos, o utilizador poderia abrir portas ou janelas, acender ou apagar luzes, pedir ajuda, ajustar a posição da cama, controlar cadeiras de rodas, entre outros. É neste sentido que surge a minha motivação de criar algo que ajude estas pessoas.

The Role of Psychological Adjustment in the Decision-Making Process for Voluntary Termination of Pregnancy

BACKGROUND: This study's objective was to evaluate the role of psychological adjustment in the decision-making process to have an abortion and explore individual variables that might influence this decision. METHODS: In this cross-sectional study, we sequentially enrolled 150 women who made the decision to voluntarily terminate a pregnancy in Maternity Dr. Alfredo da Costa, in Lisbon, Portugal, between September 2008 and June 2009. The instruments were the Depression, Anxiety and Stress Scale (DASS), Satisfaction with Social Support Scale (SSSS), Emotional Assessment Scale (EAS), Decision Conflict Scale (DCS), and Beliefs and Values Questionnaire (BVQ). We analyzed the data using Student's T-tests, MANOVA, ANOVA, Tukey's post-hoc tests and CATPCA. Statistically significant effects were accepted for p<0.05. RESULTS: The participants found the decision difficult and emotionally demanding, although they also identified it as a low conflict decision. The prevailing emotions were sadness, fear and stress; but despite these feelings, the participants remained psychologically adjusted in the moment they decided to have an abortion. The resolution to terminate the pregnancy was essentially shared with supportive people and it was mostly motivated by socio-economic issues. The different beliefs and values found in this sample, and their possible associations are discussed. CONCLUSION: Despite high levels of stress, the women were psychologically adjusted at the time of making the decision to terminate the pregnancy. However, opposing what has been previously reported, the women presented high levels of sadness and fear, showing that this decision was hard to make, triggering disruptive emotions.

Reporting earnings per share: Evidence from Portuguese annual reports

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Finance from the NOVA – School of Business and Economics